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Case Reports in Critical Care

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https://www.readbyqxmd.com/read/28523195/disseminated-necrotizing-leukoencephalopathy-complicating-septic-shock-in-an-immunocompetent-patient
#1
Pedro Gaspar-da-Costa, Sofia Reimão, Sandra Braz, João Meneses Santos, Rui M M Victorino
Disseminated necrotizing leukoencephalopathy (DNL) is characterized by multiple microscopic foci of white matter necrosis. DNL was initially thought to be exclusively associated with immunosuppression conditions but it has been recently described in immunocompetent patients in septic shock. A 90-year-old immunocompetent woman with no previous neurological impairment presented with septic shock and drowsiness that responded well to therapy with clinical improvement and a full neurological recovery. Unexpectedly deterioration with progression to coma occurred...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28480083/optic-nerve-sheath-diameter-as-a-bedside-assessment-for-elevated-intracranial-pressure
#2
Peter Williams
A previously fit and healthy 26-year-old lady with no significant medical history presented with a two-month history of headaches. The headaches were prolonged, generalised, and unusually severe for the patient. Examination revealed papilloedema. The patient's optic nerve sheath diameter was measured 3 mm posterior to the globe and found to be 7.5 mm. The patient subsequently had computed tomography scan of her brain that showed an optic nerve sheath diameter of 7.56 mm as measured 3 mm posterior to the globe...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28473928/dka-induced-takotsubo-cardiomyopathy-in-patient-with-known-hocm
#3
Ayla Gordon, Gina LaCapra, Roberto Roberti
The first published case of Diabetic Ketoacidosis-induced Takotsubo cardiomyopathy was in 2009. Our patient is the 1st reported case of Diabetic Ketoacidosis- (DKA-) induced Takotsubo cardiomyopathy (TC) in a patient with known hypertrophic cardiomyopathy (HOCM) in the United States. In the literature, there are only two examples linking DKA to TC; however, this report focuses on the biochemical and physiological causes of TC in a patient with known HOCM and new-onset DKA. TC in previously diagnosed HOCM poses particular complications...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28465843/hypercapnea-and-acidemia-despite-hyperventilation-following-endotracheal-intubation-in-a-case-of-unknown-severe-salicylate-poisoning
#4
Shannon M Fernando, Valérie Charbonneau, Hans Rosenberg
Salicylates are common substances for deliberate self-harm. Acute salicylate toxicity is classically associated with an initial respiratory alkalosis, followed by an anion gap metabolic acidosis. The respiratory alkalosis is achieved through hyperventilation, driven by direct stimulation on the respiratory centers in the medulla and considered as a compensatory mechanism to avoid acidemia. However, in later stages of severe salicylate toxicity, patients become increasingly obtunded, with subsequent loss of airway reflexes, and therefore intubation may be necessary...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28458928/iatrogenic-right-sided-pneumothorax-presenting-as-st-segment-elevation-a-rare-case-report-and-review-of-literature
#5
Bashar Alzghoul, Ayoub Innabi, Anusha Shanbhag, Kshitij Chatterjee, Farah Amer, Nikihil Meena
Pneumothorax is a well-recognized complication of central venous line insertion (CVL). Rarely, pneumothorax can lead to electrocardiogram (ECG) findings mimicking ST-segment elevation myocardial infarction. We present a 63-year-old man with iatrogenic right-sided pneumothorax who developed ST-segment elevation on a 12-lead ECG suggestive of myocardial infarction. The ECG findings completely resolved after needle decompression and chest tube placement. This case points up this rare electrocardiographic finding with discussion of possible mechanisms and differential diagnosis...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28409035/the-use-of-coupled-plasma-filtration-adsorption-in-traumatic-rhabdomyolysis
#6
Mario Pezzi, Silvia Renda, Anna Maria Giglio, Anna Maria Scozzafava, Simona Paola Tiburzi, Patrizia Casella, Fabrizio Iannelli, Mario Verre
Severe musculoskeletal injuries induce the release of sarcoplasmic elements such as muscle enzymes, potassium, and myoglobin in the systemic circulation. The circulating myoglobin damages the glomerulus and renal tubules. Conventional haemodialysis is not able to remove myoglobin, due to its high molecular weight (17,8 kilodaltons [kDa]). We treated four traumatic rhabdomyolysis patients with Coupled Plasma Filtration Adsorption (CPFA) in order to remove myoglobin followed by 14 hours of Continuous Veno-Venous Hemofiltration (CVVH)...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28409034/increased-intracranial-pressure-during-hemodialysis-in-a-patient-with-anoxic-brain-injury
#7
Anton Lund, Mette B Damholt, Ditte G Strange, Jesper Kelsen, Hasse Møller-Sørensen, Kirsten Møller
Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strategy. A 13-year-old girl was admitted after prolonged resuscitation from cardiac arrest. Computed tomography (CT) revealed an inferior vena cava aneurysm and multiple pulmonary emboli as the likely cause. An intracranial pressure (ICP) monitor was inserted, and, on day 3, continuous renal replacement therapy (CRRT) was initiated due to acute kidney injury, during which the patient developed severe intracranial hypertension...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28392947/nuclear-imaging-to-detect-diaphragmatic-perforation-as-a-rare-complication-of-microwave-ablation
#8
Stephanie Cull, Gebran Khneizer, Abhishek Krishna, Razi Muzaffar, Sameer Gadani, Zafar Jamkhana
