When real life conditions do not follow textbook diagnosis: A diagnostic challenge from a neuropsychiatric clinic

2020 ◽  
pp. 009121742097962
Author(s):  
Mahdi Razafsha ◽  
Karen Buch ◽  
Ottavio V Vitolo ◽  
Zeina Chemali
Keyword(s):  
Financial Management ◽  
Neurodevelopmental Disorder ◽  
Real Life ◽  
Memory Loss ◽  
Cognitive Disorders ◽  
Cognitive Disorder ◽  
Childhood Development ◽  
Diagnostic Challenge ◽  
Elderly Parents ◽  
History Of

We present the case of a 61-year-old retired catholic priest, who was adopted at a very young age, with psychiatric history of anxiety and depression presenting for evaluation of at least 4 year memory loss and word finding difficulties. Over the preceding couple of years his cognitive functions had rapidly declined. As a result, he became dependent on his elderly parents for most of his instrumental activities of daily living including administration of medication, financial management, and driving. He continues to be independent in his personal care. His presentation offered diagnostic challenges due to the interplay of anxiety and cognitive disorders involving both memory and language domains. In addition, he resisted to repeat formal neuropsychological evaluation. At the bedside, his poor effort on testing was often blamed on his severe anxiety confounding the clinical picture. Lack of knowledge of his family history and his childhood development, and unclear premorbid functioning complicated the diagnostic formulation. A differential diagnosis ranging from possible functional cognitive disorder to neurodevelopmental disorder and neurodegenerative disorders will be discussed.

Early and Progressive Cognitive Disorder Imposes CADASIL Syndrome in the Diagnostic Assumption

2021 ◽  
Author(s):  
Mircea-Catalin Fortofoiu
Keyword(s):  
Brain Mri ◽  
Cognitive Disorder ◽  
Personal History ◽  
Emotional Lability ◽  
State Of Health ◽  
Diagnostic Challenge ◽  
The Family ◽  
History Of ◽  
Skin Biopsies ◽  
Multiple Treatments

The case presented is a diagnostic challenge considering the family and medical history of the 65-year-old patient with a family history of migraine depression, emotional lability, and gait disorders manifested at his grandmother, his mother, and his sister. After multiple hospitalizations for the described symptoms and multiple treatments with questionable results, the diagnosis was imposed by the appearance described by brain MRI to which were added the data from the patient's family and personal history. Of course, a full confirmation of the diagnosis would have required skin biopsies and genetic testing that the patient refused to perform. However, due to its peculiarities, the presented case tries to offer a diagnostic orientation path for practitioners in situations where previous diagnoses and treatments are not sufficiently conclusive either due to the impossibility of performing specific tests at that time or either because of the patient's indifference to his state of health.

scholarly journals Studying Recent Memory in Patients Before and After Regional Anesthesia

2019 ◽  
Author(s):  
Sajedeh Alipour ◽  
Kasra Karvandian
Keyword(s):  
Regional Anesthesia ◽  
Social Life ◽  
Memory Function ◽  
Memory Loss ◽  
Cognitive Disorders ◽  
P Value ◽  
Wechsler Memory Scale ◽  
Recent Memory ◽  
Before And After ◽  
History Of

Background: Memory has an important role in our social life. General anesthesia has long been known to negatively affect the recent memory. It is also necessary to study the recent memory changes upon regional anesthesia. Methods: This study is cohort, before-after type, which was accomplished at Imam Khomeini hospital. The recent memory was evaluated before and after regional anesthesia using Wechsler memory scale-revised V. The obtained data were analyzed using SPSS 25 software to calculate median, mean, standard deviation and p-value. Results: 220 women and 180 men with an average age of 42.7 years old were interviewed, among which 248 patients had accompanied diseases and/or history of former surgeries. It was found that recent memory function reduces upon regional anesthesia. Moreover, different aspects of memory do not exhibit similar extent of sensitivity to anesthesia; logical memory and number repeat reduced pronouncedly. Conclusion: Regional Anesthesia causes recent memory loss and cognitive disorders.

