scholarly journals ACUTE TOMOGRAPHIC CHANGES OF METABOLIC ORIGIN MIMICKING BASAL GANGLIA HEMORRHAGE, CASE REPORT

2021 ◽  
pp. 8-9
Author(s):  
Paola Andrea Parra ◽  
Santiago Vasquez Builes ◽  
Alejandro Cardozo
Keyword(s):  
Neurological Complications ◽  
Serum Glucose ◽  
Focal Neurological Deficit ◽  
Fluid Infusion ◽  
Appropriate Treatment ◽  
Acute Decompensation ◽  
Basal Ganglia Hemorrhage ◽  
Altered State Of Consciousness ◽  
Seizure Episode ◽  
The Right

Patients with acute neurological changes, especially with focal neurological deficit, require images for its initial approach,generally skull tomography due to its availability.Here we report a case of an 80-year-old patient with altered state of consciousness and a seizure episode who was admitted on suspicion of cerebral hemorrhage. Her initial blood glucose was high and a hyperdense lesion was found in the right basal ganglion on brain computed tomography, laboratories in which no other metabolic alteration was identified apart from the acute decompensation of Diabetes, however, with a neuroradiology and clinical team, the diagnosis of diabetic striatopathy was made. The patient was treated with a fluid infusion, and serum glucose level was controlled with insulin. The patient gradually recovered consciousness and was alert to his baseline state within 24 hours,without neurological complications. Patients with risk factors and with findings suggesting stroke,the tomographic high densities,may suggest intracerebral hemorrhage;however,other metabolic and toxic pathologies may have similar tomographic changes. Our intention,is show to emergency physicians the presence of ganglio basal hyperintensities,mimics for gangliobasal hemorrhage should be studied according to history and clinical context and establish appropriate treatment in a timely manner.

scholarly journals Kawasaki disease manifesting as bilateral facial nerve palsy and meningitis: a case report and literature review

2019 ◽  
Vol 47 (8) ◽  
pp. 4014-4018 ◽  
Author(s):  
Bo Zhang ◽  
Yunpeng Hao ◽  
Yanfeng Zhang ◽  
Nuo Yang ◽  
Hang Li ◽  
...  
Keyword(s):  
Case Report ◽  
Kawasaki Disease ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Brain Magnetic Resonance Imaging ◽  
Neurological Complications ◽  
Appropriate Treatment ◽  
History Of ◽  
The Right

Background Kawasaki disease (KD) is an acute multisystem vasculitic syndrome that predominantly affects infants and young children. Neurological complications are rare in patients with KD and the diagnosis is challenging. We report a case of KD that manifested as bilateral facial nerve palsy and meningitis. Case report A 6-month-old boy presented with a 10-day history of fever. Four days before admission, the patient developed a rash, conjunctival injection, perioral and perianal excoriation, and bilateral facial nerve palsy. Brain magnetic resonance imaging was normal. Echocardiography showed dilated coronary arteries and coronary artery aneurysms. A cerebrospinal fluid examination showed an elevated leukocyte count. A diagnosis of KD was made, and the patient was treated with gamma globulin and aspirin. The patient’s fever subsided on the following day and the right-sided facial nerve palsy was relieved 1 month later. An 18-month follow-up showed that the left-sided facial nerve palsy persisted and the patient’s condition remained stable. Conclusion KD manifesting as bilateral facial nerve palsy and meningitis is extremely rare. Clinicians should be aware of this condition, and early diagnosis and appropriate treatment should be emphasized.

scholarly journals Case report: Intracranial Arterial Dolichoectasia

2021 ◽  
Author(s):  
Lorena Dellagnesi Depieri ◽  
Lorena Souza Viana
Keyword(s):  
Basilar Artery ◽  
Incidental Finding ◽  
Artery Aneurysm ◽  
Spontaneous Remission ◽  
Treatment Method ◽  
Neurological Complications ◽  
Focal Neurological Deficit ◽  
Life Threatening Illness ◽  
Adjacent Structures ◽  
The Right

