scholarly journals Sepsis Associated Delirium

Medicina ◽  
2020 ◽  
Vol 56 (5) ◽  
pp. 240
Author(s):  
Ben Atterton ◽  
Maria Carolina Paulino ◽  
Pedro Povoa ◽  
Ignacio Martin-Loeches
Keyword(s):  
Clinical Manifestations ◽  
Neurological Impairment ◽  
Screening Tools ◽  
Organ Support ◽  
Septic Episode ◽  
Rehabilitation Potential ◽  
Threatening Condition ◽  
Life Threatening ◽  
Sepsis Survivors ◽  
The Brain

Sepsis is a potentially life-threatening condition caused by a systemic dysregulated host response to infection. The brain is particularly susceptible to the effects of sepsis with clinical manifestations ranging from mild confusion to a deep comatose state. Sepsis-associated delirium (SAD) is a cerebral manifestation commonly occurring in patients with sepsis and is thought to occur due to a combination of neuroinflammation and disturbances in cerebral perfusion, the blood brain barrier (BBB) and neurotransmission. The neurological impairment associated with SAD can persist for months or even longer, after the initial septic episode has subsided which may impair the rehabilitation potential of sepsis survivors. Early identification and treatment of the underlying sepsis is key in the management of SAD as once present it can be difficult to control. Through the regular use of validated screening tools for delirium, cases of SAD can be identified early; this allows potentially aggravating factors to be addressed promptly. The usefulness of biomarkers, neuroimaging and electroencephalopathy (EEG) in the diagnosis of SAD remains controversial. The Society of Critical Care Medicine (SCCM) guidelines advise against the use of medications to treat delirium unless distressing symptoms are present or it is hindering the patient’s ability to wean from organ support.

scholarly journals Brain abscess due to Aggregatibacter aphrophilus and Bacteroides uniformis

2015 ◽  
Vol 44 (2) ◽  
pp. 181
Author(s):  
Maja Bogdan ◽  
Vlasta Zujić Atalić ◽  
Ivan Hećimović ◽  
Dubravka Vuković
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Surgical Treatment ◽  
Brain Abscess ◽  
Neurological Deficit ◽  
Resonance Imaging ◽  
Aggregatibacter Aphrophilus ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Brain

<p><strong>Objective</strong>. The aim of this report was to describe the occurrence of a bacterial brain abscess in a healthy individual, without any predisposing condition. <strong>Case report</strong>. A thirteen-year old boy was admitted to the Department of Neurosurgery after the onset of vomiting, headache and dizziness. A neurological deficit was detected during the physical examination so urgent magnetic resonance imaging of the brain was performed, revealing an intrahemispheric, right positioned solitary expansive mass with ring enhancement. Purulent material was obtained during osteoplastic craniotomy with total extirpation of the brain abscess. Aggregatibacter aphrophilus and Bacteroides uniformis were isolated. The patient’s general condition improved and the neurological deficit subsided as a result of the prompt recognition and treatment of this life threatening condition. <strong>Conclusion</strong>. To achieve a favourable clinical outcome, prompt recognition and surgical treatment of a brain abscess are of primary importance,followed by administration of appropriate antimicrobial therapy. To our best knowledge, this is the first report of this combination of microorganisms as the cause of a brain abscess.</p>

Anaphylaxis in the OR—Causes, Recognition, and Treatment

2018 ◽  
pp. 199-206
Author(s):  
Surangama Sharma ◽  
Lovkesh Arora
Keyword(s):  
Body Mass Index ◽  
Laparoscopic Cholecystectomy ◽  
Operating Room ◽  
Clinical Manifestations ◽  
Preventative Measures ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Elective Laparoscopic Cholecystectomy

Anaphylaxis in the operating room is a life-threatening condition that can evolve rapidly. As an anesthesiologist, it is important to understand the pathophysiology, diagnose the condition, recognize the inciting agent/agents, and manage it appropriately. It is equally important to confirm the diagnosis for preventing a catastrophic event from happening in future. This chapter defines anaphylaxis, discusses the clinical manifestations and most common causes, and describes ways it can be diagnosed. It also considers treatment and preventative measures. The chapter uses a case study of a 55-year-old female, weighing 85 kg and a body mass index of 36 with no other known comorbidities, who is scheduled to undergo elective laparoscopic cholecystectomy.

scholarly journals Dengue infection in mice inoculated by the intracerebral route: neuropathological effects and identification of target cells for virus replication

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
J. F. S. Amorim ◽  
A. S. Azevedo ◽  
S. M. Costa ◽  
G. F. Trindade ◽  
C. A. Basílio-de-Oliveira ◽  
...  
Keyword(s):  
Dengue Infection ◽  
Clinical Manifestations ◽  
Target Cells ◽  
Histopathological Analysis ◽  
Mice Model ◽  
Pia Mater ◽  
Neurological Morbidity ◽  
Life Threatening ◽  
The Central Nervous System ◽  
The Brain

