scholarly journals Hemifacial spasm is not affected by state of consciousness: a case report

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Tao Li ◽  
Zhuo Feng ◽  
Chunli Song ◽  
Zhanhua Liang
Keyword(s):  
Hemifacial Spasm ◽  
Past History ◽  
Correct Diagnosis ◽  
Vital Signs ◽  
Respiratory Arrest ◽  
Disturbance Of Consciousness ◽  
Multidisciplinary Consultation ◽  
Life Threatening ◽  
The Right ◽  
Botulinum Toxin Injections

Abstract Background  Hemifacial spasm (HFS) is a movement disorder caused by mechanical compression of the facial nerve after it has left the brainstem and is characterized by brief or sustained twitching of the muscles innervated by that nerve. Often we observe spasm in an awakening situation. Actually contractions persist during sleep. To our knowledge, there were no reports on how HFS manifests under disturbance of consciousness. Here, we report a case of primary HFS in which the patient's symptoms persisted in a coma. Case presentation A 74-year-old female with right-sided primary HFS for 20 years and had received botulinum toxin injections in our hospital. Unfortunately she was carried to emergency department after traumatic right pneumothorax by accident. During the emergency treatment, she lost consciousness due to simultaneous cardiac arrest and respiratory arrest. She was then admitted to the emergency intensive care unit for further treatment. During her hospitalization, she was in a coma with stable vital signs and persisting symptoms of HFS. Thus, a multidisciplinary consultation was requested to identify whether it was focal cortical seizures involving the right-side facial muscles. Physical examination revealed brief involuntary clonic or tonic contractions accompanied with the ‘Babinski-2 sign’. A combination of relevant data, including her past history, clinical presentation and a negative computed tomography scan of the head, led to a diagnosis of right-sided HFS. As the symptoms of HFS are not life-threatening, the use of anticonvulsants is unnecessary. Conclusions For the layperson, it is crucial to seek a multidisciplinary consultation to obtain a correct diagnosis.

scholarly journals Symptom of Hemifacial Spasm Is Not Affected By State of Consciousness: A Case Report

2021 ◽  
Author(s):  
Tao Li ◽  
Zhuo Feng ◽  
Chunli Song ◽  
Zhanhua Liang
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Past History ◽  
Botulinum Toxin Injection ◽  
Vital Signs ◽  
Emergency Rescue ◽  
Disturbance Of Consciousness ◽  
Computed Tomography Scanning ◽  
Nerve Nucleus ◽  
The Right

Abstract Background: Hemifacial spasm is characterised by twitching of the muscles innervated by facial nerve. It is believed to result from hyperexcitability of the facial nerve nucleus or ephaptic transmission within the proximal facial nerve segment of the facial nerve nucleus. Often we observe spasm in an awakening situation. Actually contractions persist during sleep. To our knowledge, there were no reports on how it manifests under disturbance of consciousness. Herein we report a case whose symptoms sustained under coma status.Case presentation: A 74-year-old female suffered from right side primary hemifacial spasm for 20 years and used to accept botulinum toxin injection in our clinic. Unfortunately she was carried to emergency department in our hospital after traumatic right pneumothorax by accident. During emergency rescue cardiac arrest and apnea happened. She was then hospitalized in emergency intensive care unit for further therapy. During hospitalization, she was under coma status. Vital signs were stable and symptoms of hemifacial spasm sustained. A multidisciplinary consultation was request to identify whether it was focal cortical seizures involving the right side facial muscles. Physical examination revealed brief involuntary clonic or tonic contractions accompanied with the ‘Babinski-2’ sign. Synthesize the relevant data including past history, clinical manifestation and negative head computed tomography scanning, diagnosis was made as hemifacial spasm. Herein symptoms of hemifacial spasm were not life threatening and anti-epileptic drug was not necessary.Conclusions: It’s better for nonspecialists to prompt diagnose instead of under or misdiagnose the symptoms as seizures as inappropriate diagnostic or therapeutic measures may be taken inadvertently.

