scholarly journals Acute disseminated encephalomyelitis with delayed onset and feasibility of the Miethke shunt and sensor reservoir system: a case report

2021 ◽  
Author(s):  
Gunnar Liminga ◽  
Anna Grabowska ◽  
Dýrleif Pétursdóttir ◽  
Kristina G. Cesarini ◽  
Elham Rostami ◽  
...  
Keyword(s):  
Case Report ◽  
Acute Disseminated Encephalomyelitis ◽  
High Dose ◽  
Vp Shunt ◽  
Delayed Onset ◽  
Reservoir System ◽  
Acute Visual Loss ◽  
First Case ◽  
Immune Mediated ◽  
System Disorder

AbstractAcute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating central nervous system disorder with predilection for early childhood. Delayed onset of ADEM is rare, and herein we present a previously healthy 5-year-old boy, with an unusual clinical course of ADEM with high intracranial pressure (ICP) and acute visual loss that was at first diagnosed as idiopathic intracranial hypertension without papilledema (IIHWOP). The boy underwent acute neurosurgical intervention with ventriculoperitoneal (VP) shunt using Miethke valve and sensor reservoir system and received high-dose steroid treatment with symptom relieve within days. This is the first case report using this system in such a young child, and we find it feasible and valuable also in younger children when VP shunt with ICP measurement is indicated.

scholarly journals Nonepileptic Myoclonus in COVID-19: Case Report

2021 ◽  
pp. 194187442110043
Author(s):  
Henly Hewan ◽  
Annie Yang ◽  
Aparna Vaddiparti ◽  
Benison Keung
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
High Dose ◽  
The Novel ◽  
Neurological Manifestations ◽  
Immune Mediated ◽  
Novel Coronavirus ◽  
Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

scholarly journals Acute Disseminated Encephalomyelitis Following Typhoid Fever: A Case Report

2014 ◽  
Vol 9 (4) ◽  
pp. 55-58
Author(s):  
R Adhikari ◽  
A Tayal ◽  
PK Chhetri ◽  
B Pokhrel
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Case Report ◽  
Typhoid Fever ◽  
Demyelinating Disease ◽  
Acute Disseminated Encephalomyelitis ◽  
Medical Sciences ◽  
Cerebellar Syndrome ◽  
Immune Mediated ◽  
The Central Nervous System

The involvement of central nervous system in children with typhoid fever is common. Acute disseminated encephalomyelitis is a rare immune mediated and demyelinating disease of the central nervous system that usually affects children. We report a 7-year-old child with typhoid fever who developed acute cerebellar syndrome due to acute disseminated encephalomyelitis.Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 55-58 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10237

High-dose Supplementation With Vitamin C–induced Pediatric Urolithiasis: The First Case Report in a Child and Literature Review

Urology ◽  
2014 ◽  
Vol 84 (4) ◽  
pp. 922-924 ◽  
Author(s):  
Xuehua Chen ◽  
Luming Shen ◽  
Xiaojian Gu ◽  
Xinjuan Dai ◽  
Li Zhang ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Vitamin C ◽  
High Dose ◽  
Pediatric Urolithiasis ◽  
First Case

A Case of Multifocal Neurological Symptoms

2018 ◽  
pp. 9-14
Author(s):  
Aaron E. Miller ◽  
Tracy M. DeAngelis ◽  
Michelle Fabian ◽  
Ilana Katz Sand
Keyword(s):  
Acute Disseminated Encephalomyelitis ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
High Dose ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Good Recovery ◽  
Related Disease ◽  
Demyelinating Disorder ◽  
Immune Mediated ◽  
Initial Onset ◽  
Adolescents And Adults

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disorder characterized by multifocal involvement of the CNS and encephalopathy. Diagnostic criteria also require MRI lesions characteristic for demyelination and that new symptoms/findings not occur more than three months after initial onset. ADEM preferentially affects young children but also occurs in adolescents and adults. An antecedent infection or vaccine may be reported, but a clear causal relationship has not been established, and more often no clear provoking factor is identified. In addition to encephalopathy, patients present with symptoms reflecting multifocal CNS involvement such as optic neuritis, ataxia, hemiparesis, spinal cord syndrome, and seizures. Respiratory failure may occur. ADEM is typically treated with high-dose corticosteroids. Plasma exchange or intravenous immunoglobulin may also be used. The course is most often monophasic with good recovery. However, a subset of patients will go on to have recurrent disease, reflecting a diagnosis of multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein related disease.