Acquired diaphragmatic perforation leading to massive hepatic hydrothorax and respiratory failure is a rare complication of microwave ablation (MWA) of hepatocellular carcinoma (HCC). Imaging modalities to detect pleuroperitoneal communication remain poorly described. We report a nuclear imaging technique used to efficiently diagnose and locate diaphragmatic defects. A 57-year-old male with cirrhosis and HCC presented with respiratory distress after undergoing MWA of a HCC lesion. He was admitted to the intensive care unit for noninvasive positive pressure ventilator support...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28373916/acute-gastric-volvulus-and-atrial-fibrillation-with-rvr-a-coincidence-or-association
#9
Omar Nadhem, Omar Salh, Faisal Khasawneh
Gastric volvulus is a rare and life-threatening condition that involves the abnormal rotation of the stomach around its axis by more than 180°. The association between acute gastric volvulus and atrial fibrillation with rapid ventricular response is rare with only few cases that have been reported. Our patient was an 86-year-old female who presented with upper abdominal pain, distension, nausea, and shortness of breath. Clinical and laboratory workup revealed acute gastric volvulus with diaphragmatic hernia...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28367339/bronchopleural-fistula-resolution-with-endobronchial-valve-placement-and-liberation-from-mechanical-ventilation-in-acute-respiratory-distress-syndrome-a-case-series
#10
Haris Kalatoudis, Meena Nikhil, Fuad Zeid, Yousef Shweihat
Patients who have acute respiratory distress syndrome (ARDS) with persistent air leaks have worse outcomes. Endobronchial valves (EBV) are frequently deployed after pulmonary resection in noncritically ill patients to reduce and eliminate bronchopleural fistulas (BPFs) with persistent air leak (PAL). Information regarding EBV placement in mechanically ventilated patients with ARDS and high volume persistent air leaks is rare and limited to case reports. We describe three cases where EBV placement facilitated endotracheal extubation in patients with severe respiratory failure on prolonged mechanical ventilation with BPFs...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28348899/abnormal-breathing-patterns-predict-extubation-failure-in-neurocritically-ill-patients
#11
Pragya Punj, Premkumar Nattanmai, Pravin George, Christopher R Newey
In neurologically injured patients, predictors for extubation success are not well defined. Abnormal breathing patterns may result from the underlying neurological injury. We present three patients with abnormal breathing patterns highlighting failure of successful extubation as a result of these neurologically driven breathing patterns. Recognizing abnormal breathing patterns may be predictive of extubation failure and thus need to be considered as part of extubation readiness.
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28337348/effective-and-safe-use-of-glucocorticosteroids-for-rescue-of-late-ards
#12
Paolo Diana, Dustin T Money, Michael G Gelvin, Nadia Lunardi
We describe a case of severe refractory hypoxemia requiring prolonged extra corporeal membrane oxygenation (ECMO) support in a case of postpartum acute respiratory distress syndrome (ARDS). The clinical course was marked by persistently poor lung compliance and several complications of ECMO, that is, significant hemolysis, hemothorax, and intracranial bleeding. We report marked improvement of lung mechanics and respiratory function, leading to accelerated separation from ECMO, following rescue administration of low dose methylprednisolone 24 days after the onset of ARDS...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28326202/venovenous-extracorporeal-membrane-oxygenation-as-a-treatment-for-obesity-hypoventilation-syndrome
#13
Nao Umei, Shingo Ichiba
The mortality rate for respiratory failure resulting from obesity hypoventilation syndrome is high if it requires ventilator management. We describe a case of severe acute respiratory failure resulting from obesity hypoventilation syndrome (BMI, 60.2 kg/m(2)) successfully treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). During ECMO management, a mucus plug was removed by bronchoscopy daily and 18 L of water was removed using diuretics, resulting in weight loss of 24 kg. The patient was weaned from ECMO on day 5, extubated on day 16, and discharged on day 21...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28316845/spinal-cord-infarction-in-the-course-of-a-septic-shock-about-one-case-and-review-of-the-literature
#14
P Henin, A Molderez, V Huberlant, H Trine
We report the case of a patient admitted to our intensive care unit in the course of a septic shock, secondary to cholangitis. After rapid hemodynamic stabilization, antibiotherapy, and endoscopic extraction of bile ducts stones, she appeared to have developed flaccid paraplegia. The suspected diagnosis of medullar ischemia was confirmed by typical MRI findings. This case stresses the potential pathogenic role of hypotension in medullar ischemia and the place of magnetic resonance imaging (MRI) as a reliable diagnostic tool...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28299209/primitive-tumour-of-the-pulmonary-valve-discussion-of-the-differential-diagnosis
#15
A Hannecart, D Ndjekembo-Shango, F Vallot, O Simonet, M De Kock
There is a paucity of information concerning cardiac tumours of the pulmonary valve due to their rarity at this location. We report a case of a 47-year-old patient suffering from haemoptysis, asthenia, and acute kidney injury (AKI). A transthoracic echocardiography (TTE) revealed a mass on the pulmonary valve. Further diagnostic investigation was completed until he exhibited worsening hemodynamic instability. This case emphasizes the lack of information regarding the management of a pulmonary valve tumour.
