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Coma Or Disorientation Or Altered Sensorium

Dan-Hua Mao, Jing-Kun Miao, Xian Zou, Na Chen, Lin-Chao Yu, Xin Lai, Meng-Yuan Qiao, Qi-Xiong Chen
Background: Neonatal bacterial meningitis is a severe infection with high mortality and morbidity. It is necessary to identify factors associated with a high risk of a poor prognosis so that we can prevent them with more appropriate treatments. This study was performed to summarize the prognostic factors known to predict adverse outcomes in neonatal bacterial meningitis. Methods: The Medline/PubMed, Cochrane Library and Embase databases were searched for studies of prognostic risk factors in neonates with bacterial meningitis...
2018: Frontiers in Neurology
Kanchana S Pillai, Trupti H Trivede, Nivedita D Mozlick
Background: :Hyponatremia is defined as serum sodium level <135 meq/L. It is the most common electrolyte abnormality seen in hospital admissions worldwide. The proportion is even higher in the ICU setting. A wide variety of factors influence the outcome of the hyponatremic patient. Present study is designed to approach to analyse etiology, clinical features, co-morbid factors, severity of hyponatremia, rate of correction, and impact of treatment on outcome of these diverse group of patients in ICU...
May 2018: Journal of the Association of Physicians of India
Ritesh Kumar, Surinder Thakur, Rajesh Bhawani, Anil Kanga, Asha Ranjan
Background: Scrub typhus is a re-emerging zoonotic rickettsial infection. Mortality is approximately 15% in some areas due to missed or delayed diagnosis. There had been only few studies on the markers for the severity of the disease, so this study has been planned to provide the knowledge regarding various aspects of scrub typhus in adult age group to detect early signs of severity . Methods: All the patients more than 18 years of age admitted with febrile illness with positive IgM ELISA for scrub typhus with or without eschar were included in the study...
May 2018: Journal of the Association of Physicians of India
Sushil Khanal, Subhash Prasad Acharya
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a reversible clinical and neurological entity. There are varieties of comorbid conditions which are associated with PRES. Chronic obstructive pulmonary disease (COPD) is a rare predisposing factor for the development of PRES. CASE PRESENTATION: A 55 year old female who was being treated for acute exacerbation of COPD developed altered sensorium and multiple episodes of seizure. Characteristic imaging findings and associated clinical symptoms led us to a diagnosis of PRES in our patient...
October 31, 2018: BMC Neurology
Anitha Swamy, Ratnakar Gogineni, Animesh Ray, Milind Jha, Smita Manchanda, Sudheer Arava, Rakesh Kumar, Kiran Kumar Dvs, Harsh Sahu, Piyush Ranjan, Ranveer S Jadon, Naval K Vikram, Rita Sood
A 56 year old lady, presented to our institute with six months history of low grade fever, generalized weakness, decreased food intake and fluctuating sensorium. Initial investigations revealed hypercalcemia, renal dysfunction and anemia. Initial working diagnosis of likely underlying hematological malignancy such as lymphoma or multiple myeloma (MM) was kept after hyperparathyroidism was ruled out. Her skeletal survey revealed lytic lesions in the skull, bone marrow aspirate showed 12% plasma cells and beta-two microglobulin level was markedly elevated...
January 2018: Journal of the Association of Physicians of India
Edward C Kuan, Karam W Badran, Frederick Yoo, Naveen D Bhandarkar, Yarah M Haidar, Tjoson Tjoa, William B Armstrong, James N Palmer, Nithin D Adappa, Marilene B Wang, Maie A St John
OBJECTIVES/HYPOTHESIS: To describe rates of complications and mortality within 30 days of open anterior skull base surgery using a large, multi-institutional outcomes database. STUDY DESIGN: Retrospective cohort study. METHODS: The study included patients who underwent open anterior skull base surgery as listed in the American College of Surgeons National Surgical Quality Improvement Project database from 2007 through 2014. RESULTS: A total of 336 open anterior skull base surgeries were identified...
