scholarly journals Takayasu arteritis presenting with massive cerebral ischemic infarction in a 15-year-old girl: a case report

2020 ◽  
Vol 7 (2) ◽  
pp. 449
Author(s):  
Mohinish S. ◽  
Dhanalakshmi K. ◽  
Sushma Veeranna Sajjan ◽  
Priyanka K.
Keyword(s):  
Case Report ◽  
Takayasu Arteritis ◽  
Past History ◽  
Clinical Manifestations ◽  
Disease Process ◽  
Lower Limbs ◽  
Diagnostic Tools ◽  
Ischemic Infarction ◽  
Ischemic Infarct ◽  
Cerebral Ischemic

Takayasu arteritis is a relatively rare type of large-vessel arteritis that primarily affects the aorta and its major branches, the coronary arteries, and the pulmonary arteries. Depending on the different groups of blood vessels involved in the disease process, the clinical presentation of Takayasu arteritis varies. Here we report a case of a girl presenting with a debilitating massive cerebral ischemic infarct that turned out to be a relatively rare first presentation of Takayasu arteritis. Case report of 15 years old adolescent female hailing from lower socio-economic status with past history of chronic headache, no significant family history, completely immunized presented with sudden onset weakness of right upper and lower limbs, which progressed over 1day with aphasia (recovering) with deviation of angle of mouth to left side On examination left radial ,carotid artery not palpable. Her laboratory results showed an elevated C-reactive protein and erythrocyte sedimentation rate, and subsequent CT angiography demonstrated narrowing and occlusion of the major branches of her aortic arch. We report the case of a patient with Takayasu arteritis presenting with a massive cerebral ischemic infarct and review the current literature on this topic. Conclusion of takayasu arteritis is a relatively rare disease with various and sometimes devastating clinical manifestations, such as massive cerebral ischemic infarction as in our case. Currently, there are multiple diagnostic tools and treatment options available, and more under investigation. Early, appropriate diagnosis and initiation of proper therapy could avoid further progression and reduce complications of the disease.

scholarly journals Case Report: Thalamomesencephalic stroke in a patient with HIV

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 1250
Author(s):  
Jerry George ◽  
Sibi Joseph ◽  
Mongezi Tau ◽  
Lourdes de Fatima Ibanez Valdes ◽  
Thozama Dubula ◽  
...  
Keyword(s):  
Medical Literature ◽  
Posterior Cerebral Artery ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Hiv Positive ◽  
Thalamic Lesion ◽  
Resonance Imaging ◽  
Babinski Sign ◽  
Ischemic Infarct ◽  
The Right

We present a 41-year-old HIV-positive female patient complaining of complete right palpebral ptosis, diplopia, and inability to balance herself. On examination, the right eye was able to move laterally and downwards. The motor exam showed left hemiparesis (4/5) on upper and lower limbs, bilateral Babinski sign with left hemiataxia without the sensory disorder. CT scan and magnetic resonance imaging angiography demonstrated an ischemic infarct on the right paramedian branch of the posterior cerebral artery territory.  This patient did not present clinical manifestations of the thalamic lesion. To our knowledge, this is the first reported case of a young patient presenting a unilateral thalamomesencephalic ischemic stroke secondary to HIV vasculitis with bilateral Babinski signs and without thalamic signs in the medical literature.

scholarly journals In Search of the Holy Grail: A Specific Diagnostic Test for Rheumatic Fever

2021 ◽  
Vol 8 ◽  
Author(s):  
David J. McMillan ◽  
Rukshan A. M. Rafeek ◽  
Robert E. Norton ◽  
Michael F. Good ◽  
Kadaba S. Sriprakash ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Laboratory Tests ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Disease Process ◽  
Adverse Outcomes ◽  
Diagnostic Tools ◽  
Antibody Array ◽  
Cellular Mechanisms ◽  
Specific Test

