scholarly journals Unilateral mydriasis in a child with a ventriculoperitoneal shunt for obstructive hydrocephalus: a diagnostic dilemma

2020 ◽  
Vol 13 (12) ◽  
pp. e237257
Author(s):  
Monidipa Banerjee ◽  
Eiman Haj Ahmed ◽  
Kathryn Foster ◽  
Arundoss Gangadharan
Keyword(s):  
Ipratropium Bromide ◽  
Obstructive Hydrocephalus ◽  
Sudden Onset ◽  
Unique Case ◽  
Diagnostic Dilemma ◽  
Vp Shunt ◽  
Life Threatening ◽  
Unilateral Mydriasis ◽  
The Brain ◽  
Rule Out

There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. An urgent CT scan of the brain did not show any new intracranial abnormality. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect.

scholarly journals CVT in the Peripartum Period: A Diagnostic Dilemma

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Leah Allbright ◽  
Francine McLeod ◽  
Donald Mauney
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Multidisciplinary Approach ◽  
Complete Recovery ◽  
Postdural Puncture Headache ◽  
Diagnostic Dilemma ◽  
Neurologic Symptoms ◽  
Life Threatening ◽  
Peripartum Period ◽  
Rule Out

Women in the peripartum period can develop headache with a variety of etiologies that require a multidisciplinary approach if unresponsive to treatment (Stella et al. 2007). Neuroimaging needs to be undertaken even occasionally in the absence of focal neurologic signs to rule out life-threatening causes of headache. We present the case of a 23-year-old woman who presented postpartum with severe frontal headache without other neurologic symptoms. Treatment was initiated for tension type, then subsequently postdural puncture headache (PDPH), and finally preeclampsia. When CT venogram was obtained ten days later, the diagnosis of cerebral venous thrombosis (CVT) was made. She was started on anticoagulation and achieved complete recovery.

scholarly journals Transient binocular blindness: A rare presentation of aortic dissection

2018 ◽  
Vol 27 (4) ◽  
pp. 236-240
Author(s):  
Abdul Hafiz Shaharudin ◽  
Muhamad Hafiq Ab Hamid ◽  
Rosliza Yahaya ◽  
Nik Ahmad Shaiffudin Nik Him ◽  
Nik Arif Nik Mohamed ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Carotid Artery ◽  
Aortic Dissection ◽  
Sudden Onset ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Introduction: Aortic dissection is a clinical chameleon that can have variable presenting features that require a careful history and physical examination. A non-specific presentation of this life-threatening condition causes a diagnostic dilemma among clinicians especially in the emergency department leading to grave consequences. Case Presentation: We present a case of aortic dissection that presented as an acute bilateral blindness that was associated with a sudden onset of loss of consciousness and central chest pain. Bedside carotid ultrasound showed a double lumen carotid artery suggesting an intraluminal flap. Computed tomography angiography revealed extensive dissection of the entire length of the aorta. Discussion: This case illustrated the need for a high index of suspicion to diagnose patients with aortic dissection especially as the patient presented with an acute binocular visual loss and chest pain. Conclusion: A bedside carotid artery ultrasound in the emergency department was found useful in screening and diagnosing a carotid artery–related pathology.

Lessons Learned From Coaching Postsecondary Students With Traumatic Brain Injury

2020 ◽  
Vol 5 (1) ◽  
pp. 88-96
Author(s):  
Mary R. T. Kennedy
Keyword(s):  
College Students ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sense Of Self ◽  
Scientific Evidence ◽  
Sudden Onset ◽  
Lessons Learned ◽  
Speech Language Pathologists ◽  
The Brain ◽  
Exhaustive List

Purpose The purpose of this clinical focus article is to provide speech-language pathologists with a brief update of the evidence that provides possible explanations for our experiences while coaching college students with traumatic brain injury (TBI). Method The narrative text provides readers with lessons we learned as speech-language pathologists functioning as cognitive coaches to college students with TBI. This is not meant to be an exhaustive list, but rather to consider the recent scientific evidence that will help our understanding of how best to coach these college students. Conclusion Four lessons are described. Lesson 1 focuses on the value of self-reported responses to surveys, questionnaires, and interviews. Lesson 2 addresses the use of immediate/proximal goals as leverage for students to update their sense of self and how their abilities and disabilities may alter their more distal goals. Lesson 3 reminds us that teamwork is necessary to address the complex issues facing these students, which include their developmental stage, the sudden onset of trauma to the brain, and having to navigate going to college with a TBI. Lesson 4 focuses on the need for college students with TBI to learn how to self-advocate with instructors, family, and peers.

