scholarly journals Hashimoto’s Encephalopathy Presenting with Acute Behavioral Disturbances: A Case Report

2020 ◽  
Vol 4 (4) ◽  
pp. 309
Author(s):  
Rozi NR ◽  
RM Yousuf ◽  
Kok HT ◽  
Mohd Unit H ◽  
Ibrahim KA ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Previous History ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Cns Infection ◽  
Behavioural Disturbance ◽  
Behavioral Disturbances ◽  
Hashimoto’S Encephalopathy ◽  
Intravenous Acyclovir ◽  
History Of

Hashimoto’s encephalopathy (HE) is a rare and poorly understood neuropsychiatric illness of presumed autoimmune origin, with elevated titres of anti-thyroid antibodies. Its clinical presentation is highly variable that mimic a variety of neurologic and/or psychiatric disorders. Clinical presentation often suggests an infectious etiology which often leads to a mistaken diagnosis. We present the case of 35 year-old female who presented with acute onset behavioural disturbance of one day duration. On examination she was unkempt, emotionally labile, appeared withdrawn and unable to respond to questions. She had no focal neurological deficits. CNS infection was suspected and lumbar puncture was suggested, which the family members refused.She was empirically treated with intravenous acyclovir and ceftriaxone.Metabolic disorder, infectious and toxic issues were ruled out through laboratory testing.In view of her previous history of hyperthyroidism, suspicion of Hashimoto encephalopathy arose.The diagnosis was supported by the elevated level of anti-thyroglobulin (TG) antibody.We report this case to increase its awareness as it is one of the few treatable and easily reversible causes of acute encephalopathy. It should be considered in the differential diagnoses in any patient who presents with acute behavioural disturbance and has concurrent thyroid disorder.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 309-312

scholarly journals Ectopic pregnancy in a tertiary care centre of Jharkhand, India

2019 ◽  
Vol 8 (8) ◽  
pp. 2969
Author(s):  
Meetali Parashar ◽  
Meena Mehta
Keyword(s):  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Previous History ◽  
First Trimester ◽  
Near Miss ◽  
Obstetrics And Gynaecology ◽  
Maternal Morbidity And Mortality ◽  
History Of ◽  
Β Hcg ◽  
A Prospective Study

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

Paroxysmal Stabbing Headache in The Multiple Dermatomes of The Head and Neck: A Variant of Primary Stabbing Headache or Occipital Neuralgia?

Cephalalgia ◽  
2007 ◽  
Vol 27 (10) ◽  
pp. 1101-1108 ◽  
Author(s):  
JH Shin ◽  
HK Song ◽  
JH Lee ◽  
WK Kim ◽  
MK Chu
Keyword(s):  
Medical Center ◽  
Previous History ◽  
Headache Disorder ◽  
Acute Onset ◽  
Occipital Neuralgia ◽  
Cervical Nerve ◽  
Primary Stabbing Headache ◽  
History Of ◽  
Stabbing Headache

A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2nd Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.

Notfallmäßige Carotis Endarterektomie im Stadium progredienter neurologischer Defizite

VASA ◽  
2001 ◽  
Vol 30 (2) ◽  
pp. 115-121 ◽  
Author(s):  
R. Brandl ◽  
R.B. Brauer ◽  
P.C. Maurer
Keyword(s):  
Complete Recovery ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Symptomatic Carotid ◽  
Urgent Surgery ◽  
Post Surgery ◽  
Elective Treatment ◽  
Carotid Stenoses ◽  
History Of

