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Medicine Dec 2022Infarct-induced lethargy is a common disabling symptom that lacks a consensual definition and a standardized method of care. Identifying the causes of the infarct in the... (Review)
Review
INTRODUCTION
Infarct-induced lethargy is a common disabling symptom that lacks a consensual definition and a standardized method of care. Identifying the causes of the infarct in the thalamic reticular nucleus (TRN) induced lethargy is crucial in stroke patients.
CASE PRESENTATION
A 68-year-old female patient was admitted to the hospital with lethargy and weakness in the right limb. A computed tomography (CT) scan performed at the presentation showed no bleeding. She was given intravenous thrombolysis. A head computed tomography (CT) scan clearly showed that the infarct was located in the TRN. After 1 hour of treatment, the weakness in the patient's limb was relieved. However, she was still lethargic, but her lethargy symptoms improved after 3 days.
DISCUSSION AND CONCLUSIONS
Our case highlights that despite the small size of the infarct, the patient was unconscious, which makes it difficult for physicians to understand and treat the condition, resulting in trouble managing the case. We performed a literature review and proposed that the infarction located in the TRN causes lethargy. However, further clinical and pathophysiological research is still needed to improve patient care.
Topics: Humans; Aged; Infarction
PubMed: 36482596
DOI: 10.1097/MD.0000000000032158 -
Annals of Medicine and Surgery (2012) Dec 2022and importance: SARS-CoV-2 infection classically presents with fever and respiratory illness. However, neurological manifestations are also being reported in the...
INTRODUCTION
and importance: SARS-CoV-2 infection classically presents with fever and respiratory illness. However, neurological manifestations are also being reported in the literature. Transverse myelitis is caused by inflammation of spinal cord. There are various possible etiologies for this neurologic condition that include viral or bacterial infections.
CASE PRESENTATION
We present a case of 2 -year-old female complained of weakness of all four limbs and lethargy.She was febrile(39), respiratory rate 30/min and oxygensaturation of 89% on room air. Neurological examination revealed intact cranial nerves, GCS of 14/15 and upper and lower limbs weakness with medical research council(MRC) score of 2/5 Sensory examination showed decreased sensation of all modalities in lower limbs with a sensory level at T4.
CLINICAL DISCUSSION
Laboratory results and cerebrospinal fluid (CSF) analysis showed normal values. Brain MRI was normal. An urgent Gadolinium-enhanced magnetic resonance imaging of the whole spine was done and revealed extensive diffuse hyper intense signal involving predominantly the grey matter of the upper cervical spinal cord. Mild enlargement and swelling of the cervical cord were also note. She was given pulse doses of IV methylprednisolone 30mg/kg followed by oral prednisolone for 40 days. She was also given IV gamma globulin 400mg/kg for five days. A marked improvement of his neurological deficit was noted over a period of 16 days after treatment.
CONCLUSION
when a patient with myelopathy is systemically ill with fever andloss of consciousness, prompt investigation of the causative agent is needed for appropriate management. Even after the pandemic Status; COVID-19 should be considered a differential diagnosis in patients presenting with loss of consciousness, ataxia, convulsions, motor deficits, encephalitis, myelitis, or neuritis.
PubMed: 36415678
DOI: 10.1016/j.amsu.2022.104911 -
BMJ Open Aug 2022To test the hypothesis that systemic and inhaled glucocorticoid use is associated with changes in grey matter volume (GMV) and white matter microstructure.
Association between use of systemic and inhaled glucocorticoids and changes in brain volume and white matter microstructure: a cross-sectional study using data from the UK Biobank.
OBJECTIVE
To test the hypothesis that systemic and inhaled glucocorticoid use is associated with changes in grey matter volume (GMV) and white matter microstructure.
DESIGN
Cross-sectional study.
SETTING
UK Biobank, a prospective population-based cohort study of adults recruited in the UK between 2006 and 2010.
PARTICIPANTS
After exclusion based on neurological, psychiatric or endocrinological history, and use of psychotropic medication, 222 systemic glucocorticoid users, 557 inhaled glucocorticoid users and 24 106 controls with available T1 and diffusion MRI data were included.
