scholarly journals Cranial Nerve VI Palsy as Presenting Sign of Previously Undiagnosed Metastatic Prostate Adenocarcinoma to the Clivus

2020 ◽  
Vol 5 (3) ◽  
pp. 1-4
Author(s):  
Jennifer E. Douglas ◽  
John Y.K. Lee ◽  
Karthik Rajasekaran
Keyword(s):  
Differential Diagnosis ◽  
Systemic Chemotherapy ◽  
The United States ◽  
Prostate Adenocarcinoma ◽  
Sudden Onset ◽  
Cranial Neuropathy ◽  
Abducens Palsy ◽  
History Of ◽  
Skull Base Lesions ◽  
Common Malignancy

Prostate adenocarcinoma is the most common malignancy in males in the United States and is typically highly treatable. Herein we present a case report of a male with a history of prostate adenocarcinoma previously managed with definitive radiation therapy who presented with sudden onset diplopia and examination consistent with an abducens palsy. He was ultimately found to have prostate adenocarcinoma metastatic to the clivus causing cranial neuropathy, and was referred for systemic chemotherapy and palliative Cyberknife stereotactic radiosurgery. While relatively rare, metastatic disease should be included in the differential diagnosis of atypical skull base lesions.

Leiomyosarcoma of the Foot

2007 ◽  
Vol 97 (6) ◽  
pp. 475-479 ◽  
Author(s):  
Erin Engel ◽  
Michael Butler ◽  
Joseph Anain
Keyword(s):  
United States ◽  
Differential Diagnosis ◽  
Malignant Tumor ◽  
Clinical Presentation ◽  
Spindle Cell ◽  
Pyogenic Granuloma ◽  
The United States ◽  
Spindle Cell Sarcoma ◽  
Cell Sarcoma ◽  
History Of

Leiomyosarcoma is a very rare malignant tumor, with only 28 new cases diagnosed in the United States each year. The prognosis varies, with average 5-year survival of 65%. Although most leiomyosarcomas occur in the lower extremity, there is a paucity in the literature on these sarcomas in the foot. Only 15 cases of leiomyosarcoma in the foot have been reported in the literature since the mid-1930s. We describe a 31-year-old man with a history of an ingrown toenail and nonhealing pyogenic granuloma. His clinical presentation suggested atypical tissue. Biopsy findings confirmed the diagnosis of spindle cell sarcoma, specifically, leiomyosarcoma. The patient was treated with amputation of the affected hallux and adjuvant therapy. The similar presentations of a pyogenic granuloma and a malignant tumor necessitate a thorough differential diagnosis with even common foot ailments. (J Am Podiatr Med Assoc 97(6): 475–479, 2007)

scholarly journals Isolated Abducens Palsy as the First Presenting Sign of Multiple Sclerosis

2017 ◽  
Vol 8 (3) ◽  
pp. 272-275 ◽  
Author(s):  
Sargon Bet-Shlimon ◽  
Mill Etienne
Keyword(s):  
Multiple Sclerosis ◽  
Differential Diagnosis ◽  
Brain Stem ◽  
Cranial Nerve ◽  
Prior History ◽  
Abducens Palsy ◽  
Cranial Nerve Palsies ◽  
Pontine Lesion ◽  
History Of ◽  
New Diagnosis

While brain stem involvement in multiple sclerosis (MS) is relatively common, isolated cranial nerve palsies are rare, especially when they represent the initial presenting sign of a new diagnosis of MS. This report describes a patient with no prior history of MS whose sole presenting sign was an isolated abducens palsy. An enhancing pontine lesion was found on MRI which correlated with his abducens palsy, and additional nonactive lesions on MRI led to a diagnosis of MS. This case demonstrates the importance of considering MS as part of the differential diagnosis of patients with isolated cranial nerve palsies.

scholarly journals HIV Infection and Acute Stroke: A Case Report and a Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Hussein Assallum ◽  
Mohammad Alkayem ◽  
Nehad Shabarek
Keyword(s):  
Hiv Infection ◽  
Cardiovascular Events ◽  
Brain Mri ◽  
Young Patients ◽  
The United States ◽  
Sudden Onset ◽  
Endothelial Damage ◽  
Acute Infarction ◽  
History Of ◽  
The Relationship