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28250995/malignant-catatonia-warrants-early-psychiatric-critical-care-collaborative-management-two-cases-and-literature-review
#16
Julia Park, Josh Tan, Sylvia Krzeminski, Maryam Hazeghazam, Meghana Bandlamuri, Richard W Carlson
Malignant catatonia (MC) is a life-threatening manifestation which can occur in the setting of an underlying neuropsychiatric syndrome or general medical illness and shares clinical and pathophysiological features and medical comorbidities with the Neuroleptic Malignant Syndrome (NMS). The subsequent diagnosis and definitive therapy of MC are typically delayed, which increases morbidity and mortality. We present two cases of MC and review recent literature of MC and NMS, illustrating factors which delay diagnosis and management...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28210509/recurrence-of-postoperative-stress-induced-cardiomyopathy-resulting-from-status-epilepticus
#17
Grant A Miller, Yousef M Ahmed, Nicki S Tarant
Introduction. Classically, stress-induced cardiomyopathy (SIC), also known as takotsubo cardiomyopathy, displays the pathognomonic feature of reversible left ventricular apical ballooning without coronary artery stenosis following stressful event(s). Temporary reduction in ejection fraction (EF) resolves spontaneously. Variants of SIC exhibiting mid-ventricular regional wall motion abnormalities have been identified. Recent case series present SIC as a finding in association with sudden unexplained death in epilepsy (SUDEP)...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28163937/a-narrowing-diagnosis-a-rare-cause-of-adult-croup-and-literature-review
#18
Jayshil J Patel, Emily Kitchin, Kurt Pfeifer
Croup or laryngotracheitis is rare in adults. We present a case of an otherwise healthy young woman that presented in the winter with 3 days of increasing dyspnea, cough, and fever. She was hemodynamically stable but was found to have a barking cough, paradoxical abdominal breathing, and stridor. Chest radiograph revealed subglottic narrowing. Respiratory viral nucleic acid amplification testing was positive for respiratory syncytial virus. The patient was treated with nebulized epinephrine, dexamethasone, and a helium-oxygen mixture...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28127473/hemadsorption-with-adult-cytosorb%C3%A2-in-a-low-weight-pediatric-case
#19
Catalin Gabriel Cirstoveanu, Ileana Barascu, Samantha Mc Kenzie Stancu
Cytokine adsorber (CytoSorb) has been used successfully as adjunctive treatment for adult patients with elevated cytokine levels in the setting with severe sepsis and septic shock and to reduce blood myoglobin, unconjugated bilirubin, and conjugated bilirubin. In this article we present the case of a nine-month-old male infant who was admitted to the NICU due to sepsis after cardiac surgery, Fallot tetralogy, and multisystem organ failure (MSOF) including liver failure and renal failure which was successfully treated by a combination of continuous hemodiafiltration (HDF) and hemadsorption with CytoSorb...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28050289/beriberi-induced-cardiomyopathy-requiring-salvage-venoarterial-extracorporeal-membrane-oxygenation
#20
Aditya Shah, Samir Patel, Sorabh Kothari, Jennifer Denk
Beriberi refers to a constellation of symptoms caused primarily by thiamine (vitamin B1) deficiency. An acute and fulminant presentation of this rare condition has been described in the literature as "Shoshin" beriberi which is characterized by catastrophic cardiovascular collapse. Early recognition and treatment lead to dramatic improvements of symptoms. We present a case of thiamine deficiency-induced acute heart failure in a malnourished patient leading to cardiac arrest necessitating VA-ECMO (venoarterial extracorporeal membrane oxygenation) with improvement in heart function secondary to thiamine administration...
2016: Case Reports in Critical Care
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