Acute-onset isolated bilateral palatal palsy in an adolescent

2021 ◽  
Vol 14 (9) ◽  
pp. e243467
Author(s):  
Avinash Shekhar Jaiswal ◽  
Rajeev Kumar ◽  
Prem Sagar ◽  
Rakesh Kumar
Keyword(s):  
Sudden Onset ◽  
Acute Onset ◽  
Age Group ◽  
Rare Presentation ◽  
Limb Weakness ◽  
Aggressive Management ◽  
History Of ◽  
Gag Reflex ◽  
Nasal Regurgitation ◽  
Rule Out

A 16-year-old patient presented with sudden-onset difficulty in swallowing food especially for liquids with nasal regurgitation and rhinolalia with no history of fever and limb weakness. Examination revealed bilateral palatal palsy with absence of gag reflex. Other neurological examinations were normal. Investigations were done to rule out any known pathology leading to such a presentation. The symptoms were attributed to an idiopathic acute-onset-acquired bilateral palatal palsy, in the absence of any identifiable cause. This is a rare presentation in adolescent age with no case reported in the literature so far in this age group. Medical management was started and patient showed complete improvement within 2 weeks of his symptoms. Early diagnosis and aggressive management of this condition lead to a favourable prognosis.

scholarly journals Lower limb weakness: an unusual cause

2018 ◽  
Vol 5 (5) ◽  
pp. 2011
Author(s):  
Antony Leo Jerry ◽  
Sundari S. ◽  
Krithika A. P.
Keyword(s):  
Lower Limb ◽  
Cord Compression ◽  
Acute Onset ◽  
Long Bones ◽  
Age Group ◽  
Rare Presentation ◽  
Limb Weakness ◽  
Solitary Lesion ◽  
Pediatric Age Group ◽  
Lower Limb Weakness

Osteochondromas are usually tumours of the long bones and occurs rarely in other bones. Osteochondroma of rib causing spinal cord compression is a rare presentation with only 8 cases reported in literature involving similar presentation in pediatric age group. Our case is a boy who presented with paraparesis of acute onset. All the usual suspects were ruled out. The cause was found to be a solitary lesion arising from the head of the 3rd rib causing cord compression. Laminectomy and decompression with excision of the lesion was done. On HPE it showed features of osteochondroma. Post operatively the child recovered well, the weakness and sensations improved.

scholarly journals Bullosis Diabeticorum: Rare Presentation in a Common Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Vineet Gupta ◽  
Neha Gulati ◽  
Jaya Bahl ◽  
Jaswinder Bajwa ◽  
Naveen Dhawan
Keyword(s):  
Sudden Onset ◽  
Common Disease ◽  
Type I ◽  
Rare Presentation ◽  
Diabetic Vasculopathy ◽  
Diabetes Mellitus Type I ◽  
Uncontrolled Diabetes ◽  
History Of ◽  
Skin Biopsies ◽  
Bullosis Diabeticorum

A 27-year-old African American male presented with a sudden onset of blisters. He had a past medical history of uncontrolled diabetes mellitus type I, diabetic vasculopathy, and neuropathy. The physical examination revealed nonerythematous skin denudations on both elbows and lateral aspect of arm bilaterally. Investigations which included skin biopsies confirmed the diagnosis of bullosis diabeticorum. The bullae were treated with hydrotherapy and healed with no complications in 4 weeks. We present this case to illustrate the rare occurrence of diabetic bulla in a diabetic patient especially with poor glycemic control. The case is also a reminder of the importance of diabetes screening in nondiabetic patients who are diagnosed with diabetic bulla.

scholarly journals Coexistence of myasthenia gravis with hypokalemic periodic paralysis: a rare presentation

2019 ◽  
Vol 12 (10) ◽  
pp. e231241 ◽  
Author(s):  
Farah Gul Khan ◽  
Sidra Namran
Keyword(s):  
Myasthenia Gravis ◽  
Young Female ◽  
Periodic Paralysis ◽  
Acute Onset ◽  
Hypokalemic Periodic Paralysis ◽  
Rare Presentation ◽  
Limb Weakness ◽  
Oral Steroids ◽  
Life Threatening ◽  
Neurological Illnesses

Bilateral symmetrical weakness of acute onset is not very uncommon and the differential varies widely from life-threatening neurological illnesses to metabolic and electrolyte derangements. We report the case of a young female with severe muscle weakness, respiratory distress and hypokalemia who required immediate intubation on arrival to emergency department. During hospital course, even after normalisation of serum potassium and some improvement in limb weakness, patient failed multiple attempts of extubation because of type II respiratory failure. Subsequently, acetyl cholinesterase antibodies were checked which came out positive, and diagnosis of myasthenia gravis and hypokalemic periodic paralysis was made. She was successfully extubated after intravenous pulse steroids, pyridostigmine and plasmapheresis. Patient was finally discharged home on oral steroids, pyridostigmine and azathioprine. In a patient presenting with hypokalemic weakness, the suspicion of a second disorder should be very high if weakness fails to resolve following correction of hypokalemia.

