scholarly journals Differential diagnosis of atypical encephalopathy in critical care: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chung Li ◽  
Ming-Yieh Peng ◽  
Chia-Hui Chang ◽  
Yuan-Yu Hsu ◽  
Min-Shiau Hsieh ◽  
...  
Keyword(s):  
Critical Care ◽  
Diabetic Ketoacidosis ◽  
Brain Magnetic Resonance Imaging ◽  
Signs And Symptoms ◽  
Middle Lobe ◽  
Deep Coma ◽  
Septic Encephalopathy ◽  
Streptococcus Intermedius ◽  
Steroid Dependent ◽  
Level Of Consciousness

Abstract Background A lower level of consciousness is a common presentation in critical care, with many different causes and contributory factors, of which more than one may be present concurrently. Case presentation We described a woman with poorly controlled diabetes and steroid-dependent asthma who presented in a deep coma. She was found to have Streptococcus intermedius bacteremia and pyogenic ventriculitis that originated from right middle lobe pneumonia. Also, multiple small parenchymal lesions were observed on brain magnetic resonance imaging and increased protein concentration was noted in cerebral spinal fluid. Initially, her coma was thought to be due to diabetic ketoacidosis and septic encephalopathy. However, her lowered level of consciousness was disproportionate to either diabetic ketoacidosis or septic encephalopathy, and her clinical course was not as expected for these two conditions. Treatment with antibiotic, corticosteroid and antihelminthic drugs was administered resulting in improving consciousness. The Streptococcus intermedius pneumonia progressed to form a large cavity that needed an early surgical lobectomy and resulted in the unexpected diagnosis of chronic cavitary pulmonary aspergillosus. Conclusions In critical care, a lowered level of consciousness may have many etiologies, and critical care clinicians should be familiar with the signs and symptoms of all possible causes to enable prompt diagnosis and appropriate treatment.

scholarly journals MEASURING KNOWLEDGE OF JORDANIAN NURSES WORKING IN CRITICAL CARE UNITS TOWARD STROKE PATIENTS

World Science ◽  
2020 ◽  
Author(s):  
Eslam Abd Alkreem Allsassmah
Keyword(s):  
Critical Care ◽  
Negative Relationship ◽  
Signs And Symptoms ◽  
Public Hospitals ◽  
Stroke Management ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Critical Care Units ◽  
Jordanian Nurses ◽  
The Impact

Background. Stroke is a devastating disease. It is a major cause for the neurological admission to hospitals all over the world. Limited knowledge among the critical care nurses about stroke in general and specifically about the risk factors, signs, and symptoms of stroke usually is a main source of delayed prompt stroke management and non-compliance with follow-up rehabilitation. Therefore, there is a need for a study that examines the impact of these factors in order to promote stroke management and improve nursing care outcomes.Aim. This study aimed at measuring the knowledge of Jordanian nurses working in critical care units toward stroke patients.Methods. This cross-sectional study used the descriptive approach in order to measure the knowledge of the Jordanian nurses working in critical care units regarding stroke patients in the Jordanian hospitals. Data were collected from Jordanian critical care units' nurses from seven hospitals; five private and two public hospitals. Critical care units’ nurses were selected conveniently based on specific inclusion criteria. Eligible participants were required to complete self–reported questionnaires about knowledge in addition to completing demographic questionnaires. The descriptive and inferential statistics were conducted using the SPSS software. Results. A total of (200) Critical care units’ nurses from public and private hospitals participated in the study. The nurses in this study exhibited poor knowledge on the study scales. There were statistically significant differences among nurses according to the type of hospital on the one scales (P< .05). There is a negative relationship between the knowledge and years of nursing practice in ER or ICU (P= .013).Conclusions. The measures of knowledge among the nurses in critical care units in the Jordanian hospitals towards stroke patients seem to be highly poor. Nurses in critical care units seem to have acceptable information, but inadequate to correctly enhance stroke awareness. There is a gap that should be stuffed via planning and implementation of educational and instructional programs focused on hospital nurses as well as community sectors in order to improve the stoke focus and experience and avoid the delay in accessing the medical help which would, in return, improve stroke management and reduce its effect in Jordan.