Introduction: Intracranial arterial dolichoectasia (IADE) is a diameter increase and/ or a long and tortuous path in one or more Intracranial arterial. Most patients keep asymptomatic and eventually present neurological complications (ischemia, bleeding or compression of adjacent structures). At around 12% of the patients with stroke present this kind of intracranial dilated, which 80% are in the posterior cerebral circulation, mainly in basilar artery. Objective: Report an unusual case of IADE refractory to the clinical treatment. Method: The information was obtained by reviewing the medical record, after the patient’s consent. Result: Patient, 51, male, hypertensive and dyslipidemic, with abdominal aortic aneurysm surgery and an incidental diagnosis in 2015 of fusiform basilar artery aneurysm, presented in March 2020 after cervical flexion, dysarthria, horizontal diplopia when looking to the right and ptosis to the left. The computed cranial angiotomography showed a basilar artery of 1.8 cm diameter fusiform aneurysm, compressing the pons and medulla oblongata, with no signs of ischemia or bleeding. He was discharged from hospital with clopidogrel without deficits, however, after 30 days, manifested a new focal neurological deficit with spontaneous remission. During the investigation a skull resonance was presented without ischemia, transcranial doppler with circulatory delay and without embolization. In view of the recurrence, an exchange in clopidogrel for ticagrelor was decided, which was kept stable for 30 days. Conclusion: IADE may be an incidental finding or even a life-threatening illness. Thus, these cases remain a major challenge in clinical practice and in interventional radiology.

scholarly journals Neurological Complications of Cardiac Procedures

2021 ◽  
Author(s):  
Courtney M. Hrdlicka ◽  
Jeffrey Wang ◽  
Magdy Selim
Keyword(s):  
Cardiac Surgery ◽  
Cognitive Dysfunction ◽  
Postoperative Cognitive Dysfunction ◽  
Neurological Complications ◽  
Diagnostic Workup ◽  
Diagnosis And Management ◽  
Percutaneous Interventions ◽  
Cardiac Procedures ◽  
Appropriate Treatment ◽  
Periprocedural Stroke

AbstractNeurological complications after cardiac surgery and percutaneous cardiac interventions are not uncommon. These include periprocedural stroke, postoperative cognitive dysfunction after cardiac surgery, contrast-induced encephalopathy after percutaneous interventions, and seizures. In this article, we review the incidence, pathophysiology, diagnosis, and management of these complications. Improved understanding of these complications could lead to their prevention, faster detection, and facilitation of diagnostic workup and appropriate treatment.

scholarly journals Neurological complications after H1N1 influenza vaccination: magnetic resonance imaging findings

2014 ◽  
Vol 72 (7) ◽  
pp. 496-499 ◽  
Author(s):  
Ronaldo Lessa ◽  
Maurício Castillo ◽  
Renata Azevedo ◽  
Fernanda Azevedo ◽  
Hildo Azevedo
Keyword(s):  
Facial Palsy ◽  
H1n1 Virus ◽  
Altered Mental Status ◽  
H1n1 Influenza ◽  
Neurological Complications ◽  
Abrupt Onset ◽  
Resonance Imaging ◽  
Post Vaccination ◽  
Peripheral Facial Palsy ◽  
The Right

Objective: To report 4 different neurological complications of H1N1 virus vaccination. Method: Four patients (9, 16, 37 and 69 years of age) had neurological symptoms (intracranial hypertension, ataxia, left peripheral facial palsy of abrupt onset, altered mental status, myelitis) starting 4-15 days after H1N1 vaccination. MRI was obtained during the acute period. Results: One patient with high T2 signal in the cerebellum interpreted as acute cerebellitis; another, with left facial palsy, showed contrast enhancement within both internal auditory canals was present, however it was more important in the right side; one patient showed gyriform hyperintensities on FLAIR with sulcal effacement in the right fronto-parietal region; and the last one showed findings compatible with thoracic myelitis. Conclusion: H1N1 vaccination can result in important neurological complications probably secondary to post-vaccination inflammation. MRI detected abnormalities in all patients.

scholarly journals Mucinous cystadenomas of the liver

2013 ◽  
Vol 141 (3-4) ◽  
pp. 173-177
Author(s):  
Radoje Colovic ◽  
Nikica Grubor ◽  
Miodrag Jovanovic ◽  
Marjan Micev ◽  
Natasa Colovic ◽  
...  
Keyword(s):  
Frozen Section ◽  
Benign Tumors ◽  
Appropriate Treatment ◽  
Head Of The Pancreas ◽  
Malignant Alteration ◽  
Mucinous Cystadenomas ◽  
The Right ◽  
Healthy Liver ◽  
Single Lesion ◽  
Partial Excision

