Peduncular hallucinosis after a thalamic stroke

2021 ◽  
Vol 14 (5) ◽  
pp. e241652
Author(s):  
Mohammad Shahab ◽  
Rashid Ahmed ◽  
Navreet Kaur ◽  
Hesham Masoud
Keyword(s):  
Filling Defect ◽  
Pharmacological Intervention ◽  
Lower Extremity Weakness ◽  
Thalamic Infarction ◽  
Peduncular Hallucinosis ◽  
History Of ◽  
Thalamic Infarct ◽  
Tv Show ◽  
Previous Medical History ◽  
New Onset

Peduncular hallucinosis is a rare form of hallucinations consisting of vivid and nonthreatening colourful visual hallucinations. It was first described by French neurologist Jean Lhermitte in 1922. It sometimes includes distorted images of animals and people. Peduncular hallucinosis has been described after vascular and infective lesions of the mesencephalon and thalamus.We present a case of peduncular hallucinosis after a right thalamic infarction. This is a case of a 75-year-old Caucasian man with a previous medical history of hypertension and hyperlipidaemia who presented as a transfer from an outside hospital with transient left facial palsy, upper and lower extremity weakness. His symptoms resolved on arrival. CTA head and neck revealed focal filling defect in the basilar artery and a right posterior cerebral artery (PCA) occlusion at its origin. MRI brain without contrast revealed a right thalamic infarct. The patient had vivid hallucinations including his wife sleeping on his hospital bed, seeing his favourite book on the table while he had left it at home, seeing his dogs and a TV show on his room television while it was off. He was easily redirectable, and the hallucinations resolved over 2 days without pharmacological intervention. In cases of thalamic, midbrain or peduncular infarctions, physicians should be cognizant of the possibility of peduncular hallucinosis and inquire about hallucinations. New onset hallucinations in a patient with no prior psychiatric history presenting with concerns for stroke should prompt physicians to strongly consider peduncular hallucinosis.

scholarly journals Acute Demyelinating Encephalomyelitis Following Measles Infection Due to Vaccine Failure: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 171-173
Author(s):  
Robert McMickle ◽  
Lauren Fryling ◽  
Ross Fleischman
Keyword(s):  
Case Report ◽  
Altered Mental Status ◽  
Acute Disseminated Encephalomyelitis ◽  
International Travel ◽  
Vaccine Failure ◽  
Lower Extremity Weakness ◽  
Vaccination Rates ◽  
Acute Encephalitis ◽  
History Of ◽  
New Onset

Introduction: Local outbreaks of measles infection are primarily mediated by international travel of persons from endemic areas, with subsequent spread of the virus via undervaccinated populations. Recent resurgences of measles in communities where vaccination rates are non-ideal secondary to philosophical objections require the emergency physician to more routinely consider the diagnosis. In cases of measles complicated by acute encephalitis or encephalopathy, the diagnosis can be especially difficult to make due to lack of a reliable primary historian. Case report: Here we present a case of altered mental status and new-onset bilateral lower extremity weakness in a fully vaccinated young woman diagnosed with measles infection caused by acute disseminated encephalomyelitis in the setting of vaccine failure. Conclusion: Despite a documented history of immunization, acute measles infection and its uncommon sequelae are possible. Recognizing vaccine failure and appropriately isolating patients are of paramount importance.

Primary acquired melanosis (PAM) without atypia/WHO low-grade conjunctival melanocytic intraepithelial lesion over areas of oculodermal melanocytosis

2020 ◽  
Vol 13 (10) ◽  
pp. e236741
Author(s):  
Bashar M Bata ◽  
Sachin M Salvi ◽  
Hardeep Singh Mudhar
Keyword(s):  
Bulbar Conjunctiva ◽  
Low Grade ◽  
Primary Acquired Melanosis ◽  
Conjunctival Biopsy ◽  
History Of ◽  
Intraepithelial Lesion ◽  
The Relationship ◽  
Oculodermal Melanocytosis ◽  
Substantia Propria ◽  
New Onset

