Recurrent Facial Focal Seizures With Chronic Striatopathy and Caudate Atrophy—A Double Whammy in an Elderly Woman With Diabetes Mellitus

2021 ◽  
pp. 194187442110353
Author(s):  
Subhankar Chatterjee ◽  
Ritwik Ghosh ◽  
Umesh Kumar Ojha ◽  
Diksha ◽  
Payel Biswas ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Neurological Complications ◽  
Low Grade ◽  
Epilepsia Partialis Continua ◽  
Vascular Insufficiency ◽  
Left Caudate ◽  
The Right ◽  
Ketotic Hyperglycemia ◽  
Superior Frontal Cortex ◽  
Space Occupying Lesion

Seizures and involuntary movements are relatively rare, but well-known neurological complications of non-ketotic hyperglycemia. While hemichorea-hemiballism secondary to diabetic striatopathy is increasingly being reported, unilateral caudate atrophy resulting from chronic vascular insufficiency/insult in a backdrop of poorly controlled diabetes mellitus is sparsely described in literature. We herein report a 75-year-old woman with poorly controlled diabetes mellitus who presented with concurrent epilepsia partialis continua involving left side of her face and hemichorea on the right side in the context of non-ketotic hyperglycemia. Neuroimaging revealed a space-occupying lesion suggestive of low-grade glioma in the right superior frontal cortex and left-sided caudate atrophy as well. Possibly, space-occupying lesion in motor cortex acted as an inciting factor for seizures and non-ketotic hyperglycemia further lowered the seizures threshold. On the other hand, atrophied left caudate had led to persistent choreiform movements secondary to chronic uncontrolled hyperglycemia. The simultaneous presence of acute and chronic neurological complications of diabetes mellitus makes this case unique. It also highlights the need for strict control of blood glucose and utility of appropriate neuroimaging to rapidly diagnose and prevent further complications.

Ketotic hyperglycemia and epilepsia partialis continua

Neurology ◽  
2001 ◽  
Vol 57 (3) ◽  
pp. 534-537 ◽  
Author(s):  
F. Placidi ◽  
R. Floris ◽  
A. Bozzao ◽  
A. Romigi ◽  
M. E. Baviera ◽  
...  
Keyword(s):  
Acid Metabolism ◽  
Brain Mri ◽  
Cerebellar Hemisphere ◽  
Seizure Threshold ◽  
Precentral Gyrus ◽  
Epilepsia Partialis Continua ◽  
Abnormal Signal ◽  
Abnormal Signal Intensity ◽  
The Right ◽  
Ketotic Hyperglycemia

Epilepsia partialis continua (EPC) may occur during nonketotic hyperglycemia but has not been described with diabetic ketoacidosis. The authors report a patient with EPC associated with ketotic hyperglycemia. Brain MRI showed two areas of abnormal signal intensity in the left precentral gyrus and in the right cerebellar hemisphere. Hyperglycemia may reduce seizure threshold because of the increase in γ-aminobutyric acid metabolism and may trigger epileptic discharges.

scholarly journals CASE REPORT: HEMICHOREA-HEMIBALLISMUS IN NON-KETOTIC HYPERGLYCEMIA AND NON-HEMORRHAGIC STROKE PATIENT WITH BASAL GANGLIA HYPERDENSITY

2019 ◽  
Vol 2 (2) ◽  
pp. 74-80
Author(s):  
Regina Caecilia Setiawan ◽  
William Septian Sonyo ◽  
Luh Kadek Trisna Lestari
Keyword(s):  
Diabetes Mellitus ◽  
Case Report ◽  
Basal Ganglia ◽  
Involuntary Movement ◽  
Clinical Manifestations ◽  
The Body ◽  
Initial Symptom ◽  
Uncontrolled Diabetes ◽  
The Right ◽  
Ketotic Hyperglycemia