Introduction. Biliary cystadenomas of the liver are rare benign tumors prone to malignant alteration so that a total excision is recommended. Objective. The aim of the paper is to present our experience in treatment and to evaluate whether a simple ablation represents the appropriate treatment. Methods. Over a 10?year period 25 patients (24 women) of the average age of 58 years suffering from cystadenomas of the liver, 18 in the right, 4 in the left and 3 in both lobes of the liver were operated. Twenty?three patients had a single lesion, while two patients had 3 and 6 lesions, respectively. Pain was present in 20, occasional vomiting in 4, discomfort in 2 and a sense of fullness in 2 patients. Three patients were jaundiced, 1 due to cystadenoma of the liver, 2 due to concomitant tumors of the head of the pancreas, while 5 patients had concomitant diseases. Results. A total ablation was performed in 22 patients, left lateral bisegmentectomy in 1 and partial excision in 2 patients. Six additional procedures were performed. Five cystadenomas of the liver had ?ovarian like? stroma, all in women. A focal malignant alteration was found in 2 patients aged 66 and 79 years, respectively. Recurrence was registered in 1 female patient in whom a partial excision had been done. Two patients with concomitant malignancy and 1 patient who developed malignant histiocytosis six months after surgery, died after 1, 2 and 3 years, respectively. Conclusion. Biliary cystadenomas of the liver may be misdiagnosed as simple liver cysts, so that ?frozen section? histology is highly recommended. In most cases the tumor may be successfully treated by ablation up to the healthy liver tissue. Major liver resections are rarely necessary.

scholarly journals 346. Head to Toe Imaging of Complications and Sequelae of COVID- 19 and COVID-19 Vaccination

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S277-S278
Author(s):  
Deepti H Vijayakumar ◽  
Deepali Saxena ◽  
Rajesh V Helavar ◽  
Raghavendra Tirupathi
Keyword(s):  
Neurological Complications ◽  
Hypercoagulable State ◽  
Ground Glass ◽  
Arterial Phase ◽  
Cardiac Complications ◽  
Fungal Sinusitis ◽  
Gastrointestinal Complications ◽  
Secondary Infections ◽  
The Right ◽  
Lung Window

Abstract Background COVID 19 is associated with a hypercoagulable state with cytokine storm syndrome and thrombocytopenia leading to complications across various systems. COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections Methods We systematically reviewed COVID-19 cases between Jan to May 2021 for pulmonary and extrapulmonary complications. Patients with recent COVID-19 vaccination and neurological symptoms were also included. Figure 1. “Black turbinate” sign of mucormycosis Contrast enhanced coronal T1 FS images of paranasal sinuses shows necrotic non-enhancing right superior and middle turbinates (*) with extension into the right orbital fat. FIGURE 2 - A composite image of Coronal CT of upper abdomen in arterial phase and lung bases in lung window showing wedge showing right renal infarcts (line arrow) due to inferior polar artery thrombosis and ground glass opacities (solid arrow) in lung bases. Results Neurological complications: Neurological complications include ischemic and haemorrhagic strokes. Other complications are encephalopathy, encephalitis, Guillain-Barré syndrome, acute hemorrhagic necrotizing encephalopathy. Demyelination and radiculopathies are seen as post vaccination complications. Mucormycosis: Unprecedented high rate of invasive fungal sinusitis in association with COVID -19 is reported from the Indian subcontinent. This has a propensity for intra orbital and intracranial extension. COVID -19 associated coagulopathy: COVID -19 is a pro-inflammatory hypercoagulable state. Pulmonary thromboembolism, deep venous thrombosis and catheter related thrombosis are well documented. Cardiac complications: Cardiac manifestations include Myocardial Injury with non-obstructed coronary arteries (MINOCA), myocarditis, myocardial ischemia, cardiomyopathy. Pulmonary complications and sequelae of COVID -19: Progression of lung injury to ARDS during the initial phase and fibrosis of parenchyma in the recovery phase. Spontaneous pneumomediastinum, pneumatoceles and pneumothorax and secondary infections are identified in our study. COVID- 19 associated gastrointestinal complications: Patients evaluated for renal colic, pancreatitis, cholecystitis showed, ground glass opacities or subpleural bands in typical Covid-19 distribution. COVID-19 may lead of acute kidney and bowel injury due to arterial thrombosis. COVID - 19 associated myonecrosis: Ischemia of the small caliber vessels may result in myonecrosis. FIGURE 3 - Coronal STIR image shows thickened and hyperintense trunks and divisions of the right brachial plexus suggestive of plexopathy in a COVID -19 patient with H/O recent COVID-19 vaccination. Figure 4. Axial CT chest section in lung window showing pneumothorax (white arrow) and pneumatocele ( grey arrow) with peripheral ground glass opacities and consolidations in both lungs. Conclusion Awareness of these unusual manifestations will facilitate an early diagnosis, improve management and help reduce morbidity and mortality Disclosures All Authors: No reported disclosures