MAIN OUTCOME MEASURES
Primary outcomes were differences in 22 volumetric and 14 diffusion imaging parameters between glucocorticoid users and controls, determined using linear regression analyses adjusted for potential confounders. Secondary outcomes included cognitive functioning (six tests) and emotional symptoms (four questions).
RESULTS
Both systemic and inhaled glucocorticoid use were associated with reduced white matter integrity (lower fractional anisotropy (FA) and higher mean diffusivity (MD)) compared with controls, with larger effect sizes in systemic users (FA: adjusted mean difference (AMD)=-3.7e-3, 95% CI=-6.4e-3 to 1.0e-3; MD: AMD=7.2e-6, 95% CI=3.2e-6 to 1.1e-5) than inhaled users (FA: AMD=-2.3e-3, 95% CI=-4.0e-3 to -5.7e-4; MD: AMD=2.7e-6, 95% CI=1.7e-7 to 5.2e-6). Systemic use was also associated with larger caudate GMV (AMD=178.7 mm, 95% CI=82.2 to 275.0), while inhaled users had smaller amygdala GMV (AMD=-23.9 mm, 95% CI=-41.5 to -6.2) than controls. As for secondary outcomes, systemic users performed worse on the symbol digit substitution task (AMD=-0.17 SD, 95% CI=-0.34 to -0.01), and reported more depressive symptoms (OR=1.76, 95% CI=1.25 to 2.43), disinterest (OR=1.84, 95% CI=1.29 to 2.56), tenseness/restlessness (OR=1.78, 95% CI=1.29 to 2.41), and tiredness/lethargy (OR=1.90, 95% CI=1.45 to 2.50) compared with controls. Inhaled users only reported more tiredness/lethargy (OR=1.35, 95% CI=1.14 to 1.60).
CONCLUSIONS
Both systemic and inhaled glucocorticoid use are associated with decreased white matter integrity and limited changes in GMV. This association may contribute to the neuropsychiatric side effects of glucocorticoid medication, especially with chronic use.
Topics: Adult; Biological Specimen Banks; Brain; Cohort Studies; Cross-Sectional Studies; Glucocorticoids; Humans; Lethargy; Prospective Studies; United Kingdom; White Matter
PubMed: 36041764
DOI: 10.1136/bmjopen-2022-062446 -
Cureus May 2022Thyroid hormone is essential in accomplishing the appropriate metabolism of the body. Achieving euthyroidism is of importance due to the deadly ramifications of being...
Thyroid hormone is essential in accomplishing the appropriate metabolism of the body. Achieving euthyroidism is of importance due to the deadly ramifications of being hypothyroid, such as multiple organ failure, profound decrease in mentation and even death. We present a case of an 80-year-old female with a history of hypertension, coronary artery disease, chronic kidney disease, hypothyroidism due to total thyroidectomy, and a cerebral vascular accident who presented with slurred speech, decreased appetite, dizziness and lethargy with new-onset weakness. She was adherent to all her medications. Her labs were significant for elevated thyroid-stimulating hormone, elevated free thyroxine, and low total triiodothyronine. Brain MRI revealed no acute pathology. She was given her home dose of Levothyroxine and was admitted to the telemetry unit for evaluation of her symptoms and abnormal thyroid panel. During her hospital course, she was found to have an abnormal rhythm and worsening lethargy. Subsequent electrocardiogram and laboratory values revealed new T-wave inversions and elevated troponin. An echocardiogram revealed a new severely reduced left ventricular function with severe global hypokinesis of the left ventricle and an ejection fraction of 30%. It was only after initiating combination therapy of levothyroxine and liothyronine that her symptoms and abnormal cardiac rhythm resolved. With this careful titration of the patient's medication, we concluded that combination therapy was essential to the patient being euthyroid. This phenomenon was also cited in multiple literature, which warrants an investigation of a certain population's inability to convert T4 to T3. By sharing this case, we aim to aid providers with their differential diagnoses and bring to light a potential area of further investigation. Ultimately, by optimizing and tailoring these medications, we hope to improve their quality of life.
