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Journal of Neuro-ophthalmology : the... Dec 2023A 55-year-old woman presented with new-onset headache, scalp tenderness, shoulder arthralgias, night sweats, and loss of appetite. She was diagnosed with giant cell...
A 55-year-old woman presented with new-onset headache, scalp tenderness, shoulder arthralgias, night sweats, and loss of appetite. She was diagnosed with giant cell arteritis by her primary care physician and commenced on oral corticosteroids. However, her headache, scalp tenderness, and night sweats persisted. She then developed right Horner syndrome and trigeminal hypoesthesia. Extensive blood work-up revealed mildly elevated inflammatory markers and a paraproteinemia. Subsequent bone marrow biopsy showed lymphoplasmacytic lymphoma, with 10% of hemopoiesis, and staging led to the diagnosis of Waldenstrom macroglobulinemia without nodal or central nervous system (CNS) lesions. Immunohistochemical staining of a temporal artery biopsy showed perivascular lymphoplasmacytic cells and paraprotein deposits. She was diagnosed with CNS involvement of her macroglobulinemia-Bing-Neel syndrome (BNS). Identification of rare CNS involvement of lymphoma is challenging when a patient is already on steroid immunosuppression. In the absence of clear diagnostic criteria, the rare and heterogenous BNS remains a clinical diagnosis.
Topics: Female; Humans; Middle Aged; Giant Cell Arteritis; Waldenstrom Macroglobulinemia; Lymphoma; Headache; Horner Syndrome
PubMed: 37594854
DOI: 10.1097/WNO.0000000000001980 -
SAGE Open Medical Case Reports 2023A 30-year-old female patient with no previous chronic illness underwent hemithyroidectomy unusually complaint of ptosis on first postoperative day. On examination, she...
A 30-year-old female patient with no previous chronic illness underwent hemithyroidectomy unusually complaint of ptosis on first postoperative day. On examination, she also had miosis. Thus, diagnosis of Horner's syndrome was made on ground of ruling out other complication. As it is caused by nerve insult, with a prolonged observation under close follow-up, the patient is fully recovered. Horner's syndrome after thyroidectomy is a rare entity. In textbook also, it is not mentioned as complication after thyroidectomy.
PubMed: 38152685
DOI: 10.1177/2050313X231220811 -
Children (Basel, Switzerland) Oct 2023To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to...
BACKGROUND
To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to describe the clinical characteristics of children with APMD and their association with an increased risk of UCs.
METHODS
We conducted a pediatric retrospective study of APMD referred to ED over a 10-year period. We described the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we applied a logistic regression model to identify the variables predictive of LT condition.
RESULTS
We analyzed 101 patients. In 59.4%, the APMD was isolated. In patients with extra-ocular involvement, the most frequently associated features were altered consciousness, headache, and vomiting. Exposure to toxic agents was reported in 48.5%. Urgent conditions occurred significantly more frequently in older children, presenting bilateral APMD and/or other ocular or extra-ocular manifestations.
CONCLUSIONS
Our study shows that UCs most commonly occur in patients presenting with bilateral APMD and other associated features. In unilateral/isolated APMD ophthalmological examination, exclusion of toxic exposure and observation until resolution of symptoms should be recommended.
PubMed: 38002830
DOI: 10.3390/children10111739 -
Journal of Neuro-ophthalmology : the... Dec 2023
Topics: Infant; Humans; Horner Syndrome; Neuroblastoma
PubMed: 36166800
DOI: 10.1097/WNO.0000000000001561 -
Neurological Sciences : Official... Dec 2023The formation of abscesses with necrosis within large, striated muscles leads to pyomyositis, a condition relatively rarely encountered outside the tropics. Intravenous...
BACKGROUND
The formation of abscesses with necrosis within large, striated muscles leads to pyomyositis, a condition relatively rarely encountered outside the tropics. Intravenous drug users and other immunocompromised individuals are predisposed toward this infection, which may occur due to local or haematogenous spread of infection to skeletal muscles previously damaged by trauma, exercise, or rhabdomyolysis.
METHODS
We report a young male intravenous drug user with rhabdomyolysis due to use of a synthetic opioid, in whom disseminated pyomyositis was detected following evaluation for sciatic and radial neuropathies and Horner's syndrome and review available reports of peripheral nerve dysfunction in the setting of this uncommon infection. We searched online databases to identify all published reports on adult patients with pyomyositis complicated by peripheral nerve dysfunction.
CONCLUSIONS
Peripheral nerve dysfunction may rarely occur via local spread of infection or compression from abscesses.
Topics: Adult; Humans; Male; Horner Syndrome; Pyomyositis; Drug Users; Substance Abuse, Intravenous; Abscess; Rhabdomyolysis; Peripheral Nervous System Diseases
PubMed: 37651041
DOI: 10.1007/s10072-023-07024-z -
European Journal of Ophthalmology Mar 2024To evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time in eyes with miosis after femtosecond laser...
PURPOSE
To evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time in eyes with miosis after femtosecond laser pretreatment.
METHODS
As retrospective study, three hundred thirty-six eyes of 336 consecutive patients who underwent the femtosecond laser and illuminated chopper-assisted cataract surgery were included. Cases with pupil less than 6 mm after femtosecond laser pretreatment were included in the miosis group. Pupil diameter, surgical time, and improved efficacy (100/surgical time×pupil size) were compared between eyes with and without miosis.
RESULTS
Of 336 eyes, 20 were included in the miosis group (6.0%). Pupil diameter was smaller in eyes with miosis than in those without miosis (5.23 ± 0.38 mm vs 7.35 ± 0.64 mm, p < 0.001); however, surgical time was not different (6.86 ± 0.73 min vs 6.60 ± 1.27 min, p = 0.071) between the two groups. Mechanical pupil dilations were not needed in any cases. As a result, improved efficacy was calculated to be higher in patients with miosis (2.83 vs 2.14, p < 0.001).
CONCLUSION
In terms of surgical time and improved efficacy, using the illuminated chopper simplified cataract surgery involving miosis after femtosecond laser pretreatment. The use of an illuminated chopper is expected to be a good solution for femtosecond laser-assisted cataract surgeries.
Topics: Humans; Retrospective Studies; Operative Time; Cataract Extraction; Miosis; Lasers; Cataract; Laser Therapy; Phacoemulsification
PubMed: 37713661
DOI: 10.1177/11206721231202277 -
Clinical Toxicology (Philadelphia, Pa.) Jan 2024Nitazenes are potent synthetic opioids and N-desethyl isotonitazene, a metabolite of isotonitazene, has emerged as a drug in its own right.
INTRODUCTION
Nitazenes are potent synthetic opioids and N-desethyl isotonitazene, a metabolite of isotonitazene, has emerged as a drug in its own right.
METHODS
This is an observational case series of patients with suspected or declared substance use who were admitted to hospitals in the Sandwell and West Birmingham National Health Service Trust between July and October 2023. All patients were found on toxicological screening to have been exposed to N-desethyl isotonitazene.
RESULTS
Twenty presentations involving 19 patients who tested positive for N-desethyl isotonitazene were included in the study. In 19 presentations, multiple substances were detected on toxicological screening. The number of patients testing positive for other substances were: 19 for cocaine and its main metabolite benzoylecgonine, 13 for morphine, 11 for the heroin-specific metabolite 6-monoacetylmorphine, ten for xylazine, eight for gabapentinoids (pregabalin and/or gabapentin), seven for methadone and/or the metabolite, 2-ethylidene-1, 5-dimethyl-3, 3-diphenylpyrrolidine, six for benzodiazepines and five for the synthetic cannabinoid MDMB-4en-PINACA. Only one patient had no other substances detected apart from N-desethyl isotonitazene. This patient presented with coma, miosis, bradypnoea and hypercapnia and responded to naloxone. In this cohort, the median concentration of N-desethyl isotonitazene was 1.53 µg/L ( = 14; range 0.59-5.48) in whole blood and 27.75 µg/L ( = 16; range 0.51-91.53) in urine.
DISCUSSION
The majority of the patients in this cohort presented with features typical of an opioid overdose, which is unsurprising as they were all experienced users of diamorphine. Although these features are also consistent with the known effects of N-desethyl isotonitazene, in only one case is it possible to attribute the patient's features to N-desethyl isotonitazene toxicity alone.
CONCLUSIONS
This case series highlights the need for toxicovigilance in the illicit drug market as patterns of substance misuse evolve and novel psychoactive substances continue to emerge.
Topics: Humans; State Medicine; Substance-Related Disorders; Analgesics, Opioid; Heroin; Hospitals; Benzimidazoles
PubMed: 38353737
DOI: 10.1080/15563650.2024.2309321 -
Journal of Biomolecular Structure &... 2023Nerve agent poisoning is still a threat to civilization. Nerve agents function by binding with the enzyme acetylcholinesterase irreversibly. Accumulation of...
