scholarly journals Multiple simultaneous embolic cerebral infarctions 11 months after COVID-19

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rajiv Advani ◽  
Torbjørn Austveg Strømsnes ◽  
Espen Stjernstrøm ◽  
Sebastian T. Lugg
Keyword(s):  
Case Report ◽  
Thromboembolic Event ◽  
Pulmonary Emboli ◽  
Shortness Of Breath ◽  
Foramen Ovale ◽  
Case Presentation ◽  
Stroke Etiology ◽  
The One ◽  
D Dimer

Abstract Background The coronavirus disease (COVID-19) pandemic has led to an unprecedented worldwide burden of disease. However, little is known of the longer-term implications and consequences of COVID-19. One of these may be a COVID-19 associated coagulopathy that can present as a venous thromboembolism (VTE) and further, as multiple paradoxical cerebral emboli. Case presentation A 51 year old man presented to the emergency department with multiple simultaneous embolic cerebral infarctions 11 months after mild COVID-19. In the subacute phase of the COVID-19 illness the patient developed increasing shortness of breath and was found to have an elevated D-dimer and multiple bilateral segmental pulmonary emboli. He was subsequently treated with 3 months of anticoagulation for a provoked VTE. The patient then presented 11 months after the initial COVID-19 diagnosis with multiple simultaneous cerebral infarctions where no traditional underlying stroke etiology was determined. A patent foramen ovale (PFO) and an elevated D-dimer were found suggesting a paradoxical thromboembolic event due to an underlying coagulopathy. Conclusions This case report highlights the one of the potentially more serious complications of long-term COVID-19 where VTE due to a persistent coagulopathy is seen almost a year after the initial illness. Due to the highly prevalent nature of PFO in the general population, VTE due to COVID-19 associated coagulopathy could lead to ischemic stroke. This case report highlights the possibility for an underlying COVID-19 associated coagulopathy which may persist for many months and beyond the initial illness.

scholarly journals Multiple Simultaneous Embolic Cerebral Infarctions 11 Months After COVID-19

2021 ◽  
Author(s):  
Rajiv Advani ◽  
Torbjørn Austveg Strømsnes ◽  
Espen Stjernstrøm ◽  
Sebastian Thomas Lugg
Keyword(s):  
Case Report ◽  
Thromboembolic Event ◽  
Pulmonary Emboli ◽  
Shortness Of Breath ◽  
Foramen Ovale ◽  
Case Presentation ◽  
Stroke Etiology ◽  
The One ◽  
D Dimer

Abstract BackgroundThe coronavirus disease (COVID-19) pandemic has led to an unprecedented worldwide burden of disease. However, little is known of the longer-term implications and consequences of COVID-19. One of these longer-term complications is a COVID-19 associated coagulopathy that can present as a venous thromboembolism (VTE) and, as yet unreported, multiple paradoxical cerebral emboli. Case PresentationA 51 year old man presented to the emergency department with multiple simultaneous embolic cerebral infarctions 11 months after mild COVID-19. In the subacute phase of the COVID-19 illness the patient developed increasing shortness of breath and was found to have an elevated D-dimer and multiple bilateral segmental pulmonary emboli. He was subsequently treated with 3 months of anticoagulation for a provoked VTE. The patient then presented 11 months after the initial COVID-19 diagnosis with multiple simultaneous cerebral infarctions where no traditional underlying stroke etiology was determined. A patent foramen ovale (PFO) and an elevated D-dimer were found indicating a paradoxical thromboembolic event due to an underlying coagulopathy. ConclusionsThis case report highlights the one of the potentially more serious complications of long-term COVID-19 where VTE due to a persistent coagulopathy is seen almost a year after the initial illness. Due to the highly prevalent nature of PFO in the general population, VTE due to COVID-19 associated coagulopathy could lead to ischemic stroke. This case report therefore highlights the challenge posed by the underlying COVID-19 associated coagulopathy which can persist for many months and beyond from the initial illness.

scholarly journals Multiple anatomic sites of infarction in a pediatric patient with M. pneumoniae infection, a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Devon W. Hahn ◽  
Claire E. Atkinson ◽  
Matthew Le
Keyword(s):  
Back Pain ◽  
Case Report ◽  
Complement Cascade ◽  
Pulmonary Emboli ◽  
Extensive Investigation ◽  
Case Presentation ◽  
First Case ◽  
Extensive Involvement ◽  
Venous Thromboses