Refractory Ascites as the Only Presenting Symptom of Chronic Calcified Constrictive Pericarditis: A Diagnostic Challenge

2014 ◽  
Vol 17 (1) ◽  
pp. 42
Author(s):  
Shi-Min Yuan
Keyword(s):  
Computed Tomography ◽  
Liver Cirrhosis ◽  
Female Patient ◽  
Constrictive Pericarditis ◽  
Delayed Diagnosis ◽  
Young Female ◽  
Refractory Ascites ◽  
Diagnostic Challenge ◽  
Massive Ascites ◽  
History Of

Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

scholarly journals A Rare Case of Spontaneous Arachnoid Cyst Rupture Presenting as Right Hemiplegia and Expressive Aphasia in a Pediatric Patient

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 78
Author(s):  
Anne Bryden ◽  
Natalie Majors ◽  
Vinay Puri ◽  
Thomas Moriarty
Keyword(s):  
Cognitive Processing ◽  
Arachnoid Cyst ◽  
Memory Loss ◽  
Acute Onset ◽  
Word Finding ◽  
Outpatient Visits ◽  
The Family ◽  
History Of ◽  
Cyst Rupture ◽  
The Brain

This study examines an 11-year-old boy with a known history of a large previously asymptomatic arachnoid cyst (AC) presenting with acute onset of right facial droop, hemiplegia, and expressive aphasia. Shortly after arrival to the emergency department, the patient exhibited complete resolution of right-sided hemiplegia but developed headache and had persistent word-finding difficulties. Prior to symptom onset while in class at school, there was an absence of reported jerking movements, headache, photophobia, fever, or trauma. At the time of neurology consultation, the physical exam showed mildly delayed cognitive processing but was otherwise unremarkable. The patient underwent MRI scanning of the brain, which revealed left convexity subdural hematohygroma and perirolandic cortex edema resulting from ruptured left frontoparietal AC. He was evaluated by neurosurgery and managed expectantly. He recovered uneventfully and was discharged two days after presentation remaining asymptomatic on subsequent outpatient visits. The family express concerns regarding increased anxiety and mild memory loss since hospitalization.

Breaking down long-term chronic aggression within a forensic hospital system

CNS Spectrums ◽  
2020 ◽  
Vol 25 (2) ◽  
pp. 216-222
Author(s):  
Benjamin Rose ◽  
Charles Broderick ◽  
Darci Delgado ◽  
Rebekah Kornbluh ◽  
Stephen M. Stahl
Keyword(s):  
Physical Aggression ◽  
Cognitive Rehabilitation ◽  
Cognitive Disorder ◽  
Treatment Programs ◽  
Cognitively Impaired ◽  
Hospital System ◽  
Forensic Hospital ◽  
Data Collection And Analysis ◽  
History Of

Objective.Historically, patients with multiple acts of aggression, or chronic aggressors, have been studied as one large group. It was our objective to subdivide this group into those patients who engage in physical aggression consistently over multiple years and see if common characteristics of chronic aggressors could classify patients into an aggressive or nonaggressive group.Method.Within a forensic hospital system, patients who had committed 5 acts of physical aggression, per year, for 3 years (2010 and 2015) were reviewed. Data was collected on clinical and demographic characteristics that have shown to be associated with chronically aggressive patients and compared to nonaggressive matched controls. Data collection and analysis were completed to determine if the variables could classify patients into an aggressive or nonaggressive group.Results.Analysis showed that 2 variables, the presence of a cognitive disorder and a history of suicidal behaviors were significant in the univariate and multivariate analyses. The 2 variables were able to correctly classify 76.7% of the cases.Conclusion.A cognitive disorder, a history of suicidal behavior, and increased age were factors associated with this subgroup of aggressive patients. Clinicians may want to explore treatment programs aimed at these clinical factors including cognitive rehabilitation and social cognition treatments, which have been shown to reduce aggression in cognitively impaired populations.

