Human Herpesvirus 6 in the CSF of a Woman with New Onset Seizures – Encephalitis or Genomic Integration?

2020 ◽  
pp. 10.1212/CPJ.0000000000001024
Author(s):  
Allyson M. Wenner ◽  
Lisa Weitz ◽  
Karoline Ostertag ◽  
Stefan Hubmer ◽  
Elisabeth Springer ◽  
...  
Keyword(s):  
Ct Perfusion ◽  
Human Herpesvirus ◽  
Occipital Lobe ◽  
Time Frame ◽  
Sudden Onset ◽  
Sensory Aphasia ◽  
Headache Onset ◽  
History Of ◽  
Intravenous Alteplase ◽  
Suspected Stroke

A 55-year-old female was referred to the Neurological Center Rosenhuegel with suspected stroke following sudden-onset sensory aphasia preceded by left-sided intermittent, pulsating ear- and headache, nausea, plus an elementary visual hallucination of bright, flashing, white lights. The ear- and headache began abruptly several days prior to arrival and were responsive to ibuprofen. The hallucinatory symptoms began suddenly after headache onset and lasted approximately five minutes. The patient also experienced aphasia immediately following the hallucinatory symptoms and was promptly transferred to the hospital. She had no known history of chronic illness, including migraines, stroke, seizures, or immunosuppression, and denied having fever or recent illness immediately prior to symptom onset. She had not been taking any regular medications, had not traveled recently, and denied alcohol and substance abuse. Family history was insignificant. Sensory aphasia was noted upon arrival at the hospital. A cranial CT-scan ruled out intracranial hemorrhage and CT-perfusion illustrated hyper-perfusion of the left occipital lobe (Figure 1). As the patient was within the appropriate time frame for thrombolytic therapy, she received intravenous alteplase due to suspected stroke and was asymptomatic the next day.

TRANSCORTICAL SENSORY APHASIA AS A MANIFESTATION OF ISCHEMIC STROKE WITH INTRACARDIAC THROMBUS

2021 ◽  
pp. 86-86
Author(s):  
Aziz Ahizoune ◽  
Ahmed Bourazza
Keyword(s):  
Language Impairment ◽  
Brain Mri ◽  
Semantic Knowledge ◽  
Sudden Onset ◽  
Left Middle Cerebral Artery ◽  
Intracardiac Thrombus ◽  
Auditory Comprehension ◽  
Sensory Aphasia ◽  
History Of ◽  
Left Middle

Transcortical sensory aphasia is characterized by impaired auditory comprehension, with intact repetition and uent speech. A 44-year-old right-handed patient with a history of hypertension on amlodipine and ischemic heart disease on aspirin was admitted to the neurology department for sudden onset of language impairment that started 2 days ago. The patient had features of transcortical sensory aphasia. Brain MRI showed an infarct in the territory of the left middle cerebral artery involving the tempo-parietal region. An apical thrombus was observed in the left ventricle on transthoracic echocardiography. This language impairment is thought to be caused by a disconnection between sensory language processes and semantic knowledge of objects. The prognosis is generally guarded and depends on the etiology and severity of the presentation

The perils and dangers of these knights (and undead peasants): Interpreting English and Scottish Extent Rolls of 1297–1305

2016 ◽  
Vol 36 (1) ◽  
pp. 13-39 ◽  
Author(s):  
J. Donnelly
Keyword(s):  
Social History ◽  
Economic History ◽  
Time Frame ◽  
Compte Rendu ◽  
History Of ◽  
Different Sources

Medieval Scottish economic and social history has held little interest for a unionist establishment but, just when a recovery of historic independence begins to seem possible, this paper tackles a (perhaps the) key pre-1424 source. It is compared with a Rutland text, in a context of foreign history, both English and continental. The Berwickshire text is not, as was suggested in 2014, a ‘compte rendu’ but rather an ‘extent’, intended to cross-check such accounts. Read alongside the Rutland roll, it is not even a single ‘compte’ but rather a palimpsest of different sources and times: a possibility beyond earlier editorial imaginings. With content falling (largely) within the time-frame of the PoMS project (although not actually included), when the economic history of Scotland in Europe is properly explored, the sources discussed here will be key and will offer an interesting challenge to interpretation. And some surprises about their nature and date.

