Hyperglycemic Hyperosmolar Syndrome Presenting with Unique Craniofacial Involuntary Movements

2020 ◽  
pp. 10.1212/CPJ.0000000000001004
Author(s):  
Manu Santhappan Girija ◽  
Ravi Yadav ◽  
Atchayaram Nalini ◽  
Jagadish Annapureddy ◽  
Manisha Gupta ◽  
...  
Keyword(s):  
Tactile Stimulus ◽  
Motor Neuropathy ◽  
Upper Limbs ◽  
Oromandibular Dystonia ◽  
Neck Extension ◽  
Abnormal Movements ◽  
History Of ◽  
The Right ◽  
Hyperglycemic Hyperosmolar Syndrome

A 54-year-old man, with a twenty-five year history of poorly controlled type 2 diabetes mellitus, presented with 4 days of abnormal movements of the right side of face precipitated by tactile stimulus over his face, upper limbs and trunk. His physical examination revealed right hemifacial spasm precipitated by auditory and tactile stimulus, opsoclonus, blepharospasm, oromandibular dystonia, perioral tremor and myoclonic jerks involving the head and neck particularly triggered by neck extension (video 1,http://links.lww.com/CPJ/A222). The patient also had features of a chronic distal sensory motor neuropathy. He had been unable to take food for nearly 72 hours due to jaw closure dystonia and had developed starvation ketosis.

Parasagittal meningioma: A not so benign entity

2017 ◽  
Vol 57 (4) ◽  
pp. 175-178 ◽  
Author(s):  
Roger W Byard
Keyword(s):  
Neurofibromatosis Type ◽  
Lethal Effect ◽  
Precentral Gyrus ◽  
Unexpected Death ◽  
Comfort Care ◽  
Posterior Displacement ◽  
History Of ◽  
The Right ◽  
Parasagittal Meningioma

While the majority of intracranial meningiomas have an indolent clinical course, sudden and unexpected death may rarely occur. Two cases are reported to demonstrate rapid clinical deterioration resulting in death in individuals with large, grade I, parasagittal meningiomas. Case 1 was a 46-year-old man with a history of headaches and epilepsy who suddenly collapsed and died. A large right frontal parasagittal meningioma with haemorrhage had compressed the brain and lateral ventricle, causing tonsillar herniation. In case 2, a previously well 83-year-old woman presented with a one-week history of progressive dysphagia and dysphasia. She suffered rapid deterioration and was prescribed comfort care. A right-sided parasagittal meningioma had compressed the right superior and middle frontal gyri with posterior displacement and compression of the right precentral gyrus. If a meningioma is found at autopsy, the possibility of a lethal effect should be considered, and evidence of neurofibromatosis type 2 or other associated heritable conditions checked for.

Spontaneous Closure of a Macular Hole in Macular Telangiectasia Type 2

2020 ◽  
pp. 247412642095890
Author(s):  
Varun Chandra ◽  
Rohan Merani ◽  
Alex P. Hunyor ◽  
Mark Gillies
Keyword(s):  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Spontaneous Closure ◽  
Full Thickness ◽  
External Limiting Membrane ◽  
Macular Telangiectasia ◽  
History Of ◽  
Macular Telangiectasia Type 2 ◽  
The Right

Purpose: Spontaneous closure of a macular hole in macular telangiectasia type 2 (MacTel) with vision improvement is described. Methods: A case report is presented. Results: A 71-year-old man presented with a 1-week history of distorted vision in his left eye. Left visual acuity (LVA) was 20/80. Optical coherence tomography showed an almost full-thickness left macular hole with an intact internal limiting membrane drape. Small inner retinal cavitations were present at the right macula; multimodal imaging confirmed MacTel. Managed conservatively, at 5 months the patient’s LVA had improved to 20/60, the defect was no longer full thickness, and the external limiting membrane had reconstituted. At the right macula, the inner cavitations grew and outer cavitations developed, but the external limiting membrane remained intact. At 32 months, right VA was 20/20 and LVA was 20/40. Conclusions: This case of MacTel with spontaneous closure of a macular hole was associated with an overlying internal limiting membrane drape.

scholarly journals Reactivation of Acute Retinal Necrosis following SARS-CoV-2 Infection

