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Case Reports in Critical Care

Aristide Ntahe
[This corrects the article DOI: 10.1155/2018/1208401.].
2018: Case Reports in Critical Care
Jan-Thorben Sieweke, Jens Vogel-Claussen, Andreas Martens, Jörn Tongers, Andreas Schäfer, Johann Bauersachs, L Christian Napp
A 66-year-old patient was admitted under continuous resuscitation for pulseless electrical activity. After return of spontaneous circulation ECG showed signs of acute inferior ST-elevation myocardial infarction, and echocardiography showed acute right ventricular failure with a dilated right ventricle. Carotid pulses were present in the absence of femoral pulses. Subsequent computed tomography demonstrated inferior myocardial infarction with ventricular septal rupture and thrombotic occlusion of the thoracic aorta, resulting in a heart-brain-circulation with loss of perfusion downstream of the aortic arch...
2018: Case Reports in Critical Care
Ester Ilyayeva, Khaled Nada, Roxane Farahi Far, Kamal Albright, Manmeet Kaur Gujral, Menachem Gold
Moyamoya disease is a rare condition affecting the circle of Willis and its branching arteries. While the pathogenesis is unclear, it causes progressive occlusion of multiple cerebral vessels leading to severe strokes. We report a case of a 47-year-old Hispanic woman with HTN presented with altered mental status and bilateral upper and lower extremity weakness with dystonic-like upper extremity movement. Serial brain CTs and angiography were performed which showed massive frontal and parietal cerebral infarcts with radiological evidence of moyamoya disease...
2018: Case Reports in Critical Care
Paula J Watts, Natasha Fazel, Dmitriy Scherbak
Neisseria meningitidis is a cause of bacterial meningitis and meningococcemia worldwide. Rarely, it causes invasive disease with significant lifelong sequela if survived. Early clinical recognition is key as meningococcemia is an easily treatable disease, yet mortality is 50% if it is left untreated. In this case review, we present a classic case of meningococcemia, with an atypical presentation.
2018: Case Reports in Critical Care
Mabrouk Bahloul, Basma Souissi, Olfa Turki, Mariem Dlela, Khaireddine Ben Mahfoudh, Mounir Bouaziz
Background: Severe scorpion envenomation can lead to severe neurological manifestations, which are an indicator of the severity of the scorpion sting. The direct action of scorpion venom on the central nervous system can explain partly these neurological disorders. Methods and Findings: We report a case of severe scorpion envenomation in 16-month-old boy with no pathological history admitted in ICU for severe scorpion envenomation. The result of cerebral MRI agrees with the hypothesis of direct action of scorpion venom on the central nervous system...
2018: Case Reports in Critical Care
Motohiro Asaki, Takamitsu Masuda, Yasuo Miki
A 57-year-old man presented to the emergency department with fever and progressive altered level of consciousness of 5 days' duration. Three days before admission, influenza A was diagnosed at a clinic. On admission, his vital signs were unstable. Pneumonia was diagnosed through chest computed tomography, and urinary Legionella antigen test was positive. A diagnosis of septic shock due to Legionella and influenza pneumonia was made, and critical care management was initiated, including mechanical ventilation and vasopressors...
2018: Case Reports in Critical Care
Naoki Kawakami, Ho Namkoong, Takanori Ohata, Shinji Sakaguchi, Fumitake Saito, Hideki Yuki
Introduction: The prognosis of mycoplasma pneumonia in adults is generally favorable, but a few patients show progression to acute respiratory distress syndrome (ARDS). We have described the management of a patient who showed progression of mycoplasma pneumonia to ARDS. Presentation of Case: A 26-year-old male patient with no significant past medical or social history presented with a 5-day history of fever. Following this, he was diagnosed with bacterial pneumonia and treated with tazobactam/piperacillin; however, he showed little clinical improvement with this treatment approach...
