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Coma Or Disorientation Or Altered Sensorium

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...
September 26, 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
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 participant 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 considered suggestive of thrombosis...
August 1, 2018: Magnetic Resonance Imaging
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