scholarly journals Unilateral asterixis, thalamic astasia and vertical one and half syndrome in a unilateral posterior thalamo‑subthalamic paramedian infarct: An interesting case report

2013 ◽  
Vol 04 (02) ◽  
pp. 220-223 ◽  
Author(s):  
Subasree Ramakrishnan ◽  
Veera Rajkumar Narayanaswamy
Keyword(s):  
Past History ◽  
Clinical Findings ◽  
Acute Onset ◽  
Interesting Case ◽  
Third Nerve Palsy ◽  
Uncontrolled Diabetes ◽  
History Of ◽  
Left Thalamus ◽  
Intense Signal ◽  
Skew Deviation

ABSTRACTA 42-year-old young lady presented with acute onset of dizziness, drooping of left eye with binocular diplopia and inability to walk unassisted. She had past history of uncontrolled diabetes mellitus and hypertension. On examination, she had left fascicular type of third nerve palsy, vertical one and half syndrome (VOHS), left internuclear ophthalmoplegia and skew deviation with ipsilesional hypertropia. She also had thalamic astasia and right unilateral asterixis. Her MRI revealed T2 and Flair hyper intense signal changes with restricted diffusion in the left thalamus, subthalamus and left midbrain. MR Angiography was normal. Thalamic‑subthalamic paramedian territory infarct is relatively uncommon. It can present with oculomotor abnormalities including vertical one and half syndrome, skew deviation, thalamic astasia and asterixis. This case is reported for the rarity of the presenting clinical findings in unilateral thalamo‑mesencephalic infarcts.

scholarly journals An Interesting Case of Rhino-Orbito-Cerebral Mucormycosis: A Case Report

2020 ◽  
Author(s):  
R Minnu Lekshmi ◽  
Stephen Sudhakar ◽  
S Rajasekharan
Keyword(s):  
Fungal Infections ◽  
Neurological Complications ◽  
Acute Onset ◽  
Interesting Case ◽  
Rapid Progression ◽  
Uncontrolled Diabetes ◽  
Immunocompromised Individual ◽  
Life Threatening ◽  
History Of ◽  
The Right

Fungal infections are the most challenging problems in an immunocompromised individual. Mucormycosis is a life-threatening fungal infection with rapid progression and high mortality in immunocompromised individuals. A case of 58-year-old female, with uncontrolled diabetes is with five days history of headache, fever, and acute onset drooping of the eyelid. The initial vision was normal which dropped to PL in the following days, with ophthalmoplegia and dilated nonreactive pupil in the right eye. Fundus and IOP were normal on presentation. MRI and MRV brain showed subtle ethmoidal cysts. CT-PNS showed mild ethmoidal thickening and cyst. Diagnostic nasal endoscopy showed unhealthy mucosa with no lesion suggesting eschar. A provisional diagnosis of orbital mucormycosis was made. The patient was started on antibiotics and IV Amphotericin B but she went on to further neurological complications. Despite treatment, she developed necrotising eschars in eyelid for which debridement was done. Further, exenteration was advised and patient developed septicaemia, however he died. The culture from debrided tissue showed growth of mucor. The objective of presenting this particular case is to emphasise the importance of considering mucormycosis as diagnosis despite subtle radiological and endoscopic findings in symptomatic immunocompromised patients. Early diagnosis and aggressive management improve better chances for survival.

scholarly journals Supplement Usage Pattern in a Group of COVID- 19 Patients in Tehran

2020 ◽  
Author(s):  
Maryam Bagheri ◽  
Fedyeh Haghollahi ◽  
Mamak Shariat ◽  
Mina Jafarabadi ◽  
Parastoo Aryamloo ◽  
...  
Keyword(s):  
Vitamin D3 ◽  
Past History ◽  
Clinical Signs ◽  
Clinical Findings ◽  
Usage Pattern ◽  
Cross Sectional ◽  
Outpatient Group ◽  
Significant Difference ◽  
Supplement Usage ◽  
History Of