AbstractDengue is an important arboviral infection, causing a broad range symptom that varies from life-threatening mild illness to severe clinical manifestations. Recent studies reported the impairment of the central nervous system (CNS) after dengue infection, a characteristic previously considered as atypical and underreported. However, little is known about the neuropathology associated to dengue. Since animal models are important tools for helping to understand the dengue pathogenesis, including neurological damages, the aim of this work was to investigate the effects of intracerebral inoculation of a neuroadapted dengue serotype 2 virus (DENV2) in immunocompetent BALB/c mice, mimicking some aspects of the viral encephalitis. Mice presented neurological morbidity after the 7th day post infection. At the same time, histopathological analysis revealed that DENV2 led to damages in the CNS, such as hemorrhage, reactive gliosis, hyperplastic and hypertrophied microglia, astrocyte proliferation, Purkinje neurons retraction and cellular infiltration around vessels in the pia mater and in neuropil. Viral tropism and replication were detected in resident cells of the brain and cerebellum, such as neurons, astrocyte, microglia and oligodendrocytes. Results suggest that this classical mice model might be useful for analyzing the neurotropic effect of DENV with similarities to what occurs in human.

scholarly journals The chest pain in neurological practice. Non deesset...

2019 ◽  
Vol 10 (2) ◽  
pp. 91-96
Author(s):  
Elena V. Shirshova ◽  
O. Y. Annenkova ◽  
E. V. Ekusheva ◽  
V. N. Petrov
Keyword(s):  
Chest Pain ◽  
Aortic Aneurysm ◽  
Clinical Manifestations ◽  
Routine Clinical Practice ◽  
Aortic Aneurysms ◽  
Aorta Aneurysm ◽  
Thoracic Aortic Aneurysms ◽  
Threatening Condition ◽  
Life Threatening ◽  
Thoracic Aorta Aneurysm

Chest pain can be a “mask” of a life-threatening condition, which the practitioner must remember. One of such life-threatening condition is aortic aneurysm, which diagnosis presents significant difficulties in routine clinical practice. Clinical manifestations of thoracic aortic aneurysms are extremely variable and non-specific and are mainly depends on the size of the aneurysmal sac, its localization and extent, as well as the etiology of the disease. Here we present a clinical case report of a 48 y.o. patient who died because of the acute cardiac tamponade as a complication of dissecting thoracic aorta aneurysm. The lack of symptoms and clinical instrumental data, initially suggesting the presence of life-threatening disease did not allow the physician to suspect aortic aneurysm and urgently take action regarding it.

scholarly journals A Rare Case of Haemoptysis Revealing Aortic Coarctation in an Adult

2020 ◽  
Author(s):  
Ahmed Ben Saad ◽  
Asma Achour ◽  
Asma Migaou ◽  
Saousen Cheikh Mhamed ◽  
Nesrine Fahem ◽  
...  
Keyword(s):  
Aortic Coarctation ◽  
Clinical Manifestations ◽  
Past Medical History ◽  
Computed Tomography Scan ◽  
Bronchial Arteries ◽  
Contrast Enhanced ◽  
Threatening Condition ◽  
Internal Mammary ◽  
Life Threatening ◽  
Tomography Scan

Haemoptysis is a frequently occurring but sometimes life-threatening condition. Congenital cardiovascular abnormalities are rare causes of haemoptysis. We report a case of a 33-year-old man without any past medical history complaining of haemoptysis with no other associated clinical manifestations. A contrast-enhanced chest computed tomography scan revealed aortic coarctation with dilation of the internal mammary, intercostal and bronchial arteries. He underwent stent placement after balloon angioplasty with favourable outcomes.

scholarly journals Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Ami Amin ◽  
Bhavika Gandhi ◽  
Steven Torre ◽  
Alireza Amirpour ◽  
Jennifer Cheng ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Diabetic Ketoacidosis ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Clinical Syndrome ◽  
Dark Urine ◽  
Threatening Condition ◽  
Hyperosmolar Hyperglycemic State ◽  
Life Threatening ◽  
Electrolyte Abnormalities

Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency.

scholarly journals Pituitary metastasis: a rare condition

2018 ◽  
Vol 7 (10) ◽  
pp. 1049-1057 ◽  
Author(s):  
Aida Javanbakht ◽  
Massimo D’Apuzzo ◽  
Behnam Badie ◽  
Behrouz Salehian
Keyword(s):  
Breast Cancer ◽  
Primary Tumor ◽  
Medical Center ◽  
Clinical Manifestations ◽  
Posterior Part ◽  
Rare Condition ◽  
National Medical ◽  
Threatening Condition ◽  
Life Threatening ◽  
Pituitary Metastasis

