Cannabis-Induced Malignant Catatonia: A Medical Emergency and Review of Prior Case Series

Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. Methods Retrospective data on patients with arterial dissection related to sports and recreation. Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. Conclusion Arterial dissection may be a complication from practicing sports.

Download Full-text

Malignant priapism due to penile metastases: Case series and literature review

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2016.2.150 ◽

2016 ◽

Vol 88 (2) ◽

pp. 150 ◽

Cited By ~ 9

Author(s):

Francesco De Luca ◽

Evangelos Zacharakis ◽

Majed Shabbir ◽

Angela Maurizi ◽

Emy Manzi ◽

...

Keyword(s):

Case Reports ◽

Case Series ◽

Rare Condition ◽

Medical Emergency ◽

Palliative Intent ◽

Patient Reported ◽

Malignant Priapism ◽

Carcinoma Of The Bladder ◽

Organ Site ◽

Penile Metastases

Malignant priapism secondary to penile metastases is a rare condition. This term was originally used by Peacock in 1938 to describe a condition of painful induration and erection of the penis due to metastatic infiltration by a neoplasm. In the current literature there are 512 case reports. The primary tumor sites are bladder, prostate and rectum. The treatment has only palliative intent and consists of local tumor excision, penectomy, radiotherapy and chemotherapy. We present one case of malignant priapism originated from prostate cancer, and two from urothelial carcinoma of the bladder. Different approaches in diagnosis and therapy were performed. The entire three patient reported a relief of the pain following the treatment, with an improvement of their quality of life, even though it was only temporary as a palliative. Malignant priapism is a rare medical emergency. Penile/pelvis magnetic resonance imaging (MRI) scan and corporal biopsies are considered an effective method of diagnosis of the primary organ site.

Download Full-text

Delayed Amplatzer Occluder Device Closure of Postinfarction Ventricular Septal Defect: A Case Report

Case Reports in Cardiology ◽

10.1155/2014/159010 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Francis Ting ◽

Aditya Bhat ◽

Neville Sammel ◽

David Muller

Keyword(s):

Ventricular Septal Defect ◽

Survival Data ◽

Septal Defect ◽

Case Series ◽

Medical Emergency ◽

Amplatzer Occluder ◽

Occluder Device ◽

Postinfarction Ventricular Septal Defect ◽

Amplatzer Occluder Device

Postinfarction ventricular septal defect (VSD) is a rare complication after acute myocardial infarction, with an incidence rate of 1-2% of all myocardial infarcts (Hutchins, 1979). It is a medical emergency with sobering survival numbers, having a mortality rate of 70–80% within two weeks of the incident event (Bouchart et al., 1998). Cardiac surgery is considered the gold standard in the management of these defects; however, its main limitation is that it carries a high risk of perioperative mortality and postoperative sequelae. Percutaneous transcatheter closure of VSD is a relatively new method of repair. Due to scarcity of reports in the literature, there is limited data regarding survival data; however, noninferiority to surgery has been demonstrated in one case series (Papalexopoulou et al., 2013). Long-term follow-up studies are lacking, and thus long-term mortality has yet to be discerned. We present a case of an 87-year-old female who, following postmyocardial infarction VSD, developed clinically significant heart failure. The patient was reluctant to undergo open repair given her age and comorbidities and she underwent successful percutaneous repair of her VSD using a 16 mm Amplatzer occluder device 18 months after her initial presentation.

Download Full-text

Somatic Treatment of Catatonia

The International Journal of Psychiatry in Medicine ◽

10.2190/x0ff-vu7g-qqp7-l5v7 ◽

1995 ◽

Vol 25 (4) ◽

pp. 345-369 ◽

Cited By ~ 83

Author(s):

John M. Hawkins ◽

Katharine J. Archer ◽

Stephen M. Strakowski ◽

Paul E. Keck

Keyword(s):