Background : Hemichorea-hemiballismus (HC-HB) is a hyperkinetic disorder characterized by uncontrolled movements, non patterned, occurring mostly in the proximal extremity on one side of the body. The etiology that most often causes HC-HB is acute cerebrovascular disorder. Non-ketotic hyperglycemia is another etiology that is very important because it is the second most common cause of HC-HB and can be manifested as an initial symptom or complication of diabetes mellitus. This case is rare and the prevalence is unknown. Case : A diabetic patient with non-ketotic hyperglycemia reported  with hemiballismus syndrome. A 60-year-old woman experiences involuntary, repetitive, and non-rhythmic movements in the left arm and leg. These patients have a history of uncontrolled diabetes mellitus and hypertension. Head CT scan images in patients showed hyperdensity lesions in the right basal ganglia which were thought to be caused by non-ketotic hyperglycemia and infarction in the right temporal lobe. Involuntary movements improve after blood glucose targets are achieved by administering basal and prandial insulin.  Clinical response in the case of hemiballismus above is reversible even though the appearance of hyperdensityt lesions can last for several months. Discussion : Hemichorea-Hemiballismus (HC-HB) is a rare disorder of involuntary movement, most often caused by focal lesions in the basal ganglia and the contralateral subthalamic nucleus. HC-HB is mainly caused by systemic processes both focal and diffuse. Nonketotic hyperglycemia is known to be a metabolic cause of HC-HB, especially in elderly patients with uncontrolled diabetes mellitus. Clinical manifestations and supporting patients support hyperglycemia and basal ganglia hyperdensity to be the etiology of hemiballismus experienced by patients. Conclusion : Many etiologies can cause this disorder, but vascular disorders and non-ketotic hyperglycemia are the most common etiologies. HC-HB in non-ketotic hyperglycemic is manifestation which is very rare in diabetes mellitus. The prognosis is quite good in most patients with or without treatment. This case report describes a successful treatment approach with positive results and a fairly short duration.

Omental Infarction: A Case Treated with Laparoscopic Surgery

2019 ◽  
pp. 1-3
Author(s):  
Bertrand Ng ◽  
Arafat Yasser
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Acute Onset ◽  
Laparoscopy Surgery ◽  
History Of ◽  
Background History ◽  
The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

scholarly journals P040 An unusual case of giant cell arteritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Jessica Ellis ◽  
Keziah Austin ◽  
Sarah Emerson
Keyword(s):  
Inflammatory Markers ◽  
Illicit Drugs ◽  
Unusual Case ◽  
Temporal Arteritis ◽  
White Cell Count ◽  
Healthcare Providers ◽  
Temporal Artery ◽  
Low Grade ◽  
Temporal Artery Biopsy ◽  
The Right

Abstract Background/Aims  A 49-year-old female of Nepalese heritage was referred with right-sided headache, scalp tenderness, and a painful swelling overlying the right temple. She denied any visual or claudicant symptoms but felt systemically unwell with a fever. There were no symptoms suggestive of an inflammatory arthritis, underlying connective tissue disease or vasculitis. She was normally fit and well with no past medical history. She did not take any regular medications and denied using over the counter or illicit drugs or recent travel. On review she had a low grade fever. There was a large tender, erythematous swelling overlying the right temple. Bilaterally the temporal arteries were palpable and pulsatile. Peripheral pulses were normal with no bruits. There was no evidence of shingles (HSV) or local infection. Full systemic examination revealed no other abnormalities. Laboratory tests showed: PV 2.56, CRP 101, total white cell count 14.38 (eosinophils 0.4), albumin 33, Hb 115. Urine dip was normal. Renal function, liver function and immunoglobulins were normal. ANCA was negative. Hypoechogenicity surrounding the right frontal branch of the right temporal artery was seen on ultrasound. There were no discrete masses suggestive of cysts, abscess or tumours. Temporal artery biopsy confirmed the presence of vasculitis; histology demonstrated transmural lymphohistiocytic inflammation, disruption of the elastic lamina and intimal proliferation. Prednisolone was started at 40mg daily. Four weeks after initially presenting she was asymptomatic and her inflammatory markers had normalised. Methods  The case is discussed below. Results  Temporal arteritis, or GCA, is primarily a disease of older adults; with age 50 often used as an inclusion criteria, and is more common in Caucasian populations. Limited reports exist of GCA in younger cohorts, but these are rare. An important differential in younger patients, such as ours, is juvenile temporal arteritis. This rare localised vasculitis affects almost exclusively the temporal artery. It is typically a disease of young males, who present with non-tender temporal swelling. Systemic symptoms are unusual and inflammatory markers are normal. Clinical or laboratory evidence of organ involvement, peripheral eosinophilia or fibrinoid necrosis on histology should prompt consideration of an AAV or PAN. Incidence of GCA increases in correlation with Northern latitude, with highest rates reported in Scandinavian and North American populations. GCA is rare in Asian populations. Higher diagnostic rates in countries where physicians have increased awareness of GCA proposed as an explanation for this difference; however differences in incidence are still observed between Asian and Caucasian populations presenting to the same healthcare providers. Conclusion  GCA is an uncommon diagnosis in younger and non-Caucasian patients. Thorough investigation through ultrasound and biopsy helped increase our diagnostic confidence in this unusual case. Rheumatologists must be alert to atypical presentations in order to deliver prompt and potentially sight-saving treatment. Disclosure  J. Ellis: None. K. Austin: None. S. Emerson: None.