A second administration of glucarpidase in a different cycle of high-dose methotrexate: Is it safe and effective in adults?

2020 ◽  
pp. 107815522094646 ◽  
Author(s):  
Amalia Domingo-González ◽  
Santiago Osorio ◽  
Elena Landete ◽  
Silvia Monsalvo ◽  
Jose L. Díez-Martín
Keyword(s):  
Renal Function ◽  
Case Report ◽  
Adverse Events ◽  
Kidney Injury ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Dose Methotrexate ◽  
First Case ◽  
Methotrexate Concentration ◽  
Unknown Area

Introduction Methotrexate intoxication following high-dose methotrexate-induced acute kidney injury is a life-threatening complication. Glucarpidase can quickly reduce extracellular methotrexate to safe levels, but the effectiveness and safety of its use in different episodes of nephrotoxicity remain an unknown area. Case Report A 30-year-old male diagnosed with acute lymphoblastic T-cell lymphoma received methotrexate 5 g/m2 intravenous (IV) as part of the first consolidation cycle. On Consolidation 3, he restarted methotrexate at a dose of 3 g/m2 IV showing slow methotrexate elimination, associated myelosuppression, and hepatic toxicity. Glucarpidase was administered (total dose of 2000 International Units (IU)). No adverse events were observed, and his renal function returned to normal. One hundred and six days later, he was diagnosed with leptomeningeal and cerebellar relapse and treatment with methotrexate 3,5 g/m2 IV day 1 and cytosine arabinoside (Ara-C) 2 g/m2 IV twice per day days 1, 3, and 5 was started. At 36 h from methotrexate infusion, serum creatinine increased up to 1.89 mg/dL and methotrexate concentration was 100 µmol/L. Management and Outcome: Ara-C was suspended, and a second administration of glucarpidase (2000 IU) was dispensed. No adverse events were noticed, methotrexate levels decreased and renal function progressively improved, recovering completely three weeks later. Discussion The effectiveness and safety of the use of glucarpidase in different episodes of nephrotoxicity remain an unknown area, and the rate and consequences of antiglucarpidase antibody formation remain poorly understood. This case report is, to our knowledge, the first case of a second administration of glucarpidase in a different cycle of high-dose methotrexate in an adult patient.

scholarly journals NCMP-23. PEMBROLIZUMAB-ASSOCIATED CD8+ VASCULITIC MONONEURITIS MULTIPLEX IN A PATIENT WITH MESOTHELIOMA: FIRST CASE REPORT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii127-ii127
Author(s):  
Michaela Baldauf ◽  
Kapauer Monika ◽  
Jörger Markus ◽  
Flatz Lukas ◽  
Regulo Rodriguez ◽  
...  
Keyword(s):  
Case Report ◽  
Checkpoint Inhibitors ◽  
Axonal Neuropathy ◽  
Immunosuppressive Treatment ◽  
Small Vessel ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Mononeuritis Multiplex ◽  
First Case ◽  
The Right

