scholarly journals Vermal cerebellar hemorrhage as the initial manifestation of undiagnosed hypertension

2016 ◽  
Vol 5 (1) ◽  
pp. 357 ◽  
Author(s):  
Alagoma Iyagba ◽  
Arthur Onwuchekwa
Keyword(s):  
Sudden Onset ◽  
Lower Limbs ◽  
Neck Stiffness ◽  
Cerebellar Haemorrhage ◽  
Initial Manifestation ◽  
Truncal Ataxia ◽  
Accident And Emergency ◽  
Undiagnosed Hypertension ◽  
History Of ◽  
Clonic Seizures

Vermal cerebellar haemorrhage is bleeding affecting the midline region of the cerebellum. It is uncommon, accounting for 5-13% of all intracerebral haemorrhages. It is a grave condition with a high mortality. The diagnosis must be made early, if not, most patients would die within 48 hours. A 70-year-old lady presented to the accident and emergency department with a six hours history of sudden onset generalized tonic-clonic seizures following activity and loss of consciousness. She was unconscious with a Glasgow coma score of 3/15 with neck stiffness, generalized hypotonia and globally diminished reflexes. Her blood pressure was 240/120 mmHg with a mean arterial pressure of 160 mmHg. The brain computerized tomographic scan showed a hyperdense area in the cerebellar vermis with extension to both hemispheres and fourth ventricle. Consciousness was regained after three weeks of conservative management following which she became extremely restless and noticed to have developed titubations with nystagmus of both eyes. She also developed intention tremors, scanning dysarthria, generalized hypotonia, dysmetria, dysdiadochokinesia and intentional bilateral tremors. Her recovery was slow and gradual. Once she was able to stand with support, she was noticed to have florid truncal ataxia, lower limbs ataxia, and titubations.

CASE REPORT ON A RARE NEUROLOGICAL COMPLICATION OF MYCOBACTERIUM TUBERCULOSIS INFECTION IN HIV PATIENT

2021 ◽  
pp. 1-2
Author(s):  
K. Shivaraju ◽  
Mandhala Saikrishna
Keyword(s):  
Spinal Cord ◽  
Mycobacterium Tuberculosis ◽  
Case Report ◽  
Neurological Complication ◽  
Transverse Myelitis ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Tuberculosis Infection ◽  
Mycobacterium Tuberculosis Infection ◽  
History Of

LETM is rarely caused by tuberculosis infection. LETM is a contiguous immune-mediated inammatory lesion of the spinal cord that extends to three or more segments of spinal cord. Here we presenting a case of 55 years old female patient with known HIV infection and no history of tuberculosis infection admitted in the hospital with complains of sudden onset of asymmetrical weakness of lower limbs and urinary incontinence from four days. on evaluation she was underwent some series of investigations, in that nally diagnosed with longitudinally extensive transverse myelitis due to tuberculosis infection. Then patient was treated with ART and ATT with steroids and supportive treatment along with physiotherapy. after some days patient condition was gradually improving with treatment and discharged, advised physiotherapy daily and followup on OPD basis. So based on this case report, we recommend that clinicians should suspect mycobacterium tuberculosis infection when patient diagnosed with transverse myelitis

scholarly journals ADULT PNEUMOCOCCAL MENINGITIS PRESENTING WITH STROKE LIKE SYMPTOMS

2021 ◽  
Vol 71 (4) ◽  
pp. 1496-97
Author(s):  
Muhammad Mohsin Sajjad ◽  
Sidra Yousaf
Keyword(s):  
Clinical Symptoms ◽  
Leukocyte Count ◽  
Sudden Onset ◽  
Acute Ischemia ◽  
Resonance Imaging ◽  
Neck Stiffness ◽  
Gram Staining ◽  
Accident And Emergency ◽  
Low Glucose ◽  
Stroke Mimic

Meningitis can present as a stroke mimic. We report a case of a 69 years old lady who presented to accident and emergency 2-hours after an episode of vomiting followed by sudden onset left sided weakness and drowsiness. Examination revealed left sided weakness with dysphasia. Initial plan was to decide if the patient was for thrombolysis. An urgent CT scan ruled out hemorrhage. On re-examination the patient was febrile and there was some degree of neck stiffness. Magnetic resonance imaging of brain was performed (DW1 no stroke) which ruled out acute ischemia. A lumber puncture was done eventually that showed low glucose, high leukocyte count, and gram staining revealed diplococci in chains. Clinicians should bear in mind the differential diagnosis of meningitis when there are risk factors and overlapping clinical symptoms.

scholarly journals Acute myocardial infarction and haemodynamic stroke in a young patient with Bardet-Biedl syndrome