scholarly journals Tacrolimus-induced neurotoxicity from bipolar disorder to status epilepticus under the therapeutic serum level: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bora Jin ◽  
Ga Yeon Kim ◽  
Sang-Myung Cheon
Keyword(s):  
Adverse Events ◽  
Therapeutic Range ◽  
Solid Organ Transplantation ◽  
Brain Magnetic Resonance Imaging ◽  
Solid Organ ◽  
Therapeutic Level ◽  
Hyperintense Lesion ◽  
Case Presentation ◽  
Delta Waves ◽  
Level Of Consciousness

Abstract Background Tacrolimus is a macrolide immunosuppressant widely used to prevent rejection after solid organ transplantation. In general, adverse events of tacrolimus occur more often as the concentration of tacrolimus in the blood increases. We report the case of a 39-year-old man who developed a variety of adverse events despite in the therapeutic level of tacrolimus in the blood. Case presentation A 39-year-old man underwent liver transplantation for liver cirrhosis due to alcoholic liver disease. The postoperative immunosuppressant consisted of tacrolimus (5 mg) and mycophenolate (500 mg) twice daily. Five months after taking tacrolimus, he presented with talkativeness, which gradually worsened. Brain magnetic resonance imaging performed 10 months after tacrolimus administration revealed a hyperintense lesion affecting the middle of the pontine tegmentum on T2WI. The blood concentration of tacrolimus was 7.2 ng/mL (therapeutic range 5–20 ng/mL). After 21 months, he exhibited postural tremor in both the hands. Twenty-four months after taking tacrolimus, he showed drowsy mentality, intention tremor, and dysdiadochokinesia. Electroencephalography presented generalized high-voltage rhythmic delta waves; therefore, tacrolimus was discontinued in suspicion of tacrolimus-induced neurotoxicity, and anticonvulsive treatment was started. The level of consciousness gradually improved, and the patient was able to walk independently with mild ataxia. Conclusion This case shows that tacrolimus-induced neurotoxicity can occur even at normal concentrations. Therefore, if a patient taking tacrolimus exhibits psychiatric or neurologic symptoms, neurotoxicity should be considered even when the blood tacrolimus is within the therapeutic range.

scholarly journals Pulmonary Hypertension in Pregnancy: Critical Care Management

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Adel M. Bassily-Marcus ◽  
Carol Yuan ◽  
John Oropello ◽  
Anthony Manasia ◽  
Roopa Kohli-Seth ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Critical Care ◽  
Right Ventricular ◽  
Pregnant Women ◽  
Signs And Symptoms ◽  
Right Ventricular Failure ◽  
Team Approach ◽  
Ventricular Failure ◽  
Critical Care Management ◽  
New Treatments

Pulmonary hypertension is common in critical care settings and in presence of right ventricular failure is challenging to manage. Pulmonary hypertension in pregnant patients carries a high mortality rates between 30–56%. In the past decade, new treatments for pulmonary hypertension have emerged. Their application in pregnant women with pulmonary hypertension may hold promise in reducing morbidity and mortality. Signs and symptoms of pulmonary hypertension are nonspecific in pregnant women. Imaging workup may have undesirable radiation exposure. Pulmonary artery catheter remains the gold standard for diagnosing pulmonary hypertension, although its use in the intensive care unit for other conditions has slowly fallen out of favor. Goal-directed bedside echocardiogram and lung ultrasonography provide attractive alternatives. Basic principles of managing pulmonary hypertension with right ventricular failure are maintaining right ventricular function and reducing pulmonary vascular resistance. Fluid resuscitation and various vasopressors are used with caution. Pulmonary-hypertension-targeted therapies have been utilized in pregnant women with understanding of their safety profile. Mainstay therapy for pulmonary embolism is anticoagulation, and the treatment for amniotic fluid embolism remains supportive care. Multidisciplinary team approach is crucial to achieving successful outcomes in these difficult cases.