October 16, 2018: Laryngoscope
Farah Gul Khan, Syed Muhammad Zubair
BACKGROUND: Transformer oil is used in oil-filled transformers for its insulating as well as coolant properties. Transformer oil ingestion for attempted suicide is seldom heard of. Our patient's case presented us with a major diagnostic as well as treatment challenge because we encountered such a case for the first time and were totally unaware of the fact that methanol might make up the main component of an aged transformer oil. CASE PRESENTATION: A 19-year-old Pakistani/Asian man was brought to our hospital with altered sensorium...
October 10, 2018: Journal of Medical Case Reports
Manasvini Bhatt, Neha Rastogi, Manish Soneja, Ashutosh Biswas
Leptospirosis is a zoonotic disease commonly affecting the tropical countries. It may have protean clinical manifestations including hepatorenal dysfunction, myocarditis, pulmonary haemorrhage, meningitis, optic neuritis and rhabdomyolysis. Neurological manifestation of leptospirosis without the classical hepatorenal dysfunction is a rare entity. This complication of leptospirosis can present with diverse central and peripheral neurological presentations. The overlapping clinical manifestations with many common tropical pathogens often pose diagnostic dilemma and delay in definitive therapy may lead to adverse clinical consequences...
October 7, 2018: BMJ Case Reports
Asif Ali Hitawala, Piyush Garg, Abhay Jain, Ashish Nahar
We discuss a case of a 20-year-old female who presented with history of fever, vomiting, and decreased oral intake for 10 days followed by one episode of generalized tonic-clonic seizure and altered sensorium for 5-6 h. On arrival in the emergency room, she had Glasgow Coma Scale 3 (E1V1M1), both pupils fixed and dilated, low blood pressure, low oxygen saturation, and few gasping breaths. She appeared to be brain dead and was assumed to have a very poor prognosis. Investigations revealed severe hypokalemia...
September 2018: Indian Journal of Critical Care Medicine
Joe M Das, Mathew Abraham, Bevinahalli N Nandeesh, Suresh N Nair
Atypical teratoid rhabdoid tumor (ATRT) is a rare, highly malignant tumor of the central nervous system, commonly affecting children below 3 years of age, with around 300 cases reported in the literature. Suprasellar area is a very rare location for such tumor in the pediatric population, with technical difficulties in complete excision. Third ventricular ATRT is very rare. Here, we report the case of a 2-year-old male child who presented with lethargy and vomiting. He had features of raised intracranial pressure with reduced vision in both eyes...
July 2018: Asian Journal of Neurosurgery
Keerthana K Kumar, Premkumar Nattanamai
Cerebral fat embolism syndrome is a rare, but potentially lethal, complication that may arise from long bone fractures and/or orthopaedic surgery. Neurological symptoms are variable, and clinical diagnosis is difficult. We report the case of a 75-year-old woman who developed cerebral fat embolism four days after a right hip arthroplasty. Maintenance of intracranial pressure monitoring (ICP) within normal limits and cerebral tissue oxygenation monitoring (PbtO2) over 20 mmHg prevented secondary brain injury and resulted in a gradual improvement of the patient's sensorium...
July 26, 2018: Curēus
Kalaivani Jayaraman, Rajeswaran Rangasami, Anupama Chandrasekharan
Viral encephalitis by definition is the result of human virus affecting the brain and sparing the meninges. The other nervous system manifestations are meningitis, meningoencephalitis, encephalomyelitis, and encephalomyeloradiculitis. Encephalitis can involve any age group from children to old people. The severity of the disease depends on the viral agent and the host immune system. The patient can present with fever, headache, seizure, neurological deficit, or altered sensorium. Laboratory investigations, imaging, and cerebrospinal fluid analysis are crucial in the diagnosis of encephalitis...
October 2018: Journal of Neurosciences in Rural Practice
Shahram Izadyar, Vishal Shah, Brandon James
BACKGROUND: The available information on postictal semiology and behavior in patients with psychogenic nonepileptic seizure (PNES) is limited. In this study, we explore the differences in postictal semiology and behavior between patients with epileptic seizure (ES) and PNES and focus on clinical features that may be helpful in differentiating these two conditions. METHODS: In this retrospective study, video-electroencephalograph (video-EEG) of 144 seizures from 64 patients with PNES and 66 seizures from 42 patients with ES were reviewed...