2018: Case Reports in Critical Care
Leonardo Cordeiro de Souza, Amarildo Abreu de Souza, Eric Eduardo Pinto de Almeida, Leo Honse Ribeiro, Marcos David Parada Godoy, Wanderlei Augusto Junior, Jocemir Ronaldo Lugon
Zika is an arbovirus infection mainly transmitted by the mosquito Aedes aegypti . In 2016, the burden of Zika epidemic in Brazil was significant. Patients affected by Zika virus can develop Guillain-Barré syndrome, evolving to muscle respiratory failure requiring mechanical ventilation. In this setting, delayed recovery of the muscle weakness can result in prolonged weaning, a condition that by itself is related to a high mortality rate. The study is reporting a case of a patient with Zika and Guillain-Barré syndrome who underwent an inspiratory muscle training program starting after twenty-five days of mechanical ventilation and guided by serial measurements of the timed inspiratory effort (TIE) index...
2018: Case Reports in Critical Care
Pablo Lucero, Sebastián Chapela
Diabetic ketoacidosis (DKA) is an acute complication of diabetes mellitus, both type I and type II, as well as other types with diabetes such gestacional diabetes mellitus. It is characterized by blood glucose levels greater than 250 mg/dL and metabolic acidosis (pH < 7.3 and serum bicarbonate < 15 mEq/dL) with an increased anion gap and the presence of ketone bodies in the blood or urine. Within this pathology, there is a subgroup of pathologies which are characterized by being present with no signs of hyperglycemia, posing a diagnostic challenge due to the absence of the main sign of the pathology and the diversity of their pathophysiology...
2018: Case Reports in Critical Care
Mark A Dobish, David A Wyler, Christopher J Farrell, Hermandeep S Dhami, Victor M Romo, Daniel D Choi, Travis Reed, Michael E Mahla
This report displays a rare presentation of lactic acidosis in the setting of status epilepticus (SE). The differential diagnosis of lactic acidosis is broad and typically originates from states of shock; however, this report highlights an alternative and rare etiology, SE, due to chronic skull base erosion from temporomandibular joint (TMJ) disease. Lactic acidosis is defined by a pH below 7.35 in the setting of lactate values greater than 5 mmol/L. Two broad classifications of lactic acidosis exist: a type A lactic acidosis which stems from global or localized tissue hypoxia or a type B lactic acidosis which occurs once mitochondrial oxidative capacity is unable to match glucose metabolism...
2018: Case Reports in Critical Care
Giorgio Berlot, Ariella Tomasini, Lorenzo Zandonà, Eugenio Leonardo, Rossana Bussani, Nadia Zarrillo
The authors describe the case of a young woman who developed a clinical pictures resembling a septic shock-related multiple organ dysfunction syndrome a couple of months after having been diagnosed suffering from a hemophagocytic lymphohistiocytosis associated with an infectious mononucleosis. Despite the aggressive treatment, which included antibiotics, vasopressors, IV immunoglobulins, and the use of an extracorporeal device aimed to remove mediators released both during sepsis and the cytokine storm determined by the hemophagocytic lymphohistiocytosis, the patient died...
2018: Case Reports in Critical Care
Alessandro Ghiani, Matthias Hansen, Konstantinos Tsitouras, Claus Neurohr
Prolonged pulmonary air leak (PAL) is a common clinical problem, associated with significant morbidity and mortality. There are numerous reports of treatment of PAL using endobronchial valves (EBV) in respiratory stable patients, but only few reports on critically ill patients, and there is virtually no practical knowledge in the treatment of PAL in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), treated with veno-venous extracorporeal membrane oxygenation (vvECMO). We describe a case where EBV placement was performed in a patient with ARDS and PAL, treated with mechanical ventilation and vvECMO...
2018: Case Reports in Critical Care
Marcos Benchimol, Laura Bernardo Madeira, Ricardo de Oliveira-Souza
Deficiency of glucose-6-phosphate dehydrogenase (G6PD) is the commonest enzyme deficiency in humans with a wide range of possible clinical manifestations depending on the specific genetic variant in each case. Here we present the case of an 86-year-old male of African descent who acutely developed symptoms of G6PD deficiency immediately after he received methylene blue for treating methemoglobinemia. The contrast between a low SO2 on pulse oximetry and a normal arterial gas sampling raised the possibility of methemoglobinemia...