scholarly journals A Painful Shoulder Revealing Langerhans Cell Histiocytosis

2020 ◽  
pp. 24-27
Author(s):  
N. A. R. Ranaivo ◽  
M. L. Rakotomahefa Narison ◽  
M. Bemena ◽  
S. H. Raobijaona
Keyword(s):  
Langerhans Cell Histiocytosis ◽  
Clinical Presentation ◽  
Bone Lesion ◽  
Langerhans Cell ◽  
Irregular Boundary ◽  
X Ray ◽  
Multidisciplinary Consultation ◽  
Life Threatening ◽  
Spontaneous Improvement ◽  
The Right

Introduction: Langerhans cell histiocytosis is a systemic proliferative disease. It is a rare disease that can affects all tissues. Evolution can be spontaneously favorable. Multi-organ involvement may be life-threatening. We report the case of an toddler with bone lesion and issues. Case Report: It was a 33-month-old infant with right shoulder pain. Clinically, she had a swelling in the front side of the right shoulder with a limited abduction. X-ray of the right shoulder showed osteolysis with an irregular boundary of the right humeral head. The blood work was normal. In view of the painful swelling of the right shoulder, a biopsy was performed. Histological examination confirmed the diagnosis of Langerhans histiocytosis. A conservative treatment was decided after a multidisciplinary consultation meeting. After six months, spontaneous improvement was noted. Conclusion: Langerhans cell histiocytosis is a proliferative pathology that can affect one or more organs. The clinical presentation is polymorphic according to the affected organ. An extension assessment is fundamental in the management in order to determine the treatment.

Introduction to Perioperative Cardiac Urgencies and Emergencies

2017 ◽  
Author(s):  
Jason B. O’Neal ◽  
Andrew Shaw
Keyword(s):  
Cardiac Arrest ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Vital Signs ◽  
Specific Treatment ◽  
Perioperative Period ◽  
Major Life ◽  
Life Threatening ◽  
Treatment Plans ◽  
Suitable Treatment

Cardiac arrest in the perioperative period is distinct from cardiac arrest in other scenarios, given that the event is typically witnessed and real-time vital signs are often being monitored. Additionally, having a mental framework by which to consider and refine the differential diagnosis is paramount, as this then guides the selection of a suitable treatment plan. However, in order to establish the correct diagnosis, one must have an adequate understanding of normal cardiac physiology, of cardiovascular pathology, and the ways in which this may adversely affect cardiac function. This chapter provides an overview of how to approach the patient with cardiovascular instability. Subsequent chapters in this section discuss specific treatment plans for the major life-threatening pathophysiologies one could encounter.

Clinical picture and risk factors of occurrence of pulmonary artery thromboembolism

2021 ◽  
pp. 34-38
Author(s):  
Roman Petrovich Stepchenkov
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Thromboembolism ◽  
Correct Diagnosis ◽  
Vascular Wall ◽  
Fat Embolism ◽  
Shortness Of Breath ◽  
Sharp Pain ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Right

Pulmonary artery thromboembolism (PATE) is a life-threatening condition in which the pulmonary artery or its branches are occluded by a detached thrombus (embolus). In this case, a thrombus can form both on the walls of blood vessels and directly in the right ventricle or atrium; in some cases, air or fat embolism may occur. The most common cause of pulmonary thromboembolism are thrombi that appear in the vessels of the lower extremities and migrate upward; a particular danger are floating thrombi, which attach to the vascular wall with one «leg» and can easily come off when coughing or exercising. Pulmonary embolism occurs in 1 case per 1000 patients, is observed mainly in adults and has a high mortality rate. There are no specific signs, characteristic of this particular pathology. Patients may have a sharp pain behind the sternum of a pleuritic nature, sudden shortness of breath, tachycardia, sometimes a cough with hemoptysis; precollaptoid state or even loss of consciousness may occur. Correct diagnosis is of utmost importance for the timely provision of emergency care. To make a diagnosis, pulse oximetry, chest radiography, CT angiography, and duplex or triplex angioscanning are used. In case of untimely provision of medical care, mortality in this condition can reach 50 %.