Nerve agent poisoning is still a threat to civilization. Nerve agents function by binding with the enzyme acetylcholinesterase irreversibly. Accumulation of acetylcholine in the synapse causes over-stimulation of muscarinic and nicotinic acetylcholinergic receptors. Thus miosis, glandular hyper secretion, bronchoconstriction, vomiting, diarrhea and bradycardia occurs (by M1-M5 receptors stimulation); whereas convulsion and seizures occur due to the nicotinic receptors. Atropine is a non-selective muscarinic antagonists but no nicotinic antagonists are known. Seizures are controlled by diazepam. Enzyme aging occurs without treatment which causes the enzyme resistant to oxime therapy. Though numerous wet-lab based works has carried out, however, recent time there is an over-growing trend to make comparative assessment of drugs and toxicants. Here we made a molecular docking based comparative assessments between nerve agents toxicity and efficacy of different drugs to prevent this toxicity. Our results suggest that VX is the most harmful organophosphate nerve agents and HI-6 is the best drug followed by Obidoxime and Pralidoxime to free acetylcholinestarase. Docking results correspond the data trend of different experiments for the assessment of severity of different nerve agents and/or effectiveness of different antidote drugs. Our study reinforces the utility of pretreatment of the enzyme with a carbamic acid derivative like Pyridostigmine bromide which inhibits the enzyme reversibly to a smaller extent and thus, prevent the enzyme from aging and the nerve agent binding.Communicated by Ramaswamy H. Sarma.
PubMed: 36152998
DOI: 10.1080/07391102.2022.2125904 -
Frontiers in Medicine 2024To evaluate adult-onset neuronal intranuclear inclusion disease (NIID)-related retinopathy with guanine-guanine-cytosine repeat expansions in .
PURPOSE
To evaluate adult-onset neuronal intranuclear inclusion disease (NIID)-related retinopathy with guanine-guanine-cytosine repeat expansions in .
MATERIALS AND METHODS
Neuro-ophthalmic evaluations, including best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure (IOP), ultrasound biomicroscopy, pupillometry, fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), Humphrey visual field, full-field electroretinography (ERG), and multifocal ERG (mf-ERG) were performed in patients with gene-proven NIID.
RESULTS
Nine patients (18 eyes) were evaluated, with a median age of 62 years (55-68) and only one man was included in our study. Six patients presented with decreased visual acuity or night blindness, whereas the other three were asymptomatic. The visual acuity was measured from 20/200 to 20/20. Miosis was present in eight patients, four of whom had ciliary process hypertrophy and pronation, and three of whom had shallow anterior chambers. Fundus photography, FAF, and OCT showed consistent structural abnormalities mainly started from peripapillary areas and localized in the outer layer of photoreceptors and inner ganglion cell layer. ERG and mf-ERG also revealed retinal dysfunction in the corresponding regions.
CONCLUSION
Patients with NIID showed both structural and functional retinopathies which were unique and different from common cone-rod dystrophy or retinitis pigmentosa. Patients with miosis may have a potential risk of an angle-closure glaucoma attack. Neuro-ophthalmic evaluations is essential for evaluating patients with NIID, even without visual symptom.
PubMed: 38288273
DOI: 10.3389/fmed.2024.1188193 -
Frontiers in Surgery 2023Horner's syndrome (HS) is a rare condition due to damage to the 3-neuron sympathetic pathway anywhere between the posterior-lateral nuclei of the hypothalamus and the...
BACKGROUND
Horner's syndrome (HS) is a rare condition due to damage to the 3-neuron sympathetic pathway anywhere between the posterior-lateral nuclei of the hypothalamus and the oculosympathetic fiber, particularly as a post-thyroidectomy symptom. In this case report, we present a case of HS following endoscopic thyroid surgery (ETS) and briefly review the literature.
CASE REPORT
During a routine physical examination, a 29-year-old female patient was incidentally found to have multiple nodules in the right thyroid. She was subsequently admitted to the Department of General Surgery for further examinations and treatment. A fine-needle aspiration biopsy confirmed malignancy in these nodules. As a result, the patient underwent radical resection of the right thyroid and ipsilateral central lymph node dissection using endoscopy. Pathological diagnosis revealed papillary thyroid carcinoma. Unexpectedly, on the third day after the operation, the patient was diagnosed with Horner's syndrome based on the presence of miosis and ptosis. After 1 week of follow-up, the symptoms related to HS significantly improved.
CONCLUSION
Horner's syndrome is an uncommon complication of thyroidectomy in patients undergoing ETS. Therefore, it is crucial to perform careful operations and minimize iatrogenic surgical damage to reduce the incidence of HS. This case serves as a reminder that making rational judgments and implementing appropriate measures are essential for achieving a favorable prognosis and preserving facial esthetics.
PubMed: 37841812
DOI: 10.3389/fsurg.2023.1267701