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IDCases 2023We report a case of a 32-year-old male with a history of type 1 diabetes, inhaled drug use, and alcohol use disorder, who presented with encephalopathy, holocranial...
We report a case of a 32-year-old male with a history of type 1 diabetes, inhaled drug use, and alcohol use disorder, who presented with encephalopathy, holocranial headaches, neck pain, confusion, and generalized tonic-clonic seizures. The patient initially presented at a rural community hospital with a fever and was found to be in diabetic ketoacidosis (DKA). He was also hemodynamically stable but stuporous, prompting intubation to protect his airway. Despite initial treatment measures, his neurological condition worsened and he remained ventilator-dependent. Key findings include a high glucose level, presence of ketones, and evidence of drug use. Blood cultures showed no growth, but his febrile state persisted. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis, hyperglycorrhachia but normal protein, with no growth. Neuroimaging showed right hemispheric slowing on EEG and diffusion restriction in the right frontal lobe on MRI. The patient's neurological status worsened on the second day of admission, manifesting as sluggish pupillary reflexes, right third nerve palsy, and decerebrate posturing. Emergent MRI suggested cerebral edema, leading to initiation of hypertonic saline. This case highlights the diagnostic challenges and critical management considerations in a patient with multiple comorbidities presenting with unexplained neurological deterioration, emphasizing the importance of a comprehensive and timely approach to diagnosis and treatment.
PubMed: 37415782
DOI: 10.1016/j.idcr.2023.e01821 -
Journal of the American Veterinary... Dec 2017
Topics: Animals; Arrhythmias, Cardiac; Diagnosis, Differential; Dog Diseases; Dogs; Electrocardiography; Fatal Outcome; Gastric Dilatation; Lethargy; Male; Orchiectomy; Stomach Volvulus; Tachycardia, Supraventricular; Vomiting
PubMed: 29190199
DOI: 10.2460/javma.251.12.1383 -
European Neurology 2015This paper sketches the early history of pituitary apoplexy, a disorder later fully described in 1950 by Brougham, Heusner and Adams. Haemorrhage or necrosis in an...
This paper sketches the early history of pituitary apoplexy, a disorder later fully described in 1950 by Brougham, Heusner and Adams. Haemorrhage or necrosis in an adenoma causes a characteristic sudden drowsiness, stupor or coma, headache and stiff neck, ocular palsy, and impaired acuity with visual field loss owing to optic nerve or chiasmal compression. The associated endocrinopathy and management are described.
Topics: History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Medical Illustration; Neurology; Pituitary Apoplexy
PubMed: 26111492
DOI: 10.1159/000431090 -
BMJ Case Reports Sep 2017We present a 65-year-old diabetic patient with a complex liver abscess and bacteraemia from The abscess resulted in a prolonged hospital stay due to ongoing sepsis...
We present a 65-year-old diabetic patient with a complex liver abscess and bacteraemia from The abscess resulted in a prolonged hospital stay due to ongoing sepsis despite ultrasound-guided drainage and broad-spectrum antibiotics. Furthermore, the patient developed several secondary complications including a right-sided pleural effusion, an inferior vena cava thrombus and septic lung emboli. The abscess was eventually managed successfully with a prolonged course of antibiotics and multiple ultrasound-guided drainage procedures.To our knowledge, this is the first reported case of probiotic consumption, confirmed by strain identification, as the likely source of a liver abscess. Probiotic products have been widely used for many years and are advocated to the general public for their health benefits with no warning of side effects. Lactobacilli are one group of bacteria commonly used in these products. Although rare, complications have been reported. Susceptible patients, such as those who are immunocompromised, should be advised against excessive consumption.
Topics: Aged; Anti-Bacterial Agents; Colony Count, Microbial; Drainage; Female; Fluconazole; Humans; Immunocompromised Host; Lactobacillus; Lethargy; Linezolid; Liver Abscess; Metronidazole; Microbial Sensitivity Tests; Pleural Effusion; Probiotics; Sepsis; Treatment Outcome; Venous Thrombosis
PubMed: 28903972
DOI: 10.1136/bcr-2016-218423 -
Revista de Neurologia Mar 2010Nonconvulsive status epilepticus (SE) is a term used to denote a range of conditions in which electrographic seizure activity is prolonged and results in nonconvulsive... (Review)
Review
INTRODUCTION
Nonconvulsive status epilepticus (SE) is a term used to denote a range of conditions in which electrographic seizure activity is prolonged and results in nonconvulsive clinical symptoms. Nowadays, some experts on nonconvulsive SE have emphasized the utility on the clinical practice to consider the classification taking in account both the clinical setting and the severity of consciousness impairment, differentiating between ambulatory patients (from almost normal mental state to stupor) which includes absence SE and complex partial SE; and nonconvulsive SE in coma.
AIM
To review the literature in relation to the diagnosis of nonconvulsive SE in comatose and/or critically ill patients.
DEVELOPMENT
Nonconvulsive SE has been reported with surprising frequency in a wide variety of acute neurological processes such as cerebrovascular disease, anoxia, subarachnoid hemorrhage, cranial trauma, encephalitis and following convulsive SE.
CONCLUSIONS
Nonconvulsive seizures and episodes of nonconvulsive SE in patients with severe impairment of consciousness are frequent and, therefore, continuous EEG monitoring is an essential neurophysiologic tool in the evaluation of comatose subjects. EEG interpretation in patients with nonconvulsive SE may be particularly difficult and problematic and, therefore, requires expert knowledge and a clinical and neurophysiologic specific training.
