Cerebral hemorrhagic infarction was diagnosed subsequently after high-amplitude slow waves detected on processed electroencephalogram during sedation: a case report

Background Continuous electroencephalogram (EEG) monitoring is useful for assessing the level of sedation and detecting non-convulsive epileptic seizures and cerebral ischemia in the intensive care unit. This report describes a case of cerebral hemorrhagic infarction diagnosed after the detection of high-amplitude slow waves on processed EEG during sedation. Case presentation A 68-year-old man who underwent cardiac surgery was sedated in the intensive care unit following an invasive procedure. High-amplitude slow waves appeared on processed EEG monitoring before the detection of anisocoria. Computed tomography revealed a cerebral hemorrhagic infarction. Conclusions In the management of critically ill patients, continuous EEG monitoring with forehead electrodes may be useful in the early detection of brain lesions.

Acute Myocardial Infarction Followed by Cerebral Hemorrhagic Infarction in Polycythemia Vera: Case Report and Literature Review

A 60-year-old man presented to our emergency room with severe chest pain. Based on the electrocardiogram and elevated serum troponin T levels, acute coronary syndrome was suspected. Coronary angiography revealed total occlusion of the middle of the left anterior descending coronary artery. However, blood cell count abnormalities were not of concern. Twelve days later, the patient developed hemorrhagic infarction in the right parieto-occipital lobe. Acute coronary syndrome and cerebral hemorrhagic infarction were primarily caused by thrombus formation due to polycythemia vera (PV), based on the presence of increased blood consistency on admission. PV was diagnosed after bone marrow biopsy and genetic testing. The patient was treated with descending cell and antiplatelet therapy. Our case highlights the importance of the urgent identification of PV. When acute myocardial infarction occurs in patients with no significant risk factors for cardiovascular disease, blood routine abnormalities should be paid close attention to. If PV was diagnosed as early as possible, thrombotic and hemorrhagic complications could be prevented in the early stages.

Hemorrhagic testicular infarction as a complication of COVID-19 (SARS-CoV-2)

Introduction. Statistically, adult patients with testicular infarction make up 7-10% of the population of all acute urological pathology. This is one of the urological nosologies, which is а part of a group of diseases called acute scrotum . Ischemic heart attack occurs as a result of an acute violation of the blood supply to the testicle from the testicular artery. Hemorrhagic infarction usually occurs as a result of impaired microcirculation or embolization of the arteries and arterioles of the testicle and is most often segmental in nature. Conditions associated with increased blood clotting also create conditions for vein obstruction with subsequent tissue necrosis in any organ, including in the testicles. It is known that COVID-19 (SARS-COV-2) causes a pathological increase in blood clotting in the patient's body and it's most dangerous complication is thrombosis in various blood vessels of the patient's organs, which often causes acute ischemia of these organs and even death in patients with COVID 19. Materials and methods. The authors consider 3 similar clinical observations of hemorrhagic testicular infarction in patients suffering from COVID-19 (SARS-COV-2) and who were in the specialized COVID department of the city hospital of Pyatigorsk (Russia, Stavropol Territory). All 3 patients were aged from 67 to 88 years and had a concomitant pathology from the cardiovascular system in the form of arterial hypertension, as well as type 2 diabetes mellitus. The authors provide one case in detail, since all 3 cases followed the same clinical scenario. Clinical observation: Patient B. 66 years old, who was in a specialized COVID department with a diagnosis of: Coronovirus infection caused by COVID 19 (confirmed), moderate form of UO7. 1, community-acquired bilateral lobar pneumonia, acute respiratory distress syndrome, respiratory failure. Concomitant diseases: atherosclerotic cardiosclerosis, arterial hypertension, type 2 diabetes mellitus. The patient received therapy for the underlying disease, but on the 9th day of his stay in the hospital, he had an acute hemorrhagic infarction of the left testicle. The diagnosis was confirmed by laboratory and instrumental examination. An emergency left-sided orchectomy was performed, and the diagnosis was confirmed histologically. Similar clinical situations were observed in two other patients with the same outcome. Conclusions. Hemorrhagic testicular infarction in patients with COVID-19 in our clinical observation can be considered as a complication of COVID-19, or as its clinical manifestation in the organs of the male reproductive system.

Purpura fulminans secondary to indian tick typhus: a case report

<p>Purpura fulminans is a rare and commonly fatal syndrome that consists of hemorrhagic infarction of the skin and intravascular thrombosis. Purpura fulminans is commonly associated with streptococcal, staphylococcal and meningococcal infection. Indian tick typhus is a rare cause of purpura fulminans. One of the rare causes of purpura fulminans is Indian tick typhus, which is a type of rickettsial spotted fever caused by <em>Rickettsia conorii</em> and transmitted to humans by <em>Rhipicephalus sanguineus </em>(also called the dog tick). Clinical features of Indian tick typhus include fever, maculopapular rash that begins on the extremities with a centripetal spread, and constitutional symptoms including headache, malaise and conjunctival congestion. Severe cases can progress to multi-organ disease including pulmonary edema, meningoencephalitis, renal failure and cardiogenic shock can occur. Current report present a case of a 48 year old male patient who presented with features of Indian tick typhus which progressed to purpura fulminans and necrotizing fasciitis.</p><p> </p>

Histopathological profile of fatal snake bite autopsy cases in a tertiary care center in South India

Background Snake bite is a major public health problem, especially in the tropical areas of the world, which the World Health Organization aims to eradicate. According to the National Crime Records Bureau in India, where agriculture is the mainstay of employment attributes about 8660 mortalities in a year. Histopathological results are of immense help in establishing the cause of death in those snake bite cases where other circumstantial shreds of evidence are lacking. Results An autopsy-based prospective study was conducted on fatal cases of snake bite reported at a tertiary care center in south India over a period of 2 years. A total of 38 fatal snake bite cases were included in the study. Epidemiological data were collected and analyzed. Histopathological findings of the kidneys, heart, and endocrine glands (pituitary, adrenals, thyroid, and pancreas) were analyzed. The significant findings of the kidneys were distinct corticomedullary demarcation on the gross surface (65.8%) and congestion and acute tubular necrosis (55.3%) on histology. On the other hand, in the set of endocrine glands, adrenals and pituitary showed predominantly hemorrhagic infarction on the histological analysis (18.4% and 52.6%) respectively. Conclusion The results of the current study enlighten the findings such as distinct corticomedullary demarcation and acute tubular necrosis in the kidneys and hemorrhagic infarction in the endocrine glands in a case of snake bite. It highlights the need for histopathological analysis in the cases of a fatal snake bite when other circumstantial and gross features become indecisive. This can aid immensely in a medico-legal investigation of snake bite cases.

Assessment of Patients with Intracerebral Hemorrhage or Hemorrhagic Transformation in the VENOST Study

<b><i>Introduction:</i></b> Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group. <b><i>Materials and Methods:</i></b> In the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. The number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded. <b><i>Results:</i></b> CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. In the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was ≥3 in 23.1% of the patients in the CH group. <b><i>Discussion and Conclusion:</i></b> CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome.