scholarly journals Cyclosporine-Associated Leukoencephalopathy in a Case of Sympathetic Ophthalmitis

2016 ◽  
Vol 7 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Mizuki Tagami ◽  
Atsushi Azumi
Keyword(s):  
Trough Level ◽  
Immunosuppressive Agent ◽  
Cortical Blindness ◽  
High Signal ◽  
Mri Findings ◽  
Case Presentation ◽  
Normal Limits ◽  
Normal Ranges ◽  
Sympathetic Ophthalmitis ◽  
Reversible Encephalopathy

Purpose: Cyclosporine (CsA) is currently widely used as a primary immunosuppressive agent in ocular disease, particularly in severe uveitis. Posterior reversible encephalopathy syndrome (PRES) is a significant complication of CsA therapy. However, there are no reports of the occurrence of PRES in response to the treatment of uveitis in the ophthalmological area. Case Presentation: We report a case with CsA-associated PRES. A 70-year-old woman with sympathetic ophthalmitis was treated with 50 mg/day of CsA for 1 week. However, the trough level in her blood was too low; thus, we increased the dose to 100 mg/day of CsA with prednisolone. She had headaches, hypertension (systolic blood pressure 180-200 mm Hg), loss of consciousness for several hours, and reduced limb movement, and her MRI showed a high signal intensity in both posterior lobes, consistent with PRES. Examination of the cerebrospinal fluid indicated that it was within normal limits. Her CsA trough level in the blood was within normal ranges on the day of the attack. Her symptoms gradually improved over the next several days; however, she presented with cortical blindness, which lasted for several weeks. Finally, she returned to her baseline values from before the attack. Her MRI findings showed that PRES had essentially disappeared. Conclusion: PRES is not directly associated with the dosage of CsA administered; however, in general, it is well known that PRES can affect strongly immunosuppressed cases undergoing organ and bone marrow transplantation. Nevertheless, our CsA dose was only 100 mg (1.8 mg/kg). In this study, we report on the occurrence of PRES after the administration of CsA to treat sympathetic ophthalmia. To our knowledge, PRES can also occur after the administration of a small dose of CsA; thus, ophthalmologists using CsA should carefully observe the systemic conditions of CsA-treated patients.

scholarly journals Preoperative Magnetic Resonance Cholangiopancreatography for Detecting Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 383
Author(s):  
Kojiro Omiya ◽  
Kazuhiro Hiramatsu ◽  
Yoshihisa Shibata ◽  
Masahide Fukaya ◽  
Masahiro Fujii ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Magnetic Resonance ◽  
Acute Cholecystitis ◽  
Signal Intensity ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Gallbladder Wall ◽  
High Signal ◽  
Mri Findings ◽  
Open Conversion ◽  
Preoperative Magnetic Resonance

Previous studies have shown that signal intensity variations in the gallbladder wall on magnetic resonance imaging (MRI) are associated with necrosis and fibrosis in the gallbladder of acute cholecystitis (AC). However, the association between MRI findings and operative outcomes remains unclear. We retrospectively identified 321 patients who underwent preoperative magnetic resonance cholangiopancreatography (MRCP) and early laparoscopic cholecystectomy (LC) for AC. Based on the gallbladder wall signal intensity on MRI, these patients were divided into high signal intensity (HSI), intermediate signal intensity (ISI), and low signal intensity (LSI) groups. Comparisons of bailout procedure rates (open conversion and laparoscopic subtotal cholecystectomy) and operating times were performed. The recorded bailout procedure rates were 6.8% (7/103 cases), 26.7% (31/116 cases), and 40.2% (41/102 cases), and the median operating times were 95, 110, and 138 minutes in the HSI, ISI, and LSI groups, respectively (both p < 0.001). During the multivariate analysis, the LSI of the gallbladder wall was an independent predictor of both the bailout procedure (odds ratio [OR] 5.30; 95% CI 2.11–13.30; p < 0.001) and prolonged surgery (≥144 min) (OR 6.10, 95% CI 2.74–13.60, p < 0.001). Preoperative MRCP/MRI assessment could be a novel method for predicting surgical difficulty during LC for AC.

scholarly journals Methomyl poisoning presenting with decorticate posture and cortical blindness

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Chih-Ming Lin
Keyword(s):  
Brain Mri ◽  
Vital Signs ◽  
Altered Mental Status ◽  
Cortical Blindness ◽  
High Signal ◽  
Blurred Vision ◽  
Cerebral Disease ◽  
Cerebral Magnetic Resonance Imaging ◽  
Neurological Effects ◽  
Magnetic Resonance Imaging Mri

Methomyl is a potent pesticide that is widely used in the field of agriculture. The systemic toxic effects of methomyl have been well described. However, the neurological effects of methomyl intoxication are not well understood. In this study, we report a 61-year-old Taiwanese man sent to our emergency department because of altered mental status. His family stated that he had consumed liquid methomyl in a suicide attempt. He was provided cardiopulmonary resuscitation because of unstable vital signs. He was then sent to an intensive care unit for close observation. On the second day of admission, he regained consciousness but exhibited irregular limb and torso posture. On the sixth day, he started to complain of blurred vision. An ophthalmologist was consulted but no obvious abnormalities could be identified. On suspicion of cerebral disease, a neurologist was consulted. Further examination revealed cortical blindness and decorticate posture. Cerebral magnetic resonance imaging (MRI) was arranged, which identified bilateral occipital regions lesions. The patient was administered normal saline and treated with aspirin and piracetam for 3 weeks in hospital. During the treatment period, his symptom of cortical blindness resolved, whereas his decorticate posture was refractory. Follow-up brain MRI results supported our clinical observations by indicating the disappearance of the bilateral occipital lesions and symmetrical putaminal high signal abnormalities. In this article, we briefly discuss the possible mechanisms underlying the cerebral effects of methomyl poisoning. Our study can provide clinicians with information on the manifestations of methomyl intoxication and an appropriate treatment direction.

scholarly journals Posterior reversible encephalopathy syndrome due to COVID-19

2021 ◽  
Vol 7 (2) ◽  
pp. 143-145
Author(s):  
Maythem Abdulhassan Al-Kaisy
Keyword(s):  
Blood Pressure ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Neurological Symptoms ◽  
Normal Blood Pressure ◽  
Blurred Vision ◽  
Case Presentation ◽  
Posterior Reversible Encephalopathy ◽  
Medical Background ◽  
Neurological Finding ◽  
Reversible Encephalopathy

Objective: During the late 2019, a group of patients had unexplained chest infections in Wuhan which turned out to be the new pandemic coronavirus disease 2019 (COVID-19). New neurological symptoms have been reported in COVID-19 patients. Posterior reversible encephalopathy syndrome (PRES) is a new neurological finding and is associated or caused by COVID-19. Case Presentation: A 32-year-old lady, with no medical background had COVID-19 infection and needed mechanical ventilation. After surviving the intensive care, she started to have multiple seizures that required general anesthesia to be aborted. The patient turned out to have PRES. Conclusion: PRES is a neurological syndrome causing seizures, headaches, and blurred vision. It is usually associated with high blood pressure, renal failure, and other risk factors. The patient in this case had nearly normal blood pressure, but still had a diagnosis of PRES. The new reported neurological symptoms associated with COVID-19 infection need further research and attention from the academic society to predict and prevent the morbidity and mortality of COVID-19 patients.

scholarly journals SAT-062 Twins with a Homozygous Variant of ARNT2, This Is a Known Saudi Mutation (KSM) of Webb- Dattani Syndrome

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Abdullah Abdulruhman Aljasser
Keyword(s):  
Genetic Testing ◽  
Autosomal Recessive ◽  
Brain Mri ◽  
Autosomal Recessive Disorder ◽  
Cortical Blindness ◽  
High Signal ◽  
Thin Corpus Callosum ◽  
Homozygous Variant ◽  
Saudi Family ◽  
Delayed Myelination

Abstract Webb-Dattani syndrome (WEDAS) is an autosomal recessive disorder caused by mutation in the ARNT2 gene characterized by frontotemporal hypoplasia, globally delayed development, and pituitary and hypothalamic insufficiency. The condition is reported to be associated with consanguinity and with Saudi Arabian ancestry. We presented twin baby girls with developmental delayment seizures, and microcephaly. They have also hypopituitarism in the form of diabetes insipidus and hypocortlisim. also they have cortical blindness. Their brain MRI shows brain atrophic changes and delayed myelination thin corpus callosum,and small pituitary gland ad absence posterior high signal spot and pituitary stalk. Genetic testing by Exome sequencing was done and it shows A homozygous variant of ARNT2 (ARNT2:NM_014862:exon3:c.147-1G&gt;A). One of this twin her condition deteriorated with uncontrolled seizures and spasticity and died at age 22 months. Conclusion: we report another cases of the ARNT2 mutation in a Saudi family illustrating the disease of webb-dattani Syndrome with seizures and hypopituitarism and severe visual impairment and global developmental delayment.