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Monica P. Gonzalez ◽  
Radames Rios ◽  
Mariella Pappaterra ◽  
Miguel Hernandez ◽  
Allison Toledo ◽  
...  
Keyword(s):  
Vision Loss ◽  
Acute Retinal Necrosis ◽  
Pcr Analysis ◽  
Prior History ◽  
Ophthalmological Examination ◽  
History Of ◽  
Polymerase Chain ◽  
Simplex Virus ◽  
The Right

Purpose. To report on a case of reactivation of acute retinal necrosis following SARS-CoV-2 infection. Methods. Observational case report. Observations. A 32-year-old female with a distant history of left retinal detachment secondary to necrotizing herpetic retinitis complained of right-eye vision loss, pain, redness, and photophobia. An ophthalmological examination revealed findings consistent with acute retinal necrosis of the right eye. A polymerase chain reaction (PCR) analysis of the right vitreous was positive for herpes simplex virus type 2 (HSV-2). A coronavirus disease 2019 (COVID-19) screening test using reverse transcriptase- (RT-) PCR was positive for SARS-CoV-2 RNA. Conclusions. Our case suggests that COVID-19 may cause a latent HSV infection to reactivate, causing contralateral involvement in patients with a prior history of HSV-associated acute retinal necrosis.

scholarly journals MON-621 Prescription Analysis Shows High Metformin Use and Acceptance in a Diabetes Specialty Centre in Eastern India

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sanat Kumar Mishra ◽  
Susant Mishra ◽  
Abhay Kumar Sahoo ◽  
Rajesh Kumar Padhi ◽  
Biswaranjan Jena ◽  
...  
Keyword(s):  
Inclusion Criteria ◽  
Type 2 Diabetics ◽  
Daily Dose ◽  
History Of ◽  
Study Population ◽  
Artery Disease ◽  
The Individual ◽  
The Right ◽  
Type 2 Diabetic

Abstract Background and aims: Achieving glycemic goals is crucial in the overall management of diabetes. Selecting the right medication for the individual patient is of paramount importance in the present day’s patient centric glucose control. Metformin is the first line and gold standard antihyperglycemic agent that can be offered to type 2 diabetics. Addition of a second or third agent or insulin should be considered in those whose HbA1c remains high despite the up-regulated metformin dose or those who do not tolerate metformin. We aimed to find the pattern of metformin use in type 2 diabetic subjects in a diabetes specialty centre in coastal Odisha. Materials and methods: This observational study was conducted in a diabetes setup in coastal Odisha in June 2018. After obtaining consent from patients, authors looked into the prescriptions of all type 2 diabetic adults. Subjects who were prescribed metformin (in any dose) were enrolled in the study. Those with established nephropathy, coronary artery disease, stroke or cancers were excluded. Results:There were 802 footfalls noted during the study period, of which 723 metformin taking participants (298 females, 41.2%) were considered for analysis (79 persons were excluded: not meeting inclusion criteria/ not willing to participate/ history of nephropathy/ CAD/ stroke). Mean age, diabetes duration, FPG, HbA1c, serum creatinine, eGFR of the study population were 51.6±10.6 years, 11.9±11.2 years, 138.7±51.7 mg/dl, 7.8±2.1%, 0.93±0.29 mg/dl and 96.5±11.1ml/min respectively. Patients were prescribed metformin in various doses, i.e., 500mg (42 patients, 5.8%), 850mg (47 patients, 6.5%), 1000mg (396 patients, 54.8%), 1500mg (13 patients, 1.8%), 1700mg (86 patients, 11.9%) and 2000mg (130 patients, 18.0%), and 2500mg (9 patients, 1.2%). Metformin was prescribed as monotherapy (n=34, 4.7%) or along with other OADs (n=589, 81.5%) or in combination with insulin (n=178, 24.6%). Retrospective analysis of the medical records and further questioning revealed that gastric intolerance was the commonest reason for withdrawal of metformin in otherwise eligible subjects. Conclusion: Metformin was the most commonly prescribed antidiabetic drug and the daily dose of more than 85% of the metformin administered individuals was 1000mg or above.