Background: Carotid endarterectomy (CEA) is well established as the elective treatment for moderate or severe carotid stenoses with a history of neurologic symptoms. In contrast, the merits of carotid revascularisation performed in emergency in patients with acute stroke or fluctuating neurological deficit remain controversial. Patients and methods: A total of 445 CEAs were performed on 424 patients for 212 (48%) asymptomatic and 233 (52%) symptomatic carotid stenoses within a 5 years period between January, 1995, and December, 1999. Of the latter, CEA was performed in emergency on 16 patients (3.8%) within 4 to 24 hours after the onset of symptoms. Patients selected for urgent surgery fulfilled the following criteria: acute onset of fluctuating hemispheric neurological symptoms, significant carotid pathology, absence of cerebral hemorrhage, uncompromised vigilance and stable cardiopulmonary conditions. Selected patients presented with a crescendo-TIA (n = 7) or fluctuating neurological deficits (n = 9) corresponding to a contralateral carotid stenosis. Results: Following CEA, the neurological deficits improved instantaneously to complete recovery in 9 patients. The symptoms of 4 patients improved to non-disabling deficits, remained unchanged in one and worsened in 2 patients from hemihypaesthesia to hemiparesis. 14/16 patients were discharged within 8 days after admission. The neurologic status after discharge did not deteriorate in any of the patients during follow up of 19.3 ± 13 months, but improved in 4 of the patients. Conclusion: Our retrospective study suggests that rescue CEA may be beneficial for selected patients with stroke in evolution and fluctuating neurological deficits. Careful adherence to selection criteria, intraoperative shunting, intensive care post surgery surveillance and an experienced team are recommended.

Microsurgery for Small Arteriovenous Malformations of the Brain: Results in 110 Consecutive Patients

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 571-577 ◽  
Author(s):  
Justin H. T. Pik ◽  
Michael K. Morgan
Keyword(s):  
Arteriovenous Malformations ◽  
Postoperative Outcome ◽  
Neurological Status ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
History Of ◽  
The Brain ◽  
Results Of Surgery

ABSTRACT OBJECTIVE To examine the results of surgery in 110 consecutive patients with arteriovenous malformations (AVMs) smaller than 3 cm in diameter. These results are compared with the published results of other microsurgical series as well as with results for patients treated with focused irradiation. METHODS From January 1989 to November 1998, 121 patients with AVMs smaller than 3 cm were treated at our institution. One hundred ten patients underwent microsurgical removal of their AVMs. The presentation, preoperative neurological status, and postoperative outcome were recorded. Follow-up was complete for all surgical cases. RESULTS Of the 110 patients, 109 (99%) had angiographically confirmed obliteration of their AVMs. Two patients (1.8%) required reoperation for residual AVM. Two (4.3%) of 46 patients with AVMs in eloquent brain areas experienced worsening of their neurological status after surgery. One (1.6%) of 64 patients was worse neurologically after removal of an AVM in a noneloquent area. CONCLUSION Microsurgical removal is a safe and effective treatment for the majority of AVMs smaller than 3 cm in diameter. Although the treatment is accompanied by a risk of acute onset of neurological deficits, this tends to be transient in the majority of cases. Furthermore, microsurgical excision of small AVMs offers patients immediate protection from the natural history of their vascular lesions.

Hot Bathtub, Cold Consequences—Misleading Wounds After Scald Injuries: A Retrospective Analysis

2020 ◽  
Author(s):  
Alperen S Bingoel ◽  
Nicco Krezdorn ◽  
Andreas Jokuszies ◽  
Khaled Dastagir ◽  
Peter Maria Vogt ◽  
...  
Keyword(s):  
Surface Area ◽  
Clinical Presentation ◽  
Previous History ◽  
The Elderly ◽  
Initial Assessment ◽  
P Value ◽  
Significant Difference ◽  
History Of ◽  
Erythematous Skin ◽  
The Mean

Abstract Scalds in the elderly are frequently associated with the use of a bathtub and a disturbed consciousness. Therefore, the total burn surface area is often high. The initial clinical presentation displays a stark erythema of the skin, which frequently does not represent the true depth. The aim of this study was to characterize and assess medical features and outcome of scalds sustained in the bathtub. We conducted a retrospective study at a burn intensive care unit (BICU) between 2011 and 2018. Medical features as well as the treatment in these patients were statistically analyzed. We identified 16 patients and divided them into two groups regarding survival and lethality. The mean total burn surface area was 37.50 ± 19.47%. In 81.25% of the patients, we found a previous history of neurological or psychiatric disorders. Dementia and alcohol abuse were the most common triggers for the trauma. The statistical analysis showed a significant difference for the ABSI-score and the presence of multi organ failure (P-value .0462, respectively, .0004). Erythematous skin areas tended to progress into full thickness burns. We, therefore, coined the term “lobster redness” for these regions. Scalds sustained in the bathtub are devastating injuries. Initial assessment can be misleading and might delay early necrectomy. The wounds request even more attention, if the injuries occurred due to unconsciousness because of the longer exposure to heat. Early necrectomy should be considered. A biopsy with histological workup can be useful. Furthermore, we recommend special safety precautions for neurologically and psychiatrically affected patients.

