scholarly journals Recovery of Severe Dialysis Disequilibrium Syndrome with Uncal Herniation Following Therapy with Mannitol, Hyperventilation and Hypertonic Saline

2021 ◽  
Author(s):  
Kuan-Hung Liu ◽  
Shao-Hua Lee ◽  
Wei-Ren Lin ◽  
Yau-Sheng Tsai ◽  
Junne-Ming Sung
Keyword(s):  
Hypertonic Saline ◽  
Temporal Evolution ◽  
Rare Complication ◽  
Brain Magnetic Resonance Imaging ◽  
Preventive Strategies ◽  
General Application ◽  
Remarkable Recovery ◽  
Dialysis Disequilibrium Syndrome ◽  
Low Efficiency ◽  
Serial Brain

Abstract Dialysis disequilibrium syndrome (DDS) is a rare complication of dialysis, especially with the general application of preventive strategies. Severe DDS with brain herniation is believed to be fatal. We present a patient presenting with bilateral uncal herniation after receiving two dialysis sessions with low-efficiency settings. The serial brain magnetic resonance imaging studies showed the temporal evolution of DDS-induced cerebral edema. With aggressive treatment of hypertonic saline and mannitol, the patient made a remarkable recovery. This case highlights that we should be cautious about this severe complication of dialysis even with preventive strategies, and recovery is possible with prompt recognition and treatment.

Nonketotic Hyperglycemic Chorea in a 10-Year-Old Asian Boy with Diabetes Mellitus

2020 ◽  
Author(s):  
Julia Marian ◽  
Firdous Rizvi ◽  
Lily Q. Lew
Keyword(s):  
Diabetes Mellitus ◽  
Parietal Lobe ◽  
Rare Complication ◽  
Brain Magnetic Resonance Imaging ◽  
Food Allergies ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Resonance Imaging ◽  
Focal Lesions

AbstractNonketotic hyperglycemic chorea-ballism (NKHCB), also known as diabetic striato-pathy (DS) by some, is a rare complication of diabetes mellitus and uncommon in children. We report a case of a 10 11/12-year-old boy of Asian descent with uncontrolled type 1 diabetes mellitus (T1DM), Hashimoto's thyroiditis, and multiple food allergies presenting with bilateral chorea-ballism. His brain magnetic resonance imaging revealed developmental venous anomaly in right parietal lobe and right cerebellum, no focal lesions or abnormal enhancements. Choreiform movements resolved with correction of hyperglycemia. Children and adolescents with a movement disorder should be evaluated for diabetes mellitus, especially with increasing prevalence and insidious nature of T2DM associated with obesity.

Catamenial Synkinetic Retroauricular Pain

Cephalalgia ◽  
2003 ◽  
Vol 23 (3) ◽  
pp. 214-217 ◽  
Author(s):  
DE Jacome
Keyword(s):  
White Matter Hyperintensities ◽  
Rare Complication ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Bell’S Palsy ◽  
Bell's Palsy ◽  
Patient Reported ◽  
Magnetic Resonance Imaging Mri ◽  
Eye Closure ◽  
Facial Synkinesis

A report of two female patients with persistent unilateral retroauricular pain and cranial synkinesis following Bell's palsy. Pain occurred during menses in the first patient and was exacerbated by menses in the second patient. Retroauricular pain often precedes or follows Bell's palsy. Pain normally disappears within 2 weeks from the onset of paralysis. Neurological examination, brain magnetic resonance imaging (MRI), computed tomography of the head and cranial electrophysiological testing were performed. The first patient had severe right retroauricular pain during her menses for several years following Bell's palsy. Her brain MRI showed non-specific T2 white matter hyperintensities. On her electromyogram she had facial synkinesis with tonic motor unit discharges on her right orbicularis oris and mentalis muscles during sustained eye closure. The second patient reported hearing a sound over her left ear when she blinked or protruded her jaw after Bell's palsy. She had ipsilateral retroauricular pain, exacerbated during menses. Her brain MRI was normal. Electromyogram showed facial synkinesis. Chronic retroauricular pain, occurring or exacerbated during menses, may be a rare complication of Bell's palsy. It can be associated with facial subclinical synkinetic dystonia and trigemino-facial synkinesis.

scholarly journals Autoimmune Encephalitis and CSF Anti-GluR3 Antibodies in an MS Patient after Alemtuzumab Treatment

2019 ◽  
Vol 9 (11) ◽  
pp. 299 ◽  
Author(s):  
Maria Chiara Buscarinu ◽  
Arianna Fornasiero ◽  
Giulia Pellicciari ◽  
Roberta Reniè ◽  
Anna Chiara Landi ◽  
...  
Keyword(s):  
Cognitive Deficits ◽  
Focal Epilepsy ◽  
Brain Magnetic Resonance Imaging ◽  
Autoimmune Encephalitis ◽  
Complete Recovery ◽  
Neurological Status ◽  
Relapsing Remitting ◽  
The Central Nervous System ◽  
Relapsing Remitting Multiple Sclerosis ◽  
Serial Brain

A 45-year-old Italian woman, affected by relapsing–remitting multiple sclerosis (RR-MS) starting from 2011, started treatment with alemtuzumab in July 2016. Nine months after the second infusion, she had an immune thrombocytopenic purpura (ITP) with complete recovery after steroid treatment. Three months after the ITP, the patient presented with transient aphasia, cognitive deficits, and focal epilepsy. Serial brain magnetic resonance imaging showed a pattern compatible with encephalitis. Autoantibodies to glutamate receptor 3 peptide A and B were detected in cerebrospinal fluid and serum, in the absence of any other diagnostic cues. After three courses of intravenous immunoglobulin (0.4 mg/kg/day for 5 days, 1 month apart), followed by boosters (0.4 mg/kg/day) every 4–6 weeks, her neurological status improved and is currently comparable with that preceding the encephalitis. Autoimmune complications of the central nervous system during alemtuzumab therapy are relatively rare: only one previous case of autoimmune encephalitis following alemtuzumab treatment has been reported to date.

scholarly journals Dialysis Disequilibrium Syndrome and Cerebellar Herniation with Successful Reversal Using Mannitol

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Anna Curtis ◽  
Christian Lamb ◽  
Hussain Rao ◽  
Andrew Williams ◽  
Amit Patel
Keyword(s):  
Complete Resolution ◽  
Rare Complication ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Imaging Findings ◽  
Brain Herniation ◽  
Tonsillar Herniation ◽  
Dialysis Disequilibrium Syndrome ◽  
Clinical Signs And Symptoms

Dialysis disequilibrium syndrome (DDS) is a morbid but rare complication of dialysis. Feared sequalae of this diagnosis are brain herniation and death. This report presents a patient who was diagnosed with DDS with subsequent tonsillar herniation shown on imaging with complete resolution of clinical signs and symptoms, as well as imaging findings of herniation after prompt initiation of intravenous mannitol. This is the first known case of reversal and survival of DDS-induced tonsillar herniation using mannitol.

scholarly journals Splenic Abscess: A Rare Complication of the UVC in Newborn

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Ameer Aslam ◽  
Emad Sadek Ahmed Shatla ◽  
Sameera Imanullah ◽  
Elsaid M. A. Bedair
Keyword(s):  
Risk Factors ◽  
Surgical Intervention ◽  
Rare Complication ◽  
Splenic Abscess ◽  
Abdominal Distension ◽  
Abdominal Ultrasound ◽  
Final Diagnosis ◽  
Preventive Strategies ◽  
Factors Associated ◽  
Causes And Risk Factors

Splenic abscess is one of the rarest complications of the UVC in a newborn and it is hypothesized that it could be due to an infection or trauma caused by a catheter. The case that is being reported presented with abdominal distension and recurrent desaturation with suspicion of neonatal sepsis versus necrotizing enterocolitis. However, the final diagnosis was splenic abscess as a complication of an inappropriate UVC insertion which was discovered by abdominal ultrasound. The patient was given broad spectrum antibiotics empirically and the symptoms were resolved without any surgical intervention. Such cases and controlled studies need to be reported in order to identify further causes and risk factors associated with splenic abscess in a patient with UVC which can eventually help us adopt preventive strategies to avoid such complications.

Rapid contrast-induced encephalopathy after a small dose of contrast agent: illustrative case

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Zhouyang Zhao ◽  
Lijin Huang ◽  
Jinhua Chen ◽  
Hongshen Zhu
Keyword(s):  
Carotid Artery ◽  
Contrast Agent ◽  
Cerebral Angiography ◽  
Small Dose ◽  
Rare Complication ◽  
Brain Magnetic Resonance Imaging ◽  
Neurological Status ◽  
Illustrative Case ◽  
Disturbance Of Consciousness ◽  
Nonionic Contrast Agent