A survey of pediatric critical care nurses' knowledge of pain management

1997 ◽  
Vol 6 (4) ◽  
pp. 289-295 ◽  
Author(s):  
C Pederson ◽  
D Matthies ◽  
S McDonald
Keyword(s):  
Critical Care ◽  
Pain Management ◽  
Signs And Symptoms ◽  
Educational Interventions ◽  
Critical Care Nurses ◽  
Toxic Metabolite ◽  
Pediatric Critical Care ◽  
Related Information ◽  
Item Scale ◽  
Nurses Knowledge

BACKGROUND: Although nurses are accountable for pain management, it cannot be assumed that they are well informed about pain. Nurses' knowledge base underlies their pain management; therefore, it is important to measure their knowledge. OBJECTIVE: To measure pediatric critical care nurses' knowledge of pain management. METHOD: A descriptive, exploratory study was done. After a pilot study, an investigator-developed Pain Management Knowledge Test was distributed to 50 pediatric ICU nurses. Test responses were collected anonymously and coded by number. Item analysis was done, and descriptive statistics were calculated. Modified content analysis was used on requests for pain-related information. RESULTS: The test return rate was 38%. The overall mean score was 63%. Mean scores within test subsections varied from 50% to 92%. Other mean scores were 85% on a nine-item scale of drug-action items and 92% on a two-item scale of intervention items. However, no nurse recognized that cognitive-behavioral techniques can inhibit transmission of pain impulses; only 32% indicated that meperidine converts to a toxic metabolite, only 47% recognized nalbuphine as a drug that may cause signs and symptoms of withdrawal if given to a patient who has been receiving an opioid; and only 63% indicated that when a child states that the child has pain, pain exists. Thirteen nurses requested pain-related information, and all requests focused on analgesic medications. CONCLUSIONS: Testing nurses' knowledge of pain indicated gaps that can be addressed through educational interventions. Research is needed in which the test developed for this study is used as both pretest and posttest in an intervention study with pediatric critical care nurses or is modified for use with nurses in other clinical areas.

scholarly journals Viral Encephalitis: A Hard Nut to Crack

2019 ◽  
Vol 55 (02) ◽  
pp. 098-109
Author(s):  
Alka Shukla ◽  
Mayank Gangwar ◽  
Sonam Rastogi ◽  
Gopal Nath
Keyword(s):  
Viral Encephalitis ◽  
Viral Infections ◽  
Neurological Complication ◽  
Clinical Signs ◽  
Geographical Location ◽  
Signs And Symptoms ◽  
Climatic Conditions ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Clinical Signs And Symptoms

AbstractViral encephalitis is inflammation of brain that manifests as neurological complication of viral infections. There are quite a good number of viruses, for example, human herpes virus, Japanese encephalitis, and enteroviruses that can result in such a dreadful condition. Geographical location, age, gender, immune status, and climatic conditions also contribute to the establishment of this disease in an individual. Clinical signs and symptoms include fever, headache, altered level of consciousness, changed mental status, body ache, seizures, nausea, and vomiting. Effective management of this disease relies on timely diagnosis that in turn depends on apt and suitable investigation techniques. Traditional investigations have thinned out these days owing to the fact that advanced molecular technologies have been introduced to the diagnostic field. Treatment of viral encephalitis mainly involves symptomatic relieve from fever, malaise, myalgia along with measures to reduce viral load in the patient. This review mentions about all the possible aspects of viral encephalitis starting from etiology to the management and preventive measures that include immunization and vector control.