Current diagnosis of Acute Rheumatic Fever and Rheumatic Heart Disease (ARF/RHD) relies on a battery of clinical observations aided by technologically advanced diagnostic tools and non-specific laboratory tests. The laboratory-based assays fall into two categories: those that (1) detect “evidence of preceding streptococcal infections” (ASOT, anti-DNAse B, isolation of the Group A Streptococcus from a throat swab) and (2) those that detect an ongoing inflammatory process (ESR and CRP). These laboratory tests are positive during any streptococcal infection and are non-specific for the diagnosis of ARF/RHD. Over the last few decades, we have accumulated considerable knowledge about streptococcal biology and the immunopathological mechanisms that contribute to the development, progression and exacerbation of ARF/RHD. Although our knowledge is incomplete and many more years will be devoted to understanding the exact molecular and cellular mechanisms involved in the spectrum of clinical manifestations of ARF/RHD, in this commentary we contend that there is sufficient understanding of the disease process that using currently available technologies it is possible to identify pathogen associated peptides and develop a specific test for ARF/RHD. It is our view that with collaboration and sharing of well-characterised serial blood samples from patients with ARF/RHD from different regions, antibody array technology and/or T-cell tetramers could be used to identify streptococcal peptides specific to ARF/RHD. The availability of an appropriate animal model for this uniquely human disease can further facilitate the determination as to whether these peptides are pathognomonic. Identification of such peptides will also facilitate testing of potential anti-streptococcal vaccines for safety and avoid potential candidates that may pre-dispose potential vaccine recipients to adverse outcomes. Such peptides can also be readily incorporated into a universally affordable point of care device for both primary and tertiary care.

scholarly journals Pulmonary Artery Involvement in Patients with Takayasu Arteritis

2019 ◽  
Vol 47 (2) ◽  
pp. 264-272 ◽  
Author(s):  
Yanru He ◽  
Naqiang Lv ◽  
Aimin Dang ◽  
Nan Cheng
Keyword(s):  
New York ◽  
Pulmonary Artery ◽  
Takayasu Arteritis ◽  
Systolic Dysfunction ◽  
Clinical Manifestations ◽  
Heart Association ◽  
Lower Limbs ◽  
Class Iii ◽  
Association Class ◽  
New York Heart Association

Objective.This study was performed to explore the clinical manifestations and longterm prognosis in patients with Takayasu arteritis (TA) with pulmonary artery involvement (PAI).Methods.The medical records of 194 patients with TA who underwent traditional catheter angiography or computed tomography of pulmonary artery from 2009 to 2016 were retrospectively reviewed. The clinical manifestations, angiographic features, and mortality of 128 patients with TA with PAI were further analyzed.Results.Patients with TA with PAI had a higher risk of pulmonary hypertension (PH) than patients with TA alone (61.7% vs 7.6%, p < 0.001). Patients with PAI and PH more frequently developed dyspnea, hemoptysis, and lower limbs edema (all p < 0.05) than those without PH. Patients with PH also had a higher incidence of bilateral PAI (84.8% vs 34.7%, p < 0.001) and a higher pulmonary artery obstruction index [23 (interquartile range 20–27) vs 10 (6–15), p < 0.001]. Left heart disease was presented in 39 (30.5%) patients with TA with PAI. During the median followup of 38 (21–58) months, 19 and 2 deaths occurred among patients with and without PH, respectively. Among patients with PAI, the mortality rate was 7 times higher in patients with than without PH (p = 0.009). Independent predictors of mortality were the disease duration (p = 0.047), New York Heart Association class III/IV (p = 0.019), right ventricular systolic dysfunction (p = 0.019), and respiratory failure (p = 0.007).Conclusion.Patients with TA with PAI have a higher risk of developing PH than patients with TA alone. The presence of PH in patients with PAI increases the risk of early mortality.

scholarly journals A CASE REPORT OF TUBERCULAR TRANSVERSE MYELIT

2020 ◽  
pp. 1-2
Author(s):  
Vasireddy Teja ◽  
Y.V.S. Prabhakar ◽  
Bollu Prasanthi
Keyword(s):  
Case Report ◽  
Lower Limb ◽  
Clinical Symptoms ◽  
Past History ◽  
Transverse Myelitis ◽  
Lower Limbs ◽  
Inflammatory Disorder ◽  
Intermittent Fever ◽  
Limb Weakness ◽  
General Physical Examination

INTRODUCTION Transverse myelitis (TM) is a focal inflammatory disorder of the spinal cord, often associated with infectious disease, which can lead to permanent paraplegia or quadriplegia. CASE REPORT: A 56-year-female ,presentedwithb/l lower limb weakness since 2 days,b/l lower limb loss of sensations since two days,inability to walk since one day,and urinary retention requiring catherisation and fecal incontinence since one day. By history there was also , intermittent fever and night sweats. There was past history of respiratory tract infection two weeks back which partially subsided with antibiotics.Patient is known hypertensive and hypotyroid. Vitals:-normal General physical examination showed moderate general condition, and presence of crackles in both lungs. Neurological examination :- arreflecticlowerlimbs,paraplegia inboth lower limbs (strength 0/5 according to the Medical Research Council grade), and a positive Babinski sign,loss of all sensations completely below umbilicus. CONCLUSION- Tuberculous transversal myelitis is rare but should be consid- ered in the differential diagnosis of non-compressive myelopa- thies, in high burden TB countries or in the presence of clinical symptoms suggestiveofTB

scholarly journals Acquired copper deficiency myeloneuropathy with resolution Only after reversion of Roux-en-Y gastrojejunostomy: a case report