An elderly white man with a history of left oculodermal melanocytosis presented with new onset brown pigmentation of the left bulbar and inferior tarsal conjunctiva. The bulbar conjunctival pigmentation was at the level of the conjunctival epithelium and was overlying areas of typical slate-grey scleral pigmentation characteristic of oculodermal melanocytosis. Both areas of new pigmentation were biopsied. The bulbar conjunctiva revealed primary acquired melanosis (PAM) without atypia with increased melanin production and the tarsal conjunctival biopsy showed PAM without atypia sine pigmentio overlying areas of substantia propria spindle-shaped heavily pigmented melanocytes of oculodermal melanocytosis. The case report examines the relationship between the epithelial and substantia propria melanocytes and correlates the findings with what is known about this association from the dermatopathology literature.

scholarly journals High level of fatty liver index predicts new onset of diabetes mellitus during a 10-year period in healthy subjects

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yukimura Higashiura ◽  
Masato Furuhashi ◽  
Marenao Tanaka ◽  
Satoko Takahashi ◽  
Masayuki Koyama ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Fatty Liver ◽  
Male And Female ◽  
Nonalcoholic Fatty Liver ◽  
Liver Index ◽  
Fatty Liver Index ◽  
History Of ◽  
Onset Of Diabetes ◽  
High Level ◽  
New Onset

AbstractFatty liver index (FLI), a predictor of nonalcoholic fatty liver disease, has been reported to be associated with several metabolic disorders. This study aimed to evaluate the relationship between FLI and new onset of diabetes mellitus (DM). We investigated the association of FLI with new onset of DM during a 10-year period in subjects who received annual health examinations (n = 28,990). After exclusion of subjects with DM at baseline and those with missing data, a total of 12,290 subjects (male/female: 7925/4365) who received health examinations were recruited. FLI was significantly higher in males than in females. During the 10-year period, DM was developed in 533 males (6.7%) and 128 females (2.9%). Multivariable Cox proportional hazard models with a restricted cubic spline showed that the risk of new onset of DM increased with a higher FLI at baseline in both sexes after adjustment of age, fasting plasma glucose, habits of alcohol drinking and current smoking, family history of DM and diagnosis of hypertension and dyslipidemia at baseline. When the subjects were divided into subgroups according to tertiles of FLI level at baseline (T1–T3) in the absence and presence of impaired fasting glucose (IFG), hazard ratios after adjustment of the confounders gradually increased from T1 to T3 and from the absence to presence of IFG in both male and female subjects. In conclusion, a high level of FLI predicts new onset of DM in a general population of both male and female individuals.

scholarly journals A Case of Priapism with Risperidone

2014 ◽  
Vol 2014 ◽  
pp. 1-2 ◽  
Author(s):  
Almari Ginory ◽  
Mathew Nguyen
Keyword(s):  
Side Effect ◽  
Penile Erection ◽  
Corpus Cavernosum ◽  
Psychotropic Medications ◽  
History Of ◽  
Future Risk ◽  
New Onset

Priapism is a urologic emergency defined as a prolonged, possibly painful, penile erection. There are several known causes of priapism including psychotropic medications. One of the mechanisms by which antipsychotics are believed to induce priapism is through alpha-1 antagonism. This is case of a 50-year-old male with a history of schizophrenia with previous priapism related to trazodone, who presents with new onset priapism associated with risperidone. In this case, the treatment of priapism includes discontinuation of the offending agent and drainage of the corpus cavernosum twice along with intracavernosal phenylephrine injections. It is important to educate patients on priapism as a possible side effect of medications. It is also important to consider previous episodes of medication-induced priapism when prescribing psychotropic medications as this may increase the patient’s future risk of priapism.

New-onset Oscillopsia in a Patient With a History of Pontine Stroke

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anna Kabanovski ◽  
Laura Donaldson ◽  
Edward Margolin
Keyword(s):  
History Of ◽  
New Onset

Case series: COVID-19 infection causing new-onset diabetes mellitus?