Brain reactivity to humorous films is affected by insomnia

SLEEP ◽  
2021 ◽  
Author(s):  
Ernesto Sanz-Arigita ◽  
Yannick Daviaux ◽  
Marc Joliot ◽  
Bixente Dilharreguy ◽  
Jean-Arthur Micoulaud-Franchi ◽  
...  
Keyword(s):  
Emotional Reactivity ◽  
Brain Activity ◽  
Brain Network ◽  
Anterior Cingulate ◽  
Neural Representation ◽  
Cingulate Gyrus ◽  
Anterior Cingulate Gyrus ◽  
Left Caudate ◽  
Neural Reactivity ◽  
The Right

Abstract Study objectives Emotional reactivity to negative stimuli has been investigated in insomnia, but little is known about emotional reactivity to positive stimuli and its neural representation. Methods We used 3T fMRI to determine neural reactivity during the presentation of standardized short, 10-40-s, humorous films in insomnia patients (n=20, 18 females, aged 27.7 +/- 8.6 years) and age-matched individuals without insomnia (n=20, 19 females, aged 26.7 +/- 7.0 years), and assessed humour ratings through a visual analogue scale (VAS). Seed-based functional connectivity was analysed for left and right amygdala networks: group-level mixed-effects analysis (FLAME; FSL) was used to compare amygdala connectivity maps between groups. Results fMRI seed-based analysis of the amygdala revealed stronger neural reactivity in insomnia patients than in controls in several brain network clusters within the reward brain network, without humour rating differences between groups (p = 0.6). For left amygdala connectivity, cluster maxima were in the left caudate (Z=3.88), left putamen (Z=3.79) and left anterior cingulate gyrus (Z=4.11), while for right amygdala connectivity, cluster maxima were in the left caudate (Z=4.05), right insula (Z=3.83) and left anterior cingulate gyrus (Z=4.29). Cluster maxima of the right amygdala network were correlated with hyperarousal scores in insomnia patients only. Conclusions Presentation of humorous films leads to increased brain activity in the neural reward network for insomnia patients compared to controls, related to hyperarousal features in insomnia patients, in the absence of humor rating group differences. These novel findings may benefit insomnia treatment interventions.

scholarly journals A Case of Atypical Bartonellosis in a 4-Year-Old Immunocompetent Child

2021 ◽  
Vol 9 (5) ◽  
pp. 950
Author(s):  
Chiara Sodini ◽  
Elena Mariotti Zani ◽  
Francesco Pecora ◽  
Cristiano Conte ◽  
Viviana Dora Patianna ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Bartonella Henselae ◽  
Delayed Diagnosis ◽  
Mitral Valve Regurgitation ◽  
Low Grade ◽  
Systemic Involvement ◽  
Mild Disease ◽  
Precise Diagnosis ◽  
Major Illness ◽  
The Right

In most cases, infection due to Bartonella henselae causes a mild disease presenting with a regional lymphadenopathy frequently associated with a low-grade fever, headache, poor appetite and exhaustion that spontaneously resolves itself in a few weeks. As the infection is generally transmitted by cats through scratching or biting, the disease is named cat scratch disease (CSD). However, in 5–20% of cases, mainly in immunocompromised patients, systemic involvement can occur and CSD may result in major illness. This report describes a case of systemic CSD diagnosed in an immunocompetent 4-year-old child that can be used as an example of the problems that pediatricians must solve to reach a diagnosis of atypical CSD. Despite the child’s lack of history suggesting any contact with cats and the absence of regional lymphadenopathy, the presence of a high fever, deterioration of their general condition, increased inflammatory biomarkers, hepatosplenic lesions (i.e., multiple abscesses), pericardial effusion with mild mitral valve regurgitation and a mild dilatation of the proximal and medial portion of the right coronary artery, seroconversion for B. henselae (IgG 1:256) supported the diagnosis of atypical CSD. Administration of oral azithromycin was initiated (10 mg/kg/die for 3 days) with a progressive normalization of clinical, laboratory and US hepatosplenic and cardiac findings. This case shows that the diagnosis of atypical CSD is challenging. The nonspecific, composite and variable clinical features of this disease require a careful evaluation in order to achieve a precise diagnosis and to avoid both a delayed diagnosis and therapy with a risk of negative evolution.

scholarly journals Provocation and prediction of visual peripersonal neglect-like symptoms in preoperative planning and during awake brain surgery

2021 ◽  
Author(s):  
Viktória Tamás ◽  
Gabriella Sebestyén ◽  
Szilvia Anett Nagy ◽  
Péter Zsolt Horváth ◽  
Ákos Mérei ◽  
...  
Keyword(s):  
Preoperative Planning ◽  
Right Hemisphere ◽  
Superior Temporal Gyrus ◽  
Low Grade ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Resonance Imaging ◽  
Parietal Area ◽  
Routine Magnetic Resonance Imaging ◽  
Visuospatial Functions ◽  
The Right

