scholarly journals Artery of Percheron Occlusion: A Diagnostic Challenge

2021 ◽  
Author(s):  
Carina Ramalho ◽  
Mariana Almeida ◽  
Francisco Gomes ◽  
Magda Silva ◽  
Joaquim Peixoto ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Diagnostic Challenge ◽  
Altered Level ◽  
Artery Of Percheron ◽  
Level Of Consciousness ◽  
Bilateral Thalamus

Artery of Percheron occlusion is a rare cause of ischaemic stroke characterized by bilateral thalamus infarction. Presentation is varied and non-specific, with the most frequent manifestations being altered level of consciousness, hypersomnolence or altered oculomotor movements. We describe the case of a 37-year-old man hospitalized for hypersomnia and hypomnesia with 3 days of evolution, who was diagnosed with a bilateral thalamus stroke due to artery of Percheron occlusion.

Direct ophthalmoscopy for the acute physicia – papilloedema and other abnormalities of the optic nerve head

2002 ◽  
Vol 1 (2) ◽  
pp. 60-63
Author(s):  
B Edmunds ◽  
◽  
P J Francis ◽  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Head ◽  
Visual Disturbance ◽  
Medical Setting ◽  
Altered Level ◽  
Level Of Consciousness ◽  
Systemic Disorder ◽  
Systemic Examination ◽  
Direct Ophthalmoscopy

Direct ophthalmoscopy is an essential part of the full systemic examination. However, the technique is challenging and time-consuming. In the acute medical setting therefore, it is advisable for the physician to identify the subgroup of patients in whom examination of the fundus is most likely to be helpful. Ophthalmoscopy should be performed where papilloedema is suspected, in those with an altered level of consciousness or other focal neurology, those with an unknown systemic disorder, and those complaining of visual disturbance.

scholarly journals Altered Mental Status and Cyanosis in a Pediatric Patient with Methemoglobinemia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Phillip M. Grenz ◽  
Robert N. Ray Jr. ◽  
Olivia A. Hardy ◽  
Andrew L. Koons ◽  
Kenneth D. Katz ◽  
...  
Keyword(s):  
Mental Status ◽  
Clinical Manifestations ◽  
Altered Mental Status ◽  
Pediatric Emergency ◽  
Abrupt Onset ◽  
Altered Level ◽  
Sustained Improvement ◽  
Oxygen Dissociation ◽  
Nail Polish ◽  
Level Of Consciousness

Methemoglobinemia results from increased amounts of oxidized hemoglobin in the blood with an ensuing change in oxygen dissociation curve and lack of oxygen delivery to tissue. A previously well, male toddler was brought to the Pediatric Emergency Department (PED) by Emergency Medical Services (EMS) with abrupt onset of altered mental status and cyanosis after a suspected ingestion of “Rush” nail polish remover. He was quickly diagnosed with methemoglobinemia by both clinical presentation and chocolate-colored blood appearance. He emergently received intravenous (IV) methylene blue (MB) with immediate and sustained improvement requiring no further doses. Though inhalation of nitrites and subsequent methemoglobinemia is frequently reported in adolescents, we were unable to find any cases in the literature detailing ingestion of this product and the resulting clinical manifestations. Our objective with this report is to describe a rare case of a toddler with an accidental ingestion of “Rush” nail polish remover, a nitrite compound. Our patient presented to the PED with abrupt onset of altered level of consciousness, hypotension, and cyanosis resulting from acquired methemoglobinemia. This case report demonstrates the importance of emergency clinicians being able to make clinical judgements and decisions based on the history and physical exam when methemoglobinemia is suspected.

scholarly journals Cardiac Angiosarcoma: From Cardiac Tamponade to Ischaemic Stroke – A Diagnostic Challenge

2019 ◽  
Vol 6 (4) ◽  
pp. 1 ◽  
Author(s):  
Vanessa Meireles Chaves ◽  
Catarina Pereira ◽  
Marta Andrade ◽  
Pedro von Hafe ◽  
Jorge Almeida
Keyword(s):  
Ischaemic Stroke ◽  
Cardiac Tamponade ◽  
Diagnostic Challenge ◽  
Cardiac Angiosarcoma

scholarly journals Brain Catastrophe presented with endocrine disruption

2020 ◽  
Vol 8 (5) ◽  
pp. 104-110
Author(s):  
Saadi JS AlJadir
Keyword(s):  
Dynamic Testing ◽  
Hemodynamic Instability ◽  
Major Surgery ◽  
Initial Manifestation ◽  
Altered Level ◽  
Identifiable Risk Factor ◽  
Conflicting Evidence ◽  
Level Of Consciousness ◽  
Threatening Condition ◽  
Life Threatening