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Rujuta Katkar ◽  
Narasa Raju Madam
Keyword(s):  
Diabetes Mellitus ◽  
Severe Acute Respiratory Syndrome ◽  
Cell Damage ◽  
Small Sample Size ◽  
Case Series ◽  
Small Sample ◽  
Onset Diabetes ◽  
History Of ◽  
New Onset Diabetes Mellitus ◽  
New Onset

Objectives: This paper seeks to explore the hypothesis of the potential diabetogenic effect of SARS-COV-2 (Severe Acute respiratory syndrome coronavirus). Case series presentation: We present a case series of observation among 8 patients of age group ranging from 34 to 74 years with a BMI range of 26.61 to 53.21 Kilogram/square meters that developed new-onset diabetes after COVID-19 infection. Severe Acute Respiratory Syndrome Coronavirus (SARS-COV-2), commonly known as Coronavirus or COVID-19(Coronavirus infectious disease), gains entry into the cells by binding to the Angiotensin-converting enzyme-2(ACE-2) receptors located in essential metabolic tissues including the pancreas, adipose tissue, small intestine, and kidneys. The evidence reviewed from the scientific literature describes how ACE 2 receptors play a role in the pathogenesis of diabetes and the plausible interaction of SARS-COV-2 with ACE 2 receptors in metabolic organs and tissues. Conclusion: The 8 patients without a past medical history of diabetes admitted with COVID-19 infection developed new-onset diabetes mellitus due to plausible interaction of SARS-COV-2 with ACE 2 receptors. The resulting downregulation of ACE-2 and ACE-2 receptors expression caused islet-cell damage resulting into diabetes. The resulting observation has the potential to adversely impact significant number of the globally affected population. Screening patients with COVID-19 for diabetes routinely can help in early detection, significantly reducing morbidity and mortality associated with diabetes. Due to limitations of observational study with a small sample size will require further investigation in the form of Clinical trial.

Extradural Thoracic Arteriovenous Malformation in a Patient with Klippel-Trenaunay-Weber Syndrome: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1275-1279 ◽  
Author(s):  
Michael J. Alexander ◽  
Peter M. Grossi ◽  
Robert F. Spetzler ◽  
Cameron G. McDougall
Keyword(s):  
Spinal Cord ◽  
Cord Compression ◽  
Magnetic Resonance Imaging Scan ◽  
Lower Extremity Weakness ◽  
Thyrocervical Trunk ◽  
Weber Syndrome ◽  
History Of ◽  
Cutaneous Hemangioma ◽  
The Right ◽  
Upper Thoracic

Abstract OBJECTIVE AND IMPORTANCE Spinal cord involvement in Klippel-Trenaunay-Weber (KTW) syndrome is rare. Cases of intradural spinal cord arteriovenous malformations (AVMs) have been associated with this syndrome. Likewise, cases of epidural hemangioma and angiomyolipoma have been reported to occur at the same segmental level as cutaneous hemangioma in KTW syndrome. This report details a rare case of an extradural thoracic AVM in a patient with KTW syndrome. CLINICAL PRESENTATION A 30-year-old man presented with a 10-month history of progressive myelopathy, bilateral lower-extremity weakness, and numbness, with the right side affected more than the left. His symptoms had progressed to the point that he was unable to walk. The patient had the characteristic manifestations of KTW syndrome, including numerous cutaneous angiomas and cavernomas, limb hypertrophy and syndactyly, and limb venous malformations. A magnetic resonance imaging scan and subsequent angiogram demonstrated a large extradural AVM causing cord compression at the T3–T4 levels. INTERVENTION The patient underwent two separate endovascular procedures, including embolization of upper thoracic and thyrocervical trunk feeders. Subsequently, he underwent T1–T4 laminectomy and microsurgical excision of the AVM. Clinically, the patient improved such that he could walk without assistance. CONCLUSION KTW syndrome represents a spectrum of clinical presentations. Although involvement of the spinal cord is uncommon, the manifestations of this syndrome may include both intradural and extradural AVMs in addition to various tumors.