2019 ◽  
Vol 12 (4) ◽  
pp. e229788
Author(s):  
Vijay Alexander ◽  
Tina George ◽  
Gifty Devarajan ◽  
Anand Zachariah
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Retinal Pigment ◽  
Sudden Onset ◽  
Systemic Hypertension ◽  
Bardet Biedl Syndrome ◽  
Left Posterior ◽  
History Of ◽  
Clonic Seizures

A 28-year-old man diagnosed with diabetes mellitus and systemic hypertension presented with a medical history of sudden onset retrosternal discomfort followed by loss of consciousness and generalised tonic clonic seizures. Examination revealed obesity, polysyndactyly and retinal pigment dystrophy. He was diagnosed to have acute myocardial infarction and left posterior watershed infarct. He was also diagnosed to have Bardet-Biedl syndrome based on clinical features. He was managed symptomatically and is currently doing well on regular follow-up in the outpatient clinic.

scholarly journals Acute spinal cord infarction syndrome unusually mimicking Transverse myelitis: A case report

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Aliyu Ibrahim ◽  
Aisha Shuaibu ◽  
Usman Adamu Nuhu ◽  
Hauwa A. Aliyu
Keyword(s):  
Spinal Cord ◽  
Transverse Myelitis ◽  
Sudden Onset ◽  
Dorsal Column ◽  
Lower Limbs ◽  
Spinal Cord Infarction ◽  
History Of ◽  
Extensor Plantar Response ◽  
Magnetic Resonance Imaging Mri ◽  
Repeat Examination

Anterior Spinal Cord Infarction (ASCI) syndrome typically results from ischemia that affects the anterior spinal artery territory characterized by history of sudden onset flaccid paraplegia or quadriplegia depending on the level of the lesion. We describe a 57-years-old woman with sudden onset flaccid weakness of the lower limbs and numbness of the feet of two days duration, preceded by a day history of fever and several episodes of vomiting. Examination initially revealed bilateral hypotonia, hyporeflexia and dense paraplegia, with preservation of dorsal column sensations (fine touch/2-point discrimination, position and vibration sensation). Twenty-four hours thereafter a repeat examination showed hyper-reflexia and extensor plantar response with spastic paraplegia. Thoracic spine Magnetic Resonance Imaging (MRI) revealed thinning of the spinal cord extending from T1 to T9 levels with associated widening of the thecal sac suggestive of anterior spinal cord infarction with no other signal changes seen within the substance.

scholarly journals Spontaneous ventral spinal epidural hematoma in a child: A case report and review of literature

2016 ◽  
Vol 07 (02) ◽  
pp. 297-299 ◽  
Author(s):  
Shailendra Ratre ◽  
Yadram Yadav ◽  
Sushma Choudhary ◽  
Vijay Parihar
Keyword(s):  
Epidural Hematoma ◽  
Neurological Status ◽  
Cord Compression ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Sensory Loss ◽  
Spinal Epidural Hematoma ◽  
Spontaneous Spinal Epidural Hematoma ◽  
History Of ◽  
Spinal Epidural

ABSTRACTSpontaneous spinal epidural hematoma is very uncommon cause of spinal cord compression. It is extremely rare in children and is mostly located in dorsal epidural space. Ventral spontaneous spinal epidural hematoma (SSEH) is even rarer, with only four previous reports in childrens. We are reporting fifth such case in a 14 year old male child. He presented with history of sudden onset weakness and sensory loss in both lower limbs with bladder bowel involvment since 15 days. There was no history of trauma or bleeding diasthesis. On clinical examination he had spastic paraplegia.Magnetic resonance imaging (MRI) of dorsal spine was suggestive of ventral spinal epidural hematoma extending from first to sixth dorsal vertebrae. Laminectomy of fourth and fifth dorsal vertebrae and complete evacuation of hematoma was done on the same day of admission. Postoperatively the neurological status was same.

scholarly journals Thyrotoxic Periodic Paralysis

2020 ◽  
Author(s):  
Suresh Sinha ◽  
Nagarajan Raghupathy
Keyword(s):  
Sudden Onset ◽  
Periodic Paralysis ◽  
Lower Limbs ◽  
Limb Weakness ◽  
Thyrotoxic Periodic Paralysis ◽  
Asian Origin ◽  
Sodium Potassium ◽  
Lower Limb Weakness ◽  
History Of ◽  
Hormone Sensitive

Thyrotoxic periodic paralysis is not uncommon in people of Asian origin. It presents as sudden onset paralysis resulting from hypokalemia due to intracellular shift of potassium because of thyroid hormone sensitive Sodium-Potassium ATPase. A 34-year-old male with history of weight loss, palpitation and increased sweating for three months presented with sudden onset weakness of both lower limbs, two hours post-dinner. On investigation, he was found to be having hypokalemia as well as thyrotoxicosis. His potassium was corrected and was put on non-selective beta blocker and carbimazole. The patient improved within 24 hours and was discharged with advice to continue with Inderal and Carbimazole and report after one month. Hyperthyroidism should be included in differential diagnosis of sudden onset lower limb weakness.

Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 155-160
Author(s):  
Mohsen Aghapoor ◽  
◽  
Babak Alijani Alijani ◽  
Mahsa Pakseresht-Mogharab ◽  
◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
The Body ◽  
Lower Limbs ◽  
Lumbar Pain ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Death Case ◽  
Therapeutic Results ◽  
History Of ◽  
Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

scholarly journals Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

2021 ◽  
Vol 07 (03) ◽  
pp. e124-e126
Author(s):  
Mark Portelli ◽  
Mark Bugeja ◽  
Charles Cini
Keyword(s):  
Computed Tomography ◽  
Young Adult ◽  
Rare Case ◽  
Surgical Repair ◽  
Bochdalek Hernia ◽  
Case Presentation ◽  
Atypical Case ◽  
Accident And Emergency ◽  
History Of ◽  
Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

scholarly journals Sirenomelia: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Asiyeh Shojaee ◽  
Firooze Ronnasian ◽  
Mahdiyeh Behnam ◽  
Mansoor Salehi
Keyword(s):  
Case Reports ◽  
Three Dimensional ◽  
First Trimester ◽  
Mendelian Inheritance ◽  
Lower Limbs ◽  
Congenital Deformity ◽  
White Family ◽  
Her Family ◽  
Caudal Regression ◽  
History Of

AbstractBackgroundSirenomelia, also called mermaid syndrome, is a rare lethal multi-system congenital deformity with an incidence of one in 60,000–70,000 pregnancies. Sirenomelia is mainly characterized by the fusion of lower limbs and is widely associated with severe urogenital and gastrointestinal malformations. The presence of a single umbilical artery derived from the vitelline artery is the main anatomical feature distinguishing sirenomelia from caudal regression syndrome. First-trimester diagnosis of this disorder and induced abortion may be the safest medical option. In this report, two cases of sirenomelia that occurred in an white family will be discussed.Case presentationWe report two white cases of sirenomelia occurring in a 31-year-old multigravid pregnant woman. In the first pregnancy (18 weeks of gestation) abortion was performed, but in the third pregnancy (32 weeks) the stillborn baby was delivered by spontaneous vaginal birth. In the second and fourth pregnancies, however, she gave birth to normal babies. Three-dimensional ultrasound imaging showed fusion of the lower limbs. Neither she nor any member of her family had a history of diabetes. In terms of other risk factors, she had no history of exposure to teratogenic agents during her pregnancy. Also, her marriage was non-consanguineous.ConclusionThis report suggests the existence of a genetic background in this mother with a Mendelian inheritance pattern of 50% second-generation incidence in her offspring.

scholarly journals Atypical cutaneous and musculoskeletal manifestation of SARS-CoV-2: ‘COVID-19 toes’ and spasticity in a 48-year-old woman

2021 ◽  
Vol 14 (3) ◽  
pp. e241410
Author(s):  
Avery Kopacz ◽  
Cameron Ludwig ◽  
Michelle Tarbox
Keyword(s):  
Nervous System ◽  
Adult Patient ◽  
Early Identification ◽  
Lower Limbs ◽  
Rare Occurrence ◽  
Cutaneous Manifestations ◽  
Crucial Component ◽  
History Of ◽  
Screening Questions ◽  
Insight Into

Establishing accurate symptomatology associated with novel diseases such as COVID-19 is a crucial component of early identification and screening. This case report identifies an adult patient with a history of clotting dysfunction presenting with rare cutaneous manifestations of COVID-19, known as ‘COVID-19 toes’', previously described predominantly in children. Additionally, this patient presented with possible COVID-associated muscle spasticity of the lower limbs, as well as a prolonged and atypical timeline of COVID-19 infection. The rare occurrence of ‘COVID-19 toes’' in this adult patient suggests that her medical history could have predisposed her to this symptom. This supports the coagulopathic hypothesis of this manifestation of COVID-19 and provides possible screening questions for patients with a similar history who might be exposed to the virus. Additionally, nervous system complaints associated with this disease are rare and understudied, so this novel symptom may also provide insight into this aspect of SARS-CoV-2.

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