Abstract INTRODUCTION Immunotherapy, especially with immune checkpoint inhibitors (ICPI), has increasingly become an attractive treatment modality for various types of cancers. However, many patients develop ICPI-associated autoimmune adverse events such as pneumonitis, colitis or rarely neurological syndromes. Large and medium vessel vasculitis haS only occasionally been reported. Here we report the first case of ICPI-associated mononeuritis multiplex in a patient with malignant mesothelioma, caused by a histological proven small vessel vasculitis. CASE REPORT A 61-year old female developed subacute progressive painful and asymmetric sensorimotor deficits on distal extremities. Electrophysiologically, signs of a severe axonal neuropathy of both legs and the right arm were found, and swellings of the corresponding nerves were seen upon nerve ultrasound exam. The clinical and electrophysiological findings were reminiscent of mononeuritis multiplex. Laboratory work up including CSF examination was normal. More than two years prior to developing peripheral nerve deficits, the patient had been diagnosed with malignant pleural mesothelioma and treated with the anti-PD1 monoclonal antibody pembrolizumab on progression after chemotherapy. Biopsy of the right sural nerve revealed a small vessel vasculitis with a lymphocyte predominance of CD8+ T cells over CD4+ T as well as B lymphocytes. Despite discontinuation of pembrolizumab and immunosuppressive treatment (high dose methylprednisone, cyclophosphamide) complemented by opioid therapy, painful allodynia persisted. CONCLUSION ICPI-associated autoimmune disorders also include small vessel vasculitis with rare phenotypes such as mononeuritis multiplex. Further studies are required to improve our understanding of the link between ICPIs, and the pathogenic process leading to vasculitis, as well as to optimize treatment options for those rare diseases.

scholarly journals Case Report: Enhanced Diazepam Elimination With the Molecular Adsorbents Recirculating System (MARS) in Severe Autointoxication: A Survival Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Anna Dobisova ◽  
Peter Vavrinec ◽  
Diana Vavrincova-Yaghi ◽  
Andrea Gebhardtova ◽  
Robert H. Henning ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Plasma Level ◽  
High Dose ◽  
Mechanically Ventilated ◽  
First Case ◽  
Blood And Urine Samples ◽  
Repeated Doses ◽  
High Doses ◽  
Elimination Clearance

Objective: Due to the extensive use of diazepam worldwide, self-induced intoxication is very common, yet rarely fatal. Nevertheless, the management of intoxication caused by extremely high doses of diazepam is not known, as well as the effectiveness of flumazenil, a specific benzodiazepine (BDZ) antagonist. Here we present the first report on the enhanced elimination (clearance) of diazepam using the Molecular Adsorbents Recirculating System (MARS) following autointoxication with an extremely high dose as part of a suicide attempt.Case: A 44-year-old male patient was admitted to the ICU because of impaired consciousness following the ingestion of 20 g of diazepam. Blood and urine samples revealed high benzodiazepine levels. Repeated doses of flumazenil were without effect on consciousness. Following deterioration of the patient's clinical condition, including unconsciousness, hypoventilation, and decreased SpO2 (88%), the patient was intubated and mechanically ventilated. On the fourth day after admission, the patient was unresponsive, with no attempt to breath spontaneously. The plasma level of benzodiazepines was 1,772 μg/l. The elimination of benzodiazepines by MARS was attempted, continuing for 5 days, with one session per day. Five sessions of MARS effectively enhanced benzodiazepine elimination. After the first MARS treatment, the plasma level of benzodiazepines dropped from 1,772 to 780 μg/l. After the final MARS treatment on the eighth day, the patient was weaned from mechanical ventilation and extubated. Two days later, the patient was discharged to the internal medicine department and subsequently to the psychiatry department.Conclusions: To the best of our knowledge, this is the first case reporting successful treatment of diazepam intoxication using MARS. In severe cases of diazepam intoxication, with prolonged unconsciousness and the necessity of mechanical ventilation, we suggest considering the use of MARS elimination therapy together with the monitoring of the BDZ plasma level.