Objective: The coronavirus disease 19 (COVID-19) is a highly transmittable and pathogenic viral infection, causes severe acute respiratory syndrome and was spread throughout the world in early 2020. The effects of vitamin and micronutrient supplements on the prevention and treatment of COVID- 19 seems challenging in scientific considerations. On the other side generally, experts warn against over-consumption of these supplements. Materials and methods: This study aimed to investigate the vitamin and micronutrient supplementation usage pattern in past history of patients with COVID-19 via a cross-sectional inquiry. Totally 510 patients referring to the infectious disease clinic of Imam Khomeini Hospital in Tehran from March 2020 to May 2020 were recruited. The inclusion criterion was suspected patients for COVID-19 based on clinical findings and CT scans of the lung. The infected patients included both inpatients (171) and outpatients (339). Demographic information, clinical signs, and the supplement pattern use were collected through a questionnaire and the data were statistically analyzed. Results: Vitamin D3 intake was reported in 30% (103 patients) of outpatients and 16.5% (28 patients) of hospitalized patients, which is statistically significant (P=0.001). It shows that, the frequency of vitamin D3 consumption in the outpatient group was higher than inpatient group. This significant difference has also been shown in zinc consumption, in 29 patients (9%) outpatients versus 4 patients (2%) inpatients were reported (P=0.007). Multi nominal regression showed that vitamin D3 intake has a supportive effect and reduces the risk of exacerbation and worsening of the disease. (OR=0.291; 95% CI 0.102-.0834, P=0.022). Conclusion: According to the results of the present study and the findings of other studies, considering the supportive effect of vitamin D3 in reducing the severity of infectious diseases; Clinical trials with an appropriate sample size are recommended to investigate the functional role of this vitamin in improving viral diseases of the respiratory tract.

scholarly journals Case of Mycotic Pseudoaneurysm of the Common Carotid Artery due to Salmonella typhi Bacteremia

2022 ◽  
pp. 263394472110610
Author(s):  
Sruti P. Nair ◽  
Aravind Reghukumar ◽  
Athul Gurudas ◽  
Kiran Kumar V. Sasidharan ◽  
Sreekumar Sivadasan
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Past History ◽  
Fatal Outcome ◽  
Systemic Infection ◽  
Salmonella Typhi ◽  
High Dose ◽  
Uncontrolled Diabetes ◽  
Life Threatening ◽  
History Of

Aneurysm of the extracranial carotid artery is a rare disease, mycotic pseudoaneurysms being even less common. They are a life-threatening complication of systemic infection and atherosclerosis. Immunocompromised people, including patients with HIV, uncontrolled diabetes melltus, those on immunosuppressants like high-dose steroids, and chemotherapy, are at a higher risk for development of mycotic pseudoaneurysms. Due to the high risk of potential complications like rupture and thromboembolic events, mycotic aneurysms always require surgical management. Early detection followed by restoration of blood flow is critical to minimize a fatal outcome. Here we report the case of a 52-year-old man with a past history of hypertension and dyslipidemia who presented with a pulsatile painful neck swelling. On evaluation, the patient was diagnosed to have Salmonella typhi bacteremia, HIV infection, and a mycotic aneurysm of the left common carotid artery.

scholarly journals Acute splenic responses in patients with ischemic stroke and intracerebral hemorrhage

2015 ◽  
Vol 36 (6) ◽  
pp. 1012-1021 ◽  
Author(s):  
Farhaan S Vahidy ◽  
Kaushik N Parsha ◽  
Mohammad H Rahbar ◽  
MinJae Lee ◽  
Thanh-Tung Bui ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Past History ◽  
Clinical Findings ◽  
Spleen Volume ◽  
Stroke Patients ◽  
Post Stroke ◽  
Cytokine Analysis ◽  
Cytokine Levels ◽  
History Of ◽  
Using Data

Animal models provide evidence of spleen mediated post-stroke activation of the peripheral immune system. Translation of these findings to stroke patients requires estimation of pre-stroke spleen volume along with quantification of its day-to-day variation. We enrolled a cohort of 158 healthy volunteers and measured their spleen volume over the course of five consecutive days. We also enrolled a concurrent cohort of 158 stroke patients, measured initial spleen volume within 24 h of stroke symptom onset followed by daily assessments. Blood samples for cytokine analysis were collected from a subset of patients. Using data from healthy volunteers, we fit longitudinal quantile regression models to construct gender and body surface area based normograms of spleen volume. We quantified day-to-day variation and defined splenic contraction. Based on our criteria, approximately 40% of stroke patients experienced substantial post-stroke reduction in splenic volume. African Americans, older patients, and patients with past history of stroke have significantly higher odds of post-stroke splenic contraction. All measured cytokine levels were elevated in patients with splenic contraction, with significant differences for interferon gamma, interleukin 6, 10, 12, and 13. Our work provides reference standards for further work, validation of pre-clinical findings, and characterization of patients with post-stroke splenic contraction.