November 2018: Epilepsy & Behavior: E&B
Nishanth Dev
Vector-borne diseases cause a significant burden on healthcare facilities. An increasing number of cases reported with multiple co-infections only add to the ordeal. The presence of co-infection may modify clinical and laboratory parameters significantly making diagnosis and treatment a challenge. Cases of malaria and dengue with other infections such as chikungunya, leptospirosis and hepatitis have been reported previously. We report a case of acute febrile illness with altered sensorium which was eventually diagnosed to have quadruple infection with malaria, dengue, chikungunya and Japanese encephalitis...
September 27, 2018: Tropical Doctor
Gourav Goyal, Abhishek Charan, Rambir Singh
Introduction: Cerebral venous sinus thrombosis (CVST) is an unusual cause of stroke with potentially serious consequences. This study was designed to investigate the clinical and neuroimaging features in patients with CVST and to analyze the predictors of brain parenchymal lesions. Materials and Methods: A retrospective study of 181 patients with CVST was conducted in a tertiary care hospital. Results: Of 181 patients (age range 14-96 years, mean age: 34...
July 2018: Annals of Indian Academy of Neurology
Nitin Gupta, Ankit Mittal, Sharada V Kutty, Arvind Kumar, Naveet Wig
Context: There is a huge burden of patients with acute febrile illness (AFI) during the post-monsoon season in India. It is very important to have a functioning triage system, whereby patients with high likelihood of developing a severe illness are referred to higher levels of care. Aim: The objective of this study was to identify the alarm signs which would help in triaging of those patients with AFI without any specific diagnosis. Methods: This was a retrospective review of records, whereby clinical and laboratory parameters of patients with AFI admitted in our tertiary care center between July 2016 and October 2016 were reviewed...
July 2018: Journal of Family Medicine and Primary Care
Chloe Orkin, Kathleen E Squires, Jean-Michel Molina, Paul E Sax, Wing-Wai Wong, Otto Sussmann, Richard Kaplan, Lisa Lupinacci, Anthony Rodgers, Xia Xu, Gina Lin, Sushma Kumar, Peter Sklar, Bach-Yen Nguyen, George J Hanna, Carey Hwang, Elizabeth A Martin
Background: Doravirine (DOR), a novel non-nucleoside reverse-transcriptase inhibitor (NNRTI), is active against wild-type Human Immunodeficiency Virus (HIV)-1 and the most common NNRTI-resistant variants, and has a favorable and unique in vitro resistance profile. Methods: DRIVE-AHEAD is a phase 3, double-blind, non-inferiority trial. Antiretroviral treatment-naive adults with ≥1000 HIV-1 RNA copies/mL were randomized (1:1) to once-daily, fixed-dose DOR at 100 mg, lamivudine at 300 mg, and tenofovir disoproxil fumarate (TDF) at 300 mg (DOR/3TC/TDF) or to efavirenz at 600 mg, emtricitabine at 200 mg, and TDF at 300 mg (EFV/FTC/TDF) for 96 weeks...
August 31, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Luis Cartier R, Cristian Romero O, Gerardo Pérez P
Upgaze or sustained elevation of the eyes, is an alteration of ocular motility initially described in hypoxic coma. We report a 65-year-old woman admitted with hypotension and alteration of sensorium due to the ingestion of 9.5 g of Bupropion. She presented two seizures of short duration, without epileptic activity on the EEG. She had a persistent asynchronous myoclonus in extremities, tachycardia and prolonged Q-t. She suffered a cardiac arrest caused by asystole, which recovered quickly in five minutes. At that moment, upgaze appeared, associated with a persistent ocular opening, which persisted for days, but finally disappeared, without remission of coma...
May 2018: Revista Médica de Chile
Somnath S Kumar, K P Selvarajan Chettiar, Rakul Nambiar
BACKGROUND: Several studies have been published in the western literature on the incidence, clinical course and outcome of patients with ARDS. However, there is limited data about ARDS in the tropics and moreover, the etiology and outcomes of ARDS in tropical countries are different from those of western nations. In tropical countries like India, resources are limited and costs of therapy play a major role in deciding treatment options. This prospective observational study was designed to analyze the clinical profile, outcomes and predictors of mortality of patients with ARDS in an urban tropical setting...
August 2018: Journal of the National Medical Association
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
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