Fact file 1: Critical care and emergency medicine

2017 ◽  
Author(s):  
Daisy Fancourt
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Sports Medicine ◽  
Orthopaedic Surgery ◽  
Extreme Environment ◽  
Disaster Medicine ◽  
Medical Attention ◽  
Life Threatening ◽  
Medical Disciplines ◽  
The Brain

Emergency medicine involves the care of patients who require immediate medical attention. The specialty encompasses a broad range of medical disciplines, including anaesthesia, cardiology (a field related to the heart), neurology (a field related to the brain), plastic surgery, orthopaedic surgery (surgery relating to the bones or muscles), and cardiothoracic surgery (surgery relating to the heart, chest, or lungs). There are also a number of subspecialties including extreme environment medicine, disaster medicine and sports medicine. Related to emergency medicine is the specialty of critical care medicine, which is concerned with the care of patients with life-threatening conditions often treated in intensive care settings....

scholarly journals Hypothetical COVID-19 protection mechanism: hints from centenarians

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Franca Rosa Guerini ◽  
Matteo Cesari ◽  
Beatrice Arosio
Keyword(s):  
Adaptive Immune Response ◽  
Human Leukocyte ◽  
Human Longevity ◽  
Biological Mechanisms ◽  
Protection Mechanism ◽  
Leukocyte Antigen ◽  
Adaptive Immune ◽  
Life Threatening ◽  
Coronavirus Infection ◽  
Rule Out

AbstractThe risk of serious complications and the fatality rate due to COVID-19 pandemic have proven particularly higher in older persons, putting a further strain in healthcare system as we dramatically observed.COVID-19 is not exclusively gerophile (géro “old” and philia “love”) as young people can be infected, even if older people experience more severe symptoms and mortality due to their greater frailty. Indeed, frailty could complicate the course of COVID-19, much more than the number of years lived. As demonstration, there are centenarians showing remarkable capacity to recover after coronavirus infection.We hypothesize that centenarian’s portfolio could help in identifying protective biological mechanisms underlying the coronavirus infection.The human leukocyte antigen (HLA) is one of the major genetic regions associated with human longevity, due to its central role in the development of adaptive immune response and modulation of the individual’s response to life threatening diseases. The HLA locus seems to be crucial in influencing susceptibility and severity of COVID-19.In this hypothesis, we assume that the biological process in which HLA are involved may explain some aspects of coronavirus infection in centenarians, although we cannot rule out other biological mechanisms that these extraordinary persons are able to adopt to cope with the infection.

Revision Targeted Muscle Reinnervation Improves Secondary Pain Insult in an Upper Extremity Amputee: A Case Report

Hand ◽  
2021 ◽  
pp. 155894472199246
Author(s):  
David D. Rivedal ◽  
Meng Guo ◽  
James Sanger ◽  
Aaron Morgan
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerves ◽  
Nerve Biopsy ◽  
Sensory Cortex ◽  
Denervated Muscle ◽  
Unique Case ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
And Function ◽  
The Brain

Targeted muscle reinnervation (TMR) has been shown to improve phantom and neuropathic pain in both the acute and chronic amputee population. Through rerouting of major peripheral nerves into a newly denervated muscle, TMR harnesses the plasticity of the brain, helping to revert the sensory cortex back toward the preinsult state, effectively reducing pain. We highlight a unique case of an above-elbow amputee for sarcoma who was initially treated with successful transhumeral TMR. Following inadvertent nerve biopsy of a TMR coaptation site, his pain returned, and he was unable to don his prosthetic. Revision of his TMR to a more proximal level was performed, providing improved pain and function of the amputated arm. This is the first report to highlight the concept of secondary neuroplasticity and successful proximal TMR revision in the setting of multiple insults to the same extremity.

scholarly journals Multidisciplinary Approach to Suspected Sudden Death Caused by Arteriovenous Malformation Rupture: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 644
Author(s):  
Federico Giuseppe Patanè ◽  
Massimiliano Esposito ◽  
Andrea Giovanni Musumeci ◽  
Monica Palermo ◽  
Marco Torrisi ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Cause Of Death ◽  
Venous Malformation ◽  
Healthy Woman ◽  
Unexpected Death ◽  
Medical Problems ◽  
Variable Diameter ◽  
Life Threatening ◽  
Brain Avms ◽  
The Brain

Arteriovenous malformations (AVMs) are rare congenital conditions with a prevalence of less than 1% and are mostly asymptomatic. However, these malformations can suddenly cause intense pain or bleeding, leading to life-threatening medical problems. This report presents a case of an unexpected death in a 37-year-old previously healthy woman due to an intra-cerebellum arteriovenous malformation rupture identified during autopsy. While infective processes where preliminarily excluded, a Post Mortem Computed Tomography (PMCT) identified a tetra ventricular hemorrhage and intra-cerebellum hemorrhage. Toxicological examination was negative for most substances of abuse. During autopsy an intense hemorrhagic infiltrate in the subarachnoid space was observed. After formalin fixation of the brain the cerebellum showed hemorrhagic infarction on fourth ventricle sides, as well as several small reddish infarctions across the entire cerebellum parenchyma. Histological examination of the brain and cerebellum showed a suffusion of erythrocytes in the sub-arachnoid region. Evidence of an arterio-venous malformation, with several intertwine vessels of variable diameter, surrounded by hemorrhagic evidence. The autopsy played a crucial role in identifying the location and the possibly affected vessel, as well as defining the cause of death. It is necessary to have a greater number of autopsies to make an epidemiological contribution. Furthermore, it is crucial to create a multicenter data network with other authors from other departments to improve information about epidemiological, clinical, diagnostic and therapeutic data. Most brain AVMs as cause of death are often undiscovered.