scholarly journals Abdominal incisional hernia: retrospective study

2018 ◽  
Vol 6 (9) ◽  
pp. 2990
Author(s):  
Archana Shukla ◽  
Sameer Ahmed
Keyword(s):  
Retrospective Study ◽  
Incisional Hernia ◽  
Clinical Presentation ◽  
Previous History ◽  
Age Group ◽  
Precipitating Factors ◽  
Medical College ◽  
Operative Complications ◽  
History Of ◽  
Gandhi Medical College

Background: Incisional hernia presents as herniation or protrusion occurring along a prior abdominal scar. It is a known complication of abdominal surgery. They are the second most common type of hernia after inguinal hernias. This study was undertaken to study the incidence and various risk factors leading to incisional hernia.Methods: It is a retrospective study done in Gandhi Medical College, Bhopal; Department of Surgery during January 2017 to January 2018. All the cases were analyzed in various aspects like age, sex, relative incidence, clinical presentation, nature of previous operation, site of previous scar, precipitating factors like obesity, wound infection, abdominal distension.Results: The incidence is around 18.5%. Patients in the age group of 30-50 years found to have highest incidence of incisional hernia. Females outnumbered the males with the ratio of 6:1. Incisional hernia was more common in patients with previous history of gynecological operation. Most of the patients presented with incisional hernia in the infra umbilical region.Conclusions: Incisional hernias can be prevented by avoidance of midline incisions, especially in the infra umbilical region. Mesh repair results in less post-operative complications provided drains are used.

scholarly journals Clinical effects from household insecticide: pyrethroid or organophosphate toxicity?

2019 ◽  
Vol 12 (11) ◽  
pp. e230966
Author(s):  
Zahir Basrai ◽  
Cynthia Koh ◽  
Manuel Celedon ◽  
Jonathan Warren
Keyword(s):  
Emergency Room ◽  
Clinical Presentation ◽  
Acute Onset ◽  
Subsequent Treatment ◽  
Burning Sensation ◽  
Clinical Effects ◽  
Limited Data ◽  
History Of ◽  
Low Threshold ◽  
Organophosphate Toxicity

A 54-year-old man with a history of schizophrenia presented to the emergency room for weakness with associated lacrimosis, drooling, nausea, emesis, diarrhoea, diplopia and burning sensation on his skin that began 6 hours after spraying five cans of Raid on his carpet. He was noted to have miotic pupils and hyperactive bowel sounds. Given the clinical presentation, the patient was diagnosed with organophosphate (OP) toxicity. After being admitted, he developed symptoms associated with his OP toxicity and was successfully treated with atropine and pralidoxime. Most Raid products contain pyrethroids; however, both OPs and pyrethroids are available in commercial pesticides and patients may misidentify ingestions. There are limited data reporting the toxicity of pyrethroid overdose in humans and to guide its subsequent treatment. It is crucial to keep a low threshold for diagnosing and treating patients with acute onset of symptoms suspicious for an OP or pyrethroid toxidrome.

scholarly journals A Comparative Study of Characteristics and Outcomes of Patients with Proved and Suggested Sarcoid Uveitis Occurring after Ophthalmic Procedure

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Yvan Jamilloux ◽  
Aude Taleb ◽  
Audrey De Parisot ◽  
Laurent Pérard ◽  
Carole Burillon ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Previous History ◽  
Control Group ◽  
Disease Course ◽  
Significant Difference ◽  
History Of ◽  
Potential Trigger ◽  
Incident Cohort ◽  
New Onset