Background. In the United States, ischemic stroke in HIV-infected patients has increased by 60%. However, unexpected cardiovascular events in relatively young patients have been observed.Clinical Vignette.A 31-year-old male who presented with a 5-hour history of sudden onset slurred speech and left hemiplegia. He has medical history of HIV infection for 2 years taking ARTs. On exam, a significant left hemiparesis was noticed. Brain MRI showed right anterior corona radiata and basal ganglia acute infarction.Discussion.Several mechanisms have been proposed for the relationship between HIV infection and cardiovascular risk. (i) HIV-associated dyslipidemia: HIV-infected patients tend to develop decrease in HDL-c and LDL-c levels. ART was associated with an increase in LDL-c but little change in HDL-c. (ii) Endothelial dysfunction: certain antiretroviral agents may independently contribute to endothelial damage. (iii) Hypertension: systolic blood pressure is higher in those using ART for greater than five years. (iv) Insulin resistance and diabetes have been noticed with ART. (v) Chronic inflammation. (vi) Hypercoagulability: decrease in proteins C and S was associated with HIV infection.Conclusion.Poorly controlled HIV infection and/or the introduction of ATR might be risk factors for cardiovascular events. More studies needed to address this medical dilemma.

scholarly journals Pediatric unilateral knee swelling: a case report of a complicated differential diagnosis and often overlooked cause

2022 ◽  
Vol 0 (0) ◽  
Author(s):  
Katherine E. Guardado ◽  
Shane Sergent
Keyword(s):  
Differential Diagnosis ◽  
Lyme Disease ◽  
The United States ◽  
Lyme Arthritis ◽  
Tick Bite ◽  
Joint Effusion ◽  
Test Results ◽  
History Of ◽  
Vector Borne

Abstract Lyme disease is the most common vector-borne illness in the United States. However, Lyme arthritis is a diagnosis that is often missed, even in children, who are the population with the highest incidence of Lyme disease. Lyme arthritis, which presents in the later stage of Borrelia burgdorferi infection, needs to be recognized and managed promptly, especially in endemic areas or when exposure to ticks is known. We present a case of a 3-year-old female presenting to the emergency department with a history of limping for 2 weeks. The mother of the child recognized a tick bite. However, the child was not taken to seek care expeditiously, because she had not developed any rashes. Test results demonstrated that the patient was IgG positive and IgM negative for Lyme disease, with Western blot confirming the diagnosis of Lyme arthritis. Most patients presenting with Lyme arthritis do not recall having a tick bite, making it difficult to differentiate it from other pediatric conditions. When this diagnosis is missed, it can result in long-term morbidity, which is generally refractory to intravenous antibiotic therapy, oftentimes requiring synovectomy. Hence, this underscores the importance of the consideration of Lyme arthritis as a differential diagnosis in patients presenting with joint effusion.

Afternoon Tea Hemichorea

2021 ◽  
pp. 10.1212/CPJ.0000000000001048
Author(s):  
Stefan Williams ◽  
Joshua Kirby ◽  
Ana Maria Garcia
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Blood Glucose ◽  
Reperfusion Therapy ◽  
Sudden Onset ◽  
Past Medical History ◽  
Drug Induced ◽  
History Of ◽  
The Right ◽  
Possible Cause

A 78 year old lady, with a past medical history of hypertension, presented to the Accident & Emergency department after a sudden onset of right sided involuntary movements while she was having afternoon tea with her friends. Examination showed isolated unilateral chorea, affecting the right arm and leg (video). Her blood glucose and sodium levels were normal. The MRI head scan showed a left globus pallidus infarct (figure 1). Tetrabenazine was prescribed with very good response, and weaned off after 4 weeks. Hyperkinetic movement disorders are uncommon in acute stroke (1%)1. Lesions in regions functionally connected to the posterolateral putamen are implicated in hyperkinetic movement disorders2. The differential diagnosis includes hyperglycaemia, hyponatraemia and drug-induced chorea. In cases of sudden onset, it is important to recognise stroke as a possible cause to avoid missing reperfusion therapy opportunities