scholarly journals Subacute Sclerosing Panencephalitis manifesting as Bell’s palsy and bilateral macular necrotizing retinitis: an atypical presenting feature

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lagan Paul ◽  
Tanya Jain ◽  
Manisha Agarwal ◽  
Shalini Singh
Keyword(s):  
Subacute Sclerosing Panencephalitis ◽  
Clinical History ◽  
Neurological Complications ◽  
Bell’S Palsy ◽  
Ocular Involvement ◽  
Bell's Palsy ◽  
Diagnostic Challenge ◽  
Bladder Control ◽  
Mri Brain ◽  
History Of

Abstract Background Subacute sclerosing panencephalitis (SSPE) is a potentially lethal complication of measles infection. Neurological complications take years to manifest after primary viral infection of brain and can lead to blindness in some individuals. Findings A 13-year-old female patient with history of Bell’s palsy 2 months prior, presented with rapidly progressing necrotizing retinitis in both eyes. Soon after, she was unable to walk, developed myoclonic jerks, altered sensorium and loss of bowel and bladder control. Her clinical history, CSF IgG measles antibody analysis, MRI brain and EEG findings confirmed the diagnosis of SSPE. Conclusion SSPE in our case presented as Bell’s palsy and sudden painless diminution of vision due to ocular involvement, and developed full blown disease within 2 months. SSPE can present as a diagnostic challenge and warrants early identification and referral for timely diagnosis and management.

scholarly journals 12-month incidence, prevalence, persistence, and treatment of mental disorders among individuals recently admitted to assisted living facilities in Maryland

2013 ◽  
Vol 25 (5) ◽  
pp. 721-731 ◽  
Author(s):  
Quincy M. Samus ◽  
Chiadi U. Onyike ◽  
Deirdre Johnston ◽  
Lawrence Mayer ◽  
Matthew McNabney ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Assisted Living ◽  
Cognitive Disorders ◽  
Cognitive Disorder ◽  
Incidence Rates ◽  
Direct Care ◽  
Care Staff ◽  
Care Practice ◽  
Longitudinal Impact ◽  
Incidence Prevalence

ABSTRACTBackground: To estimate the 12-month incidence, prevalence, and persistence of mental disorders among recently admitted assisted living (AL) residents and to describe the recognition and treatment of these disorders.Methods: Two hundred recently admitted AL residents in 21 randomly selected AL facilities in Maryland received comprehensive physician-based cognitive and neuropsychiatric evaluations at baseline and 12 months later. An expert consensus panel adjudicated psychiatric diagnoses (using DSM-IV-TR criteria) and completeness of workup and treatment. Incidence, prevalence, and persistence were derived from the panel's assessment. Family and direct care staff recognition of mental disorders was also assessed.Results: At baseline, three-quarters suffered from a cognitive disorder (56% dementia, 19% Cognitive Disorders Not Otherwise Specified) and 15% from an active non-cognitive mental disorder. Twelve-month incidence rates for dementia and non-cognitive psychiatric disorders were 17% and 3% respectively, and persistence rates were 89% and 41% respectively. Staff recognition rates for persistent dementias increased over the 12-month period but 25% of cases were still unrecognized at 12 months. Treatment was complete at 12 months for 71% of persistent dementia cases and 43% of persistent non-cognitive psychiatric disorder cases.Conclusions: Individuals recently admitted to AL are at high risk for having or developing mental disorders and a high proportion of cases, both persistent and incident, go unrecognized or untreated. Routine dementia and psychiatric screening and reassessment should be considered a standard care practice. Further study is needed to determine the longitudinal impact of psychiatric care on resident outcomes and use of facility resources.

FROM TESTIMONY TO HETEROGLOSSIA: THE VOICE(S) OF LAMENT IN WE ARE THE PERSIANS!

