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case history in neurology

Kunal Gandhi, Dharmendra Prasad, Vinay Malhotra, Dhananjai Agrawal
Gitelman's syndrome is an autosomal recessive renal tubular disorder characterized by hypomagnesemia, hypokalemia, hypocalciuria, and metabolic alkalosis. Hypocalcemic tetany as a presentation of Gitelman's syndrome has rarely been reported in literature. We report a rare case of Gitelman's syndrome presenting with hypocalcemic tetany along with hypokalemic periodic paralysis. A 17-year-old female was admitted to our hospital with a history of perioral numbness and carpal spasms of five days duration with progressive quadriparesis developing over a period of few hours...
September 2016: Saudi Journal of Kidney Diseases and Transplantation
Prakash Aroor Sarvotham Rao, S N Nagendra Prakash, Somanath Vasudev, M Girish, Arun Srinivas, H P Guru Prasad, P Jayakumar, Venu Gopal Anandaswamy
We present a 62-year-old lady admitted in our hospital with two episodes of acute ischemic stroke about 2 weeks apart. She was evaluated for acute ischemic stroke and was thrombolysed for recent stroke in right MCA territory first time. On further evaluation, she was found to have a RVOT mass. A transthoracic and transesophageal echocardiogram revealed a PFO and a large, 5.1cm×2.3cm, ovoid, well circumscribed, echogenic mass in the right ventricle outflow tract attached by small pedicle to the ventricular side of anterior tricuspid leaflet, partly obstructing the right ventricular outflow tract and protruding through the pulmonic valve during systole...
September 2016: Indian Heart Journal
Panna Sanga, Nathaniel Katz, Elena Polverejan, Steven Wang, Kathleen M Kelly, Juergen Haeussler, John Thipphawong
OBJECTIVE: To evaluate long-term safety and efficacy of fulranumab in patients with moderate-to-severe chronic osteoarthritis (OA) knee or hip pain. METHODS: In this placebo-controlled, phase-2 double-blind (DB) extension study, patients who were equally randomized to 1mgQ4wk, 3mgQ8wk, 3mgQ4wk, 6mgQ8wk, or10mgQ8wk fulranumab (s.c.) or placebo in the 12-week DB efficacy phase, and completed this DB efficacy phase, were eligible to continue the dose throughout a 92-week extension phase followed by a 24-week posttreatment follow-up (PFTU)...
October 16, 2016: Arthritis & Rheumatology
Yi-Chia Su, Chih-Chien Wu
A 54-year-old woman presented at the emergency department after experiencing lower limb weakness and bilateral ankle pain for 2 days. She had a history of type 2 diabetes mellitus, diabetes mellitus nephropathy with chronic kidney disease, and chronic gouty arthritis. She had received 0.6 mg colchicine orally once or twice daily for 8 months. Four days prior to her emergency department visit, she was discharged from our nephrology ward, where she had been admitted because of a urinary tract infection. During hospitalization, she was treated with intravenous cefazolin for 7 days...
December 2015: Drug Saf Case Rep
Joachim Alexandre, Xavier Humbert, Marion Sassier, Paul Milliez, Antoine Coquerel, Sophie Fedrizzi
Cluster headache (CH) is a primary headache disorder with relatively effective treatments. Although few sufficiently controlled trials are available, verapamil is recommended as the first-line prophylactic drug for CH by the French Headache Society (with a low level of evidence, level B) and by the EFNS (European Federation of Neurological Societies, level A). Daily doses of more than 480 mg (and up to 1200 mg daily) are frequently used off-label, while 360 mg daily is the only dosage to have demonstrated its effectiveness in a double-blind trial against placebo, and the usual label posology used by cardiologists is 240 mg daily in hypertension...
December 2015: Drug Saf Case Rep
Michael A Bohl, James Forseth, Peter Nakaji
BACKGROUND: Arginine vasopressin (AVP) is a common second-line or third-line vasopressor used in critically ill neurosurgical patients. Neurosurgical indications include hyperdynamic therapy for vasospasm, maintenance of cerebral perfusion pressure in patients with intracranial hypertension, and prevention of hypotension in patients with sepsis. CASE DESCRIPTION: A series of six neurosurgical patients receiving AVP infusions developed severe but transient diabetes insipidus (tDI) after cessation of AVP...
