ACUTE HIPPOCAMPAL INFARCTIONS PRESENTING AS SUDDEN ONSET TRANSIENT MEMORY LOSS, PICKED UP BY EARLY MRI IMAGING

2017 ◽  
Author(s):  
Lankanatha Alwis
Keyword(s):  
Memory Loss ◽  
Sudden Onset ◽  
Mri Imaging

Functional (PET/CT) compared to conventional (mammography [M], sonography [US], MRI) imaging: Defining novel assessment modalities for inflammatory breast cancer (IBC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 600-600
Author(s):  
W. T. Yang ◽  
H. T. Le-Petross ◽  
A. Gonzalez-Angulo ◽  
H. Macapinlac ◽  
H. Macapinlac ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Imaging Modality ◽  
Distant Metastases ◽  
Sudden Onset ◽  
Cancer Center ◽  
Architectural Distortion ◽  
Mri Imaging ◽  
Nodal Disease ◽  
Eligibility Criteria ◽  
Pet Ct

600 Background: IBC is an aggressive frequently lethal form of breast cancer that is defined by sudden onset breast erythema often without an associated clinical or radiological breast mass. Tissue diagnosis remains problematic due to inability to define an area for biopsy. The aim of this study was to compare conventional [M, US, MRI] vs. functional imaging [PET/CT] in detecting a primary breast parenchymal lesion (BPL) at initial presentation of IBC. Methods: Patients (pts) with a new clinical diagnosis of IBC evaluated at the M. D. Anderson Cancer Center between January 2003 to December 2006 who had M, US, MRI, or PET/CT were included in this study. The visibility of a BPL and skin abnormality on each imaging modality was compared. Regional (axillary, supraclavicular, internal mammary) nodal disease confirmed by pathology was assessed at US and PET/CT. The presence of metastatic disease at diagnosis with PET/CT was documented. Results: Sixty-seven pts met eligibility criteria. Median age was 51 years, (range, 25 to 78). Of these, 61 (91%) had M, 62 (93%) had US, 21 (31%) had MRI, and 13 (19%) had PET/CT. By M, no BPL (mass or calcifications) was observed in 16% (10/61), skin-only abnormality (SOA) in 14% (9/61), and a BPL in 84% (51/61). By US, no BPL (mass or architectural distortion) and SOA were noted in 6% (4/62), and a PBL in 94% (58/62). By MRI, 21/21 (100%) showed malignant enhancing BPL and skin thickening. By PET/CT, 100% (13/13) showed hypermetabolic BPL and skin thickening. Pathologically confirmed regional nodal disease was diagnosed in 96% (59/62) by US and in 69% (9/13) by PET/CT. Distant metastases in the bone and lung were diagnosed in 15% (2/13) by PET/CT, one of which was visible on bone scan. Conclusions: MRI and PET/CT showed a primary BPL in all cases of IBC while conventional imaging (M and US) failed to reveal a BPL amenable to biopsy in up to 16%. US can diagnose regional nodal disease to facilitate loco-regional therapeutic planning. PET/CT provides additional information on distant metastasis and should be considered in the initial staging of IBC. No significant financial relationships to disclose.

Voltage Gated Potassium Channel Antibody(VGKC)-associated Encephalopathy and Psychiatric Symptoms (case report)

2017 ◽  
Vol 41 (S1) ◽  
pp. S660-S661
Author(s):  
U. Narayana ◽  
P. Nirodi
Keyword(s):  
Cognitive Impairment ◽  
Psychiatric Symptoms ◽  
Care Home ◽  
Memory Loss ◽  
Sudden Onset ◽  
Acute Onset ◽  
Treatment Resistant ◽  
Care Needs ◽  
Liaison Psychiatry ◽  
Home Setting

Introduction and ObjectivesThe limbic system is primarily responsible for modulating behaviour, emotions and neuro-endocrine functions. Limbic encephalopathy involves this part of the brain and is characterised by the acute or sub-acute onset of seizures, recent memory loss, confusion and psychiatric symptoms. Here we describe an unusual presentation of a well-functioning elderly man, who presented with sudden onset of confusion, cognitive impairment, treatment resistant hyponatremia, seizures and psychiatric symptoms.Methods (Presentation)This 79 year old gentleman, previously well and independent was admitted to the acute hospital with a 3 week history of sudden onset of confusion, odd behaviour and weight loss. On admission he was hyponatremic (Na-118), developed treatment resistant seizures and progressive cognitive impairment. He was referred to the Liaison Psychiatry team with increasing paranoia, agitation and persecutory delusions.ResultsMRI and CT brain remained normal. Lumbar puncture revealed a positive VGKC antibody and his blood titres for VGKC was more than 3000. His hyponatremia and seizures remained chronic, but improved with plasmapheresis, oral corticosteroids and cyclophosphamide. He was commenced on aripiprazole for psychiatric symptoms, but was transferred to the acute psychiatric unit after being detained under section 2 of the MHA due to risks of aggression and absconsion.ConclusionsPsychiatric symptoms related to this form of encephalitis have not been emphasised in literature. His aggression improved over time on aripiprazole, but was transferred to a residential care home setting due to persisting cognitive deficits and social care needs This case highlights the importance of recognising multimorbidity, joint working and more research required in the area.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals SUN-273 A Rare Case of IgG4-Related Hypophysitis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sindhura Ravindra ◽  
Pouneh Fazeli
Keyword(s):  
Plasma Cell ◽  
Rare Case ◽  
Systemic Disease ◽  
Sudden Onset ◽  
Pituitary Hormone ◽  
Mri Imaging ◽  
Free T4 ◽  
Central Hypothyroidism ◽  
Endoscopic Endonasal ◽  
Serum Igg4