Abstract Background Although M. pneumoniae (M. pneumoniae) infections have been associated with various extrapulmonary manifestations, there have been very few documented cases of thrombotic events in pediatrics, and none to our knowledge with such extensive involvement as the patient described here. We aim to contribute to the urgency of discovering the mechanism of the coagulopathy associated with M. pneumoniae infections. Case presentation This 10-year-old boy was admitted after 2 weeks of fever, sore throat, worsening cough, and progressive neck and back pain. During hospitalization, he developed clots in several different organs: bilateral pulmonary emboli, cardiac vegetations, multiple splenic infarcts, and deep venous thromboses in three of four extremities. He was treated with long-term antibiotics and anticoagulation, and fully recovered. Conclusions This is the first case known to us of a child with an extensive number of thrombotic events in multiple anatomic sites associated with M. pneumoniae infection. The mechanism by which M. pneumoniae infection is related to thrombotic events is not fully understood, but there is evidence that the interplay between the coagulation pathways and the complement cascade may be significant. This patient underwent extensive investigation, and was found to have significant coagulopathy, but minimal complement abnormalities. By better understanding the mechanisms involved in complications of M. pneumoniae infection, the clinician can more effectively investigate the progression of this disease saving time, money, morbidity, and mortality.

scholarly journals Phenylketonuria and juvenile idiopathic arthritis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ting Ting Zhu ◽  
Jin Wu ◽  
Li Yuan Wang ◽  
Xiao Mei Sun
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Case Report ◽  
Autoimmune Diseases ◽  
Hip Joint ◽  
Metabolic Disorder ◽  
Rare Case ◽  
Molecular Data ◽  
Methotrexate Therapy ◽  
Case Presentation

Abstract Background Phenylketonuria (PKU) is a genetic metabolic disorder in which patients have no ability to convert phenylalanine to tyrosine. Several autoimmune diseases have been reported to combine with PKU, co-existent of PKU and Juvenile Idiopathic Arthritis (JIA) has not been presented. Case presentation The girl was diagnosed with PKU at the age of 1 month confirmed by molecular data. At the age of 3.5 years, she presented with pain and swelling of her right ankle, right knee, and right hip joint. After a serial of examinations, she was diagnosed with JIA and treated with a nonsteroidal anti-inflammatory drug. Conclusions We report a rare case of a 4-year-old girl with PKU and JIA, which supports a possible interaction between PKU and JIA. Long-term metabolic disturbance may increase the susceptibility to JIA. Further chronic inflammation could alter the metabolism of tryptophan and tyrosine to increase blood Phe concentration. In addition, corticosteroid and methotrexate therapy for JIA may increase blood Phe concentration.

D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale

2015 ◽  
Vol 114 (09) ◽  
pp. 614-622 ◽  
Author(s):  
Young Dae Kim ◽  
Dongbeom Song ◽  
Hyo Suk Nam ◽  
Kijeong Lee ◽  
Joonsang Yoo ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Patent Foramen Ovale ◽  
Pulmonary Thromboembolism ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Stroke Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
D Dimer

SummaryPatent foramen ovale (PFO) is a potential cause of cryptogenic stroke, given the possibility of paradoxical embolism from venous to systemic circulation. D-dimer level is used to screen venous thrombosis. We investigated the risk of embolism and mortality according to the presence of PFO and D-dimer levels in cryptogenic stroke patients. A total of 570 first-ever cryptogenic stroke patients who underwent transesophageal echocardiography were included in this study. D-dimer was assessed using latex agglutination assay during admission. The association of long-term outcomes with the presence of PFO and D-dimer levels was investigated. PFO was detected in 241 patients (42.3 %). During a mean 34.0 ± 22.8 months of follow-up, all-cause death occurred in 58 (10.2 %) patients, ischaemic stroke in 33 (5.8 %), and pulmonary thromboembolism in 6 (1.1 %). Multivariate Cox regression analysis showed that a D-dimer level of > 1,000 ng/ml was an independent predictor for recurrent ischaemic stroke in patients with PFO (hazard ratio 5.341, 95 % confidence interval 1.648–17.309, p=0.005), but not in those without PFO. However, in patients without PFO, a D-dimer level of > 1,000 ng/ml was independently related with all-cause mortality. The risk of pulmonary thromboembolism tended to be high in patients with high D-dimer levels, regardless of PFO. Elevated D-dimer levels in cryptogenic stroke were predictive of the long-term outcome, which differed according to the presence of PFO. The coexistence of PFO and a high D-dimer level increased the risk of recurrent ischaemic stroke. The D-dimer test in cryptogenic stroke patients may be useful for predicting outcomes and deciding treatment strategy.