2018: Case Reports in Critical Care
Pramod K Guru, Anjali Agarwal, Mario Pimentel, Diane C McLaughlin, Vikas Bansal
Postobstructive pulmonary edema (POPE) also known as negative pressure pulmonary edema (NPPE) is an underdiagnosed entity in clinical practice and can lead to life-threatening hypoxemia. A 64-year-old male patient's perioperative course was complicated by acute hypoxemic respiratory failure, after extubation following general anesthesia, following the excision of the right vocal cord papilloma. His chest X-ray showed features of pulmonary edema, EKG showed dynamic ST-T changes in the lateral leads, and echocardiography showed evidence of regional motion abnormalities...
2018: Case Reports in Critical Care
Aristide Ntahe
Background: Seizures are frequent in ICU and their diagnosis is challenging, often delayed or missed. Their diagnosis requires a conventional EEG recording. When cEEG is not available, there is no consensus on how patients should be monitored when there is high risk of seizure. This case illustrates how a bispectral index monitor allowed an early diagnosis of an NCSE recurrence. Case Presentation: A NCSE was diagnosed at the admission. cEEG was not available and then a bispectral index (BIS) monitor was placed and processed parameters were monitored as usual...
2018: Case Reports in Critical Care
Dominick Roto, Michelle L Malnoske, Shira Winters, Steve N Georas
Background: Influenza B is generally regarded as a less severe counterpart to influenza A, typically causing mild upper respiratory symptoms. Myocardial involvement with influenza B is a rare complication, better described in children than adults. However, when it occurs, it can lead to profound myocarditis with progression to shock requiring aggressive supportive care. Case Presentation: We present a case of cardiac tamponade in the setting of influenza B infection in a previously healthy 57-year-old woman, with progression to refractory shock and death...
2018: Case Reports in Critical Care
Elena Mantovani, Stefano Busani, Emanuela Biagioni, Claudia Venturelli, Lucia Serio, Massimo Girardis
Primary infection by Capnocytophaga canimorsus after dog bite is rare but may be difficult to identify and rapidly lethal. We describe a case of fatal septic shock with fulminant purpura occurred in a patient without specific risk factor two days after an irrelevant dog bite. The patient was brought to hospital because of altered mental status, fever, and abdominal pain. In a few hours patient became hypoxic and cyanotic. The patient became extremely hypotensive with shock refractory to an aggressive fluid resuscitation (40 ml/kg crystalloids)...
2018: Case Reports in Critical Care
Jeremy Bourenne, Raphaëlle Fresco, François Kerbaul, Pierre Michelet, Marc Gainnier
[This corrects the article DOI: 10.1155/2017/3731069.].
2018: Case Reports in Critical Care
Maxime Nguyen, Thomas Bièvre, Abdelouaid Nadji, Bélaïd Bouhemad
We describe here an unusual case of brain death following cardiac arrest. Brain electric activity had totally ceased, allowing the confirmation of brain death, despite normal cerebral blood flow (assessed by both transcranial doppler and tomodensitometry) and no evidence of intracranial hypertension. In our case, a residual electric activity was assessed at admission and lesions worsened on imaging during ICU stay, suggesting that part of the neuronal damage occurred after brain reperfusion. All these elements suggest BD rather by cellular toxicity than intracranial pressure elevation...
2018: Case Reports in Critical Care
Giorgio Berlot, Rossana Bussani, Vennus Shafiei, Nadia Zarrillo
The release of fat and bone marrow fragments is a common occurrence following traumatic and nontraumatic events. In most cases, they go symptomless or cause only minor disturbances, but occasionally they can determine a multiorgan dysfunction whose severity ranges from mild to fatal. The authors describe the case of a patient who became deeply comatose and ultimately died after a traffic accident in which he suffered the exposed right femoral and tibial fracture in the absence of other injuries. He underwent the external fixation of the fractured bones 2 hours after the admission under general anesthesia...
2018: Case Reports in Critical Care
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