Pituitary Apoplexy (PA) is an acute critical endocrine condition that is infrequently encountered in daily medical practice. Its life-threatening condition that mandates prompt diagnosis and urgent treatment and may be neurosurgical intervention. Majority of cases are attributed to ischemic infarction or hemorrhage of the pituitary gland usually in the vicinity of pituitary adenoma, and in most cases could be the initial manifestation of these tumors! In reviewing the literatures there is conflicting evidence of which are the predominant, non-functional, or functional adenomas, some reports were showed that prolactin-secreting are at highest risk. There are recognizable risk factors that might precipitate this endocrine emergency like hypertension, medications, major surgery, head injury, radiation, or dynamic testing, but in majority of cases at presentation no identifiable risk factor could be detected. The typical clinical scenario includes persistent worsening headache, vomiting, and altered level of consciousness, visual defect or loss with extreme hormonal derangements which are shown by hemodynamic instability, adrenal crises with variable hormonal deficiencies.

scholarly journals Spectrum of Intracerebral Hemorrhage in Children: A Report from PICU of a Resource Limited Country

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Qalab Abbas ◽  
Qurat ul Ain Merchant ◽  
Bushra Nasir ◽  
Anwar ul Haque ◽  
Basit Salam ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Medical Records ◽  
Vascular Malformations ◽  
Pediatric Intensive Care ◽  
Conventional Angiography ◽  
Altered Level ◽  
Vascular Intervention ◽  
Resource Limited ◽  
Level Of Consciousness ◽  
Gender Presentation

Intracerebral hemorrhage (ICH) in children is a rare but disabling disease that accounts for almost half cases of stroke. We report our experience of ICH in children. Retrospective review of medical records of children (1 month-16 years) admitted in Pediatric Intensive Care Unit between January 2007 and December 2014 was done. Data collected included age, gender, presentation, examination findings, neuroimaging done (CT, MRI, and angiography) management (conservative/intervention), and outcome. Results are presented as frequency and percentages. Of the total 50 patients, 58% were male and 26% were <1 year. On presentation 44% had vomiting, 42% had seizures, and GCS < 8 while 40% had altered level of consciousness. Single bleed was present in 88%, 94% had supratentorial bleed, and 32% had intraventricular extension. 72% had bleed volume of <30 mL and 8% had >60 mL. CT scan was done in 98% patients and MRI in 34%, while 6% underwent conventional angiography. 60% patients were managed conservatively, 36% underwent neurosurgical intervention, and 6% underwent radiological vascular intervention. Hematologic causes were identified in 52% patients and vascular malformations in 14% and in 26% no cause could be identified. 26% of patients expired.

Artery of Percheron infarct: a diagnostic challenge

2021 ◽  
Vol 14 (4) ◽  
pp. e236189
Author(s):  
Joana Morais ◽  
Ana Andrade Oliveira ◽  
Inês Burmester ◽  
Olga Pires
Keyword(s):  
Anatomical Variation ◽  
Sudden Change ◽  
Rare Event ◽  
Rare Condition ◽  
Final Diagnosis ◽  
Diagnostic Challenge ◽  
Cranial Ct ◽  
Artery Of Percheron ◽  
Ischaemic Lesion ◽  
Change Of Consciousness

The artery of Percheron is a rare anatomical variation that supplies thalamus and the midbrain. A stroke in this area is a rare event. The presentation varies widely, with some bizarre disturbances, like transient episodic loss of consciousness similar to coma, somnolence, cognition and memory impairment and psychosis. We report a case of a patient who presented at the emergency department with a sudden change of consciousness. During the observation, she oscillated reactive state of consciousness with obnubilation similar to coma. The first exams were normal, which include a cranial CT of the brain, and so the patient was kept under observation. The final diagnosis was only possible 24 hours later with cranial CT where an ischaemic lesion on the Percheron territory was identified. This case highlights an unusual clinic and a difficult neuroimaging stroke diagnosis of a rare condition, that is unknown to most of the physicians.

Evaluation of Seizures and Seizurelike Events

2021 ◽  
pp. 722-730
Author(s):  
Angela M. Parsons ◽  
Joseph F. Drazkowski
Keyword(s):  
Diagnostic Tests ◽  
Diagnostic Testing ◽  
The United States ◽  
Social Consequences ◽  
Altered Level ◽  
Safety Issues ◽  
The People ◽  
Level Of Consciousness ◽  
Self Reports ◽  
Proper Diagnosis

Correctly diagnosing seizures and seizurelike events is important for numerous reasons, including safety issues, social consequences, and therapy. Patients with transient neurologic events of unknown cause are commonly admitted to hospitals, and an estimated 10% of the people in the United States have a seizure in their lifetime. These facts highlight the importance of diagnostic accuracy. History taking is imperfect, but it is still a cornerstone in making the proper diagnosis of transient neurologic events. Focused, supporting diagnostic tests may add accuracy in arriving at the proper diagnosis, but even with a good history, diagnostic testing, and physical examination findings, the diagnosis may be inaccurate. Self-reports of seizure frequency are notoriously inaccurate and often miss more than 50% of focal-onset seizures, especially if the seizures begin in the dominant hemisphere (largely because the effects of the event cause an altered level of consciousness).

scholarly journals Deep venous structures distortion in spontaneous intracranial hypotension as an explanation for altered level of consciousness

2013 ◽  
Vol 2013 (sep24 2) ◽  
pp. bcr2013010823-bcr2013010823
Author(s):  
A. M. Ajlan ◽  
H. Al-Jehani ◽  
C. Torres ◽  
J. Marcoux
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Altered Level ◽  
Level Of Consciousness
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