2021 ◽  
Author(s):  
Paulo de Lima Serrano ◽  
Igor Braga Farias ◽  
Bruno de Mattos Lombardi Badia ◽  
José Marcos Vieira de Albuquerque Filho ◽  
Paulo Victor Sgobbi de Souza ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Case Report ◽  
Copper Deficiency ◽  
Clinical Manifestations ◽  
Vitamin B12 Deficiency ◽  
Lower Limbs ◽  
Therapeutic Approaches ◽  
Hyperintense Signal ◽  
B12 Deficiency ◽  
Gastric By Pass

Introduction: The performance of bariatric surgeries has increased in recente years. Secondary mal- absorptive syndrome is an important cause of acquired copper deficiency, especially after Roux-em-Y gastric by-pass. The clinical manifestation of this deficiency disorder can occur years or decades after the surgery. Objective: To describe the course, clinical manifestations, therapeutic approaches and to raise concern about acquired copper deficiency in patients who underwent bariatric surgery. Methods: A case report seen in the neuromuscular service of the federal university of São Paulo.SP. Results: The patient underwent Roux-en-Y gastrojejunostomy in 2010, 6 years before the initial manifestations of paresthesia on the lower limbs and anemia. The symptons progressed to imbalance and falls. Magnetic resonance image depicted T2 hyperintense signal in the posterior column from C4- T4. A Vitamin B12 deficiency was considered to be the cause but intramuscular therapy was ineffective. The neurological condition deteriorated and the patient was unable to walk without a walker. A severe copper deficiency was diagnosed but oral and intravenous replacement did not improve the clinical picture. Only after reversion of the Roux-em-Y gastric by-pass that the patient improved. Conclusion: Obesity is growing health problem and the incidence of bariatric surgery is increasing. Acquire copper deficiency should always be on mind when facing a patient with myeloneuropathy that underwent these group of surgeries. Rapidly installed therapeutic approach can prevent neurological sequelae.

scholarly journals An Interesting Case of Takayasu’s Arteritis with an Atypical Presentation in an Adolescent Asian Girl

2021 ◽  
pp. 1-4
Author(s):  
Nilesh Pachakawade ◽  
◽  
Naresh Tayade ◽  
Amrut Swami ◽  
◽  
...  
Keyword(s):  
Rare Disease ◽  
Takayasu Arteritis ◽  
Myocardial Dysfunction ◽  
Color Doppler ◽  
Clinical Manifestations ◽  
Specific Treatment ◽  
Clinical Severity ◽  
Diagnostic Tools ◽  
Significant Discrepancy ◽  
Initial Symptoms

Introduction: Takayasu arteritis (TA) is a chronic non-specific inflammatory disease mainly affecting the medium and large arteries and is a common cause of renovascular hypertension among young Asian females. The initial symptoms and signs vary due to the heterogeneity of affected vessels. Case Presentation: Here we reporting a case of a rare disease in a 15 years old female presenting with abdominal distension, swelling over feet, facial puffiness lasting 1 month after which she was transferred to our hospital for further treatment. Blood Pressure showed significant discrepancy in upper limb and lower limb. Her laboratory results showed an elevated C-reactive protein and D-dimer. Also Color Doppler ultrasound and Computed Tomography Aortography (CTA) leading to diagnosis of TA, after which we started the patient on medical treatment and cardiological intervention. Vasculitis-induced renovascular secondary hypertension resulted in myocardial dysfunction, which recovered with treatment of hypertension and TA. Delayed diagnosis and lack of specific treatment could explain the extent and the clinical severity of the disease at time of hospital admission. Conclusion: Takayasu arteritis is a relatively rare disease with various clinical manifestations, such as ascities, anasarca as in our case. Currently, there are multiple diagnostic tools and treatment options available, and more under investigation. Early, appropriate diagnosis and initiation of proper therapy could avoid further progression and reduce complications of the disease. Hence early diagnosis and treatment is warranted

scholarly journals Case Report: Thalamomesencephalic stroke in a patient with HIV

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1250
Author(s):  
Jerry George ◽  
Sibi Joseph ◽  
Mongezi Tau ◽  
Lourdes de Fatima Ibanez Valdes ◽  
Thozama Dubula ◽  
...  
Keyword(s):  
Medical Literature ◽  
Posterior Cerebral Artery ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Hiv Positive ◽  
Thalamic Lesion ◽  
Resonance Imaging ◽  
Babinski Sign ◽  
Ischemic Infarct ◽  
The Right