Case Reports ◽

Case Series ◽

Complete Response ◽

Positive Outcome ◽

Line Treatment ◽

First Line ◽

Frequency Of Use ◽

Specific Symptoms ◽

First Line Treatment ◽

Malignant Catatonia

Objective: The authors reviewed the recent literature regarding the treatment of catatonia as a syndrome of multiple etiologies. Given the historical and clinical association of catatonia with schizophrenia, the authors' examined the assumption that the first-line treatment of catatonia is antipsychotic medication. Methods: Articles published between January 1, 1985 and December 31, 1994 were located using the Paperchase® medical literature search system. Additionally, references from those identified articles were examined for possible inclusion in this review. To be included in this review, articles had to be written in English and report specific symptoms of catatonia to determine, retrospectively, if DSM-IV criteria for catatonia were met. Results: Seventy publications met inclusion criteria and reported on a total of 178 patients and included 270 separate treatment episodes. Most of the articles were case-reports, although a few case-series were identified. Multiple causes of catatonia were identified in these reports. The most commonly reported treatment for catatonia was with benzodiazepines which were effective in 70 percent of the cases, with lorazepam demonstrating the highest frequency of use and a 79 percent complete response rate. Electroconvulsive therapy (ECT) was also efficacious (85%) and was more likely to provide a positive outcome in cases of malignant catatonia. Antipsychotics demonstrated poor efficacy. Conclusions: Catatonia is a nonspecific syndrome with multiple etiologies. Treatment of catatonia should be based on the underlying cause when it is identifiable. Lorazepam appears to offer a safe, effective first-line treatment of catatonia. ECT should be considered when rapid resolution is necessary (e.g., malignant catatonia) or when an initial lorazepam trial fails.

Download Full-text

Medical Emergency and Public Health Response in Disaster Settings: A Case Series of Pidie Jaya, Lombok and Palu Earthquakes

Budapest International Research in Exact Sciences (BirEx) Journal ◽

10.33258/birex.v2i2.1016 ◽

2020 ◽

Vol 2 (2) ◽

pp. 264-267

Author(s):

Safrizal Rahman ◽

Muhammad Bayu Zohari Hutagalung

Keyword(s):

Public Health ◽

Emergency Response ◽

Disaster Response ◽

Case Series ◽

Medical Emergency ◽

Severe Injury ◽

Public Health Response ◽

Middle Income ◽

Health Response ◽

Recent Earthquakes

Indonesia is one of the most disaster-prone countries, often regarded as a “world disaster laboratory.” Natural disasters cause destruction and human suffering, especially in low- and middle-income countries Objective: This paper presents the overview of a medical emergency and public health response towards several recent earthquakes in Pidie Jaya, Lombok, and Palu of Indonesia. Case Series: The authors examine the appropriateness and effectiveness of the organized disaster response of the Pidie Jaya, Lombok, and Palu earthquakes in medical emergency response. Pidie Jaya Earthquake: A 6.4 magnitude earthquake struck off Pidie Jaya Regency, province of Aceh in Sumatra Island, Indonesia, resulting in 104 people died and others 395 injured. Lombok Earthquake: A series of moderate and strong earthquakes have rocked cities and regencies in Lombok Island, West Nusa Tenggara (NTB) causing 436 people died, 783 people with severe injury and 570 people with a mild injury. Palu Earthquake: The 7.7 magnitude earthquake hit Donggala district and also affected Palu city and Parigi Mountong regency causing 2657 people died, 4471 people with severe injury and 87,835 people with a mild injury. Important Findings: Though Indonesia has made outstanding progress in disaster management, the country still has many challenges and problems to overcome. The integration of data and information about health needs the progress of relief work, and about various other problems related to health is one of the most urgent and vital for better improving the medical emergency response and public health-related support in disaster settings.

Download Full-text

Acute Cervical Disk Herniation Resulting in Sudden and Severe Neurologic Deterioration: A Case Series

The Surgery Journal ◽

10.1055/s-0036-1593357 ◽

2016 ◽

Vol 02 (03) ◽

pp. e96-e101

Author(s):

Ran Harel ◽

Nachshon Knoller

Keyword(s):

Case Reports ◽

Academic Medical Center ◽

Tertiary Care ◽

Case Series ◽

Medical Emergency ◽

Rare Entity ◽

Disk Herniation ◽

Neurologic Deterioration ◽

Cervical Disk Herniation ◽

Cervical Disk

Objective Nontraumatic acute cervical disk herniation resulting in acute severe neurologic deficit is a rare entity described in a limited number of case reports. We describe the management and outcome in patients presenting with severe neurologic deterioration caused by acutely herniated cervical disks. Methods Four patients (mean age 39.5 years) presented to our tertiary care academic medical center from September 2012 to September 2013 with severe progressive neurologic deficits due to cervical disk herniation and were included in the series. Patients' surgical, medical, and imaging records were retrospectively reviewed under an Institutional Review Board waiver of informed consent. Results Patients in the series presented with acute neurologic deterioration, including paraparesis, Brown-Séquard syndrome, or quadriparesis deteriorating to quadriplegia. Emergent magnetic resonance imaging (MRI) scans and emergent decompression and fusion for acute soft disk herniation were performed in all cases. All patients recovered to excellent functional status with Frankel score improvement from B (one patient)/C (three patients) to E (three patients)/D (one patient). Conclusions Acute cervical disk herniation with acute neurologic deterioration is a medical emergency necessitating emergent MRI and surgical decompression. Clinical presentation varies. In patients with rapid-onset neurologic deterioration, a high level of suspicion for this rare entity is indicated.