Abstract Introduction: Hypophysitis is an acute or chronic inflammation of the pituitary gland and is an important diagnostic consideration in a patient with a sellar lesion. The annual incidence of hypophysitis is estimated to be 1 in 7–9 million and it accounts for approximately 0.4% of pituitary surgery cases. The following highlights a rare case of isolated IgG4-related hypophysitis Clinical Case: A 63-year-old Caucasian female presented with sudden onset of diplopia and decreased visual acuity. This was associated with a 3-month history of headaches and 5-lbs weight loss. Past medical history was significant for hypertension and a 1.5cm sellar/suprasellar mass incidentally discovered during the work-up for persistent headaches 1-month prior. Initial anterior pituitary hormone evaluation was normal and the patient was scheduled for endoscopic endonasal resection of a presumed non-functioning pituitary adenoma. Family history was negative for pituitary tumors or hyperparathyroidism. Physical examination was notable for medial deviation of her left eye but neurologic examination was otherwise normal. Laboratory studies were notable for a normal TSH [1.769 uIu/ml (normal: 0.3–5.0)] and low free T4 [0.44 ng/ml (normal: 0.89–1.78)] consistent with central hypothyroidism; an inappropriately normal FSH for a postmenopausal woman [5.6 mIu/ml (normal: 0.3–10.5), and a normal prolactin level [16 ng/ml (0.6–20)]. An 8am cortisol was low at 2mcg/dL (5–21) with an ACTH level of 10 pg/mL (9–46). IGF-1 was normal at 89 ng/mL (41–279). Repeat pituitary MRI imaging demonstrated a homogenously enhancing sellar/suprasellar mass measuring 3.8 cm with displacement of the optic chiasm. Serum IgG4 levels were normal. The patient was started on 50mg IV hydrocortisone every 8 hours for central adrenal insufficiency and levothyroxine 88 mcg daily for central hypothyroidism and underwent an endoscopic endonasal biopsy of the lesion. Surgical pathology was notable for plasma cell-rich lymphohistiocytic hypophysitis and IgG4 plasma cells constituted >40% of the total plasma cell population. The patient subsequently received 1g of rituximab and repeat imaging one week later showed marked improvement in the size and extent of the lesion. The patient was discharged on prednisone and levothyroxine and received a second dose of rituximab at follow-up. The patient reports a decrease in the frequency of her headaches but continues to endorse diplopia. Conclusion: IgG4-related hypophysitis typically presents as part of a multifocal systemic process. This case highlights a rare entity of IgG4-related hypophysitis without other features of systemic disease and with normal serum levels of IgG4. Although glucocorticoids are universally regarded as the first line of therapy, an immunosuppressive agent or B-cell depletion therapy such as Rituximab may improve remission and decrease the risk of relapse.

scholarly journals Transient global amnesia: an uncommon presentation of acute myocardial infarction

2018 ◽  
Vol 12 (2) ◽  
pp. 148
Author(s):  
Paolo Tirelli ◽  
Fulvio Cacciapuoti ◽  
Filomena Scarano ◽  
Federico Cacciapuoti
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Rare Case ◽  
Memory Loss ◽  
Transient Global Amnesia ◽  
Sudden Onset ◽  
Sympathetic Hyperactivity ◽  
Uncommon Presentation ◽  
Temporal Structures ◽  
Global Amnesia

Transient global amnesia (TGA) is an acute neurological syndrome characterized by sudden-onset global (anterograde and retrograde) amnesia, without compromising other neurological functions. This clinical condition lasts up to 24 h with whole restoration. Several causes have been proposed as responsible for it. Among these, acute myocardial infarction (AMI) was reported as a rare cause of TGA. Sympathetic hyperactivity occurring too early in AMI seems to induce vasospasm, responsible for venous cerebral congestion acting on hippocampal and temporal structures and consequent memory loss. A rare case of TGA as precocious display of subsequent AMI was described.

