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altered sensorium

Vinoth K Sethuraman, Stalin Viswanathan, Rajeswari Aghoram
An empty sella is reported to occur in 5.5%-23.5% of the population and is usually asymptomatic. It can be associated with endocrine disturbances. We report a 48-year-old woman who presented with refractory hypoglycemia, seizures, and shock that improved with levothyroxine, hydrocortisone, and octreotide. Investigations revealed central hypothyroidism, hypoprolactinemia, low gonadotropins, normal C-peptide and a primary empty sella. Case reports of Sheehan syndrome with or without empty sella causing hypoglycemia have been reported occasionally...
June 13, 2018: Curēus
Vinod Kumar, Sushant M Nanavati, Gabriel Melki, Mira Upadhyaya, Raman Dhillon, Sandra Gibiezaite, Patrick Michael, Monisha Singhal
Diabetic Ketoacidosis commonly presents with hyponatremia, but hypernatremia is a rare entity. We report a unique case of a 50-year-old woman admitted with altered sensorium with blood glucose 979 milligrams/deciliter, serum osmolarity 363 mOsm/kilograms, and serum sodium 144 milliequivalents/liter. Patient was given initial bolus of isotonic saline and continued on half isotonic saline for correction of hypernatremia along with insulin infusion therapy. Patient was successfully treated with intravenous fluids, insulin infusion, and the altered sensorium was resolved without any sequelae...
2018: Case Reports in Endocrinology
Sumera Akram, Muhammad Ahmed Khan, Abdul Rehman
Allgrove syndrome is a rare autosomal recessive syndrome of unknown prevalence. The first case of Allgrove syndrome was reported in 1978 by Allgrove. It is characterized by triad of achalasia, alacrima and adrenal hypoplasia. There are also associated autonomic and neurological manifestations. We report the case of a 7 years old boy being treated for achalasia cardia, presented with fits and altered sensorium which on further investigations was found to be due to adrenal insensitivity (Raised ACTH level, low Cortisol level, and normal Aldosterone and Renin ratio)...
August 2018: JPMA. the Journal of the Pakistan Medical Association
Devashish Desai, Kartik Gupta, Rohit Kumar, Ashutosh Biswas
A 53-year-old woman, known case of diabetes mellitus and rheumatoid arthritis, presented with a 4-day history of hyperthermia, rigidity, tremor and altered sensorium. She developed these symptoms after having been administered parenteral levosulpiride to control vomiting due to secondary adrenal insufficiency. We managed her as a case of life-threatening neuroleptic malignant syndrome (NMS) requiring mechanical ventilation, bromocriptine and other supportive care. She subsequently recovered and was discharged in a stable condition...
August 11, 2018: BMJ Case Reports
Smriti Panda, Manoj Phalak, Alok Thakar, Sundara Krishnan
BACKGROUND: Non-steroidal androgen receptor blocker like flutamide has been described as an adjuvant treatment for preoperative shrinkage of extensive juvenile nasopharyngeal angiofibroma (JNA).We present a case of CSF (cerebrospinal fluid) leak due to flutamide induced tumour shrinkage. CASE REPORT: A 15- year- old male with a prior diagnosis of JNA stage IIIB on preoperative flutamide for 3.5 weeks presented with altered sensorium, meningeal signs and clear watery nasal discharge consistent with CSF leak...
August 9, 2018: World Neurosurgery
Chamara Dalugama, Indika Bandara Gawarammana
BACKGROUND: Dengue is a common arboviral infection with a diverse spectrum of clinical manifestations. Dengue hemorrhagic fever is a more severe form of infection characterized by plasma leak and hemoconcentration. Although hepatic dysfunction is common in dengue illness, massive liver necrosis is rarely reported. Lactic acidosis is a poor prognostic marker in liver failure related to dengue. Management of acute renal injury in dengue hemorrhagic fever due to prolonged shock is challenging as the fluid reabsorption during the recovery phase expands the intravascular volume and precipitates heart failure and pulmonary edema...