The Aristocracy in England and Tuscany, 1000 - 1250

2019 ◽  
Author(s):  
Peter Coss
Keyword(s):  
Time Frame ◽  
Grand Narrative ◽  
English History ◽  
Internal Dynamics ◽  
Italian Experience ◽  
English Society ◽  
History Of ◽  
External Stimuli ◽  
The Relationship ◽  
Interpretative Framework

Part I of this book is an in-depth examination of the characteristics of the Tuscan aristocracy across the first two and a half centuries of the second millennium, as studied by Italian historians and others working within the Italian tradition: their origins, interests, strategies for survival and exercise of power; the structure and the several levels of aristocracy and how these interrelated; the internal dynamics and perceptions that governed aristocratic life; and the relationship to non-aristocratic sectors of society. It will look at how aristocratic society changed across this period and how far changes were internally generated as opposed to responses from external stimuli. The relationship between the aristocracy and public authority will also be examined. Part II of the book deals with England. The aim here is not a comparative study but to bring insights drawn from Tuscan history and Tuscan historiography into play in understanding the evolution of English society from around the year 1000 to around 1250. This part of the book draws on the breadth of English historiography but is also guided by the Italian experience. The book challenges the interpretative framework within which much English history of this period tends to be written—that is to say the grand narrative which revolves around Magna Carta and English exceptionalism—and seeks to avoid dangers of teleology, of idealism, and of essentialism. By offering a study of the aristocracy across a wide time-frame and with themes drawn from Italian historiography, I hope to obviate these tendencies and to appreciate the aristocracy firmly within its own contexts.

Sigmoid Volvulus in 16-year-old Boy with an Associated Anomalous Congenital Band

2013 ◽  
Vol 79 (11) ◽  
pp. 1140-1141 ◽  
Author(s):  
Ann A. Albert ◽  
Tracy L. Nolan ◽  
Bryan C. Weidner
Keyword(s):  
Abdominal Pain ◽  
African American Male ◽  
Pediatric Patients ◽  
Primary Anastomosis ◽  
Exploratory Laparotomy ◽  
Sigmoid Volvulus ◽  
Sudden Onset ◽  
Contrast Enema ◽  
Pediatric Age Group ◽  
History Of

Sigmoid volvulus, a condition generally seen in debilitated elderly patients, is extremely rare in the pediatric age group. Frequent predisposing conditions that accompany pediatric sigmoid volvulus include intestinal malrotation, omphalomesenteric abnormalities, Hirschsprung's disease, imperforate anus and chronic constipation. A 16-year-old previously healthy African American male presented with a 12 hour history of sudden onset abdominal pain and intractable vomiting. CTwas consistent with sigmoid volvulus. A contrast enema did not reduce the volvulus, but it was colonoscopically reduced. Patient condition initially improved after colonoscopy, but he again became distended with abdominal pain, so he was taken to the operating room. On exploratory laparotomy, a band was discovered where the mesenteries of the sigmoid and small bowel adhered and created a narrow fixation point around which the sigmoid twisted. A sigmoidectomy with primary anastomosis was performed. The diagnosis of sigmoid volvulus may be more difficult in children, with barium enema being the most consistently helpful. Seventy percent of cases do not involve an associated congenital problem, suggesting that some pediatric patients may have congenital redundancy of the sigmoid colon and elongation of its mesentery. The congenital band found in our patient was another potential anatomic factor that led to sigmoid volvulus. Pediatric surgeons, accustomed to unusual problems in children, may thus encounter a condition generally found in the debilitated elderly patient.

Penetrating Atherosclerotic Ulcer of the Aorta

2001 ◽  
Vol 8 (5) ◽  
pp. 534-538 ◽  
Author(s):  
Aditya K. Samal ◽  
Christopher J. White ◽  
James B. Kot
Keyword(s):  
Computed Tomography ◽  
Ventricular Hypertrophy ◽  
Sudden Onset ◽  
Left Ventricular ◽  
Descending Thoracic Aorta ◽  
Penetrating Atherosclerotic Ulcer ◽  
Severe Chest Pain ◽  
Mediastinal Hematoma ◽  
History Of ◽  
Mediastinal Widening