scholarly journals A rare case of fatal cerebral phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompetent individual in India

2020 ◽  
Author(s):  
Ranjana Rohilla ◽  
Suneeta Meena ◽  
Nishant Goyal ◽  
Neelam Kaistha
Keyword(s):  
Rare Case ◽  
Parietal Lobe ◽  
Mass Effect ◽  
Radical Resection ◽  
Sudden Onset ◽  
Magnetic Resonance Imaging Scan ◽  
Limb Weakness ◽  
Immunocompetent Individual ◽  
Post Operation ◽  
History Of

Background and Purpose: Herein, we describe a rare case of fatal cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent individual without any underlying risk factors.Case report: A 55-year-old female presented with a short history of fever for 1 month, as well as headache, sudden onset of right-sided upper and lower limb weakness, and loss of speech for 10 days. Contrast-enhanced magnetic resonance imaging scan revealed large, peripherally enhancing, well-defined, cystic, space-occupying, axial lesion in the left parietal lobe with a mass effect. The patient was subjected to craniotomy, and the drained pus revealed pigmented septate hyphae in potassium hydroxide mount examination, which was identified as Cladophialophora bantiana. The patient was started on amphotericin B and voriconazole. However, she developed acute respiratory infection leading to multi-organ failure and death on day 27 post-operation. Conclusion: In the absence of comparative trials owing to the rarity of the disease, the radical resection of lesion, drainage of pus, and prolonged targeted antifungal therapy with close postoperative radiological surveillance are the therapeutic measures of choice for patients with brain abscess caused by phaeoid fungi.

Submucosal Lipoma at the lead point of Small bowel Intussusception in an Adult

2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S59-S59
Author(s):  
F Kiran ◽  
I M Asuzu ◽  
S Noreen
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Acute Mesenteric Ischemia ◽  
Distal Segment ◽  
Postoperative Recovery ◽  
Sudden Onset ◽  
Lead Point ◽  
Small Bowel Intussusception ◽  
History Of ◽  
Rule Out

Abstract Introduction/Objective Morbidity and mortality among adult patients presenting with acute abdominal pain are high, and these patients often require hospitalization with prompt surgical consultation Important differentials include small bowel obstruction from previous surgeries and hernias, acute mesenteric ischemia, and ruptured abdominal aortic aneurysm. Intussusception in adults is rare accounting for about 1% - 5% of small bowel obstructions and thus requiring a high index of suspicion for early detection. In most cases, the lead point is a benign mass, commonly a lipoma, but histopathologic examination of the resected segment is required to rule out malignancy. Methods/Case Report We present a case of a 50-year old male with a medical history of psoriasis and hypertension who was admitted on account of a 1-day history of sudden onset persistent abdominal pain with associated nausea non-bilious emesis. Physical examination reveals no fever and soft non-distended abdomen with diffuse tenderness. CT scan demonstrated long segment small bowel-small bowel intussusception with markedly edematous and dilated bowel, compatible with obstruction. The lead-point was suspected to be a 3.9cm lipoma. Segmental resection and primary re-anastomosis were performed. Gross examination revealed a 13cm segment of bowel telescoping into a distal segment with a lead-point demonstrating mucosal congestion and submucosal thickening corresponding to a well-circumscribed 3.5cm tan yellow soft lobulated mass with yellow cut surface. Histopathology was consistent with lipoma. The patient made an uneventful postoperative recovery. Results (if a Case Study enter NA) N/A Conclusion Intussusception should be kept in the differential diagnosis of adults presenting with sudden onset abdominal pain and pathologic examination of the resected segment is necessary to rule out malignancy.

scholarly journals Pseudo-Meigs syndrome: a rare presentation of pedunculated fibroid

2020 ◽  
Vol 9 (7) ◽  
pp. 3052
Author(s):  
Sunita Dubey ◽  
Poonam Goel ◽  
Nidhi Pandey ◽  
Pavithra H. N.
Keyword(s):  
Pleural Effusion ◽  
Abdominal Distension ◽  
Uterine Sarcoma ◽  
Ca 125 ◽  
Rare Presentation ◽  
Atypical Symptoms ◽  
Extensive Evaluation ◽  
History Of ◽  
Intramural Fibroids ◽  
Rule Out