Cerebral infarction and femoral venous thrombosis detected in a patient with diabetic ketoacidosis and heterozygous factor V Leiden G1691A and PAI-1 4G/5G mutations

2015 ◽  
Vol 28 (9-10) ◽  
Author(s):  
Selcen Yaroglu Kazanci ◽  
Osman Yesilbas ◽  
Melike Ersoy ◽  
Hasan Serdar Kihtir ◽  
Hamdi Murat Yildirim ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Venous Thrombosis ◽  
Diabetic Ketoacidosis ◽  
Factor V Leiden ◽  
Neurological Complications ◽  
Factor V ◽  
Altered Level ◽  
Femoral Catheter ◽  
Level Of Consciousness ◽  
Pai 1

AbstractCerebral infarction is one of the serious neurological complications of diabetic ketoacidosis (DKA). Especially in patients who are genetically prone to thrombosis, cerebral infarction may develop due to inflammation, dehydration, and hyperviscocity secondary to DKA. A 6-year-old child with DKA is diagnosed with cerebral infarction after respiratory insufficiency, convulsion, and altered level of consciousness. Femoral and external iliac venous thrombosis also developed in a few hours after central femoral catheter had been inserted. Heterozygous type of factor V Leiden and

scholarly journals Pituitary Apoplexy Presenting as Ophthalmoplegia and Altered Level of Consciousness without Headache

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Nooshin Salehi ◽  
Anthony Firek ◽  
Iqbal Munir
Keyword(s):  
Ct Scan ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Brain Magnetic Resonance Imaging ◽  
Acute Onset ◽  
Altered Level ◽  
Level Of Consciousness ◽  
The Right

Background. Pituitary apoplexy (PA) is a clinical syndrome caused by acute ischemic infarction or hemorrhage of the pituitary gland. The typical clinical presentation of PA includes acute onset of severe headache, visual disturbance, cranial nerve palsy, and altered level of consciousness. Case Report. A 78-year-old man presented to the emergency department with one-day history of ptosis and diplopia and an acute-onset episode of altered level of consciousness which was resolving. He denied having headache, nausea, or vomiting. Physical examination revealed third-cranial nerve palsy and fourth-cranial nerve palsy both on the right side. Noncontrast computed tomography (CT) scan of the head was unremarkable. Brain magnetic resonance imaging (MRI) showed a pituitary mass with hemorrhage (apoplexy) and extension to the right cavernous sinus. The patient developed another episode of altered level of consciousness in the hospital. Transsphenoidal resection of the tumor was done which resulted in complete recovery of the ophthalmoplegia and mental status. Conclusion. Pituitary apoplexy can present with ophthalmoplegia and altered level of consciousness without having headache, nausea, or vomiting. A CT scan of the head could be negative for hemorrhage. A high index of suspicion is needed for early diagnosis and timely management of pituitary apoplexy.

scholarly journals Dyke-Davidoff-Masson Syndrome: A case Report in a patient presenting with drug-resistant epilepsy and pseudoseizures

2021 ◽  
Author(s):  
Pedro Schmidt dos Reis Matos Figueiredo ◽  
Thiago Oliveira Chaves
Keyword(s):  
Case Report ◽  
Cognitive Dysfunction ◽  
Brain Magnetic Resonance Imaging ◽  
Rare Condition ◽  
Signs And Symptoms ◽  
Drug Resistant ◽  
Cerebral Hemiatrophy ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Drug Resistant Epilepsy

Context: Dyke-Davidoff-Masson (DDM) syndrome is a rare neurological condition, first described in 1933. Characteristics include cerebral hemiatrophy, contralateral hemiparesis, seizures, and cognitive dysfunction, combined into different degrees and patterns. Brain magnetic resonance imaging (MRI) is used to perform diagnosis throughout its specific findings. Case Report: A eighteen-year-old female presented to our service with a history of cognitive dysfunction and seizures since early childhood, which persistence even with adequate use of antiepileptic drugs. During Investigation were found signs and symptoms compatible with DDM syndrome, and evidence of pseudoseizures captured in a video electroencephalography monitoring. Conclusion: DDM syndrome is a rare condition that must be part of differential diagnosis in patients with seizures and cerebral hemiatrophy. Management is based on adequate control of seizures and other comorbidities.