Purpose: To describe a case of penetrating atherosclerotic ulcer of the aorta with a review of its natural history, diagnosis and management. Case Report: An elderly patient with a history of hypertension presented to the emergency room with the sudden onset of severe chest pain radiating to the back. The electrocardiogram showed left ventricular hypertrophy; the chest radiograph revealed mediastinal widening. Computed tomography was suspicious for a mediastinal hematoma without aortic dissection. Transesophageal echocardiography was also negative for dissection. An aortogram revealed a penetrating atherosclerotic ulcer of the descending thoracic aorta. The patient underwent successful resection and repair of the lesion. Conclusions: Penetrating atherosclerotic ulcer of the aorta is a potentially lethal lesion that must be promptly diagnosed and treated.

Perilymph Fistulas

1978 ◽  
Vol 87 (6) ◽  
pp. 797-803 ◽  
Author(s):  
George T. Singleton ◽  
Kathryn Nolan Post ◽  
Marc Simeon Karlan ◽  
Douglas G. Bock
Keyword(s):  
Discriminant Analysis ◽  
Effective Means ◽  
Bed Rest ◽  
Sudden Onset ◽  
Effective Control ◽  
Speech Discrimination ◽  
Mean Values ◽  
Long Duration ◽  
History Of ◽  
Physical Findings

Fifty-one patients suspected of having a perilymph fistula were evaluated. We postulated that many patients with predominantly vestibular complaints had unrecognized perilymph fistulas. An analysis was made of symptoms, physical findings, vestibular and audiometric test results in order to determine appropriate diagnostic criteria for the presence of perilymph fistulas. The patient population was divided into two groups, those with and without fistulas. Data from both groups were compared by mean values of variables, step-wise discriminant analysis, and factor analysis. A history of trauma with sudden onset of dizziness and/or hearing loss should alert the physician to a fistula. Findings of significance were positional nystagmus of short latency and long duration without import of nystagmus direction, canal paresis and reduced speech reception threshold with poor speech discrimination scores. Discriminant analysis correctly classified 19 fistula and 10 nonfistula cases explored operatively and identified two error judgments in 22 nonoperated cases. Bed rest for the first five days proved to be the most effective means of therapy. Surgical intervention with repair of the fistula by perichondrial graft provided effective control of vertigo more frequently than restoration of hearing.

scholarly journals Identification of Risk Factors to Predict the Occurrences of Relapses in Individuals with Schizophrenia Spectrum Disorder in Iran

2021 ◽  
Vol 18 (2) ◽  
pp. 546
Author(s):  
Omran Davarinejad ◽  
Tahereh Mohammadi Majd ◽  
Farzaneh Golmohammadi ◽  
Payam Mohammadi ◽  
Farnaz Radmehr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Suicide Attempts ◽  
Disease Onset ◽  
Sudden Onset ◽  
Spectrum Disorder ◽  
Therapeutic Interventions ◽  
Schizophrenia Spectrum Disorder ◽  
Schizophrenia Spectrum ◽  
History Of ◽  
Log Normal

Schizophrenia Spectrum Disorder (SSD) is a chronic psychiatric disorder with a modest treatment outcome. In addition, relapses are commonplace. Here, we sought to identify factors that predict relapse latency and frequency. To this end, we retrospectively analyzed data for individuals with SSD. Medical records of 401 individuals with SSD were analyzed (mean age: 25.51 years; 63.6% males) covering a five-year period. Univariate and multivariate Penalized Likelihood Models with Shared Log-Normal Frailty were used to determine the correlation between discharge time and relapse and to identify risk factors. A total of 683 relapses were observed in males, and 422 relapses in females. The Relapse Hazard Ratio (RHR) decreased with age (RHR = 0.99, CI: (0.98–0.998)) and with participants’ adherence to pharmacological treatment (HR = 0.71, CI: 0.58–0.86). In contrast, RHR increased with a history of suicide attempts (HR = 1.32, CI: 1.09–1.60), and a gradual compared to a sudden onset of disease (HR = 1.45, CI: 1.02–2.05). Gender was not predictive. Data indicate that preventive and therapeutic interventions may be particularly important for individuals who are younger at disease onset, have a history of suicide attempts, have experienced a gradual onset of disease, and have difficulties adhering to medication.

