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Purpose: Horizontal gaze deviation (HGD) is a predictor of acute large vessel occlusion (LVO) and helps to expedite the triage of patients to CTA and endovascular-capable sites. Patients with acute cerebellar ischemia, particularly involving the PICA territory, can also exhibit HGD., Materials and Methods: We reviewed 2260 CTA stroke assessment cases between January 2016 and May 2020. Forty-six patients with CTA-proven acute PICA occlusions were identified and compared with 114 patients with acute LVO (ICA, M1, and M1/2). Both clinical and radiographic HGD were examined. The degree of radiographic HGD was measured for each patient. Site of ischemia was confirmed on subsequent MRI., Results: Of the 46 patients with acute PICA occlusions, 20 (43.5%) patients had radiographic (+) HGD with either ipsilateral or contralateral gaze deviation, 6 of whom (13.0%) displayed clinical HGD. Of the 114 patients with LVO (control group), 72 (63.2%) patients had radiographic (+) HGD, all ipsilateral, 49 of whom (68.0%) displayed clinical HGD. The mean degree of HGD between PICA and LVO were 30.0° vs. 22.9°, respectively, p < 0.001; AUC = 0.68., Conclusion: Patients with acute PICA occlusion can exhibit either ipsilateral or contralateral HGD and a higher degree of HGD than LVO occlusion on NECT. In hyperacute stroke, the presence of radiographic HGD > 30° in the absence of ischemic changes in the MCA territory should prompt clinicians to closely evaluate for features of early ischemic changes in the cerebellar hemispheres that suggest acute PICA occlusion., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Pica is a serious condition that is characterized by ingesting inedible things which can prove to be fatal (glass, pebbles, etc.) We present the case of a 64-year-old male patient who is admitted to the emergency room with the following complaints: upper GI tract bleeding manifested through hematemesis and melena, epigastric pain, lack of bowel movements. A contrast computed tomograohy is performed showing the presence of a hyper-dense stomach content, gastric wall thickening, abdominal fluid but with no signs of intestinal occlusion. A laparotomy is performed and ollowing an anterior gastrotomy a large quantity of pebbles is found along with a hemorrhagic and stenotic tumor of the lesser curvature. Taking into account the intraoperative aspect the decision was made to perform an end-to-side stapled esophago-jejunal anastomosis on an omega loop with a Braun entero-entero anastomosis following total gastric resection and D1 lymphadenectomy. Postoperative course is uneventful. A barium swallow carried out on the 10th day following surgery shows a functional anastomosis without leakage. On day 11, the patient is discharged. Pica is usually discovered by accident, most frequently on the operating table which is why thorough preoperative examination and investigations are required., (Celsius.)

Determining the cause of death and differentiating self-inflicted injuries from non-self-inflicted injuries is a primary goal in legal medicine. Especially with unidentified decedents, autopsy findings alone are often not sufficient; there is no knowledge of pre-existing conditions and only circumstantial evidence is available from the scene of death. In our case, radiological, histological, and toxicological examinations provided an explanatory model for extraordinary autopsy findings consistent with pica, a rare eating disorder. In cases of pica, variable and potentially lethal complications emerge, depending on the type and amount of material ingested. Our case is of an apparently uncontrolled intake of wooden objects (xylophagia). The resulting mechanical damage to the gastrointestinal tract and subsequent soft tissue damage supports that this behavioral disorder is not only of medical concern, but also identifies it as a mental disease with medico-legal relevance.

Background: Childhood soil pica is associated with, and can be a cause of, iron deficiency. It can also contribute to lead poisoning. Often pica is first recognised by the clinician during investigation of abdominal pain when an X-ray is performed., Objective: To highlight the frequency of pica, and to discuss its association with iron deficiency and the risks of lead ingestion in areas of contaminated soil., Discussion: Pica is probably more common than we think. In areas with polluted soil it is a particularly important diagnosis to make, as the ingestion of toxins, such as lead, will continue until the pica ceases. In areas where there is lead contamination, whole blood lead levels should be tested in children who exhibit pica.

Bezoars are rare foreign bodies in the gastrointestinal tract. They may be composed of hair (trichobezoars), vegetable matter (phytobezoars), milk curds (lactobezoars) and, very rarely, stones (lithobezoars). Colonic lithobezoars are very rare findings in children. We report an eight-year-old boy with a giant rectosigmoid lithobezoar, who presented with history of recurrent constipation and pica for five years. Four hundred and seventy two (472) pieces of asphalt stones ware manually evacuated via the anus.

A 20-year-old woman was brought to the surgical outpatient department with the strange history of irresistible desire to ingest metallic substances, mainly nails and pins. Her problems were initiated after she was forced to marry against her wish. She had no abdominal complaints and on examination the abdomen appeared absolutely normal. Plain radiograph confirmed numerous nails and pins inside her GI tract. On detailed psychologic evaluation, she was found to be suffering from deviant sexual behavior and marriage against her wish acted as a stressor in the development of this habit.

A 14-month-old girl presented with elevated lead levels and a metallic foreign body was detected on abdominal radiograph. Subsequent evaluation, performed after the child failed to pass the foreign body with cathartics, revealed a bezoar proximal to a partial duodenal obstruction. The metallic foreign body was later removed and found to contain lead, however, the patient has subsequently had recurrent elevations of lead levels with episodes of pica. This case reiterates the need to evaluate children with retained foreign bodies for lead poisoning due to associated pica. In addition, retained foreign bodies should point to possible congenital anomaly of the duodenum causing partial obstruction.

Eleven Aboriginal patients from the Northern Territory, in whom radiological examination of the abdomen demonstrated opaque masses of clay in the colon are described. This was due to the eating of white clay which is found only in streams, springs and billabongs of the coastal areas of the Territory. The habit does not appear to be a perversion of appetite, nor is it related to anaemia or pregnancy. The clay is eaten mainly for medicinal purposes or to allay hunger. The results are not always beneficial, since clay caused complications (including obstruction and perforation of the colon) in five of our 11 patients.

A young Arab woman with pica is presented. The diagnosis was suggested by the recurrent presence of numerous radiopaque particles in the course of the gastrointestinal tract. The particles changed location and concentration in successive abdominal X-rays taken at intervals of several weeks. Pica and its implications are discussed.

The significance of pica and geophagia as a public health problem is well known. The objective radiographic diagnosis of geophagia depends on the abnormal opacification of the bowel as an immediate manifestitation of the condition. The chance of detectability of geophagia is highest in the colon and can be improved by using low penetration films, particularly for smaller amounts of ingested clay. Other radiologic changes frequently associated with the prolonged practice of geophagic are an atonic pattern of the colon, secondary radiographic changes due to iron-deficiency anemia and bone-age retardation. The occurrences of intestinal obstruction due to pica in the presence of preexisting bowel stricture is demonstrated.

Studies were carried out on the diagnostic effectiveness of the 131I-captation test, the thyro-cap, thyro-con, res-o-mat method, and the scintigraphic method in the investigation of sheep with hypo- and hyperfunction of the thyroid gland. It was established that the first of these methods displayed negligible diagnostic capacity, embracing the changes in the inorganic phase of the iodine metabolism at hypo- and hyperfunction of the thyroid. The data obtained for the T-3, T-4, and FT-4 values on the basis of the radioimmune tests used reflected precisely and differentially the changes in the level of the hormone synthesis taking place in the thyroid at various physiologic conditions. Scintigraphic studies with 131I and 99mTc did not give account for the functional changes taking place in the parenchyma of the thyroid gland.