scholarly journals Reconhecendo os principais sinais e sintomas da cetoacidose diabética: uma revisão integrativa

2021 ◽  
Vol 10 (12) ◽  
pp. e75101220149
Author(s):  
Karine Souza Rodrigues ◽  
André Carvalho de Sousa ◽  
Andressa Nogueira Cardoso ◽  
Manoelise Linhares Ferreira Gomes ◽  
Vitória Ferreira do Amaral ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Medical Literature ◽  
Signs And Symptoms ◽  
Literature Analysis ◽  
Medical Database ◽  
On Line

Objetivo: identificar os principais sinais e sintomas da cetoacidose diabética evidenciados na literatura científica. Metodologia: trata-se de revisão integrativa da literatura, desenvolvida no período de maio a junho de 2021. A busca foi realizada por meio do portal de periódicos Coordenação de Aperfeiçoamento de Pessoas de Nível Superior, nas seguintes bases de dados: Excerpta Medical dataBASE, Medical Literature Analysis and Retrieval Sistem on-line e Literatura Latino-americana e Caribenha em Ciências da Saúde. A estratégia de busca consistiu no cruzamento dos descritores “Diabetic Ketoacidosis”, “Signs and Symptoms Diagnosis”, mediados pelo operador booleano “AND”. Foram incluídos artigos publicados de 2017 a 2021 nos idiomas português, inglês e espanhol. Foram excluídos os estudos da literatura cinza e artigos duplicados. Resultados: averiguaram-se 423 estudos, e destes, apenas sete atenderam aos critérios de elegibilidade. Identificaram-se polidipsia, poliúria e perda de peso, como os sintomas mais frequentes, entre pacientes com diagnóstico de cetoacidose diabética. Quanto ao reconhecimento, observou-se baixo nível de identificação dos sinais e sintomas da cetoacidose diabética pelos pais de crianças com diabetes mellitus e profissionais da saúde. Bem como, se verificou a influência da idade e do nível socioeconômico frente à prevalência dessa emergência endócrina. Conclusão: percebeu-se reconhecimento reduzido sobre sinais e sintomas da cetoacidose diabética, além da baixa especificidade da sintomatologia dessa complicação, o que dificulta o diagnóstico, controle e monitoramento.

scholarly journals Endoscopic Intraventricular Atrial Adhesiolysis for the Treatment of Entrapped Temporal Horn after İntraventricular Tumor Surgery

2020 ◽  
Vol 11 (02) ◽  
pp. 337-340
Author(s):  
Bashar Abuzayed ◽  
Khaled Alawneh ◽  
Majdi Al Qawasmeh ◽  
Liqaa Raffee
Keyword(s):  
Third Ventricle ◽  
Brain Magnetic Resonance Imaging ◽  
Central Neurocytoma ◽  
Early Postoperative Period ◽  
Temporal Horn ◽  
Left Posterior ◽  
Level Of Consciousness ◽  
Posterior Parietal ◽  
Significant Regression ◽  
Ventricle Size

AbstractA 21-year-old male patient was operated for third ventricle tumor (central neurocytoma) and showed improvement in the early postoperative period. After 2 weeks of surgery, the patient neurologic status deteriorated with acute decreased level of consciousness. Neuroimaging of the brain revealed entrapped left temporo-occipital horns with adhesion bands at the level of the atrium. Patient was operated with neuronavigation-guided endoscopic approach to the left atrium through the left posterior parietal region. Band adhesiolysis was performed with no complications. The patient showed fast improvement, and follow-up brain magnetic resonance imaging after 2 years showed the release of the ventricular entrapment with significant regression of the left ventricle size.

Sign in / Sign up

Export Citation Format

Share Document