scholarly journals MON-084 Hyperosmolar Hyperglycemic State as Initial Presentation of Type 1 Diabetes in Children

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fabiola D’Ambrosio ◽  
Isabella Marranzini-Rodriguez ◽  
Roxana Aguirre Castaneda ◽  
Claudia Boucher-Berry
Keyword(s):  
African American ◽  
Early Recognition ◽  
Fluid Management ◽  
Low Frequency ◽  
Serum Glucose ◽  
African American Female ◽  
Appropriate Treatment ◽  
Hyperosmolar Hyperglycemic State ◽  
History Of ◽  
Sugary Beverages

Abstract INTRODUCTION: We present 2 pediatric patients with Hyperosmolar Hyperglycemic State (HHS) at diabetes onset. CASE 1: 3 year old African American female presented to the pediatrician office with a 5 day history of polydipsia, polyuria and emesis. POCT glucose read high and patient was transferred to the PICU. Laboratory studies were significant for serum glucose of 1032 mg/dl, Na 128 mMOL/L (corrected 142mMOL/L), VBG showed pH 7.36, HCO3 20 mMOL/L, Serum osm 331 mOsm/Kg. Patient received a 20ml/kg bolus of 0.9%NaCl, followed by 2 times maintenance IV fluids and glargine 2 units. Glucose dropped from 418 to 122 mg/dl in 3 hours. Due to this Dextrose was added and IVF rate was decreased. CASE 2: 8 year old African American obese male was admitted to the PICU for management of new onset diabetes. He presented with 3 days of flu-like symptoms and worsening drowsiness. Patient had increased consumption of large quantities of sugary beverages due to increased thirst. Laboratory workup: serum glucose of 2309 mg/dl, Na 133 mMOL/L (corrected 168 mMOL/L), pH 7.13, HCO3 10 mMOL/L. Patient was given 30 cc/kg NS bolus followed by an insulin drip of 0.1 u/kg/hour. Repeat studies 3 hours later showed a serum glucose of 1,414 mg/dl, Na 152 mMol/L (corrected 184 mMOL/L), pH 7.19, HCO3 17 mMOL/L, and serum osmolality of 408 mOsm/Kg. IVF were adjusted to correct the water deficit and insulin drip was decreased to 0.05u/kg/hour. DISCUSSION: HHS continues to be a challenging diagnosis due to its low frequency compared with Diabetic Ketoacidosis especially when presenting at a very young age. Most practitioners will mistake the presentation for DKA and start an insulin drip. The early use of insulin is not necessary in the setting of HHS due to the risk of complications. A fast drop in glucose decreases the osmotic pressure and compromises the circulatory status with a higher chance of thromboembolism. In mixed HHS and DKA, the management aligns more with the DKA management but the amount of fluids needed is higher and insulin infusion may cause fast drop of glucose with potential decrease of intravascular volume as in our second patient. It is imperative that the diagnosis of HHS is made early so that the appropriate treatment can be instituted. CONCLUSION: Appropriate fluid administration and delay in insulin administration are key in the management of HHS. The awareness of this possible presentation and the early recognition and appropriate fluid management are needed to improve outcomes. REFERENCE: Zeitler, Phil, et al. “Hyperglycemic Hyperosmolar Syndrome in Children: Pathophysiological Considerations and Suggested Guidelines for Treatment.” The Journal of Pediatrics, vol. 158, no. 1, 2011, doi:10.1016/j.jpeds.2010.09.048

Fatal external bleeding from self-severed arterial dialysis tube: An unusual method of suicide

2019 ◽  
Vol 59 (4) ◽  
pp. 210-213
Author(s):  
Supawon Srettabunjong
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Multidisciplinary Approach ◽  
Early Screening ◽  
Haemodialysis Catheter ◽  
Appropriate Treatment ◽  
Treatment Of Depression ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