scholarly journals Spontaneous rupture of an unscarred uterus during pregnancy: an interesting case report

2017 ◽  
Vol 6 (12) ◽  
pp. 5642
Author(s):  
Durga K.
Keyword(s):  
Uterine Rupture ◽  
Spontaneous Rupture ◽  
Past History ◽  
Abdominal Cavity ◽  
Interesting Case ◽  
Emergency Laparotomy ◽  
History Of ◽  
Uterine Curettage ◽  
Rupture Of Uterus ◽  
Uterine Scar

Uterine rupture in pregnancy is very rare and potentially catastrophic for both mother and foetus. The most common cause of uterine rupture is giving away of previous caesarean uterine scar. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present a rare case of a spontaneous complete uterine rupture in a non-labouring unscarred uterus of a 33-year-old nulliparous woman at 35 weeks of gestation. She presented with lower abdomen pain and decreased foetal movements at Institute of Obstetrics and Gynaecology, Chennai. Even before getting into labour, patient suddenly collapsed, and emergency laparotomy was proceeded in view of suspicious concealed abruption. There was frank hemoperitoneum along with a dead baby in the abdominal cavity. There was rupture of uterine fundus extending from one cornual end to the other and closure of uterine rent proceeded. Spontaneous rupture of uterus occurs when there is an upper segment uterine scar. She had a past history of eventful uterine curettage which was the risk factor for uterine rupture. 

scholarly journals Scar Endometriosis: Cytological Diagnosis

2018 ◽  
Vol 56 (209) ◽  
pp. 550-552
Author(s):  
Urvashee Dwivedi ◽  
Saumya Shukla ◽  
Nidhi Anand ◽  
Chetan Parashar ◽  
Nuzhat Husain
Keyword(s):  
Past History ◽  
Needle Aspiration ◽  
Interesting Case ◽  
Aspiration Cytology ◽  
Scar Endometriosis ◽  
Careful Clinical Examination ◽  
Stromal Component ◽  
History Of ◽  
A Cell ◽  
Needle Aspiration Cytology

Endometriosis occurring in a surgical scar is called incisional endometriosis. It is rare and can be diagnosed on the basis of detailed history, careful clinical examination and characteristic histology. An interesting case with immunocytological (ICC) confirmation is being reported. A 28-year-old female presented with a mass over anterior abdominal wall, of 3 years duration.  She had a past history of LSCS. On examination, the swelling was subcutaneous, measures 3x2cm was firm in consistency and located close to the previous incisional scar. Fine needle aspiration cytology was performed and the smears were moderately cellular and showed monolayered sheets of epithelial cells and stromal fragments. A cell block was also prepared that revealed few glands lined by tall columnar epithelium, surrounded by loose stroma. Immunohistochemistry panel comprising of CK 7 and CD 10 was performed, which were positive in glandular and stromal component respectively.

scholarly journals A Rare Case of Paclitaxel and/or Trastuzumab Induced Acute Hepatic Necrosis

2015 ◽  
Vol 2015 ◽  
pp. 1-2 ◽  
Author(s):  
Hiren Mandaliya ◽  
Pinky Baghi ◽  
Amy Prawira ◽  
Mathew K. George
Keyword(s):  
Ductal Carcinoma ◽  
Radical Mastectomy ◽  
Left Breast ◽  
Hepatic Necrosis ◽  
Clinical Findings ◽  
Acute Onset ◽  
Hepatocellular Injury ◽  
Her2 Receptor ◽  
Trastuzumab Therapy ◽  
History Of

Paclitaxel induced mild derangement of liver functions including bilirubin, alkaline phosphatase, and AST has been infrequently noticed in clinical trials. Contrary to Paclitaxel, hepatocellular injury, hepatitis, and liver tenderness are common laboratory and clinical findings with Trastuzumab. However, hepatic failure/necrosis secondary to Paclitaxel or Trastuzumab has never been reported in literature. A 62-year-old lady, previously healthy, was treated with adjuvant therapy for left breast stage II, high grade invasive ductal carcinoma which was node negative, oestrogen receptor negative, progesterone receptor positive, and HER2 receptor positive. After modified radical mastectomy and axillary clearance, she finished four cycles of Doxorubicin/Cyclophosphamide chemotherapy and then commenced on Paclitaxel/Trastuzumab combination chemotherapy. Within twelve hours of first dose of Paclitaxel/Trastuzumab therapy, patient required hospital admission for acute onset respiratory failure. Patient died within 36 hours of therapy and autopsy was suggestive of acute hepatic necrosis without any other significant findings. Detailed investigations were not carried out as event was quick with rapid deterioration. There was no history of prior liver pathology/injury and preliminary investigations for major organ involvement were unremarkable. As per our knowledge, Paclitaxel and/or Trastuzumab induced acute hepatic necrosis has never been reported in literature before, hence difficult to predict.

