Episodic Hemiparesis, Cognitive Decline, and Seizures in a Woman With Pernicious Anemia

A 46-year-old woman with a history of pernicious anemia, sought care for intermittent episodes of weakness in her right upper extremity and speech difficulties followed by a headache. It was initially thought that she had migraine headaches. Blood tests showed increased thyrotropin and low free thyroxine levels, and she was diagnosed with Hashimoto thyroiditis. She initiated treatment with levothyroxine. One month later, the patient had a confusional episode and over the course of the following 2 months, the cognitive difficulties progressed. She was brought to the emergency department after a generalized tonic-clonic seizure. On examination, she was profoundly encephalopathic. Formal bedside cognitive testing could not be obtained. Findings of magnetic resonance imaging of the brain were normal. Electroencephalography revealed diffuse slowing. Cerebrospinal fluid analysis showed increased protein concentration and lymphocytic pleocytosis. Thyroid peroxidase antibody value was markedly increased. Thyroglobulin antibody value was also increased. Consistent with her history of pernicious anemia, she was positive for gastric parietal cell antibodies. The clinical presentation was compatible with steroid-responsive encephalopathy associated with autoimmune thyroiditis, also known as Hashimoto encephalopathy. The patient started levetiracetam therapy and had no further seizures. She received intravenous methylprednisolone. At the completion of treatment, her confusion rapidly and substantially improved. She was discharged home on oral prednisone. She also started pantoprazole, calcium, and vitamin D supplementation and Pneumocystis jirovecii prophylaxis. For long-term immunotherapy, she initiated methotrexate. Three months later, the patient and her family reported 90% improvement in her cognitive functioning and resolution of the episodes of hemiparesis. The patient continued tapering prednisone. It was recommended that she continue methotrexate for 5 years before discontinuing. Steroid-responsive encephalopathy associated with autoimmune thyroiditis, also known as Hashimoto encephalopathy, was initially described as strokelike episodes and subacute encephalopathy months after the onset of autoimmune (Hashimoto) thyroiditis.

Pathogenesis and treatment of pernicious anemia in the light of modern views

Malignant anemia, first described by Birmer in 1868 and 1871. and later developed by Ehrlich, according to its clinical data, according to the severity of the suffering itself, has long attracted the attention of clinicians and hematologists. A lot of theories were proposed that tried to explain the origin of this disease, there were a number of attempts to treat this suffering, which did not give any beneficial effect until recent years.

Ligation of the splenic artery in pernicious anemia Volkmann (Munch, med. Woch.,. 1925, No. 4)

Ligation of the splenic artery in case of pernicious anemia in all cases where it is impossible or dangerous to remove the spleen, such as, for example, when the patient is exhausted or with abundant organ fusion, Volkmann recommends on the basis of his favorable clinical experience (Munch, med. Woch.,. 1925, No. 4).

Adrenal transplant for pernicious anemia. Prof. M. I. Arinkin (Vesti. Khir., Book 19)

Prof. MI Arinkin (Vesti. Khir., Book 19) describes 2 cases where such a transplant resulted in a significant improvement in the patients' well-being, the disappearance of weakness and dizziness and some improvement in blood composition.

HEMORRHAGIC ULCERATED STOMACH CANCER IN A PATIENT WITH PERNICIOUS ANEMIA. A CASE REPORTS.

Stomach cancer is one of the most common tumors, often detected in later stages as patients remain asymptomatic until later stages with black stools, accompanied by bodily weakness. Pernicious anemia. a known cause of vitamin B12 deciency, is a classic risk factor for stomach cancer. Patients with PA usually present with megaloblastic anemia and peripheral neuropathy; however, they may also present with nonspecic symptoms, such gastrointestinal hemorrhage with hemodynamic changes. A 73-year-old man presents in the emergency room of the hospital in Lushnja, Albania, with abdominal pain, black stools, accompanied by bodily weakness. Complaints have started for several weeks, where the pain is constantly aggravated, until it forced him to appear in the emergency department of Lushnja Hospital. The patient complains of burning sensation in the chest, decreased appetite, physical weakness, and has lost weight 14 kg in the last 3 months, accompanied by nervous disorders. Up to the moment of hospitalization did not refer for nausea, vomiting, dysphagia, without a history of gastrointestinal disease. Initial laboratory work revealed severe B12 deciency, pancytopenia, by the endoscope that revealed a mass of gastric fundus important for adenocarcinoma on biopsy

About "neutrophilic twins"

The term "neutrophilic twins" ("neutrophileZwillinge") V. Schilling designates neutrophilic leukocytes, which have a double size against the norm and two separate nuclei, similar in structure and shape. Castillo (Vireh. Arch. F. Path. An., Bd. 247, H. 1, 1923) found them, almost as a rule, with significant neutrophilic hyperleukocytosis, especially often in infectious diseases, in particular, pneumonia and scarlet fever. They are often also found in processes when an increased neoplasm of neutrophils occurs, as, for example, with myeloid leukemia, pernicious anemia, ulcerative-chronic endocarditis, etc.

B₁₂-deficiency anemia in the work of the nurse

B₁₂-deficiency anemia (megaloblastic anemia, pernicious anemia, Addison-Birmer disease), characterized by progressive hyperchromic, macrocytic anemia, hypersegmentation of neutrophil nuclei, megaloblastic erythropoiesis and morphological abnormalities of other hematopoietic growths in the bone marrow; Unlike other anemias, B₁₂-deficiency anemia is often associated with the development of pathological psycho-neurological symptoms (funicular myelosis).This article deals with problems of etiology, pathogeny, clinical symptomatology, approaches to detection and treatment of B₁₂-deficiency anemia.