scholarly journals Susac's Syndrome

2011 ◽  
Vol 38 (2) ◽  
pp. 335-337 ◽  
Author(s):  
Kevin Lian ◽  
Rekha Siripurapu ◽  
Robert Yeung ◽  
Julia Hopyan ◽  
Kenneth T. Eng ◽  
...  
Keyword(s):  
Corpus Callosum ◽  
White Matter Hyperintensities ◽  
Brain Biopsy ◽  
High Dose ◽  
Normal Brain ◽  
Left Hand ◽  
Elevated Protein ◽  
Fluid Attenuated Inversion Recovery ◽  
History Of ◽  
Previous Medical History

A 40-year-old woman with no significant previous medical history presented with a three month history of ataxia, confusion, memory difficulties, and headaches. Physical examination revealed numbness in the left hand, but was otherwise unremarkable. Magnetic resonance imaging fluid-attenuated inversion recovery (MRI FLAIR) images demonstrated multiple small white matter hyperintensities, including lesions involving the corpus callosum. There were also deep gray nuclei lesions (Figure 1). The corpus callosum lesions involved the central fibers (Figure 2). Post gadolinium T1 images demonstrated enhancement of some of the lesions as well as extensive perivascular and leptomeningeal enhancement (Figure 3). Extensive infectious serology, autoimmune panel, and paraneoplastic antibodies were negative. Lumbar puncture revealed elevated protein (1116 mg/L), but was otherwise normal. Brain biopsy indicated no apparent pathology. The patient was tentatively diagnosed with acute encephalopathy and treated with high dose steroids seven days after presentation. She was subsequently discharged and was sent for rehabilitation.

Unusual Presentation of Childhood Reversible Angiopathy: Aphasia due to Acute Bilateral Paramedian Thalamic Infarct

2018 ◽  
Vol 16 (04) ◽  
pp. 248-252
Author(s):  
Makram Othman ◽  
Leila Massoud ◽  
Fatma Kamoun ◽  
Chahnez Triki ◽  
Khadija Moalla
Keyword(s):  
Spatial Neglect ◽  
Unusual Presentation ◽  
Thalamic Infarction ◽  
Thalamic Lesions ◽  
Thalamic Aphasia ◽  
Thalamic Infarct ◽  
Normal Speech ◽  
Thalamic Infarcts

AbstractAn 8-year-old right-handed girl manifested aphasia after bilateral thalamic infarcts. The features of thalamic aphasia are similar to that of previously reported patients with thalamic lesions. Paucity of speech, reduced voice volume, some paraphasia, and severe dysgraphia were present, but comprehension and repetition were preserved. Thalamic aphasia is usually associated with left thalamic lesions. Our patient also had spatial neglect and anosognosia probably due to right thalamic infarction. She had recovered near-normal speech after rehabilitation.

scholarly journals Accelerated Bilateral Cataract Formation as a First Manifestation of Diabetes Mellitus

2013 ◽  
Vol 114 (4) ◽  
pp. 258-262 ◽  
Author(s):  
M. R. Manaviat ◽  
Nasim Oveisi ◽  
A. Zare-Bidoki
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Emergency Room ◽  
Type 1 Diabetes Mellitus ◽  
Cataract Formation ◽  
Bilateral Cataract ◽  
Duration Of Diabetes ◽  
History Of ◽  
New Onset

There is a proved relationship between diabetes mellitus and the cataract formation. The incidence of this is usually related to the duration of diabetes. In this manuscript we report a 15 years old female presented to the emergency room with a 4 hour history of rapid bilateral diminished vision, initially diagnosed with idiopathic cataracts, but after more laboratory evaluations revealed new-onset type 1 diabetes mellitus without ketosis.

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