scholarly journals Glioblastoma in a Patient with a Hereditary Cancer Syndrome

2008 ◽  
Vol 35 (1) ◽  
pp. 98-101 ◽  
Author(s):  
J L Steckley ◽  
C J Watling ◽  
W. Ng
Keyword(s):  
Brain Cancer ◽  
Memory Loss ◽  
Sudden Onset ◽  
Hereditary Cancer Syndrome ◽  
Valve Repair ◽  
Cancer Syndrome ◽  
Eye Pain ◽  
Word Finding ◽  
Basal Cell Carcinomas ◽  
Paternal Aunt

A 68-year-old Caucasian male presented to emergency with a spontaneous sudden onset headache localized behind the left eye. Pain was severe and associated with vomiting, agitation, anxiety, memory loss, and word-finding difficulty. There was no preceding trauma and no meningeal symptoms. Further history was significant for mitral valve repair, atrial fibrillation treated with coumadin, colorectal cancer treated with right-sided hemicolectomy 17 years prior, and multiple skin tumors, which included squamous cell and basal cell carcinomas of his face and ears. Family history was significant for colon cancer in his father (at age 50), a sister (at age 40), and a niece (at age 38), as well as primary brain cancer in his paternal aunt.

scholarly journals Transient global amnesia and functional retrograde amnesia: contrasting examples of episodic memory loss

1997 ◽  
Vol 352 (1362) ◽  
pp. 1747-1754 ◽  
Author(s):  
◽  
Mark Kritchevsky ◽  
Joyce Zouzounis ◽  
Larry R. Squire
Keyword(s):  
Retrograde Amnesia ◽  
Clinical Picture ◽  
Memory Loss ◽  
Transient Global Amnesia ◽  
Anterograde Amnesia ◽  
Sudden Onset ◽  
Memory Problems ◽  
Essentially Normal ◽  
Amnesic Syndrome ◽  
Global Amnesia

We studied 11 patients with transient global amnesia (TGA) and 10 patients with functional retrograde amnesia (FRA). Patients with TGA had a uniform clinical picture: a severe, relatively isolated amnesic syndrome that started suddenly, persisted for 4−12 h, and then gradually improved to essentially normal over the next 12−24 h. During the episode, the patients had severe anterograde amnesia for verbal and non-verbal material and retrograde amnesia that typically covered at least two decades. Thirty hours to 42 days after the episode, the patients had recovered completely and performed normally on tests of anterograde and retrograde amnesia. By contrast, patients with FRA had a sudden onset of memory problems that were characterized by severe retrograde amnesia without associated anterograde amnesia and with a clinical presentation that otherwise varied considerably. The episodes persisted from several weeks to more than two years, and some of the patients had not recovered at the time of our last contact with them. The uniform clinical picture of TGA and the variable clinical picture of FRA presumably reflect their respective neurologic (‘organic’) and psychogenic (‘non-organic’) aetiologies.

scholarly journals Diagnostic challenge of rapidly progressing sporadic Creutzfeldt-Jakob disease

2019 ◽  
Vol 12 (9) ◽  
pp. e230535 ◽  
Author(s):  
Gi Tae Kwon ◽  
Min Sung Kwon
Keyword(s):  
Disease Onset ◽  
Memory Loss ◽  
Cerebral Atrophy ◽  
Sudden Onset ◽  
Postmortem Brain ◽  
Diagnostic Tools ◽  
Diagnostic Challenge ◽  
Progressive Dementia ◽  
Diagnostic Dilemma ◽  
Jakob Disease

Antemortem assessment of sporadic Creutzfeldt-Jakob disease (sCJD) can be significantly hampered due to its rarity, low index of clinical suspicion and its non-specific clinical features. We present an atypical case of definitive sCJD. The patient died within 5 weeks of the disease onset. This unusually short duration of disease presented a significant diagnostic dilemma. The patient presented with 2-week history of sudden-onset cognitive decline, memory loss, aphasia and ataxia. MRI Diffusion-weighted sequences revealed cortical ribboning sign without cerebral atrophy. Protein 14-3-3 from cerebrospinal fluid (CSF) was detected, and postmortem brain autopsy confirmed the diagnosis of sCJD. This case underscores the importance of considering CJD as a potential diagnosis for rapidly progressive dementia. Serology tests, EEG, MRI and CSF study are invaluable diagnostic tools when assessing for sCJD. Appropriate use of those diagnostic tests, along with a detailed clinical examination, can successfully and promptly exclude other differential diagnoses and confirm sCJD.

scholarly journals Case Report: Ulcerative Colitis with Multiple Dural Venous Thrombosis