A high risk of suicide has been observed in adults with end-stage renal disease who are undergoing haemodialysis. Since suicide is preventable, early screening, a prompt multidisciplinary approach and appropriate treatment of depression are critical and are recommended to treating physicians. Recently, the case of a woman with end-stage renal disease who had been undergoing haemodialysis was encountered. She died by suicide after self-severing the temporary haemodialysis catheter secured to the right side of her neck. This method of suicide is unusual and rare. This case not only underscores the association between haemodialysis and suicide in patients with end-stage renal disease but also raises awareness of the possibility of such deaths.

scholarly journals Outcomes from stereotactic surgery for essential tremor

2018 ◽  
Vol 90 (4) ◽  
pp. 474-482 ◽  
Author(s):  
Robert Francis Dallapiazza ◽  
Darrin J Lee ◽  
Philippe De Vloo ◽  
Anton Fomenko ◽  
Clement Hamani ◽  
...  
Keyword(s):  
Essential Tremor ◽  
Focused Ultrasound ◽  
Neurological Complications ◽  
Treatment Modalities ◽  
Beneficial Effects ◽  
Appropriate Treatment ◽  
Long Term Follow Up ◽  
Added Benefit ◽  
One Year

There are several different surgical procedures that are used to treat essential tremor (ET), including deep brain stimulation (DBS) and thalamotomy procedures with radiofrequency (RF), radiosurgery (RS) and most recently, focused ultrasound (FUS). Choosing a surgical treatment requires a careful presentation and discussion of the benefits and drawbacks of each. We conducted a literature review to compare the attributes and make an appraisal of these various procedures. DBS was the most commonly reported treatment for ET. One-year tremor reductions ranged from 53% to 63% with unilateral Vim DBS. Similar improvements were demonstrated with RF (range, 74%–90%), RS (range, 48%–63%) and FUS thalamotomy (range, 35%–75%). Overall, bilateral Vim DBS demonstrated more improvement in tremor reduction since both upper extremities were treated (range, 66%–78%). Several studies show continued beneficial effects from DBS up to five years. Long-term follow-up data also support RF and gamma knife radiosurgical thalamotomy treatments. Quality of life measures were similarly improved among patients who received all treatments. Paraesthesias, dysarthria and ataxia were commonly reported adverse effects in all treatment modalities and were more common with bilateral DBS surgery. Many of the neurological complications were transient and resolved after surgery. DBS surgery had the added benefit of programming adjustments to minimise stimulation-related complications. Permanent neurological complications were most commonly reported for RF thalamotomy. Thalamic DBS is an effective, safe treatment with a long history. For patients who are medically unfit or reluctant to undergo DBS, several thalamic lesioning methods have parallel benefits to unilateral DBS surgery. Each of these surgical modalities has its own nuance for treatment and patient selection. These factors should be carefully considered by both neurosurgeons and patients when selecting an appropriate treatment for ET.

Metastatic intracranial carcinoid with immunohistochemical observation

1990 ◽  
Vol 73 (1) ◽  
pp. 130-136 ◽  
Author(s):  
Tsunenori Ozawa ◽  
Tadasu Terabayashi ◽  
Hitoshi Takahashi ◽  
Norio Takeda ◽  
Yasushi Ito ◽  
...  
Keyword(s):  
Occipital Lobe ◽  
Neurological Complications ◽  
Serotonin Release ◽  
Blood Levels ◽  
Metastatic Carcinoid ◽  
Intracranial Metastasis ◽  
Content Type ◽  
Hydroxyindoleacetic Acid ◽  
The Right ◽  
Immunohistochemical Studies

✓ A case of metastatic carcinoid tumor in the right occipital lobe originating from a primary tumor in the right colon is reported in a 68-year-old man. The tumor had a high bromodeoxyuridine labeling index. Although immunohistochemical studies of the tumor specimen showed positive reactivity for serotonin and somatostatin, blood levels of serotonin and urinary 5-hydroxyindoleacetic acid content were normal. This suggests that coexistence of somatostatin with serotonin in the tumor tissue might lead to inhibition of serotonin release by “autocrine regulation.” The neurological complications of carcinoid tumors, including intracranial metastasis, are discussed briefly.

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