FRI0488 CLINICAL AND LABORATORY FEATURES OF PATIENTS WITH REMITTING SERONEGATIVE SYMMETRICAL SYNOVITIS WITH PITTING EDEMA COMPARED TO PATIENTS WITH SERONEGATIVE RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 842-843
Author(s):  
M. Higashida-Konishi ◽  
K. Izumi ◽  
S. Hama ◽  
Y. Hayashi ◽  
Y. Okano ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Secondary Analysis ◽  
Sudden Onset ◽  
Finger Joints ◽  
Before And After ◽  
History Of ◽  
Rs3pe Syndrome ◽  
The Mean ◽  
Old Females ◽  
Pitting Edema

Background:In the case of seronegative arthritis, it was difficult to make a differential diagnosis between remitting seronegative symmetrical synovitis with pitting edema syndrome (RS3PE) and seronegative rheumatoid arthritis (seronegative RA) because the distribution of affected joints was similar and the patients with RS3PE or seronegative RA may have edema.Objectives:To compare the clinical characteristics of RS3PE and seronegative RAMethods:We retrospectively examine consecutive patients diagnosed with RS3PE or seronegative RA in our hospital from 2007 to 2019. Patients in whom both ACPA and RF were negative were included. The patients with RS3PE met the criteria of McCarty et al.: (1) pitting edema of the dorsum of both hands and both feet, (2) sudden onset of polyarthritis, (3) seronegative for ACPA and RF. (4)no radiologically evident erosions developed. The patients with seronegative RA met the EULAR/ACR 2010 criteria. The patients who were diagnosed with RS3PE at first and then diagnosed with seronegative RA afterward were included in seronegative RA group. The first analysis was performed on the affected joints, CRP, ESR, Hb, LDH, edema, the history of malignancy 2 years before and after the diagnosis, treatment, and the history of infection requiring hospitalization after the start of treatment. The affected joints were shoulders, elbows, wrists, finger joints (the MCP, and PIP joints), hips, knees, ankles, and toe joints (the MTP and PIP joints). The secondary analysis was performed on the above evaluations with a propensity score (PS) matching for age.Results:In the first analysis, 20 patients with RS3PE and 122 patients with seronegative RA were enrolled. The mean ages (RS3PE, seronegative RA) were 81.1, 67.4 years old. Females were 60.0%, 63.1%. The mean observation period was 25.4, 63.6 months. The proportion of affected joints were shoulders (25.0%, 42.6%), elbows (10.0%, 29.5%: p=0.06), wrists (85.0%, 73.8%), finger joints (80.0%, 95.1%: p=0.01), hips (0%, 9.8%), knees (40.0%, 37.7%), ankles (65.0%, 39.3%: p=0.03) and toe joints (40.0%, 32.8%). Edema at diganosis was observed in 100%, 17.21% (p <0.0001). The mean levels of the following blood tests at diagnosis were noted: CRP, 9.0 and 4.8 mg/dL (p=0.02); ESR, 87.6 and 60.7 mm/1h (p=0.003); Hb, 10.4 and 11.8 mg/dl (p=0.001); LDH, 198.3 and 177.9 U/L (p = 0.12); MMP-3, 742.5 and 633.8 ng/mL (p = 0.14). The proportion of patients with high LDH levels (>222 U/L) was 13.6% and 9.0% (p=0.0269). The proportion of patients having the history of malignancy was 20.0%, 8.2% (p=0.10). The patient treated with prednisolone as the initial treatment was 100% and 41.0%; the mean dose was 14.3 and 9.9 mg/d. After the start of treatment, the proportion of infection requiring hospitalization was 20.0 and 3.28% (p=0.002).In the secondary analysis with PS, 17 patients with RS3PE and 17 patients with seronegative RA were enrolled. The mean ages were 80.4, 78.9 years old. Females were 52.9, 76.4%. The affected joints with difference were elbows (11.8, 35.3%: p=0.10), wrists (82.4, 100%: p=0.06), and finger joints (82.4, 100%: p=0.06). The mean levels of Hb at diagnosis was 10.4, 11.4 mg/dL (p=0.01). The proportion of patients having the history of malignancy was 23.5% and 0% (p=0.03). After the start of treatment, the proportion of infection requiring hospitalization was 23.5% and 0% (p=0.03).Conclusion:When the ankles are affected and edema is observed, RS3PE is more likely than seronegative RA. RS3PE had higher levels of CRP, ESR, and LDH. The proportion of anemia was higher in RS3PE. The proportions of infection requiring hospitalization and the history of malignancy were higher in RS3PE.References:[1]McCarty DJ, O’Duffy JD et al. Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE Syndrome). JAMA 1985; 254: 2763–2767. DOI:10.1001/jama.1985.03360190069027Disclosure of Interests:Misako Higashida-Konishi: None declared, Keisuke Izumi Grant/research support from: Asahi Kasei Pharma, Takeda Pharmaceutical Co., Ltd., Speakers bureau: Asahi Kasei Pharma Corp, Astellas Pharma Inc., Bristol Myers Squibb, Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Mitsubishi Tanabe Pharma Co., Satoshi Hama: None declared, Yutaro Hayashi: None declared, Yutaka Okano: None declared, Hisaji Oshima: None declared