2021 ◽  
pp. 504-509
Author(s):  
Safia Mohamud ◽  
Mosunmola Oyawusi ◽  
Roger Weir ◽  
Richard M. Millis ◽  
Ozra Dehkordi
Keyword(s):  
Ulcerative Colitis ◽  
Magnetic Resonance ◽  
Vital Signs ◽  
Memory Loss ◽  
Lower Abdominal Pain ◽  
Neurological Status ◽  
Sudden Onset ◽  
University Hospital ◽  
History Of ◽  
Sound Sensitivity

<b>Background</b> Cerebral sinus vein thrombosis (CVT) is a rare but serious complication associated with ulcerative colitis (UC), an idiopathic autoimmune inflammatory disease of the gastrointestinal tract. Management approaches for CVT remain unclear but may include anticoagulation and surgical thrombectomy. Herein, we report a case of a 23-year-old male who developed CVT with a history of UC. The patient was presented to Howard University Hospital when he slipped and fell. On arrival at the hospital, he complained of a headache with an aching sensation, associated with light/sound sensitivity. The patient had a history of uncontrolled UC. He had positive bloody diarrhea, lower abdominal pain, but denied any other neurological deficit. Computed tomography of the head showed left frontoparietal lobe hypodensities. Neurological exam was nonfocal. Vital signs were within normal range, but the patient experienced some memory loss and personality changes. Subsequent diagnosis of CVT was made with magnetic resonance angiography and magnetic resonance venography. Immediate treatment with low-molecular-weight intravenous heparin (18 IU/kg) was introduced. His UC was managed with methylprednisolone (60 mg IV daily), proton pump inhibitors, mesalamine, ciprofloxacin, and metronidazole. His condition gradually improved. On discharge, he was prescribed prednisone, azathioprine for his UC, levetiracetam for seizure, and warfarin with an INR goal of 2–3. In conclusion, the sudden onset and/or acute worsening of neurological status such as headache and mental confusion in a patient with UC should alert the treating physician about the possibility of CVT so that timely intervention could be employed to prevent disabling and potentially lethal sequelae of this disease.

Intramuscular Nerve and Neuromuscular Junction Alteration In Extraocular Muscles of Diabetic Mice

1985 ◽  
Vol 43 ◽  
pp. 682-683
Author(s):  
Bruce R. Pachter
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Nerves ◽  
Sudden Onset ◽  
Extraocular Muscles ◽  
Diabetic Patients ◽  
Oculomotor Palsy ◽  
Third Nerve Palsy ◽  
Patients With Diabetes ◽  
Intramuscular Nerve ◽  
Oculomotor Nerves

Diabetes mellitus is one of the commonest causes of neuropathy. Diabetic neuropathy is a heterogeneous group of neuropathic disorders to which patients with diabetes mellitus are susceptible; more than one kind of neuropathy can frequently occur in the same individual. Abnormalities are also known to occur in nearly every anatomic subdivision of the eye in diabetic patients. Oculomotor palsy appears to be common in diabetes mellitus for their occurrence in isolation to suggest diabetes. Nerves to the external ocular muscles are most commonly affected, particularly the oculomotor or third cranial nerve. The third nerve palsy of diabetes is characteristic, being of sudden onset, accompanied by orbital and retro-orbital pain, often associated with complete involvement of the external ocular muscles innervated by the nerve. While the human and experimental animal literature is replete with studies on the peripheral nerves in diabetes mellitus, there is but a paucity of reported studies dealing with the oculomotor nerves and their associated extraocular muscles (EOMs).

Lessons Learned From Coaching Postsecondary Students With Traumatic Brain Injury

2020 ◽  
Vol 5 (1) ◽  
pp. 88-96
Author(s):  
Mary R. T. Kennedy
Keyword(s):  
College Students ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sense Of Self ◽  
Scientific Evidence ◽  
Sudden Onset ◽  
Lessons Learned ◽  
Speech Language Pathologists ◽  
The Brain ◽  
Exhaustive List

Purpose The purpose of this clinical focus article is to provide speech-language pathologists with a brief update of the evidence that provides possible explanations for our experiences while coaching college students with traumatic brain injury (TBI). Method The narrative text provides readers with lessons we learned as speech-language pathologists functioning as cognitive coaches to college students with TBI. This is not meant to be an exhaustive list, but rather to consider the recent scientific evidence that will help our understanding of how best to coach these college students. Conclusion Four lessons are described. Lesson 1 focuses on the value of self-reported responses to surveys, questionnaires, and interviews. Lesson 2 addresses the use of immediate/proximal goals as leverage for students to update their sense of self and how their abilities and disabilities may alter their more distal goals. Lesson 3 reminds us that teamwork is necessary to address the complex issues facing these students, which include their developmental stage, the sudden onset of trauma to the brain, and having to navigate going to college with a TBI. Lesson 4 focuses on the need for college students with TBI to learn how to self-advocate with instructors, family, and peers.

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