Download Full-text

A case series of acquired haemophilia in a Malaysian hospital: unpredictably rare medical emergency

Oxford Medical Case Reports ◽

10.1093/omcr/omv055 ◽

2015 ◽

Vol 2015 (10) ◽

pp. 330-332

Author(s):

Chiou Perng Lee ◽

Bahariah Bt Khalid

Keyword(s):

Case Series ◽

Medical Emergency ◽

Acquired Haemophilia

Download Full-text

Unusual complications of a common disease in COVID times: a case series

International Surgery Journal ◽

10.18203/2349-2902.isj20214007 ◽

2021 ◽

Vol 8 (10) ◽

pp. 3128

Author(s):

Avneet Kaur ◽

Avneet Singh Chawla ◽

T. Lirangla Sangtam ◽

Mandalapu Himaja ◽

Pooja Sewalia

Keyword(s):

Acute Appendicitis ◽

Case Series ◽

Perforated Appendicitis ◽

Medical Emergency ◽

Common Disease ◽

Delayed Presentation ◽

Disease Course ◽

Generalized Peritonitis ◽

Appropriate Treatment ◽

Routine Medical Care

Acute appendicitis is the most common abdominal surgical emergency worldwide. 20-30% of cases of appendicitis can complicate which is defined as perforation, purulent peritoneal collection, abscess formation and generalized peritonitis. The risk of perforated appendicitis increases when appropriate treatment for acute appendicitis is delayed. There has been an avoidance of both urgent or emergency and routine medical care because of Coronavirus disease 2019 (COVID-19) concerns all over the world. In our study, the delayed presentation of the patients with acute appendicitis to the hospital prevented appropriate management leading to a much more morbid disease course. Increasing accessibility of medical and telehealth services might help prevent delay of needed care. Even during the COVID-19 pandemic, persons experiencing a medical emergency should seek and be provided care without delay.

Download Full-text

Thrombotic Thrombocytopenic Purpura: A Case Series from a Tertiary Care Centre in Northern India

Blood ◽

10.1182/blood-2018-99-110773 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5006-5006

Author(s):

Sanjeev Kumar Sharma ◽

Dharma Choudhary ◽

Meet P. Kumar ◽

Rasika Setia ◽

Vipin Khandelwal ◽

...

Keyword(s):