Correlative microscopy in distrubuted (client/server) computing environments: tools for catalyzing the rapid dissemination of information about the cell biology of the human prostate

1995 ◽  
Vol 53 ◽  
pp. 682-683
Author(s):  
A. Hakam ◽  
J.T. Gau ◽  
M.L. Grove ◽  
B.A. Evans ◽  
M. Shuman ◽  
...  
Keyword(s):  
United States ◽  
Cell Biology ◽  
Tissue Bank ◽  
The United States ◽  
Prostate Adenocarcinoma ◽  
Correlative Microscopy ◽  
Client Server ◽  
Critical Elements ◽  
Transplant Organ

Prostate adenocarcinoma is the most common malignant tumor of men in the United States and is the third leading cause of death in men. Despite attempts at early detection, there will be 244,000 new cases and 44,000 deaths from the disease in the United States in 1995. Therapeutic progress against this disease is hindered by an incomplete understanding of prostate epithelial cell biology, the availability of human tissues for in vitro experimentation, slow dissemination of information between prostate cancer research teams and the increasing pressure to “ stretch” research dollars at the same time staff reductions are occurring.To meet these challenges, we have used the correlative microscopy (CM) and client/server (C/S) computing to increase productivity while decreasing costs. Critical elements of our program are as follows:1) Establishing the Western Pennsylvania Genitourinary (GU) Tissue Bank which includes >100 prostates from patients with prostate adenocarcinoma as well as >20 normal prostates from transplant organ donors.

Special Considerations for Evaluation and Treatment of Spanish-Speaking Patients with Cleft Palate

2016 ◽  
Vol 1 (5) ◽  
pp. 41-49
Author(s):  
Ellen Moore
Keyword(s):  
Cleft Palate ◽  
The United States ◽  
Culturally Competent ◽  
Speech Language Pathology ◽  
Spanish Speaking ◽  
Appropriate Treatment ◽  
Oral Pressure ◽  
Language Pathology ◽  
History Of ◽  
Spanish Speaking Population

As the Spanish-speaking population in the United States continues to grow, there is increasing need for culturally competent and linguistically appropriate treatment across the field of speech-language pathology. This paper reviews information relevant to the evaluation and treatment of Spanish-speaking and Spanish-English bilingual children with a history of cleft palate. The phonetics and phonology of Spanish are reviewed and contrasted with English, with a focus on oral pressure consonants. Cultural factors and bilingualism are discussed briefly. Finally, practical strategies for evaluation and treatment are presented. Information is presented for monolingual and bilingual speech-language pathologists, both in the community and on cleft palate teams.

State-by-State Use of AMA Guides

2019 ◽  
Vol 24 (5) ◽  
pp. 3-7, 16
Keyword(s):  
Expert Testimony ◽  
Narrow Range ◽  
The United States ◽  
Workers Compensation ◽  
Federal Employees ◽  
Permanent Disability ◽  
Sixth Edition ◽  
History Of ◽  
Canadian Provinces

Abstract This article presents a history of the origins and development of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), from the publication of an article titled “A Guide to the Evaluation of Permanent Impairment of the Extremities and Back” (1958) until a compendium of thirteen guides was published in book form in 1971. The most recent, sixth edition, appeared in 2008. Over time, the AMA Guides has been widely used by US states for workers’ compensation and also by the Federal Employees Compensation Act, the Longshore and Harbor Workers’ Compensation Act, as well as by Canadian provinces and other jurisdictions around the world. In the United States, almost twenty states have developed some form of their own impairment rating system, but some have a narrow range and scope and advise evaluators to consult the AMA Guides for a final determination of permanent disability. An evaluator's impairment evaluation report should clearly document the rater's review of prior medical and treatment records, clinical evaluation, analysis of the findings, and a discussion of how the final impairment rating was calculated. The resulting report is the rating physician's expert testimony to help adjudicate the claim. A table shows the edition of the AMA Guides used in each state and the enabling statute/code, with comments.

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