scholarly journals Extreme Lateral Supracerebellar Infratentorial Approach to the Lateral Midbrain

2018 ◽  
Vol 79 (S 05) ◽  
pp. S415-S417
Author(s):  
M. Kalani ◽  
William Couldwell
Keyword(s):  
Cranial Nerves ◽  
Sudden Onset ◽  
Superior Cerebellar Artery ◽  
Entry Zone ◽  
Cerebellar Artery ◽  
Sensory Disturbances ◽  
History Of ◽  
Supracerebellar Infratentorial Approach ◽  
The Right ◽  
Piecemeal Resection

This video illustrates the case of a 52-year-old man with a history of multiple bleeds from a lateral midbrain cerebral cavernous malformation, who presented with sudden-onset headache, gait instability, and left-sided motor and sensory disturbances. This lesion was eccentric to the right side and was located in the dorsolateral brainstem. Therefore, the lesion was approached via a right-sided extreme lateral supracerebellar infratentorial (exSCIT) craniotomy with monitoring of the cranial nerves. This video demonstrates the utility of the exSCIT for resection of dorsolateral brainstem lesions and how this approach gives the surgeon ready access to the supracerebellar space, and cerebellopontine angle cistern. The lateral mesencephalic safe entry zone can be accessed from this approach; it is identified by the intersection of branches of the superior cerebellar artery and the fourth cranial nerve with the vein of the lateral mesencephalic sulcus. The technique of piecemeal resection of the lesion from the brainstem is presented. Careful patient selection and respect for normal anatomy are of paramount importance in obtaining excellent outcomes in operations within or adjacent to the brainstem.The link to the video can be found at: https://youtu.be/aIw-O2Ryleg.

scholarly journals Correlating light absorbance parameters in peach skin with susceptibility to streaking and association with rainwater components

2021 ◽  
Author(s):  
Linus Schmitz ◽  
Guido Schnabel
Keyword(s):  
South Carolina ◽  
Color Space ◽  
Physical Property ◽  
Time Frame ◽  
Fruit Production ◽  
Symptom Development ◽  
Fruit Maturation ◽  
History Of ◽  
Rain Events ◽  
Light Absorbance

Since first observed in 2003, peach skin streaking (PSS) has increasingly affected fruit production in the Southeast. Since 2017 we have documented the occurrence of peach skin streaking on 21 cultivars in South Carolina and symptoms have also been reported in Maryland and Pennsylvania. PSS seems to be linked to an unidentified causal agent mediated in rainwater with susceptibility closely related to the ripening status of maturing fruit. Over the course of the 2019 peach growing season, we collected rainwater at a South Carolina peach farm with a history of PSS and analyzed samples for chemical and physical property. Five cultivars were monitored for occurrence of PSS to associate specific rain events with symptom development in the field. PSS was observed in the field on one of the monitored and three additional cultivars between May and June, and five rain events coincided in time with symptom development. However, chemical, and physical properties from these rainwater samples were not significantly different from samples not associated with PSS in that time frame. Fruit of the five cultivars were also collected at 21, 14, 7 and 0 days before harvest, to determine light absorbance parameters, ΔA and color space, and to induce symptoms under laboratory conditions by treatment with ClO2. There were significant correlations between symptom development and light absorbance parameters illustrating how proneness to PSS increases during fruit maturation.

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