October 11, 2016: World Neurosurgery
Jennifer Singleton, Jonathan A Edlow
Acute back pain is a common presenting complaint in the emergency department that leads to a great deal of resource utilization. The differential diagnosis is long and most cases are caused by benign pathology that will resolve on its own. Imaging is over-used and rarely helps. This article presents an algorithmic approach using red flags in the history and physical examination that will help physicians better identify the small of patients with serious conditions that, if untreated, will result in significant neurological damage...
November 2016: Emergency Medicine Clinics of North America
Rolfe M Radcliffe, Yasmine Messiaen, Nita L Irby, Thomas J Divers, Curtis W Dewey, Katharyn J Mitchell, Lauren V Schnabel, Abraham J Bezuidenhout, Peter V Scrivani, Norm G Ducharme
OBJECTIVE: To report a transnasal, endoscopically guided ventral surgical approach for accessing the cranial and caudal segments of the sphenopalatine sinus for mass removal in a horse. STUDY DESIGN: Case report. ANIMAL: Adult horse with acute onset blindness referable to a soft tissue mass within the sphenopalatine sinus. CLINICAL REPORT: A 7-year-old Warmblood gelding presented with a history of running into a fence and falling...
October 12, 2016: Veterinary Surgery: VS
Rintaro Yokoyama, Satoshi Iihoshi, Kei Miyata, Kentaro Toyama, Katsuya Komatsu, Masahiko Wanibuchi, Nobuhiro Mikuni
OBJECT: We report a relatively rare case of pediatric iatrogenic extradural vertebral arteriovenous fistula. CASE: A five-year-old boy with a history of multiple surgeries for Total Anomalous Pulmonary Venous Return(TAPVR)exhibited vascular engorgement of his right neck from about 4 years old. We thought that this was caused by his past operations. He demonstrated swollen blood vessels in the right neck and pulmonary hypertension with increased right heart load...
October 2016: No Shinkei Geka. Neurological Surgery
Theodore E Nash, Javier A Bustos, Hector H Garcia
Taenia solium (the pork tapeworm) is present in most developing countries, where it is a frequent cause of seizures and other neurological disease. Parasitic larvae invade the human brain, establish, and eventually resolve, leaving a calcified scar. While these lesions are common in endemic regions, and most of these are clinically silent, a proportion of individuals with calcified cysticerci develop seizures from these lesions, and 30-65% of these cases are associated with perilesional edema (PE), likely due to host inflammation...
October 3, 2016: Trends in Parasitology
K S Rommelfanger
Placebo therapy can produce meaningful, clinical relief for a variety of conditions. While placebos are not without their ethically fraught history, they continue to be used, largely covertly, even today. Because the prognosis for psychogenic disorders is often poor and recovery may be highly dependent on the patient's belief in the diagnosis and treatment regimen, some physicians find placebo therapy for psychogenic disorders compelling, but also particularly contentious. Yet placebos also have a long tradition of being used for provocative diagnosis (wherein placebo is used to elicit and/or terminate the symptoms as a way of diagnosing symptoms as "psychogenic")...
2017: Handbook of Clinical Neurology
P Schwingenschuh, G Deuschl
Functional tremor is the commonest reported functional movement disorder. A confident clinical diagnosis of functional tremor is often possible based on the following "positive" criteria: a sudden tremor onset, unusual disease course, often with fluctuations or remissions, distractibility of the tremor if attention is removed from the affected body part, tremor entrainment, tremor variability, and a coactivation sign. Many patients show excessive exhaustion during examination. Other somatizations may be revealed in the medical history and patients may show additional functional neurologic symptoms and signs...
2017: Handbook of Clinical Neurology
K Roelofs, J Pasman
Conversion disorder (CD) has traditionally been ascribed to psychologic factors such as trauma, stress, or emotional conflict. Although reference to the psychologic origin of CD has been removed from the criteria list in DSM-5, many theories still incorporate CD as originating from adverse events. This chapter provides a critical review of the literature on stressful life events in CD and discusses current cognitive and neurobiologic models linking psychologic stressors with conversion symptomatology. In addition, we propose a neurobiologic stress model integrating those cognitive models with neuroendocrine stress research and propose that stress and stress-induced changes in hypothalamus-pituitary-adrenal (HPA) axis function may result in cognitive alterations, that in turn contribute to experiencing conversion symptoms...