scholarly journals Self-medicated, satranidazole induced fixed drug eruption: a case report

2020 ◽  
Vol 9 (12) ◽  
pp. 1903
Author(s):  
Divyashanthi Chellathambi Malathi ◽  
Anusha Bommasani ◽  
Raman Palanisami Priyadharsini
Keyword(s):  
Drug Eruption ◽  
Causality Assessment ◽  
Past History ◽  
Systemic Exposure ◽  
Interesting Case ◽  
Probability Scale ◽  
Fixed Drug Eruption ◽  
Cutaneous Adverse Reaction ◽  
Fixed Drug ◽  
History Of

Fixed drug eruption (FDE) is described as the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug; these reactions normally resolve with hyperpigmentation and may recur at the same site with re-exposure to the drug. Repeated exposure to the offending drug may cause new lesions to develop in addition to lighting up the older hyperpigmented lesions. Here we present an interesting case of satranidazole induced FDE with a past history of FDE to the same drug 5 months back. Since the eruption occurred in the same site on re-exposure to the same drug, a diagnosis of FDE was made and causality assessment by Naranjo adverse drug reaction probability scale showed a certain relationship between the cutaneous adverse reaction and the offending drug

scholarly journals Autoimmune Encephalitis: An Unusual Presentation as Nonconvulsive Status Epilepticus

2019 ◽  
Vol 7 (01) ◽  
pp. 41-43
Author(s):  
Deepak Solanki ◽  
Saurabh Anand
Keyword(s):  
Status Epilepticus ◽  
Autoimmune Encephalitis ◽  
Refractory Status Epilepticus ◽  
Clinical Findings ◽  
Acute Onset ◽  
Prior History ◽  
Laboratory Findings ◽  
Epileptiform Discharges ◽  
Refractory Status ◽  
History Of

AbstractWhen refractory status epilepticus (RSE) occurs in an individual without any history of epilepsy and no immediate underlying etiology is found, it is referred to as new-onset refractory status epilepticus (NORSE). This clinical scenario may be notoriously difficult to treat and does not respond to initial medications. In cases of NORSE in which an etiology is found, antibody-mediated disorders are the most common cause. Autoimmune encephalitis refers to a diverse group of neuropsychiatric disorders and can present with an array of symptoms many of which make diagnosis difficult due to similarities in clinical, imaging, and laboratory findings with respect to other forms of autoimmune or infectious encephalitis. This case report highlights how a patient with acute-onset history, showing generalized periodic epileptiform discharges on electroencephalogram (EEG) but with no prior history of seizures, was eventually diagnosed as autoimmune encephalitis based on clinical findings, cerebrospinal fluid (CSF) reports, and EEG analysis.

scholarly journals Fibrous Dysplasia of the Skull Base Presenting Acutely in an Adult

2006 ◽  
Vol 33 (3) ◽  
pp. 325-327 ◽  
Author(s):  
F. Amoozegar ◽  
A. Guberman
Keyword(s):  
Skull Base ◽  
Fibrous Dysplasia ◽  
Previous History ◽  
Acute Onset ◽  
Low Grade ◽  
Third Nerve Palsy ◽  
History Of ◽  
Acute Headache ◽  
Eye Closure ◽  
Time Of Presentation

Fibrous dysplasia (FD) of the bone is an idiopathic disorder in which bone-forming mesenchyme develops abnormally. Here, we describe an unusual case in an adult, with recurrent acute headache and third nerve palsy due to FD of the skull base and low-grade fibrosarcoma.A previously healthy 32-year-old female office clerk, presented with an eight day history of acute-onset, severe, right occipital and retro-orbital continuous headache, associated with nausea and vomiting. She had required dimenhydrinate, acetaminophen with 15 mg codeine, and meperidine with only mild relief of the headache. She also described a 5-day history of right eye ptosis which had progressed to eye closure by the time of presentation. She had otherwise been well, with no systemic or constitutional symptoms and no previous history of headaches.

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