THUR 101 SCA-1 with unusual early dysautonomia and delayed cerebellar signs

2018 ◽  
Vol 89 (10) ◽  
pp. A10.3-A10
Author(s):  
d’Ersu Eleanor ◽  
Anwar NurAizaan ◽  
Al-Mayhani Talal ◽  
Sidhu Meneka
Keyword(s):  
Autonomic Dysfunction ◽  
Cerebellar Atrophy ◽  
Intention Tremor ◽  
Initial Examination ◽  
Autonomic Changes ◽  
Unsteady Gait ◽  
History Of ◽  
The Right

A 59-year-old right-handed bus driver presented with gradually worsening erectile dysfunction, urinary frequency and nocturia over 18 months. He had a past medical history of hypertension with regular medications including amlodipine, aspirin and atorvastatin. Initial examination revealed a mild bilateral intention tremor.The patient had undergone brain imaging showing brainstem and cerebellar atrophy with a ‘hot cross bun sign’. The patient was then referred for autonomic function tests that demonstrated mild cardiovascular autonomic changes, and suggested sympathetic dysfunction. A working diagnosis of multiple system atrophy (MSA) was made.Over the next two years, his tremor worsened with the development of slurred speech and unsteady gait. On examination, he had prominent fasciculations and wasting in the right shoulder, severe bilateral intention tremor with past-pointing. In addition he had Parkinsonism and signs of a sensorimotor neuropathy.This atypical clinical evolution with prominent neuropathy and cerebellar signs led to investigations for spinocerebellar ataxia (SCA), particularly type 2 or 3 (given the autonomic dysfunction). However, the genetic testing showed a mutation in ATXN1, confirming a diagnosis of SCA type 1.To our knowledge, this is the first reported case of prominent early autonomic dysfunction associated with SCA type 1.

scholarly journals Splenosis: fetters of the unknown or step through existing precautions (part I)

2020 ◽  
Vol 24 (4) ◽  
pp. 64-73
Author(s):  
N. B. Gubergrits ◽  
A. D. Zubov ◽  
K. N. Borodiy ◽  
T. L. Mozhyna
Keyword(s):  
Detailed Analysis ◽  
Diagnostic Process ◽  
Laboratory Studies ◽  
Imaging Studies ◽  
Palpable Mass ◽  
Anatomy And Physiology ◽  
History Of ◽  
Post Traumatic ◽  
The Right

Aim: to present a rare clinical case of multiple post-traumatic intra-abdominal splenosis in combination with type 2 macroamylasemia, chronic pancreatitis in a 27-year-old woman, clinically manifested like a palpable mass in the right iliac region.Main results. In the first part of the article, a detailed analysis of the medical history is given, the results of archival imaging studies and the data of laboratory and instrumental examination at the time of treatment are presented. The literature review presents modern definitions of splenosis, as well as brief information about the anatomy and physiology of the spleen.Conclusion. The diagnostic process requires a detailed analysis of the history of the disease, the performance of laboratory studies in combination with modern imaging studies, as well as a thorough study of the literature data.

‘Bone within bone appearance’ in a pathological fracture

2020 ◽  
Vol 13 (12) ◽  
pp. e238567
Author(s):  
Sathish Muthu ◽  
Eswar Ramakrishnan ◽  
Girinivasan Chellamuthu
Keyword(s):  
Histopathological Examination ◽  
Subtrochanteric Fracture ◽  
Fracture Site ◽  
The Body ◽  
Diagnostic Dilemma ◽  
History Of ◽  
Similar Appearance ◽  
The Right

A 60-year-old man presented to our hospital with complaints of pain and deformity on his right thigh for the past 2 days following a history of accidental slip and fall. Radiological investigations suggested a pathological type 2 Seinsheimer subtrochanteric fracture of the right femur with a ‘bone within bone’ appearance, which posed a diagnostic dilemma as this radiological appearance is seen in a spectrum of conditions. Radiographic skeletal survey failed to identify a similar appearance elsewhere in the body. Laboratory investigations pointed in favour of bone mineral disease, and histopathological examination of the bone narrowed it down to Paget’s disease. The fracture was fixed with a contralateral distal femur locking compression plate. The fracture site failed to show signs of union until 6 months postsurgery and hence the patient was advised for grafting procedure. The patient deferred surgery and remains without major complications until 18 months of follow-up.

scholarly journals COVID-19 and ST elevations–keep an open mind: a case report

2020 ◽  
Author(s):  
Michael R Kendall ◽  
Sridhar M Reddy ◽  
Laura E Meinke ◽  
Deepak Acharya*
Keyword(s):  
Myocardial Injury ◽  
Left Ventricular ◽  
Clinical State ◽  
Local Hospital ◽  
Normal Left Ventricular ◽  
History Of ◽  
St Elevation ◽  
Artery Disease ◽  
The Right

