scholarly journals Acute Confusional State Revealing Moyamoya Disease in the Emergency Department: A Rare Entity

2021 ◽  
Author(s):  
Javier Guerrero-Niño ◽  
Sarah Uge-Ginsberg ◽  
Pierre Marcueyz ◽  
Pierrick Le Borgne ◽  
Xavier Jannot ◽  
...  
Keyword(s):  
Emergency Department ◽  
Moyamoya Disease ◽  
Altered Mental Status ◽  
Rare Entity ◽  
Resonance Imaging ◽  
Perceptual Awareness ◽  
Acute Confusional State ◽  
Confusional State ◽  
Blood Tests ◽  
The Brain

A 54-year-old woman was admitted to the emergency department for an acute, fluctuating altered mental status and reduced perceptual awareness of her surroundings as well as disorganized thinking. Blood tests, including for drugs, were normal. A CT scan of the brain was normal. Magnetic resonance imaging and CT angiography of the supra-aortic vessels were both were consistent with moyamoya disease. The patient was hospitalized for further investigations.

scholarly journals 40-year-old Male with a Headache and Altered Mental Status

2020 ◽  
Vol 4 (4) ◽  
pp. 499-504
Author(s):  
Rebecca Rubenstein ◽  
Leen Alblaihed ◽  
Zachary Dezman ◽  
Laura Bontempo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Emergency Department ◽  
Differential Diagnosis ◽  
Magnetic Resonance ◽  
Mental Status ◽  
Altered Mental Status ◽  
Resonance Imaging ◽  
Status Change ◽  
Mental Status Change ◽  
The Brain

A 40-year-old man presents to the emergency department with headache, nausea and paresthesias, with subsequent fever and mental status change. Magnetic resonance imaging showed increased fluid-attenuation inversion recovery signal involving multiple areas of the brain, including the pons. This case takes the reader through the differential diagnosis of rhombencephalitis (inflammation of the hindbrain) with discussion of the unanticipated ultimate diagnosis and its treatment.

Altered Mental Status in the Emergency Department

2019 ◽  
Vol 39 (01) ◽  
pp. 005-019 ◽  
Author(s):  
Austin Smith ◽  
Jin Han
Keyword(s):  
Emergency Department ◽  
Mental Status ◽  
Altered Mental Status ◽  
Detailed History ◽  
Radiographic Testing ◽  
Life Threatening ◽  
Secondary Survey ◽  
Acute Changes ◽  
Department Evaluation ◽  
The Brain

AbstractAltered mental status is an umbrella term that covers a broad spectrum of disease processes that vary greatly in chronicity and severity. Causes can be a primary neurologic insult or a result of a systemic illness resulting in end-organ dysfunction of the brain. Acute changes in mental status are more likely than chronic changes to be immediately life-threatening and are therefore the focus of this review. Given the potential time-sensitive nature, acute changes in mental status must be addressed immediately and with urgency. We recommend a primary survey followed by a secondary survey with special attention to immediate life-threatening reversible causes. We then recommend a systems-based approach searching for any other life-threatening or reversible causes. Because the differential for altered mental status is broad, a comprehensive emergency department evaluation including a detailed history and physical exam as well as laboratory and radiographic testing is needed.

scholarly journals Opioid Overdose With Parkinsonian Features

2019 ◽  
Vol 3 (4) ◽  
pp. 440-441
Author(s):  
Paul Cohen ◽  
Jason Hack
Keyword(s):  
Magnetic Resonance Imaging ◽  
Emergency Department ◽  
Magnetic Resonance ◽  
Opioid Overdose ◽  
Resonance Imaging ◽  
Younger Adults ◽  
Heroin Users ◽  
Bilateral Lesions ◽  
The Brain ◽  
Ischemic Encephalopathy

A 54-year-old man presented to the emergency department with confusion and Parkinsonian features after suspected heroin snorting. He had magnetic resonance imaging of the brain demonstrating isolated symmetric bilateral globus pallidus (GP) restricted diffusion and edema consistent with hypoxic ischemic encephalopathy. In contrast to other anoxic/ischemic insults, where the GP is preferentially spared, autopsy reports on intravenous heroin users have found the GP to be specifically affected, often demonstrating symmetric bilateral lesions. Opioid toxicity should be considered in patients presenting with Parkinsonian features on examination or pallidal lesions on imaging, especially in younger adults where infarction is less common.