scholarly journals Congenital absence of the right coronary artery with acute myocardial infarction: report of two cases and review of the literature

2020 ◽  
Vol 48 (12) ◽  
pp. 030006052097150
Author(s):  
Zhongbo Chen ◽  
Jinhua Yan ◽  
Xiaorong Han ◽  
Binay Kumar Adhikari ◽  
Jin Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Correct Diagnosis ◽  
Congenital Absence ◽  
Clinical Complications ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
The Right

Congenital absence of the right coronary artery (RCA) is a rare coronary anomaly. Few cases of this condition have been reported. Congenital absence of the RCA is considered as a benign anomaly. However, in certain cases, these patients may develop life-threatening clinical complications that include acute myocardial infarction, stroke, or sudden death. We report two patients who were diagnosed with congenital absence of the RCA and presented with acute myocardial infarction. We discuss our experience in diagnosis and treatment of this disease. Congenital absence of the RCA with acute myocardial infarction is an uncommon clinical emergency. Therefore, early detection, correct diagnosis, and appropriate treatment are important.

scholarly journals Serological Parameters and Vascular Investigation for a Better Assessment in DVT during Pregnancy—A Systematic Review

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 160
Author(s):  
Catalina Filip ◽  
Demetra Gabriela Socolov ◽  
Elena Albu ◽  
Cristiana Filip ◽  
Roxana Serban ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Correct Diagnosis ◽  
Thrombotic Event ◽  
Vein Thrombosis ◽  
Major Consequence ◽  
Life Threatening ◽  
The Right ◽  
Deep Vein

Pregnancy and the postpartum period represent a condition characterized by a thrombotic predisposition. The majority of pregnant women do not face acute or severe thrombotic events. In general, mild inconveniences such as leg swelling or moderately painful thrombotic events (phlebitis) are encountered. However, when pregnancy is associated with inherited or acquired deficits that affect homeostasis, the risk of acute or even life-threatening events can increase significantly. The major consequence is the loss of the fetus or the venous thromboembolism that endangers the mother’s life. Venous thromboembolism is caused by deep vein thrombosis, therefore timely detection and especially the assessment of the extent of the thrombotic event are crucial. In this paper we have summarized the most important paraclinical investigations. The study emphasizes the importance of selecting the methods of investigation. The right choice allows establishing a correct diagnosis and individualizing the treatment.

scholarly journals Brain Abscess of Dental Origin: A Case Report and Literature Review

2021 ◽  
pp. 1-5
Author(s):  
Selmi wissal ◽  
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Brain Abscess ◽  
Correct Diagnosis ◽  
Final Diagnosis ◽  
Oral Infections ◽  
Pubmed Database ◽  
Dental Origin ◽  
Life Threatening ◽  
The Right

Introduction: Brain abscess (BA)of dental origin is a rare but potentially life-threatening complication of odontogenic infection that requires immediate neurosurgical attention. It is defined as an encapsulated collection of pus in various areas of the brain. The infectious process spreads from the dental site and occurs in 2 ways: haematogenous route or by contiguity. Treatment should ideally be based on the etiological factor excision, combined with drainage and adjuvant antibiotic therapy. The aim of this article was to report a case of frontal brain abscess of dental origin and to review the literature. Case report: We present the case of a 36-year-old man diagnosed with a brain abscess located in the frontal lobe and caused by a periodontal lesion of the right upper first molar. The final diagnosis was established due to the availability of computed tomography and magnetic resonance imaging. Drainage of the pus combined with extraction of the tooth and antibiotic therapy was followed by an excellent recovery. Clinical and radiological features, treatment and follow-up data were documented. A review of the literature using the PubMed database was performed Conclusion: Oral infections can lead to life-threatening infections, such as brain abscesses. Early detection of this condition through correct diagnosis is essential to give the patient the best treatment; in addition, improving of the oral environment and treating oral infections is highly recommended to limit this serious condition.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Dry Needling Can Be An Alternative Treatment for Hemifacial Spasm