Plasma Exchange ◽

Thrombotic Thrombocytopenic Purpura ◽

Hemolytic Anemia ◽

Case Series ◽

High Index ◽

Medical Emergency ◽

Microangiopathic Hemolytic Anemia ◽

Thrombocytopenic Purpura ◽

Post Transplant ◽

High Index Of Suspicion

Abstract Abstract: Thrombotic thrombocytopenic purpura is a medical emergency with varied clinical manifestations. High index of suspicion with careful evaluation of thrombocytopenia and hemolytic anemia is of paramount importance. Laboratory parameters of microangiopathic hemolytic anemia i.e. schitocytosis and increased LDH and indirect hyperbilirubinemia support the diagnosis. Plasma exchange is the treatment of choice. Post stem cell transplant TTP carries a poorer prognosis. Introduction: Thrombotic thrombocytopenic purpura (TTP) is a disorder characterized by microangiopathic hemolytic anemia and thrombocytopenia associated with fever, renal dysfunction and neurological manifestations. Without treatment, TTP is almost uniformly fatal with a mortality rate approaching 90%. With the timely institution of therapeutic plasma exchange mortality decreases to about less than 10% (1). Recent reports indicate that rituximab can induce remission in the majority of patients with classic TTP (2). We report here 13 cases of TTP who were treated at our hospital in last 4 years. Six of these patients developed features of TTP post allogenic stem cell transplantation. Materials and Methods: The study included retrospective analysis of patients who presented with the features of TTP. Patients with characteristic features of TTP included two or more features among the pentad commonly considered diagnostic of TTP. Evidence of microangiopathic hemolytic anemia and thrombocytopenia were the minimal requirement for the diagnosis with or without fever, renal dysfunction and neurological manifestations. Coagulation profile included prothrombin time and APTT. Liver and kidney function analysis was done in all patients. Response was assessed by clinical and laboratory parameters with monitoring platelet counts, LDH, and schistocytes in the peripheral blood film. Patients with LDH in normal range and platelet counts more than 100,000/µl were considered to have achieved remission. Results: Patients with classic TTP recovered with plasma exchange and/or rituximab. Post-transplant TTP patients had a poorer prognosis as five out of six post-transplant TTP patients died. Discussion: TTP can have a varied clinical presentation and can be associated with many other diseases. Our case series highlight the varied manifestations and associations of TTP and their management and outcome. TTP is a medical emergency and needs high index of suspicion for the diagnosis. In our series, TTP was diagnosed by the findings of thrombocytopenia and hemolytic anemia evidenced by presence of schistocytes in the peripheral blood film and increased LDH, in the absence of coagulopathy. TTP should be suspected in the presence of microangiopathic hemolytic anemia and thrombocytopenia (1,3), and treatment should be started immediately, as delay in treatment can increase the mortality (1). Plasma exchange has changed the prognosis of this highly fatal disease to a highly curable disease. Rituximab has further improved the management of TTP (2). Patients with classic TTP were treated with plasma exchange but 3 patients also required rituximab. All patients with classic TTP are in remission. Transplant-associated microangiopathy (TAM) is a MAHA and thrombocytopenia that occurs after bone marrow transplantation. Patients with post-transplant TTP were diagnosed based on thrombocytopenia and features of microangiopathic hemolytic anemia with schistocytosis and raised LDH, in the absence of coagulopathy. They were treated with FFP and steroids, as plasma exchange is not beneficial for post-transplant TTP (1). Repeated plasma exchange with increased frequency and/or rituximab therapy are the agents of choice in relapsing disease (3). Rituximab is a safe and effective treatment for newly diagnosed TTP, and has been shown to decrease the number of plasma exchange required to achieve remission. We used rituximab in 3 patients and all improved. Post transplant MAHA carried poor prognosis. Conclusion: Diagnosis of TTP requires a high index of suspicion and prompt treatment with plasma exchange, which results in a high cure rate. Rituximab is useful in patients relapsing or showing partial recovery. Plasma exchange has not been reported to be effective in post-transplant TTP. Acknowledgment: We are thankful to Ms Bharti Sharma for compiling the data. Disclosures No relevant conflicts of interest to declare.

Download Full-text

PORTO-SYSTEMIC ENCEPHALOPATHY (PSE);

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.05.2336 ◽

2012 ◽

Vol 19 (05) ◽

pp. 672-678

Author(s):

ATIF SITWAT HAYAT ◽

MOHAMMAD ADNAN BAWANY ◽

FURRUKH NAZ SILAWAT ◽

Mohammad Akber Memon

Keyword(s):

Renal Impairment ◽

Tertiary Care ◽

Case Series ◽

University Hospital ◽

Medical Emergency ◽

Precipitating Factors ◽

Case Series Study ◽

Statistical Program ◽

Series Study ◽

Study Setting

Background: Porto-systemic encephalopathy (PSE) is a common medical emergency at our settings due to increasedprevalence of chronic liver disease. Objective: To determine frequency of common precipitating factors in patients having porto-systemicencephalopathy (PSE) at tertiary care settings in Hyderabad. Study design: Descriptive case series study. Setting: Department of MedicineIsra University Hospital Hyderabad. Period: 1st April 2011 to 31st December 2011. Methods: A total 100 patients manifesting clinical featuresof PSE were included in this study by non-probability convenience sampling. The data was evaluated in statistical program SPSS version 16.Results: As 100 patients with PSE were enrolled in the current study, out of these 96 patients have precipitating factors involved while only 4patients have no such factors. Out of these 96 patients, 36 patients have only single risk factor found while in 64 cases multiple factors wereimplicated. Constipation, infections (except SBP) and renal impairment were noted in 36%, 24% and 22% respectively. Conclusions:Constipation, infections (except SBP) and renal impairment were the most common precipitating factors of porto-systemic encephalopathy inour study. Hence priority should be given to them in terms of hospital funds, medicines and human efforts.

Download Full-text