scholarly journals Penetrating Orbitocranial Injury With a Good Aesthetic and Functional Outcome: A Case Report

2021 ◽  
Vol 7 (1) ◽  
pp. 61-66
Author(s):  
Youssef Fahde ◽  
◽  
Davis Mpando ◽  
Mehdi Laghmari ◽  
Houssine Ghannane ◽  
...  
Keyword(s):  
Case Report ◽  
Multidisciplinary Approach ◽  
Violent Behavior ◽  
Case Presentation ◽  
Frontal Horn ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Life Threatening

Background and Importance: Transorbitocranial assaults with sharp objects like a knife are rare neuro-ophthalmologic emergencies. However, they can have dramatic functional and life-threatening consequences. Our presentation aims to report the importance of an urgent multidisciplinary approach and to raise awareness among the general population on the importance of preventing violent behavior. Case Presentation: A 33-year-old man was a victim of a knife attack without obvious brain or ophthalmological lesions. The knife entered the medial part of the orbit. Neurological examination was normal, and Computed Tomography (CT) scan showed intracranial trajectory through the orbit to the frontal horn of the lateral ventricle. The knife was extracted without complications. The patient reported spectacular improvement in visual acuity without neurological or oculomotor deficit at long-term follow-up. In this case report, we will discuss the radiological diagnosis and surgical management of transorbital and orbitocranial injuries by foreign body penetration. Conclusion: Urgent multidisciplinary management in orbitocranial trauma by stabbing is mandatory to avoid life-threatening complications and irreversible damages.

scholarly journals Combining Techniques to Treat Isolated Deep Recession-Type Defects: A Case Report with Long-Term Stability

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
João Carnio ◽  
Anna Tereza Carnio
Keyword(s):  
Case Report ◽  
Root Coverage ◽  
Case Presentation ◽  
Term Stability ◽  
Long Term Stability ◽  
Dental Procedures ◽  
Donor Area ◽  
Deep Recession

Introduction. The purpose of this case report was to show the clinical long-term stability of a successful two-step root coverage procedure. A combination of two single techniques was used to treat an isolated deep-wide defect. Case Presentation. A 28-year-old female patient was referred in order to treat a single recession defect at #22. Due to her fear of dental procedures and a poor economic situation, the team developed an alternative solution. They used a modified apically repositioned flap (MARF) to increase the donor area and then a laterally positioned flap (LPF) to treat the root defect. Clinical evaluation at the three-year follow-up revealed complete resolution of the defect, a gain in clinical attachment, excellent esthetic results, and minor morbidity to the patient. Conclusion. The combination of the MARF and the LPF procedures was able to successfully treat a single deep recession defect with some advantages over traditional techniques such as simplicity, ideal color match of tissues, and the absence of palatal donor tissue.

Fructose-1,6-Bisphosphatase Deficiency: A Pediatric Case Report

2021 ◽  
Author(s):  
jiaying cao ◽  
lu xu ◽  
jiahua pan
Keyword(s):  
Case Report ◽  
Glucose Metabolism ◽  
Compound Heterozygote ◽  
Metabolic Decompensation ◽  
Pediatric Case ◽  
Case Presentation ◽  
Fructose 1,6 Bisphosphatase ◽  
Chromosome 9Q22 ◽  
Bisphosphatase Deficiency

Abstract Background: Fructose-1,6-bisphosphatase (FBPase) deficiency is a rare disorder of glucose metabolism, mainly revealed by hypoglycemia and lactic acidosis. The disease is caused by a mutation of FBP1 gene, which is clustered in a 31-kb region on chromosome 9q22. Case presentation: We described a two-and-half-year-old boy diagnosed as FBPase deficiency. The result of gene analysis showed that the patient had a compound heterozygote for the G164S and P308R, respectively inherited from his father and mother. To some degree, mutations are associated with activity of enzyme, which is corresponding to the level of glucose and extent of brain damage. Patients are advised to reduce intake of fructose and sucrose and avoid long-term fasting in order to reduce the risk of metabolic decompensation. Conclusions: This report would like to provide profound insights of FBPase deficiency.