AbstractNeglect is a severe neuropsychological/neurological deficit that usually develops due to lesions of the posterior inferior parietal area of the right hemisphere and is characterized by a lack of attention to the left side. Our case is a proven right-handed, 30-year-old female patient with a low-grade glioma, which was located in the temporo-opercular region and also in the superior temporal gyrus of the right hemisphere. Upon presurgical planning, the motor, language, and visuospatial functions were mapped. In order to achieve this, the protocol for routine magnetic resonance imaging and navigated transcranial magnetic stimulation has been expanded, accordingly.

scholarly journals Test-Retest Reliability of Isokinetic Knee Strength Measurements in Type 2 Diabetes Mellitus Patients

2021 ◽  
Vol 13 (3) ◽  
pp. 1343
Author(s):  
José Carmelo Adsuar ◽  
Jose Parraca ◽  
Armando Raimundo ◽  
Miguel Angel Garcia-Gordillo ◽  
Patricia Polero ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Peak Torque ◽  
Total Sample ◽  
Good For ◽  
The Right ◽  
Test Retest Reliability ◽  
Standard Error Of Measurement

Background: Reliability studies are used to verify the evaluation accuracy of a given device. Strength is an important factor for the development of daily activities and its correct management is fundamental. The objective of this study was to examine the reliability of a concentric strength test in people with type 2 diabetes mellitus (T2DM). Methods: Twenty-seven individuals with T2DM performed three repetitions of extension-flexion in concentric-concentric action at 60°/s, for both legs, using an isokinetic dynamometer. For the reliability analysis, we performed an intra-session test retest. Results: The total sample and men sub-group intra-class correlation coefficient (ICC) values were excellent for peak torque and work. In the women sub-group, ICC values were excellent for extensors in both peak torque and work; however, concerning flexor, the ICC values were good for peak torque while, for work, they were good for the right leg and moderate for the left leg. Standard error of measurement (SEM) percentage oscillated from 3.85% to 6.80%, with the smallest real difference (SRD) percentage being from 10.66% to 18.86% for peak torque. Furthermore, the SEM (%) was around 5.5% and SRD (%) was around 15% for work. Conclusions: The isokinetic dynamometry had “good” to “excellent” relative reliability for peak torque (0.862–0.983) and work (0.744–0.982) of extension-flexion in concentric-concentric action at 60°/s. In addition, our study showed that, in general, an SRD < 20% could indicate a true change in strength regarding this protocol in T2DM.

scholarly journals LINC-06. OBSERVATION ONLY IN A PATIENT WITH SUSPECTED LOW GRADE GLIOMA. SHOULD NEUROSURGERY ALWAYS BE THE FIRST STEP IN LOW AND MIDDLE INCOME COUNTRIES?

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii379-iii379
Author(s):  
Carlos Leal - Cavazos ◽  
Jose Arenas-Ruiz ◽  
Oscar Vidal-Gutierrez
Keyword(s):  
Brain Mri ◽  
Internal Capsule ◽  
Pediatric Brain Tumor ◽  
Clinical History ◽  
Low Grade ◽  
Large Tumor ◽  
Middle Income ◽  
Dismal Prognosis ◽  
Close Observation ◽  
The Right

Abstract BACKGROUND Low grade gliomas (LGGs) are the most frequent pediatric brain tumor and they comprise a variety of histologies. Complete surgery is curative but sometimes its location makes it difficult. Recent publications highlight the excellent long-term outcomes of patients with LGGs with complete and incomplete resected tumors. Current strategies are focused on reducing risks of treatment related sequelae. METHOD We describe a patient with a suspected LGG managed by close observation. We describe the case of a 6 year old female with 5 months history of focal onset seizures. During this time a brain MRI was requested and tumor was evidenced. After “tumor diagnosis” was made family visited a handful of private neurosurgeons with a uniformly dismal prognosis and high risk morbidity from procedures offered. When first seen at our Hospital, the clinical history seemed compatible with a LGG and seizures well controlled with antiepileptic drugs. Neurological examination was completely normal. MRI showed a large tumor (7x5x5 cm) hypointense on T1, hyperintense on T2, without contrast enhancement, involving the right temporal lobe white matter, insula, internal capsule, hipoccampus, thalamus and mesencephalus with middle cerebral artery encasement. Interval imaging was proposed and after 4.5 years since diagnosis the tumor has been stable and patient clinically excellent. CONCLUSION Overall survival in pediatric LGGs is excellent and risk of sequelae should always be part of multidisciplinary team considerations. In centers with significant neurosurgical morbidity, biopsy of large tumors that are compatible with LGG may not be required in selected cases.

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