August 8, 2018: Journal of Medical Case Reports
Amrit Bansod, Ravindra Kumar Garg, Imran Rizvi, Hardeep Singh Malhotra, Neeraj Kumar, Amita Jain, Rajesh Verma, Neera Kohli, Praveen Kumar Sharma, Ravi Uniyal, Shweta Pandey
BACKGROUND: This study evaluated the prevalence and predictors of venographic abnormalities in tuberculous meningitis. MATERIAL AND METHODS: Consecutive patients of tuberculous meningitis were included in the study. Clinical evaluation, cerebrospinal fluid examination and contrast-enhanced MRI of brain were done. Every subject was subjected to time of flight magnetic resonance venography (MRV). Presence of filling defects at superior sagittal sinus, dominant transverse or sigmoid sinus, and non-visualization of deep venous system was suggestive of thrombosis...
August 1, 2018: Magnetic Resonance Imaging
Firas Ido, Reina Badran, Brandon Dmytruk, Zain Kulairi
A stroke is a clinical syndrome characterized by a focal neurologic deficit that can be attributed to a vascular territory within the brain. The presenting features of an acute stroke depends on the area of the brain affected. Although unusual, the presenting feature may include psychosis with auditory and/or visual hallucinations. A 56-year-old female was admitted to the psychiatric unit after threatening her husband with a knife. She reported experiencing altered sensorium for one week with suicidal and homicidal command hallucinations...
2018: Case Reports in Neurological Medicine
Se Hyun Oh, Hui Dong Kang, Sang Ku Jung, Sangchun Choi
Cerebral arterial gas embolism (CAGE) shows various manifestations according to the quantity of gas and the brain areas affected. The symptoms range from minor motor weakness, headache, and confusion to disorientation, convulsions, hemiparesis, unconsciousness, and coma. A 46-year-old man was transferred to our emergency department due to altered sensorium. Immediately after a controlled ascent from 33 m of seawater, he complained of shortness of breath and rigid extremities, lapsing into unconsciousness...
July 17, 2018: Therapeutic Hypothermia and Temperature Management
Viswas Chhapola, Sandeep Kumar Kanwal, Ankita Goel Sharma, Virendra Kumar
Cassia occidentalis is an annual tropical shrub causing toxicity in cattle. However, human case reports of its poisoning are scarce. We, here, report three young children, residents of Western Uttar Pradesh in North India, who presented with lethargy, jaundice, and altered sensorium after consumption of Cassia seeds. The toxidrome was defined as hepatomyoencephalopathy. The children were resuscitated, managed for acute liver failure, and subsequently discharged without sequel. Although few studies have previously documented this association, this is the first such case series documenting a direct causal relationship of Cassia to hepatomyoencephalopathy syndrome...
June 2018: Indian Journal of Critical Care Medicine
Kavin M Patel, Jennie Johnson, Ioannis M Zacharioudakis, Jerrold L Boxerman, Timothy P Flanigan, Rebecca M Reece
The Powassan Virus is the arthropod-borne vector responsible for Powassan neuroinvasive disease. The virus was first isolated in 1958 and has been responsible for approximately 100 cases of neuroinvasive disease. Rates of infection have been on the rise over the past decade with numerous states reporting their first confirmed case; New Jersey, New Hampshire and Connecticut all reported their first case within the last five years. We present here the first confirmed case of Powassan neuroinvasive disease in the nearby state of Rhode Island...
2018: IDCases
Modak Meera, Thakar Vrushali, Tanaya, Lahiri Krunal
Cystic hydatidosis caused by Echinococcus granulosus is a rare disease which mainly involves the liver and lungs. In 1%-2% cases, it may affect the brain. Primary multiple hydatid cysts of the brain are very rare. A 14-year-old girl presented with a history of headache and altered sensorium. Computed tomography scan and magnetic resonance imaging showed multicystic intraventricular lesions and patient was operated by neurosurgeon. Multiple cysts were removed. Antihelminthic medication was started, and patient was discharged with full recovery of neurological function...
January 2018: Tropical Parasitology
Sarah S Premraj, K Mayilananthi, Durga Krishnan, K Padmanabhan, D Rajasekaran
Background & objectives: Scrub typhus is as an emerging infectious disease that generally causes acute febrile illness, with disease spectrum ranging from mild illness to multiorgan dysfunction. This study was aimed to report the clinical profile, complications and risk factors associated with severe illness in patients with scrub typhus, outside the intensive care setting. Methods: It was a prospective study, which involved recruitment of patients with acute febrile illness and diagnosed to have scrub typhus, who were admitted to the general medical wards of a tertiary care centre in Kanchipuram district, in semi-urban south India, over a 12 month period between June 2015 and May 2016...