scholarly journals Percutaneous Balloon Pericardiotomy (PBP) Revisited: A Case Report and Review of Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Raed Aqel ◽  
Muawiyah Elqadi ◽  
Ahmad Hammouri ◽  
Mohammad S. Alqadi
Keyword(s):  
Case Report ◽  
Pericardial Effusion ◽  
Stage Iv ◽  
Shortness Of Breath ◽  
Review Of Literature ◽  
Pericardial Window ◽  
Severe Respiratory Distress ◽  
Case Presentation ◽  
Percutaneous Balloon ◽  
Recurrent Pericardial Effusion

Background. A Percutaneous Balloon Pericardiotomy (PBP) procedure is a reemerging nonsurgical technique that helps in preventing the reaccumulation of pericardial effusion. It is done percutaneously without general anaesthesia. It has been proved to be effective in alleviating and preventing recurrent pericardial effusion. Case Presentation. We reported a 52-year-old male with stage IV adenocarcinoma causing recurrent pericardial effusion. The patient experienced a worsening shortness of breath. A surgical pericardial window was denied by the surgery team secondary to severe respiratory distress; subsequently, the patient underwent Percutaneous Balloon Pericardiotomy. Conclusion. Percutaneous Balloon Pericardiotomy is efficacious and safe when done by well-trained physicians. We think it should be considered as a preferred treatment modality in most sicker patients with recurrent pericardial effusion.

Early Recurrence of an Infantile Endodermal Oculomotor Nerve Cyst following Surgical Fenestration: A Case Report

2021 ◽  
Vol 56 (2) ◽  
pp. 157-162
Author(s):  
Victor M. Lu ◽  
Aditya Raghunathan ◽  
Michael J. Link ◽  
David J. Daniels
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Early Recurrence ◽  
Oculomotor Nerve ◽  
Rare Entity ◽  
Oculomotor Palsy ◽  
Case Presentation ◽  
Postoperative Course

Introduction: Infantile endodermal oculomotor nerve cyst (EONC) is an extremely rare entity. There are very few pediatric cases reported in the literature, and as expected, oculomotor palsy is the most common presenting symptom. To date however, the risk of recurrence of these lesions following surgical intervention is unclear due to a lack of long-term radiological follow-up. Case Presentation: We present a case of a 13-month-old male patient with an EONC and detail his surgical fenestration and postoperative course. Somewhat surprisingly, re-expansion occurred within 6 months and remained stable 2 years later. Discussion: A surgical approach to fenestration of an EONC in an infant is possible and should be performed by an expert neurosurgeon. Early recurrence is underreported in the current literature, and we encourage longer term radiological surveillance of these lesions after surgery to optimize primary and recurrent management in the future.

scholarly journals Long‐term recurrence and brain metastasis of nasopharyngeal carcinoma mimicking cystic radiation encephalopathy relapse: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuhui Chen ◽  
Lijie Ren ◽  
Guozhen Qiu ◽  
Liming Cao
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Case Report ◽  
Nasopharyngeal Carcinoma ◽  
Brain Metastasis ◽  
Skull Base ◽  
Case Presentation ◽  
Radiation Encephalopathy ◽  
The Right

Abstract Background During medical imaging, cystic radiation encephalopathy and brain metastasis are difficult to differentiate, and hence they are easily misdiagnosed. To our knowledge, a nasopharyngeal carcinoma recurrence after more than seven years with cerebral metastasis that mimicked cystic radiation encephalopathy has not been reported. Case presentation A 52-year-old man was admitted to the hospital owing to weakness of the right limb for one month, which increased in intensity for three days. He had been diagnosed with nasopharyngeal carcinoma in 2011, which was treated by radiotherapy. The patient successively developed cystic radiation encephalopathy and brain metastasis from the nasopharyngeal carcinoma, which mimicked cystic radiation encephalopathy relapse. Left frontotemporal craniotomy, surgical resection of brain metastasis, and repair of the skull base and dura were performed. Postoperative computed tomography showed that midline deviation recovered, and brain edema was reduced. Conclusions This report is significant because brain metastasis from nasopharyngeal carcinoma can masquerade as a benign entity and cause fatal consequences. In patients presenting with cystic radiation encephalopathy, brain metastasis should be considered as a differential diagnosis.

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