Topics: Adult; Cerebral Hemorrhage; Coma; Electroencephalography; History, 20th Century; Humans; Prognosis; Status Epilepticus
PubMed: 20217649
DOI: No ID Found -
Indian Journal of Psychiatry Jul 2001
PubMed: 21407873
DOI: No ID Found -
The Tokai Journal of Experimental and... Apr 2020The condition of periodic psychosis of adolescence based on the clinical features of recurrent depressive symptoms, sub-stupor, and psychotic symptoms whose features...
The condition of periodic psychosis of adolescence based on the clinical features of recurrent depressive symptoms, sub-stupor, and psychotic symptoms whose features return to a normal state within 2 weeks with no residual symptoms has been often seen during adolescence. However, international recognition of periodic psychosis of adolescence is low and the condition is not recognized as an independent disease in ICD-10 or DSM-5. We presented a case report of a depressive episode central to periodic psychosis of adolescence in a 16-year old female. The symptoms presented in the case correspond to the DSM-5 classification of premenstrual dysphoric disorder. However, a diagnosis of periodic psychosis of adolescence was made due to the presence of clinical features of victim mentality, increased irritability, suicidal ideations, and changes in consciousness over short periods of time and sub-stupor. This report was focused on the medical treatment of the episode of periodic psychosis of adolescence with the aim of verifying its current significance.
Topics: Adolescent; Depression; Familial Mediterranean Fever; Female; Humans; Lithium Carbonate; Psychotic Disorders; Remission Induction
PubMed: 32219802
DOI: No ID Found -
Frontiers in Neurology 2021Catatonia is a psychomotor syndrome common to several medical and neuropsychiatric disorders. Here, we report on the case of a 95-year-old woman who underwent a radical...
Catatonia is a psychomotor syndrome common to several medical and neuropsychiatric disorders. Here, we report on the case of a 95-year-old woman who underwent a radical change in personality characterized by sexual disinhibition, and physical and verbal aggressiveness. Over several months, she developed verbal stereotypies, gait deterioration, and double incontinence. She eventually developed mutism and an active opposition to all attempts to be fed or cared for. Benzodiazepines, olanzapine and electroconvulsive therapy were of no benefit. Magnetic resonance imaging revealed asymmetric (more severe on the right) frontotemporal, parietal, and upper brainstem atrophy. She died from sepsis without recovering from stupor seven years after the onset of symptoms. We believe that the initial behavioral disinhibition was related to the frontotemporal injury, whereas catatonic stupor reflected the progression of the degenerative process to the parietal cortices. Our case adds to the small number of cases of catatonia as a symptom of degenerative dementia. It also supports the idea that damage to the parietal cortex gives rise to pathological avoidance of which catatonic stupor represents an extreme form.
PubMed: 35115996
DOI: 10.3389/fneur.2021.798264 -
BMJ Case Reports Jun 2020A 57-year-old woman presented with severe lethargy, dizziness and nausea 1 week after transsphenoidal resection of a growth hormone secreting pituitary adenoma. She was...
A 57-year-old woman presented with severe lethargy, dizziness and nausea 1 week after transsphenoidal resection of a growth hormone secreting pituitary adenoma. She was found to have severe hyponatremia of 115 mmol/L. Importantly, she was neurologically intact and clinically euvolaemic. Her fluid intake was restricted and her sodium levels increased to 131 mmol/L over 4 days. She made a full recovery.She was diagnosed with isolated second-phase diabetes insipidus, a state of symptomatic hypoosmolar hyponatremia that usually occurs 7-10 days after transsphenoidal surgery. The sodium levels improve with fluid restriction.
Topics: Adenoma; Diet Therapy; Dizziness; Drinking Water; Female; Humans; Hyponatremia; Hypophysectomy; Lethargy; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Sphenoid Bone; Treatment Outcome; Water-Electrolyte Imbalance
PubMed: 32606131
DOI: 10.1136/bcr-2020-235499 -
BMJ Case Reports Mar 2016We report a case of a 19-year-old immunocompetent Malay woman who presented with a worsening psychotic disorder of 1-year duration. She initially presented with social...
We report a case of a 19-year-old immunocompetent Malay woman who presented with a worsening psychotic disorder of 1-year duration. She initially presented with social isolation with subsequent mutism and stupor. Physical examination revealed a stuporous, emaciated, dehydrated woman with Glasgow Coma Scale of 11/15 (E4V2M5). She had a blank stare, mutism and akinesia. Motor examination revealed upper motor neuron findings. Neck stiffness was present, however, Kernig's and Brudzinski's signs were negative. There were no other findings on other systems. Brain imaging and EEG were normal. Cerebrospinal fluid investigations revealed positive cerebrospinal fluid Mycobacterium tuberculosis PCR (MTB PCR). The patient was treated with empirical antituberculosis drugs and steroids. On follow-up visit 1 month later, her psychotic symptoms had fully resolved. She was able to ambulate and care for herself; she was unable to recall the symptoms she had experienced before and during admission.
Topics: Antitubercular Agents; Female; Humans; Mycobacterium tuberculosis; Psychotic Disorders; Reflex, Abnormal; Steroids; Tuberculosis, Meningeal; Young Adult
PubMed: 26969352
DOI: 10.1136/bcr-2015-213171