Moyamoya Disease Presenting with an Acute Confusional State in an Elderly Patient

2010 ◽  
Vol 19 (3) ◽  
pp. 247-250
Author(s):  
Megumi Nakanishi ◽  
Muichi Kaito ◽  
Yuichiro Gondo ◽  
Hisashi Takada ◽  
Makoto Matsui ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Moyamoya Disease ◽  
Acute Confusional State ◽  
Confusional State

Less Invasive Pedicled Omental-Cranial Transposition in Pediatric Patients With Moyamoya Disease and Failed Prior Revascularization

2013 ◽  
Vol 10 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Ramon Navarro ◽  
Kevin Chao ◽  
Peter A. Gooderham ◽  
Matias Bruzoni ◽  
Sanjeev Dutta ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Pediatric Patients ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Pedicled Flap ◽  
Resonance Imaging ◽  
Major Treatment ◽  
Omental Transposition ◽  
The Brain ◽  
Better Than

Abstract BACKGROUND: Patients with moyamoya disease and progressive neurological deterioration despite previous revascularization pose a major treatment challenge. Many have exhausted typical sources for bypass or have ischemia in areas that are difficult to reach with an indirect pedicled flap. Omental-cranial transposition has been an effective, but sparingly used technique because of its associated morbidity. OBJECTIVE: We have refined a laparoscopic method of harvesting an omental flap that preserves its gastroepiploic arterial supply. METHODS: The pedicled omentum can be lengthened as needed by dividing it between the vascular arcades. It is transposed to the brain via skip incisions. The flap can be trimmed or stretched to cover ischemic areas of the brain. The cranial exposure is performed in parallel with pediatric surgeons. We performed this technique in 3 pediatric patients with moyamoya disease (aged 5-12 years) with previous superficial temporal artery to middle cerebral artery bypasses and progressive ischemic symptoms. In 1 patient, we transposed omentum to both hemispheres. RESULTS: Blood loss ranged from 75 to 250 mL. After surgery, patients immediately tolerated a diet and were discharged in 3 to 5 days. The ischemic symptoms of all 3 children resolved within 3 months postoperatively. Magnetic resonance imaging at 1 year showed improved perfusion and no new infarcts. Angiography showed excellent revascularization of targeted areas and patency of the donor gastroepiploic artery. CONCLUSION: Laparoscopic omental harvest for cranial-omental transposition can be performed efficiently and safely. Patients with moyamoya disease appear to tolerate this technique much better than laparotomy. With this method, we can achieve excellent angiographic revascularization and resolution of ischemic symptoms.

scholarly journals Myelitis due to Coccidioidomycosis in an Immunocompetent Patient

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Tetyana Vaysman ◽  
Sean Villaflores ◽  
Carlyn Estrella ◽  
Suman Radhakrishna ◽  
Antonio Liu
Keyword(s):  
Altered Mental Status ◽  
Immunocompetent Patient ◽  
Resonance Imaging ◽  
Fatal Complication ◽  
Significant Past Medical History ◽  
Uncommon Presentation ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Study ◽  
Disseminated Disease ◽  
The Brain

Myelitis of the spinal cord is an uncommon presentation of disseminated coccidioidomycosis. Most infected patients present subclinically, but patients, especially those who are immunocompromised, may progress to disseminated disease. We present a 50-year-old immunocompetent patient with no significant past medical history exhibiting symptoms of altered mental status, dizziness, headache, nausea, and quadriplegia. Upon investigation with lumbar puncture, cerebrospinal fluid (CSF) culture, and coccidioidal antibody studies, the patient was found to have acute coccidioidomycosis. Magnetic resonance imaging (MRI) of the brain demonstrated meningeal enhancements suggestive of meningitis, and further MRI study of the cervical spine revealed myelitis. Treatment with IV fluconazole for 2 weeks and IV voriconazole therapy over 3 weeks yielded limited improvement. The presentation of myelitis due to coccidioidomycosis infection is very rare and has infrequently reported in the literature. Awareness of this potentially fatal complication in immunocompetent patients can aid in faster recognition and treatment.

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