scholarly journals Bedside examination of the vestibular and ocular motor system in patients with acute vertigo or dizziness

2019 ◽  
Vol 3 (2) ◽  
pp. 2514183X1988615
Author(s):  
Alexander A Tarnutzer ◽  
Marianne Dieterich
Keyword(s):  
Diagnostic Testing ◽  
Initial Assessment ◽  
Head Impulse Test ◽  
Motor Deficits ◽  
Ocular Motor ◽  
Bedside Examination ◽  
Life Threatening ◽  
Ocular Motor System ◽  
Bedside Tests ◽  
The Brain

In the initial assessment of the patient with acute vertigo or dizziness, both structured history-taking and a targeted bedside neuro-otological examination are essential for distinguishing potentially life-threatening central vestibular causes from those of benign, self-limited peripheral labyrinthine origin and thus for deciding on further diagnostic testing. In this article, the key elements of the vestibular and ocular motor examination, which should be obtained at the bedside in these acutely dizzy patients, will be discussed. Specifically, this will include the following five domains: ocular stability for (I) nystagmus and for (II) eye position (skew deviation), (III) the head-impulse test (HIT), (IV) postural stability, and (V) ocular motor deficits of saccades, smooth pursuit eye movements, and optokinetic nystagmus. We will also discuss the diagnostic accuracy of specific combinations of these bedside tests (i.e. HIT, testing for nystagmus and vertical divergence, referred to as the H.I.N.T.S. three-step examination), emphasizing that the targeted neuro-otological bedside examination is more sensitive for identifying central causes in acute prolonged vertigo and dizziness than early MRI of the brain.

Neurosurgical management of a giant colloid cyst with atypical clinical and radiological presentation

2014 ◽  
Vol 121 (5) ◽  
pp. 1185-1188 ◽  
Author(s):  
Joel Woodley-Cook ◽  
Jaime L. Martinez ◽  
Anish Kapadia ◽  
David G. Munoz ◽  
Aditya Bharatha ◽  
...  
Keyword(s):  
Vision Loss ◽  
Obstructive Hydrocephalus ◽  
Memory Loss ◽  
Final Diagnosis ◽  
Colloid Cyst ◽  
Ct Scans ◽  
Mr Images ◽  
Diagnostic Dilemma ◽  
Foramen Of Monro ◽  
Histopathological Investigation

The finding of a colloid cyst on neuroimaging is often incidental. These lesions are usually located at the foramen of Monro, are hyperdense on CT scans, and generally demonstrate signal intensity of water on MR images, although this depends on their content. When symptomatic, they frequently present with headaches and nausea due to an obstructive hydrocephalus. The authors describe a case of a giant colloid cyst in a patient presenting with complete left-sided vision loss and progressive memory loss, two very atypical findings in colloid cyst presentation. Imaging findings were also atypical, and this case proved to be a diagnostic dilemma because of its clinical and radiological presentation. Histopathological investigation was of utmost importance in the final diagnosis of a colloid cyst. To the authors' knowledge this colloid cyst is larger than any other described in the literature.

scholarly journals Acute Onset Peripartum Cardiomyopathy in a Woman with Severe Pre-eclamptia: A Diagnostic Dilemma

2013 ◽  
Vol 6 (1) ◽  
pp. 33-34 ◽  
Author(s):  
Sonela Basak ◽  
Pallab Rudra
Keyword(s):  
Late Pregnancy ◽  
Acute Onset ◽  
Peripartum Cardiomyopathy ◽  
Lifestyle Modifications ◽  
Diagnostic Dilemma ◽  
Life Threatening ◽  
Physiological Reserve ◽  
Proper Diagnosis ◽  
Future Pregnancy ◽  
Lateral Thinking

Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that can present as acute life-threatening pulmonary oedema in late pregnancy or early puerperium, its diagnosis is mainly by exclusion of other causes. Morbidity is high due to the reduced physiological reserve in pregnancy. PPCM and severe pre-eclampsia can co-exist and their clinical presentation may overlap, making the diagnosis more difficult and often delayed, with potentially devastating consequences. Here, we would like to share our experience of such a case and present to the readers how we dealt with the challenge. As obstetricians we often do not resort to transthoracic echocardiography, which in our case prompted the diagnosis timely. Lateral thinking and a heightened suspicion does help. Proper diagnosis is extremely important not only for the immediate appropriate management but also for advising long-term lifestyle modifications to minimize risk and counselling for future pregnancy.

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