2021 ◽  
Vol 1 (46) ◽  
pp. 151-182
Author(s):  
Marios Chatziprokopiou ◽  
Keyword(s):  
Asylum Seekers ◽  
Real Life ◽  
Main Body ◽  
Original Play ◽  
Documentary Theatre ◽  
History Of ◽  
Audiovisual Archives ◽  
Displaced People ◽  
The Voice ◽  
Ancient Drama

We are the Persians! was a contemporary adaptation of Aeschy-lus’s The Persians presented in June 2015 at the Athens and Epidaurus Festival. Performed by displaced people from Afghanistan, Pakistan and Bangladesh, and directed by Yolanda Markopoulou, the piece grew out of the Station Athens group’s five-year theatre workshops. Extracts from the original play were intertwined with performative material brought to the project by the participants: from real-life testimonies to vocal improvisations, poems, and songs in different languages. High-lighting the historical thematic of the play, this adaptation was presented as a documentary theatre piece, and the participants as ‘modern-day heralds’ who provided on stage ‘shocking accounts’ concerning ‘contem-porary wars’ (programme notes, 2015). After briefly revisiting the main body of literature on the voice of lament in ancient drama and in Aeschylus’s The Persians in particular, but also after discussing the recent stage history of the play in Greece, I conduct a close reading of this adaptation. Based on semi-directed interviews and audiovisual archives from both the rehearsals and the final show,I argue that the participants’ performance cannot be limited to their auto-biographical testimonies, which identify their status as refugees and/or asylum seekers. By intertwining Aeschylus with their own voices and languages, they reappropriate and reinvent the voice(s) of lament in ancient drama. In this sense, I suggest that We are the Persians! can be read as a hybrid performance of heteroglossia, which disrupts and potentially transforms dominant ways of receiving ancient drama on the modern Greek stage.

Tuberculosis in Children in a Pediatric Hospital in Mexico

2021 ◽  
Author(s):  
Napoleón González Saldaña ◽  
Mercedes Macías Parra ◽  
Hugo Juárez Olguín ◽  
José Iván Castillo Bejarano ◽  
Monica Punzo Soto ◽  
...  
Keyword(s):  
Pediatric Hospital ◽  
Diagnostic Challenge ◽  
Abnormal Chest ◽  
Culture Sensitivity ◽  
History Of ◽  
Chest X Ray ◽  
Epidemiological Evaluation ◽  
Polymerase Chain ◽  
Tuberculosis In Children ◽  
Skin Test Result

Tuberculosis (TB) remains a global problem and a diagnostic challenge, especially in pediatrics. The aim of this study was to describe the clinical, microbiological, radiological, and histopathological data of TB in children. A 7-year retrospective and descriptive cohort study that included 127 patients under 18 years of age with diagnosis of active TB was conducted from 2011 to 2018 in a pediatric hospital. Tuberculosis was microbiologically confirmed using Ziehl–Neelsen (ZN) staining, culture or polymerase chain reaction (PCR) in a total of 94 (74%) cases. Thirty-three cases were defined as probable TB based on tuberculin skin test result and epidemiological evaluation. The TB forms found were lymph node (39.3%), bone (15.7%), lung (13.6%), and meningeal TB (8.6%). The most common symptoms were fever (48.8%) and adenopathy (45.6%). History of contact was established in 34.6%. Positive ZN staining (sensitivity 30%) and culture (sensitivity 37%) were found in 29% and 37.7% of subjects, respectively. About 64.5% depicted abnormal chest X-ray. Xpert MTB/RIF® (PCR) was positive in 9.4% and biopsy was compatible in 52.7% of these samples. It is fundamental to have laboratory and epidemiological evaluation that support the diagnosis of the disease in children and thus, define its management; since, in most cases, early microbiologic confirmation is lacking.

Sign in / Sign up

Export Citation Format

Share Document