Bilateral Uveitis Following Typhoid Fever: Case Report and Review of the Literature

2017 ◽  
Vol 1 (5) ◽  
pp. 344-346
Author(s):  
Joshua D. Levinson ◽  
Richard A. Garfinkel ◽  
Michael M. Lai
Keyword(s):  
Case Report ◽  
Typhoid Fever ◽  
Acute Infection ◽  
Febrile Illness ◽  
High Dose ◽  
Retrospective Case ◽  
Blurred Vision ◽  
Travel History ◽  
Cotton Wool Spots ◽  
Immune Mediated

Purpose: To report a case of presumed immune-mediated bilateral uveitis following infection with typhoid fever. Methods: Retrospective case report. Results: A 70-year-old Caucasian man developed typhoid fever while on vacation in Jamaica which was successfully treated with antibiotic therapy. Three weeks after onset of fever, he developed bilateral blurred vision and floaters. Clinical examination demonstrated anterior chamber cell, 1 to 2+ vitritis, and cotton wool spots bilaterally. The patient was diagnosed with postinfectious uveitis and started on prednisone 80 mg/d (1 mg/kg) which was slowly tapered by 10 mg/d/wk. By week 4 of steroid therapy, visual symptoms and evidence of intraocular inflammation had resolved. The patient successfully completed the steroid taper without recurrence of inflammation. Conclusion: Immune-mediated uveitis may occur 3 to 6 weeks following acute infection with typhoid fever. Post-typhoid uveitis is responsive to high-dose systemic steroids. Patients presenting with new-onset uveitis should be questioned for recent febrile illness or travel history.

scholarly journals Intoxication after Extreme Oral Overdose of Quetiapine to Attempt Suicide: Pharmacological Concerns of Side Effects

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
C. Müller ◽  
H. Reuter ◽  
C. Dohmen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Psychotic Disorders ◽  
Case Reports ◽  
Gastric Lavage ◽  
High Dose ◽  
Airway Protection ◽  
Residual Symptoms ◽  
First Case

Quetiapine is an atypical antipsychotic approved for the treatment of patients with psychotic disorders. Since approvement several case reports about intoxication with quetiapine were linked mainly with tachycardia,QTc-prolongation, somnolence, and hyperglycemia. Here, we present the first case report of an intoxication with an extreme overdose of quetiapine (36 g), ingested by a 32-year-old female (62 kg bodyweight) to attempt suicide. Symptoms associated with intoxication were coma without arterial hypotension, persistent tachycardia, hyperglycemia, and transient hypothyreoidism.QTc-interval was moderately extended. Management consisted of intubation for airway protection, gastric lavage, the use of activated charcoal, i.v. saline, and observation for 17 hours on an intensive care unit. Despite the extremely high dose of quetiapine, the patient recovered completely without residual symptoms.

scholarly journals Use of Cyclophosphamide in a Child With Fulminant Acute Disseminated Encephalomyelitis

2018 ◽  
Vol 5 ◽  
pp. 2329048X1875463
Author(s):  
Hana Ayed ◽  
Mohammed W. Chaudhary ◽  
Raidah AlBaradie ◽  
Ali Mir
Keyword(s):  
Intravenous Immunoglobulin ◽  
Immunosuppressive Agents ◽  
Acute Disseminated Encephalomyelitis ◽  
High Dose ◽  
Intravenous Methylprednisolone ◽  
First Line ◽  
Demyelinating Disorder ◽  
Immune Mediated ◽  
Minimal Improvement ◽  
The Central Nervous System

Acute disseminated encephalomyelitis is an immune-mediated inflammatory demyelinating disorder of the central nervous system. The first-line treatment is usually high-dose intravenous methylprednisolone. Intravenous immunoglobulin and plasmapheresis have also shown to be beneficial. Immunosuppressive agents like cyclophosphamide have been used in adults with fulminant acute disseminated encephalomyelitis. We report a case of a 3-year-old boy with fulminant acute disseminated encephalomyelitis. Minimal improvement was seen with high-dose intravenous methylprednisolone, intravenous immunoglobulin, and plasmapheresis. Based on the reports of cyclophosphamide being used successfully to treat adult patients with fulminant acute disseminated encephalomyelitis, we used it in our patient who then showed dramatic and quick improvement. We suggest that if conventional treatment fails, cyclophosphamide could be tried in pediatric patients with fulminant acute disseminated encephalomyelitis.

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