BACKGROUNDContrast-induced encephalopathy is a rare complication of cerebral angiography with only few cases reported to date. This paper reports on contrast-induced encephalopathy mimicking meningoencephalitis following cerebral angiography with iopromide, a subhypertonic nonionic contrast agent.OBSERVATIONSA 50-year-old woman underwent cerebral angiography for assessment of recurrent nasopharyngeal carcinoma with invasion of internal carotid artery. The patient experienced symptoms including a disturbance of consciousness, seizures, frequent blinking, and stiffness in the extremities immediately after angiography of the left common carotid artery using iopromide (4 ml/s, total 6 ml). Computed tomography scans of the brain showed no obvious abnormalities, whereas brain magnetic resonance imaging showed swelling of the left cerebral cortex without signs of ischemia or hemorrhage. The patient was treated with intravenous rehydration, mannitol dehydration, and other supportive treatment. With this treatment, neurological status progressively improved, with complete resolution of symptoms at day 10.LESSONSThis observation highlights that even a small dose of subhypertonic nonionic contrast agent can rapidly induce contrast encephalopathy.

scholarly journals Subacute Sclerosing Panencephalitis Presenting with Unilateral Periodic Myoclonic Jerks

2003 ◽  
Vol 30 (4) ◽  
pp. 384-387 ◽  
Author(s):  
Zaitoon M. Shivji ◽  
Ibrahim S. Al-Zahrani ◽  
Yousef A. Al-Said ◽  
Mohammed M.S. Jan
Keyword(s):  
Measles Virus ◽  
Clinical Course ◽  
Rare Complication ◽  
Subacute Sclerosing Panencephalitis ◽  
Brain Magnetic Resonance Imaging ◽  
Motor Weakness ◽  
Advanced Stages ◽  
Periodic Complexes ◽  
Symptoms And Signs ◽  
Atypical Manifestation

Background:Subacute sclerosing panencephalitis (SSPE) is a rare complication of measles virus infection. The disease is characterized by behavioural abnormalities, intellectual deterioration, motor weakness, and generalized myoclonic jerks progressing to coma and death in one to two years in 80% of the cases. The myoclonic jerks are associated with characteristic generalized slow periodic complexes on electroencephalography (EEG). The symptoms and signs of SSPE are frequently quite variable. The clinical course is equally variable and difficult to predict. The characteristic periodic myoclonus can rarely occur unilaterally particularly in the early stages of the disease. As well, the periodic EEG complexes have been reported unilaterally in up to 3% of cases.Case Report:A 12-year-old boy, who was seen at a later stage with atypical manifestation of myoclonic body jerks confined entirely unilaterally, combined with contralateral periodic EEG complexes. One could assume clinically that the more diseased hemisphere was responsible for generating the jerks. However, brain magnetic resonance imaging revealed asymmetric hemispheric changes suggesting that the less neurologically damaged hemisphere is responsible for generating the unilateral myoclonic jerks. This has led to the interpretation that the more severely damaged hemisphere has lost the neuronal connectivity required to generate these periodic myoclonic jerks.Conclusion:Subacute sclerosing panencephalitis may have asymmetric hemispheric involvement, not only early, but also in the advanced stages of the disease, which can result in unilateral periodic myoclonic jerks.

scholarly journals DIALYSIS DISEQUILIBRIUM SYNDROME: A RARE COMPLICATION OF HEMODIALYSIS

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A777
Author(s):  
Jose Lopez ◽  
Javas Gupta ◽  
Sheyla Gonzalez ◽  
Richard Medina-Perez ◽  
Yoosif Abdalla
Keyword(s):  
Rare Complication ◽  
Dialysis Disequilibrium Syndrome

Steroid-Responsive Edema Interfering With Deep Brain Stimulation Programming

2020 ◽  
pp. 129-132
Author(s):  
Pravin Khemani ◽  
Shilpa Chitnis
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Vasogenic Edema ◽  
Rare Complication ◽  
Brain Mri ◽  
Clinical Signs ◽  
Brain Magnetic Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
T2 Hyperintensity ◽  
Deep Brain

Deep brain stimulation (DBS) surgery–associated complications are most commonly due to infections and issues with surgical hardware. An uncommon postsurgical complication hindering effective programming is noninfectious edema appearing as an abnormal peri-electrode T2 signal hyperintensity on brain magnetic resonance imaging (MRI). A 72-year-old woman with Parkinson disease underwent bilateral subthalamic nucleus (STN) implantation for medication-refractory motor symptoms. Worsening balance shortly after surgery and suboptimal response to DBS programming prompted brain MRI, which showed an abnormal T2 hyperintensity around the left STN electrode. Although intravenous antibiotics were considered, the absence of clinical signs and lack of postcontrast T2 signal enhancement argued against infection. Suspecting vasogenic edema, a short course of oral dexamethasone steroids was initiated, with gradual improvement in balance and resolution of the abnormal MRI signal. The mechanism of steroid-responsive vasogenic edema after DBS surgery is not well-understood. This case underscores the importance of being vigilant about this rare complication, differentiating it from infection based on clinical presentation and radiographic characteristics, and treating it appropriately.

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