2020 ◽  
Vol 6 (2) ◽  
pp. 20-28
Author(s):  
Selly Marisdina ◽  
Henry Sugiharto ◽  
A Pradian
Keyword(s):  
Botulinum Toxin ◽  
Hemifacial Spasm ◽  
Alternative Treatment ◽  
Epidemiological Data ◽  
Clinical Severity ◽  
Decompression Surgery ◽  
Dry Needling ◽  
Significant Difference ◽  
Microvascular Decompression Surgery ◽  
Botulinum Toxin Injections

Back Ground: Hemifacial spasm is one of movement disorder case that commonly found in daily clinical practice. Epidemiological data are very limited, the average prevalence is 11 per 100,000 population, 14.5 per 100,000 in women and 7.4 per 100,000 in men. In Germany, the estimated prevalence is 8000 to 9000 peoples.1 The incidence of women is more than that of men with a ratio of 2:1. Based on Yaltho and Jankovic study in 2011, out of 215 patients, the ratio of men to women was 1:1.8.2 One study in Indonesia also reported that most of the subjects were female (64.7%).3 Treatment with botulinum toxin injections is preferred to microvascular decompression surgery therapy, but this injection is only effective in a few months and quite expensive. This study is the first study to assess the effectiveness of dry needling on clinical improvement of hemifacial spasm compared to standard therapy of botulinum toxin injection.Methods: The study design was quasi experimental. Total of 24 subjects were divided into two groups. The first group underwent dry needling intervention while the other had botulinum injection. Clinical severity before and after treatment in both groups was assessed using Jankovic and HFS7 scores.Results: In dry needling group there were significant differences between Jankovic and HFS7 score at baseline and at week 1, 2, 3 and 4. While in botox group significant differences were also Jankovic and HFS7 score at baseline and at weeks 2 and 4. There were also a significant difference of Jankovic and HFS7 score when we compared dry needling group to botulinum toxin group.Conclusion: Dry needling can be an alternative treatment for hemifacial spasm, although clinical improvements based on Jankovic and HFS7 scores in dry needling group were not as effective as those with botulinum toxin injections.

Clinical Case: Complications after Endovascular Treatment of Intracranial Aneurysm in a Patient after Subarachnoid Hemorrhage

2020 ◽  
Vol 8 (1) ◽  
pp. 9-15
Author(s):  
Petrov Nikolay ◽  
◽  
Marinova R. ◽  
Odiseeva Ev.
Keyword(s):  
Intracranial Aneurysm ◽  
Endovascular Treatment ◽  
Clinical Case ◽  
Endovascular Coiling ◽  
Published Data ◽  
Military Medical Academy ◽  
Life Threatening ◽  
Arachnoid Hemorrhage ◽  
The Right ◽  
Brain Artery

Abstract: Intracranial aneurysm is one of the most common neurovascular complications. During the recent years the accepted treatment of enraptured cranial aneurysm is noninvasive endovascular coiling. This technique is modern but it is not without complications which can be serious and life-threatening. A clinical case of a patient admitted to the ICU of Military Medical Academy - Sofia with sub arachnoid hemorrhage is described. After a positive clinical course, the check-up magnetic resonance showed intracranial aneurism of the right carotid artery. The patient underwent angiographic endovascular treatment. Vasospasm of the middle and right brain artery and thrombosis were detected during the procedure. Attempt of thromboaspiration was made without success. This article reviews published data on broad-spectrum researches concerning complications of endovascular coiling of intracranial aneurysms and the ways to prevent and reduce them.

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