Tumor metastasis to the pituitary gland is a rare, not well-documented and life-threatening condition associated with a shortened life span. A better understanding of its clinical manifestations could lead to earlier diagnosis, appropriate therapy and potentially improving quality of life. Therefore, we retrospectively studied the charts of patients with pituitary metastases who were treated at the City of Hope National Medical Center (Duarte, CA) from 1984 to 2018. We reviewed and analyzed tumor origin, primary pituitary clinical manifestation, duration between primary tumor diagnosis and pituitary metastasis, type of treatment and patient survival. A total of 11 patients were identified with a mean age of 59.2 years and median survival following the diagnosis of metastasis of 10 months. Breast cancer and lymphoma were the most common primary origins in these cases, and diabetes insipidus and panhypopituitarism were the most common clinical manifestations of their metastasis. We also compared our results with reports in the literature published between 1957 and 2018. A total 289 patients with pituitary metastasis have been reported in the literature. Breast cancer was the most frequent primary origin of the metastasis, and visual symptoms were the most common primary manifestation. The posterior part of the pituitary is more susceptible than the anterior to metastasis. Pituitary metastasis may occur as a consequence of successful primary tumor treatment prolonging the chance of seeding. Future studies are needed to determine the molecular mechanism of metastasis to the pituitary.

scholarly journals Thiamine Deficiency in Self-Induced Refeeding Syndrome, an Undetected and Potentially Lethal Condition

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Einat Hershkowitz ◽  
Alon Reshef ◽  
Olga Munich ◽  
Bracha Yosefi ◽  
Arie Markel
Keyword(s):  
Clinical Manifestations ◽  
Oral Feeding ◽  
Neurological Dysfunction ◽  
Severe Malnutrition ◽  
Refeeding Syndrome ◽  
Threatening Condition ◽  
Metabolic Imbalance ◽  
Life Threatening ◽  
Rapid Restoration ◽  
Biochemical Abnormalities

Rapid restoration of nutrients and electrolytes after prolonged starvation could result in a life threatening condition characterized by sensory and neurological dysfunction and severe metabolic imbalance that has been designated as refeeding syndrome. Its diagnosis is frequently missed resulting in severe complications and even death. We describe a 25-years-old female patient with mental disorders and severe malnutrition who developed severe clinical manifestations and biochemical abnormalities characteristic of the refeeding syndrome, after restarting oral feeding on her own. Schizophrenia was later diagnosed. Increased awareness of this condition and its complications is necessary to prevent its detrimental complications.

scholarly journals The Potential Role of Extracorporeal Cytokine Removal in Hemodynamic Stabilization in Hyperinflammatory Shock

Biomedicines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 768
Author(s):  
Fatime Hawchar ◽  
Cristina Rao ◽  
Ali Akil ◽  
Yatin Mehta ◽  
Christopher Rugg ◽  
...  
Keyword(s):  
Critically Ill ◽  
Hemodynamic Instability ◽  
Pooled Analysis ◽  
Organ Support ◽  
Pubmed Database ◽  
Threatening Condition ◽  
Life Threatening ◽  
Mean Differences ◽  
The Impact

Hemodynamic instability due to dysregulated host response is a life-threatening condition requiring vasopressors and vital organ support. Hemoadsorption with Cytosorb has proven to be effective in reducing cytokines and possibly in attenuating the devastating effects of the cytokine storm originating from the immune over-response to the initial insult. We reviewed the PubMed database to assess evidence of the impact of Cytosorb on norepinephrine needs in the critically ill. We further analyzed those studies including data on control cohorts in a comparative pooled analysis, defining a treatment effect as the standardized mean differences in relative reductions in vasopressor dosage at 24 h. The literature search returned 33 eligible studies. We found evidence of a significant reduction in norepinephrine requirement after treatment: median before, 0.55 (IQR: 0.39–0.90); after, 0.09 (0.00–0.25) μg/kg/min, p <0.001. The pooled effect size at 24 h was large, though characterized by high heterogeneity. In light of the importance of a quick resolution of hemodynamic instability in the critically ill, further research is encouraged to enrich knowledge on the potentials of the therapy.

scholarly journals Pulmonary Artery Dissection: A Fatal Complication of Pulmonary Hypertension

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Chuanchen Zhang ◽  
Xiaoyong Huang ◽  
Shuhua Li ◽  
Hengchen Yao ◽  
Bin Zhang
Keyword(s):  
Pulmonary Artery ◽  
Rare Case ◽  
Pulmonary Valve ◽  
Clinical Manifestations ◽  
Acute Chest Pain ◽  
Artery Dissection ◽  
Fatal Complication ◽  
Threatening Condition ◽  
Right Pulmonary Artery ◽  
Life Threatening

Pulmonary artery dissection is extremely rare but it is a really life-threatening condition when it happens. Most patients die suddenly from major bleeding or tamponade caused by direct rupture into mediastinum or retrograde into the pericardial sac. What we are reporting is a rare case of a 46-year-old female patient whose pulmonary artery dissection involves both the pulmonary valve and right pulmonary artery. The patient had acute chest pain and severe dyspnea, and the diagnosis of pulmonary artery dissection was confirmed by ultrasonography and CT angiography. Moreover, its etiology, clinical manifestations, and management are also discussed in this article.

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