PubMed: 35712337
DOI: 10.7759/cureus.25024 -
Journal of Clinical Microbiology Nov 2016
Topics: ADP-ribosyl Cyclase 1; Blood; Humans; Immunohistochemistry; Lethargy; Lymphadenopathy; Male; Membrane Glycoproteins; Microscopy; Middle Aged; Polymerase Chain Reaction; Skin; Trypanosoma brucei gambiense; Trypanosomiasis, African
PubMed: 27935830
DOI: 10.1128/JCM.03285-14 -
The Western Journal of Emergency... May 2018Use of synthetic cannabinoids (SC) has recently emerged as a new drug epidemic. Our emergency departments (EDs) received a surge of SC users presenting with lethargy and...
INTRODUCTION
Use of synthetic cannabinoids (SC) has recently emerged as a new drug epidemic. Our emergency departments (EDs) received a surge of SC users presenting with lethargy and bradycardia, contrasting prior reports of SC-induced tachycardia and agitation. Our goal was to describe these novel presentations and characterize the compounds.
METHODS
We present a case series of patients with SC intoxication who presented to our toxicology service covering two tertiary care EDs between 2/11/2015 and 6/23/2015. A retrospective chart review recorded initial vital signs, chief complaint and clinical course. Urine, blood and xenobiotic samples were analyzed using either liquid chromatography/mass spectrometry or gas chromatography/mass spectrometry. We compared resulting spectra against databases containing numerous SCs or metabolites and scored based on a reference comparison.
RESULTS
Between 2/11/2015 and 6/23/2015, we identified 141 visits. Males comprised 139 visits (age range 21-68 years; median 35, interquartile range 20). Sixty-eight percent presented with lethargy or loss of consciousness. Hypotension (SBP <90 mmHg) and bradycardia (HR<60 bpm) were seen in 10% and 24% of visits, respectively. While most patients were discharged after observation, three were admitted to the intensive care unit and seven to telemetry. Admissions were for vital sign instability, bradycardia requiring pacing, prolonged sedation and respiratory failure requiring mechanical ventilation.Laboratory analysis revealed SC in the XLR-11 family in 18/36 drug, 9/12 blood, and 23/31 urine samples. Carboxamide indazole derivative (CID) family compounds were detected in 13/36 drug samples, 21/31 urine samples, but no blood samples; 11/31 drug samples contained both XLR-11 and CID. Other compounds detected included PB-22 and nicotine. No JWH compounds, opiates, imidazoline receptor agonists, benzodiazepines or other sedative-hypnotics were detected.
CONCLUSION
Unlike their predecessors, novel SC may be associated with significant central nervous system depression and bradycardia. While prior reports indicated that SC mostly contained JWH compounds, none were detected in these samples. The most commonly identified compounds in this series were CID and alkyl SC derivatives, such as INACA compounds and XLR-11. These tend to be full agonists at the cannabinoid receptor and are presumably more potent. The lack of other depressants suggests that the clinical findings are due to the combination of these compounds and not coingestants or adulterants. SC intoxication should be considered for patients with undifferentiated psychomotor depression and bradycardia.
Topics: Adult; Bradycardia; Cannabinoids; Chromatography, Liquid; Databases, Factual; Emergency Service, Hospital; Female; Gas Chromatography-Mass Spectrometry; Humans; Lethargy; Male; Retrospective Studies; Substance Abuse Detection
PubMed: 29760857
DOI: 10.5811/westjem.2017.12.36968 -
Pharmaceutics Jun 2023Cystinosis is a severe inherited metabolic storage disease caused by the lysosomal accumulation of cystine. Lifelong therapy with the drug cysteamine bitartrate is...