Purpose. To describe patients with new onset sarcoid uveitis occurring after an ophthalmic procedure and compare them with patients with sarcoid uveitis without ocular procedure. Methods. Retrospective analysis of case records from patients with postophthalmic procedure sarcoid uveitis seen at our institution between April 2004 and October 2016. Patients with a previous history of uveitis were not included. Each patient was randomly matched with four controls from our incident cohort of new onset sarcoid uveitis without ophthalmic procedure. Results. We identified 11 patients (8.5%) from our incident cohort of sarcoid uveitis (n=130), who were all women, with a postophthalmic procedure uveitis (mostly after cataract surgery (36%)). These patients were older (69.7 vs 52.7 years) and presented more synechiae than controls. After a mean follow-up of 30 (3–60) months, there was no significant difference between the postprocedure and the control group with regard to demography, clinical presentation, disease course, treatment, and outcome. Conclusions. Sarcoid uveitis has similar characteristics in patients with new onset sarcoid uveitis after or without ophthalmic procedure. As a consequence, ophthalmic intervention should be seen as a potential trigger of latent sarcoidosis.

scholarly journals Traumatic perforations of tympanic membrane: our experience

2018 ◽  
Vol 5 (1) ◽  
pp. 131
Author(s):  
Anuja Bhargava ◽  
Syed M. Faiz ◽  
Mohammad Shakeel ◽  
Nafas J. Singh ◽  
Kumar Gaurav
Keyword(s):  
Domestic Violence ◽  
Middle Ear ◽  
Clinical Presentation ◽  
Previous History ◽  
Good Prognosis ◽  
Common Etiology ◽  
History Of ◽  
The Right ◽  
Inferior Quadrant ◽  
Pathology Data

<p class="abstract"><strong>Background:</strong> The aim of the study was to evaluate various etiological factors, clinical presentation in patients presenting with Traumatic ear perforations.</p><p class="abstract"><strong>Methods:</strong> 27 patients were taken in our study who reported within two weeks of history of trauma with no previous history of middle ear pathology. Data was collected and patients were treated.  </p><p class="abstract"><strong>Results:</strong> 27 patients were studied (11 males and 16 females); age ranging from 15 years to 56 years. Laterality of trauma was found to be more in left ear. Aural Fullness &amp; pain in ear were the most common presenting complaints. Most common etiology was found to be assault and poster inferior quadrant was found to be most commonly involved.</p><p class="abstract"><strong>Conclusions:</strong> Traumatic perforations have a very good prognosis if they are treated at the right time. We would also like to stress on the fact that domestic violence is still prevalent in our society leading to patients of traumatic perforation.</p><p class="abstract"> </p>

scholarly journals Clinico- etiological profile of acute poisoning and intoxication in children in western Nepal

2021 ◽  
Vol 8 (10) ◽  
pp. 1643
Author(s):  
Love K. Sah ◽  
Munu Mahat ◽  
Prince Pareek ◽  
Ram P. Pokhrel ◽  
Reema Garegrat
Keyword(s):  
Clinical Presentation ◽  
Signs And Symptoms ◽  
Acute Poisoning ◽  
Acute Onset ◽  
Accidental Poisoning ◽  
Emergency Physicians ◽  
Medical College ◽  
Different Types ◽  
Common Clinical Presentation ◽  
History Of

Background: Pediatric poisoning is a common emergency. The present study was done to assess the incidence, clinico-etiological profile of acute poisoning and intoxication in children.Methods: This study was conducted in the Department of Pediatrics, Lumbini Medical College and Teaching Hospital, Nepal in which children aged less than 18 years, with history of consumption of poison accompanied or unaccompanied by container or poison or with doubtful history of consumption of poison but with definite signs and symptoms of acute poisoning we included. We also included children with history of bites by poisonous creatures like snakes, scorpions, bees and insects or with doubtful history of bites due to poisonous creatures but with definite acute onset of signs and symptoms locally or systemically.Results: In the present study, during the study duration, 68 children were included. The most common age group of included children was 1 to 5 years (59%). Accidental poisoning was reported in 93% of the cases, while the rest had suicidal poisonings. The most common type of poison used were different types of pesticides (46%). We observed that vomiting was the most common clinical presentation (79%). In our study sample, arrival of 46% of the children was delayed by 30 minutes to 2 hours. Majority of the patients arrived in the afternoon to the hospital (51%).Conclusions: The findings of the present study would enable emergency physicians to identify clinical features of common poisonings among children, which would enable manage the cases better.

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