We present a 41-year-old HIV-positive female patient complaining of complete right palpebral ptosis, diplopia, and inability to balance herself. On examination, the right eye was able to move laterally and downwards. The motor exam showed left hemiparesis (4/5) on upper and lower limbs, bilateral Babinski sign with left hemiataxia without the sensory disorder. CT scan and magnetic resonance imaging angiography demonstrated an ischemic infarct on the right paramedian branch of the posterior cerebral artery territory.  This patient did not present clinical manifestations of the thalamic lesion. To our knowledge, this is the first reported case of a young patient presenting a unilateral thalamomesencephalic ischemic stroke secondary to HIV vasculitis with bilateral Babinski signs and without thalamic signs in the medical literature.

scholarly journals Chronic kidney disease and periodontal disease. Case report

2018 ◽  
Vol 21 (1) ◽  
pp. 133
Author(s):  
Camilla Magnoni Moretto Nunes ◽  
Camila Lopes Ferreira ◽  
Daniella Vicensotto Bernardo ◽  
Andréa Carvalho De Marco ◽  
Mauro Pedrine Santamaria ◽  
...  
Keyword(s):  
Renal Failure ◽  
Case Report ◽  
Chronic Renal Failure ◽  
Periodontal Disease ◽  
Periodontal Diseases ◽  
Treatment Plan ◽  
Clinical Manifestations ◽  
Disease Process ◽  
Periodontal Treatment ◽  
Disease Case

<p>Chronic renal disease promotes a decrease on kidneys filterability and nitrogen products accumulation on blood, electrolyte and system endocrine functions imbalance. Among the many clinical manifestations of chronic renal failure (CRF) in the oral cavity, there are: dry mouth, uremic stomatitis, radiographic changes in maxillary and jaw bones and accumulation of calculus on the teeth that increases levels of periodonto pathogenic microorganisms able to lead a periodontal tissue destruction and also have the potential to act from a distance on other organs, e.g. the kidneys. Thus, it becomes evident that a periodontal treatment of patients suffering from chronic renal failure is crucial for maintaining their general health conditions and a subsequent successful organ transplant.Thus, the objectives of this case report were to highlight how important the periodontal treatment is for chronic renal failure patients and to demonstrate improvements in their clinical condition through the treatment plan proposed herein. A patient with 43 years old carrier generalized moderate chronic periodontitis and CRF was submitted to scaling and root planning sessions, and later surgical access for scaling where the basic treatment not resulted in a resolution of the inflammatory periodontal process. The results obtained from a well-developed periodontal treatment and an effective cooperation of patient showed satisfactory results with periodontal disease process resolution or stabilization.Thus, periodontal treatment and patient compliance were crucial for the improvement of periodontal clinical conditions enabling a future successful renal transplantation.</p><p><strong>Keywords</strong></p><p>Dental care; Periodontal diseases; Renal insufficiency.</p>

scholarly journals Dystrophic epidermolysis bullosa associated with congenital contractures of the upper and lower limbs: literature review

2015 ◽  
Vol 3 (4) ◽  
pp. 51-59
Author(s):  
Olga Evgenievna Agranovich ◽  
Dmitry Stepanovich Buklaev ◽  
Tatiana Ivanovna Tikhonenko
Keyword(s):  
Epidermolysis Bullosa ◽  
Clinical Manifestations ◽  
Disease Process ◽  
Hereditary Disease ◽  
Lower Limbs ◽  
Dystrophic Epidermolysis Bullosa ◽  
Cutaneous Manifestations ◽  
Inner Organs ◽  
Hands And Feet ◽  
A Minor

Epidermolysis bullosa (EB) is a rare hereditary disease. Its main feature is vesication and weeping sores (erosions) of the skin and mucous membranes, resulting from a minor injury. Clinical manifestations of the disease may vary from localized vesicles on the hands and feet to a generalized rash of the skin as well as lesions of the mucosa of the inner organs. At present, there are four main groups of EB: simple, intermediate, dystrophic, and Kindler syndrome. Mutations cause changes in the structure of the proteins responsible for the adhesion between layers of the dermis, leading to vesication. Treatment of EB is a challenge because of the lack of opportunities for the direct influence on the disease process, and its main purpose is to correct the existing cutaneous manifestations and prevent the occurrence of new elements. This article describes the main types of EB, methods of current diagnosis, and treatment of the disease as well as a clinical case of a rare combination of two severe disorders: 1) dystrophic EB and 2) arthrogryposis with upper and lower limb involvement.

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