2017: Handbook of Clinical Neurology
Jamie C Fong, Julio C Rojas, Jee Bang, Andrea Legati, Katherine P Rankin, Sven Forner, Zachary A Miller, Anna M Karydas, Giovanni Coppola, Carrie K Grouse, Jeffrey Ralph, Bruce L Miller, Michael D Geschwind
Patients with pathogenic truncating mutations in the prion gene (PRNP) usually present with prolonged disease courses with severe neurofibrillary tangle and cerebral amyloidosis pathology, but more atypical phenotypes also occur, including those with dysautonomia and peripheral neuropathy. We describe the neurological, cognitive, neuroimaging, and electrophysiological features of a 31-year-old man presenting with an orbitofrontal syndrome, gastrointestinal symptoms, and peripheral neuropathy associated with PRNP Q160X nonsense mutation, with symptom onset at age 27...
October 4, 2016: Journal of Alzheimer's Disease: JAD
Rui Fan, Ruirui Ji, Wenxin Zou, Guoliang Wang, Hu Wang, Daniel James Penney, Jin Jun Luo, Yuxin Fan
Andersen-Tawil syndrome (ATS) is an autosomal dominant, multisystem channelopathy characterized by periodic paralysis, ventricular arrhythmias and distinctive dysmorphic facial or skeletal features. The disorder displays marked intrafamilial variability and incomplete penetrance. Myasthenia gravis (MG) is an autoimmune disorder that demonstrates progressive fatigability, in which the nicotinic acetylcholine receptor (AChR) at neuromuscular junctions is the primary autoantigen. The present study reports a rare case of a 31-year-old woman with a history of morbid obesity and periodic weakness, who presented with hemodynamic instability, cardiogenic shock and facial anomalies...
October 2016: Experimental and Therapeutic Medicine
Gregory S Day, David F Tang-Wai, Michel C F Shamy
We review the case of a young man who developed a constellation of symptoms and signs-bizarre behavior, seizures, abnormal movements, and autonomic instability-that evaded diagnosis at the time of presentation. We use this case to explore the way medical knowledge changes over time. Despite the dramatic advances in our understanding of neurological diseases in recent decades, physicians tend to approach diseases and diagnoses as if they were immutable. Our case reinforces how the diagnosis and treatment of disease are determined by an ever-changing historical context driven by the rapid expansion of medical knowledge...
October 2016: Neurohospitalist
K Rammohan, Shyma M Mundayadan, Robert Mathew
CONTEXT: Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2-6 cm in diameter. AIMS: The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature. SETTINGS AND DESIGN: A prospective, observational study conducted in a tertiary care center...
October 2016: Journal of Neurosciences in Rural Practice
F Alby-Laurent, N Honoré-Goldman, A Cavau, N Bellon, S Allali, V Abadie
INTRODUCTION: Exposure to metallic mercury can cause severe accidental intoxications in children, whose clinical symptoms can vary depending on the route of administration, the dose, as well as the time and duration of the exposure. It has become unusual in France, yet it must be considered when taking a patient's medical history in cases of multisystemic involvement without a clear explanation. CLINICAL CASE: We report the case of a 12-year-old patient hospitalized because of a cough, poor general condition, chills, night sweats, psychomotor retardation, and skin lesions that had been developing for several weeks...
September 27, 2016: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Catherine Bowen, Ann Ashburn, Mark Cole, Margaret Donovan-Hall, Malcolm Burnett, Judy Robison, Louis Mamode, Ruth Pickering, Dan Bader, Dorit Kunkel
BACKGROUND: Ill-fitting shoes have been implicated as a risk factor for falls but research to date has focused on people with arthritis, diabetes and the general older population; little is known about people with neurological conditions. This survey for people with stroke and Parkinson's explored people's choice of indoor and outdoor footwear, foot problems and fall history. METHODS: Following ethical approval, 1000 anonymous postal questionnaires were distributed to health professionals, leads of Parkinson's UK groups and stroke clubs in the wider Southampton area, UK...
2016: Journal of Foot and Ankle Research
K A Bartholomew, K E Stover, N J Olby, S A Moore
Fibrocartilaginous embolic myelopathy (FCE) is common in dogs; however, there is conflicting information in the veterinary literature regarding clinical characteristics and data on recovery in severe cases is sparse. A systematic review of canine FCE was performed to delineate the natural history of this disease. 322 previously reported cases and 71 previously unreported cases were identified for inclusion. Source publications were identified via PubMed central search and by references from review articles...
September 28, 2016: Veterinary Record
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