Serosal fibroid of uterus are usually asymptomatic but rarely; it may present with atypical symptoms to simulate malignancy and needs extensive evaluation. Authors are reporting a case of 26 years old P1L1 female with history of asymptomatic multiple intramural fibroids since 6 years came with complained of progressively increasing abdominal distension and mild pain abdomen from 2-3 months. On evaluation, she had ascites, pleural effusion and raised Ca-125. MR imaging of pelvis revealed moderate ascites and pedunculated serosal fibroid in addition to intramural fibroids with normal bilateral ovaries. She was evaluated to rule out uterine sarcoma and tuberculosis but diagnosis of them could not be established. Finally, conclusion of Pseudo-Meigs syndrome was made. Myomectomy of single pedunculated fibroid relieved her symptoms. Though, subserosal fibroids are benign in pathology, timely surgery is must to avoid morbidity and mortality owing to massive ascites and pleural effusion.

scholarly journals An Unusual case of flaccid Quadriplegia

2018 ◽  
pp. 8-10
Author(s):  
Sajith Sebastian ◽  
Jenny Susan Roy
Keyword(s):  
Sudden Onset ◽  
Acute Onset ◽  
Posterior Column ◽  
Systemic Hypertension ◽  
Cervical Cord ◽  
Prior History ◽  
Acute Setting ◽  
Upper Cervical ◽  
History Of ◽  
Post Menopausal

This case describes a 47 years old Obese post menopausal lady with sudden onset flaccid quadriparesis with sparing of posterior column sensation .She has a prior history of Diabetes mellitus ,systemic hypertension ,Dyslipidemia , and hypothyroidism on regular .She was admitted for 1 day history of fever and malaise, laboratory parameters suggestive of a Possible a viral ethnology .She developed sudden onset of weakness, initially started on her Lower limb and progressing to her upper limb within few hours along with bladder involvement which appeared on the next day of hospitalisation prompt thinking of a demyelination like pattern after ruling out mechanical causes with a radiograph .In the background of a fever prompted thinking of a fast progressing demyelination like a GBS/ADEM and even started IVIG as there is always some time delay for MRI to arrive. The MRI report suggested of Thrombosis of ASA territory involving the anterior paramedian aspect of Medulla extending up to the upper cervical cord. She remained quadriplegic thereafter and 6 months later despite receiving antiplatelets, Physiotherapy and other supportive treatments. The case described here elaborates the clinical presentation and outcome of ASA thrombosis. ASA thrombosis though rare is be thought as a differential of acute onset flaccid quadriparesis in an acute setting .The clinical course and devastating nature of illness should be aware off. Its necessary to diagnose this syndrome in the earliest when patient presents with acute onset of motor weakness sparing the posterior column sensation

scholarly journals A rare acute presentation of intestinal malrotation in the elderly

2020 ◽  
Vol 7 (10) ◽  
pp. 3432
Author(s):  
Abidemi A. Adesuyi ◽  
Oladele O. Situ ◽  
Cephas S. Batta
Keyword(s):  
The Elderly ◽  
Intestinal Malrotation ◽  
Age Group ◽  
Midgut Volvulus ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Acute Presentation ◽  
History Of ◽  
High Index Of Suspicion

Intestinal malrotation, a congenital anomaly of the midgut, typically presents in pediatrics age group with the most feared complication of midgut volvulus and its catastrophic sequelae. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist. We report a 65-year-old man admitted following a referral with a 12-hour history of acute abdomen with an initial diagnosis of acute pancreatitis but later had laparotomy with intraoperative findings of a midgut volvulus and gangrenous ileal segment secondary to intestinal malrotation. This case emphasizes the importance of early diagnosis to prevent the disastrous complication of this disease. The rarity of this condition portends a formidable diagnostic challenge in adults hence the awareness of its possibility and a high index of suspicion is crucial in diagnosis.

scholarly journals Clinical profile of pityriasis rosea: a descriptive study from urban Karnataka

2019 ◽  
Vol 5 (3) ◽  
pp. 637
Author(s):  
Dayanand Raikar ◽  
Mohammed Waseem Javed ◽  
Anant A. Takalkar
Keyword(s):  
Acne Vulgaris ◽  
Unknown Origin ◽  
Sudden Onset ◽  
Clinical Profile ◽  
Prodromal Symptom ◽  
Age Group ◽  
Pityriasis Rosea ◽  
Male Predominance ◽  
Medical College ◽  
History Of