scholarly journals A vaginal fibroepithelial stromal polyp: a case report with magnetic resonance images

2022 ◽  
Author(s):  
Naoko Ogura ◽  
Mieko Inagaki ◽  
Ritsuko Yasuda ◽  
Shigeki Yoshida ◽  
Tetsuo Maeda
Keyword(s):  
Magnetic Resonance ◽  
Signal Intensity ◽  
Vaginal Wall ◽  
Magnetic Resonance Images ◽  
High Signal ◽  
Soft Tissue Tumour ◽  
Mri Findings ◽  
Vaginal Mass ◽  
Diffusion Weighted Images ◽  
Tissue Tumour

A fibroepithelial stromal polyp is a benign soft tissue tumour that can occur in the vagina, vulva and uterine cervix. Magnetic resonance imaging (MRI) findings have been reported in patients with vulvar fibroepithelial stromal polyps, not in those with vaginal polyps. We present MRI findings of vaginal fibroepithelial stromal polyp in a postmenopausal female. A 1 to 2 cm firm vaginal mass arising from the left side of the vaginal wall with hypointense signal changes on T1W MRI was identified. A well-defined vaginal mass (1 cm diameter) was detected with inhomogeneous signal intensity on T2W images. However, a major portion had high signal intensity on diffusion-weighted images. A benign vaginal lesion with oedematous changes or myxoid degeneration was suspected. Vaginal resection was performed, and fibroepithelial stromal polyp was pathologically diagnosed. MRI may be a useful non-invasive modality for preoperatively diagnosing vaginal fibroepithelial stromal polyps.

Posterior reversible encephalopathy syndrome in HIV-positive patients: a case report and literature review

2018 ◽  
Vol 29 (9) ◽  
pp. 937-941 ◽  
Author(s):  
Erica RM Pool ◽  
Michael Porte ◽  
Nigel Durham ◽  
Sue Urwin ◽  
Paul Laboi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Rare Condition ◽  
Rapid Diagnosis ◽  
Cortical Blindness ◽  
Hiv Positive ◽  
Posterior Reversible Encephalopathy ◽  
Aggressive Management ◽  
Underlying Causes ◽  
Reversible Encephalopathy

We are reporting the case of a woman who was admitted acutely to our intensive care unit without any collateral history. She was diagnosed with posterior reversible encephalopathy syndrome (PRES) as a consequence of poor adherence to anti-hypertensive, anti-diabetic and anti-retroviral medications. PRES is a rare condition, which may cause cortical blindness; contrary to its name it is not always reversible. Rapid diagnosis and aggressive management of underlying causes facilitate reversibility of PRES. We also summarise the literature on patients with HIV and PRES.

Posterior Reversible Encephalopathy (PRES) in a Child with Severe Dengue

2019 ◽  
Vol 66 (3) ◽  
pp. 322-326
Author(s):  
Yogini Sawant ◽  
Suresh Birajdar ◽  
Hiren Doshi ◽  
Pooja Soni ◽  
Deepak Patkar ◽  
...  
Keyword(s):  
Pediatric Population ◽  
White Blood Cells ◽  
Neurological Complications ◽  
Severe Dengue ◽  
Mri Findings ◽  
Posterior Reversible Encephalopathy ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes ◽  
Reversible Encephalopathy ◽  
Csf Examination

Abstract Among neurological complications associated with dengue, posterior reversible encephalopathy syndrome (PRES) has not been reported in pediatric population. We report a 10-year-old girl with severe dengue who developed PRES. The patient presented with hemorrhagic shock that required fluid resuscitation and inotropic support. She developed seizures with encephalopathy 2 days after recovering from the shock. Cerebrospinal fluid (CSF) examination was negative for dengue (no white blood cells in CSF with negative polymerase chain reaction for dengue). Her clinical features and magnetic resonance imaging (MRI) findings showed typical changes associated with posterior encephalopathy that reverted after resolution of hypertension. Repeat MRI after a month was normal. PRES should be considered as a possible differential diagnoses of dengue associated encephalopathy, especially in cases with normal CSF examination and characteristic MRI changes.

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