Abstract Background Coronavirus disease 2019 (COVID-19) has been associated with a range of cardiovascular manifestations, including myocardial injury and thrombo-embolism. Pulmonary embolism (PE) causing anteroseptal/anterior ST elevations that mimic myocardial infarction have previously been described. This phenomenon is thought to be related to right ventricular injury from large emboli. Case summary A 48-year-old woman with history of type 2 diabetes mellitus and hypertension presented to her local hospital with fever, cough, nausea, and dyspnoea. A test for SARS-CoV-2 was taken, and she was discharged with instructions to self-quarantine. She was subsequently notified of a positive SARS-CoV-2 result. Three days later, she re-presented with worsening dyspnoea and respiratory failure requiring intubation. On hospital Day 6, she became acutely hypoxic and hypotensive. Telemetry was noted to have ST changes, prompting ECG that revealed sinus tachycardia with prominent new ST elevations in her precordial leads. Transthoracic echocardiogram showed normal left ventricular function; however, the right ventricle was moderately dilated with positive McConnell’s sign. Due to her unstable clinical state and high suspicion for PE, she was treated with tenecteplase 50 mg i.v. with complete resolution of her ST elevations and improved oxygenation. Discussion Given the high rates of thrombo-embolic events in COVID-19 patients, PE should be in the differential diagnosis of ST elevation, particularly in younger patients with few risk factors for coronary artery disease.

scholarly journals HEMICHOREA-HEMIBALLISMUS INDUCED BY NON-KETOTIC HYPERGLYCEMIA: CASE REPORT

2021 ◽  
Vol 9 (06) ◽  
pp. 610-613
Author(s):  
Mohammed Ajamat ◽  
◽  
Naoufal Assoufi ◽  
Youssouf Benmoh ◽  
Amal Satte ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Rare Complication ◽  
Undiagnosed Diabetes ◽  
Glucose Levels ◽  
Abnormal Movements ◽  
Blood Glucose Levels ◽  
Moroccan Woman ◽  
The Right ◽  
Ketotic Hyperglycemia

Non-ketotic hyperglycemia with hemichorea-Hemiballismus (HGSC) is a rare complication of a non-equilibrated diabetic disease characterized by a continuous rapid, non-rhythmic, involuntary unilateral movement of the extremities, caused in most cases by decreased activity of the contralateral subthalamic nucleus of the basal ganglia. It may reveal undiagnosed diabetes. We describe here the case of an 84-year-old Moroccan woman followed for type 2 diabetes mellitus under treatment, who presented with abnormal movements of the right half-body. Laboratory tests showed higher blood glucose levels, urinary ketones were negative, brain CT without injection showed high density in the basal ganglia on the left side.

scholarly journals Atelectasis: An Uncommon Sign of Achalasia in Childhoo

2021 ◽  
Author(s):  
Aykut Ekşi ◽  
Gökçen Kartal Öztürk ◽  
Gözde Şakul ◽  
Emre Divarcı ◽  
Hüseyin Hüdaver Alper ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Standard Test ◽  
Middle Lobe ◽  
Respiratory Problems ◽  
Breath Sounds ◽  
Bird Beak ◽  
Pediatric Pulmonology ◽  
History Of ◽  
The Right

An 11-year-old boy presented to our pediatric pulmonology clinic with a 3-month history of atelectasis evident on his chest radiography. Breath sounds revealed fine crackles in the right lower zone and rhonchi in the upper zones. His initial pulmonary function test was compatible with restrictive pulmonary disease. Chest tomography revealed that the trachea, right intermediate, and middle lobe bronchi were narrowed by megaesophagus. Esophagogram determined dilatation of the esophagus and “bird-beak” sign in the esophagogastric junction but it was not sufficient to diagnose. Esophageal manometry which is the gold standard test for achalasia was performed and type 2 achalasia was diagnosed. His symptoms improved following Heller myotomy conducted together with Dor fundoplication. Although respiratory problems are more common in infants and younger children, atypical respiratory presentations may also occur during adolescence. Achalasia should be one of the rare differential diagnoses of pediatric restrictive pulmonary disease.

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