Cystinosis is a severe inherited metabolic storage disease caused by the lysosomal accumulation of cystine. Lifelong therapy with the drug cysteamine bitartrate is necessary. Cysteamine cleaves intralysosomal cystine, and thereafter, it can exit from the organelle. The need for frequent dosing every 6 h and the high prevalence of gastrointestinal side effects lead to poor therapy adherence. The purpose of our study was to improve cysteamine treatment by comparing the efficacy of two cysteamine formulas. This is highly relevant for the long-term outcome of cystinosis patients. The cystine and cysteamine levels of 17 patients taking immediate-release cysteamine (IR-cysteamine/Cystagon) and 6 patients taking encapsulated delayed-release cysteamine (EC-cysteamine) were analyzed. The EC-cysteamine levels showed a near-ideal pharmacokinetic profile indicative of delayed release (longer T and T), and the corresponding cystine levels showed few fluctuations. In addition, the C of IR-cysteamine was greater, which was responsible for unbearable side effects (e.g., nausea, vomiting, halitosis, lethargy). Treatment with EC-cysteamine improves the quality of life of cystinosis patients because the frequency of intake can be reduced to 2-3 times daily and it has a more favorable pharmacokinetic profile than IR-cysteamine. In particular, cystinosis patients with no access to the only approved delayed-release cysteamine Procysbi could benefit from a cost-effective alternative.
PubMed: 37514038
DOI: 10.3390/pharmaceutics15071851 -
Journal of the American Veterinary... Jan 2019
Topics: Animals; Arrhythmias, Cardiac; Cat Diseases; Cats; Diagnosis, Differential; Electrocardiography; Hernia, Diaphragmatic; Lethargy; Male
PubMed: 30668297
DOI: 10.2460/javma.254.1.71 -
Turkish Journal of Medical Sciences 2015The purpose of this study was to determine the epidemiological and clinical characteristics of patients diagnosed with tularemia and the effectiveness of the...
BACKGROUND/AIM
The purpose of this study was to determine the epidemiological and clinical characteristics of patients diagnosed with tularemia and the effectiveness of the administered treatments.
MATERIALS AND METHODS
Patients treated in our hospital between January 2009 and March 2011 and diagnosed with tularemia were evaluated retrospectively. Patients' epidemiological and clinical characteristics, administered treatments, and posttreatment findings were recorded on patient monitoring forms.
RESULTS
At anamnesis, 29% of patients used water from wells and 71% used water from the network supply; moreover, 48.4% had a history of contact with animals and 87.1% a history of lethargy. At physical examination, 96.8% had a mass in the neck and 90.3% had fever. Gentamycin + doxycycline therapy was administered to 45.2% of patients, while levofloxacin, gentamycin, and streptomycin were used for the other patients. After treatment, neck masses persisted in 48.4% of patients and complaints of lethargy and fever in 6.5%. Treatment of these patients was initiated once tularemia had been diagnosed, as test results were announced about 3 weeks later. Lymphadenopathy excision was performed on 19.4% of patients in whom neck mass persisted.
CONCLUSION
Appropriate empiric antibiotherapy should be commenced in patients presenting with neck mass, fever, and lethargy in regions with tularemia epidemics.
Topics: Adolescent; Adult; Animals; Anti-Bacterial Agents; Disease Management; Disease Outbreaks; Disease Vectors; Doxycycline; Female; Francisella tularensis; Gentamicins; Humans; Lethargy; Levofloxacin; Lymphatic Diseases; Male; Middle Aged; Oropharynx; Streptomycin; Tularemia; Turkey
PubMed: 26422865
DOI: 10.3906/sag-1403-111 -
The Veterinary Clinics of North... May 2014A variety of disease agents can affect the gastrointestinal tract of the exotic companion mammal, some of which can pose zoonotic health concerns. Many conditions... (Review)
Review
A variety of disease agents can affect the gastrointestinal tract of the exotic companion mammal, some of which can pose zoonotic health concerns. Many conditions present with nonspecific clinical signs (lethargy, variable degrees of diarrhea, and for most sick rodents, presenting hunched with spiky fur), necessitating additional laboratory testing to reach a diagnosis. Primary tumors of the digestive tract are also presented as well as miscellaneous conditions ranging from toxins to trauma.
Topics: Animals; Gastrointestinal Diseases; Gastrointestinal Tract; Mammals; Pets; Rodentia
PubMed: 24767738
DOI: 10.1016/j.cvex.2014.01.002