<p class="abstract"><strong>Background:</strong> Pityriasis rosea (PR) is common, self-limited papulo-squamous dermatosis of unknown origin, which mainly appears in adolescents and young adults (10-35 years). It has a sudden onset, and in its typical presentation, the eruption is proceeded by a solitary patch termed “herald patch”, mainly located on the trunk. The objective of the study was to assess the clinical profile of pityriasis rosea.</p><p class="abstract"><strong>Methods:</strong> The data was collected from patients attending the Department of Dermatology, Basaveshwar Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Gulbarga. It is a descriptive observational study. A total 79 patients suffering from pityriasis rosea who attended the outpatient department were included in the present study during the period from 2006 to 2007.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 79 patients studied, majority were from 11-20 years age group 33 (41.8%) followed by 27.8% from 21-30 years age group. The mean age of study population was found to be 21.3±6.4 years. 11% gave history of acne vulgaris, 8% each had history of atopy and drugs. Commonly observed prodromal symptoms were URTI (25.3%) and fever (17.7%). Herald patch was seen on trunk in majority of patients i.e. 36 (61%) followed by 18.6% cases on upper extremity and on neck (8.5%).</p><p class="abstract"><strong>Conclusions:</strong> Our study concludes that pityriasis is common in 11-20 years age group with male predominance having URTI as common prodromal symptom and typical rash.</p>

scholarly journals P039 Muscle wasting & weakness: a rare presentation of sarcoidosis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Clare Tomlinson ◽  
Asim Khan ◽  
Debashish Mukerjee ◽  
Naveen Bhadauria
Keyword(s):  
Lower Limb ◽  
Muscle Wasting ◽  
Correct Diagnosis ◽  
Lower Limbs ◽  
High Dose ◽  
Rare Presentation ◽  
Multisystem Disease ◽  
Limb Weakness ◽  
History Of ◽  
Noncaseating Granulomas

Abstract Background/Aims  Sarcoidosis is a rare multisystem disease characterised by the presence of noncaseating granulomas. It most commonly affects the lungs though can affect any other organ system. Rarely, it can manifest as an acute myopathy. We describe a case of a patient presenting with muscle weakness and constitutional symptoms who was eventually diagnosed with sarcoidosis. Methods  A 48-year-old male with a background of lumbar spondylosis and BPH, presented with a 6-week history of progressive upper and lower limb weakness, myalgia and reduced mobility. He also described an 18-month history of progressive fatigue, drenching night sweats and 10-kilogram weight loss. His symptoms meant he was unable to work as a firefighter. Examination demonstrated profound muscle wasting and reduced power in the proximal muscles of his upper and lower limbs. There was no evidence of rash, synovitis or lymphadenopathy. Blood tests showed a normocytic anaemia (Hb 100 g/L) and raised C-reactive peptide (180 mg/L) and erythrocyte sedimentation rate (100 mm/hour). The creatine kinase ranged between 20-42 units/litre. He had a weakly positive anti-nuclear antibody (1:80). The remaining autoantibody screen was negative including ENA, DSDNA, ANCA, rheumatoid factor and anti-CCP. Complement proteins were unremarkable. Furthermore, an extended myositis panel revealed no myositis-specific or myositis-associated antibodies. Serum calcium and angiotensin-converting enzyme (ACE) levels were normal. Blood cultures and virology screen including for HIV, hepatitis B, hepatitis C, CMV, EBV, COVID-19 and respiratory viruses were all negative. A chest radiograph was also unremarkable. Results  He subsequently underwent electromyography which revealed generalised myopathy. An MRI of the lower limb proximal musculature showed evidence of muscle oedema worse on the right-side but no definitive evidence of myositis. A PET-CT followed revealing FDG-avid generalised lymphadenopathy and polyarticular uptake, but little uptake in the skeletal muscles. He underwent an external iliac lymph node core biopsy which demonstrated multiple noncaseating granulomas and lymphadenitis. Cultures for Tuberculosis were negative and there was no evidence of a lymphoproliferative disorder. A muscle biopsy was desired but not possible due to lack of availability because of the COVID-19 pandemic. The patient was diagnosed with sarcoidosis and commenced on three pulses of intravenous methylprednisolone followed by a weaning regimen of high-dose oral prednisolone and subcutaneous methotrexate. This resulted in a sustained improvement in his symptoms and normalisation of inflammatory markers. Conclusion  Symptomatic myopathy is present in only 0.5-2.5% of sarcoidosis patients. This unique case highlights the heterogeneity of this disease and the vital role different diagnostic modalities play in achieving the correct diagnosis. It is also pertinent that the lymphadenopathy, found incidentally via imaging, led to the diagnosis. Although notoriously a diagnosis of exclusion, this case emphasises the importance of considering sarcoidosis even in the absence of respiratory symptoms, a raised ACE or hypercalcaemia. Disclosure  C. Tomlinson: None. A. Khan: None. D. Mukerjee: None. N. Bhadauria: None.

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