January 2018: Journal of Vector Borne Diseases
Gaurav Baheti, Varshil Mehta, Menka Ramchandani, Gopal Chandra Ghosh
The clinical profile and presentation of patients with dengue fever may differ from asymptomatic infection to the dreadful complications like dengue shock syndrome. However, neurological complications are very rare. Dengue encephalitis occurs by a direct involvement of central nervous system by the dengue virus which is an extremely rare complication. A 33-year-old man presented with fever, vomiting and severe headache. He had one episode of generalised tonic-clonic seizure followed by an altered sensorium on the day of admission to the hospital...
June 15, 2018: BMJ Case Reports
Banshi Lal Kumawat, Chandra Mohan Sharma, Pankaj Kumar Saini, Ankur Garg
Chronic Myeloid Leukaemia (CML) presenting with isolated Central Nervous System (CNS) blast crisis is an uncommon entity. A 22-year-old man, diagnosed with chronic phase CML in 2011 and was in haematological and cytogenetic remission until July 2016, had acute onset headache and vomiting with meningeal signs and was admitted elsewhere, investigated by brain imaging and cerebrospinal fluid (CSF) analysis and suspected to have tubercular meningitis, for which steroids and antitubercular medications were started...
June 12, 2018: BMJ Case Reports
M S Joshi, B V Tandale, M M Gore, S Bhalla, Y K Gurav, G N Sapkal, K P Kushwaha, A C Mishra, S D Chitambar
The etiological agent remained unidentified in a large number of patients hospitalized for acute encephalitis syndrome (AES) in 2008-2009 in Uttar Pradesh and Bihar, north India. All patients were found to present with fever and altered sensorium, while 28%, 19% and 13% showed hepatomegaly, splenomegaly and meningeal signs, respectively. Involvement mostly of children with abnormal hepatic features prompted us to undertake an exploratory study on viral hepatitis A to determine its association, if any, with hepatic derangements...
2018: Acta Virologica
Kalimullah Jan
A 61-year-old gentleman, with a long-standing history of alcohol abuse presented with altered sensorium and unsteady gait for 2 weeks. A diagnosis of Wernicke encephalopathy (WE) was considered. The magnetic resonance imaging brain showed features consistent with the WE, thus supporting the diagnosis. He was treated with parenteral thiamine with good outcome.
May 2018: Oxford Medical Case Reports
Benjamin Thomas, Edward Durant, Sophie Barbant, Arun Nagdev
We report a case of a 52-year-old man who presented to the emergency department (ED) in extremis (hypotensive with an altered sensorium) with subsequent cardiac arrest after a motor vehicle collision. The initial trauma evaluation did not reveal a source of the hemodynamic compromise. A point-of-care ultrasound revealed severe mitral regurgitation secondary to an anterolateral papillary muscle rupture. Patient underwent successful emergent mitral valve replacement after initial resuscitative efforts and intraaortic balloon pump placement...
August 2017: Clinical practice and cases in emergency medicine
Akella Radha Rama Devi, Shaik Mohammad Naushad
Here, we report SLC25A13 c.1610_1612delinsAT mutation from India in a 13-year old boy who presented with recurrent episodes of delirium and hyperammonemia. This is the second case with this mutation; the first case was of Pakistani origin. The boy responded to diet modification, sodium benzoate and arginine supplementation. Furthermore, we have aimed to establish genotype-phenotype correlation of 79 cases of citrin deficiency (46 males and 33 females) reported in 24 studies from all over the world. Inverse association was observed between age of onset and jaundice (r = -0...
August 20, 2018: Gene
Rikesh Baral, Binit Vaidya
Primary amoebic meningoencephalitis (PAM) is a rare, fulminating, hemorrhagic infection of the brain caused by Naegleria fowleri , a thermophilic, free-living amoeba. A 74-year male presented with sudden severe global headache and fever with features of anomic aphasia. Magnetic resonance imaging (MRI) suggested herpes encephalitis and acyclovir (IV) was started but the patient developed altered sensorium, agitation and progressive weakness of lower limbs with gradual truncal weakness. Repeat MRI showed increase in lesion size and edema with confluent blood areas...
May 2018: Oxford Medical Case Reports
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