RESUMEN
In this study, we describe an unusual occurrence of spinal cord infarct associated with acute usage of crack cocaine. A 64-year-old male patient was brought to the hospital after being found down, displaying weakness in his lower extremities and positive for cocaine use on a urine toxicology test. The patient was administered intravenous fluids and evaluated for syncope and rhabdomyolysis. Upon initial medical assessment, the patient exhibited sensation loss up to the level of the mid-thigh, paraplegia, urinary retention, and decreased rectal sphincter tone. Neurological examination and neurological imaging were suggestive of acute spinal cord infarct.
RESUMEN
Infection with West Nile virus (WNV) is often characterized by a mild febrile illness, but it can progress to meningitis, encephalitis, flaccid paralysis, and respiratory failure. The neuro-ophthalmological manifestations of this disease are uncommonly discussed. This case describes a 49-year-old undomiciled male who developed WNV flaccid paralysis with ophthalmoplegia. His symptoms began with difficulty in walking and progressed over several days to flaccid paralysis and ophthalmoplegia. Cerebrospinal fluid was positive for WNV immunoglobulin M antibodies and electromyography demonstrated acute denervation in several muscle groups. This is an unusual case of neuro-invasive WNV presenting with flaccid paralysis and ophthalmoplegia.
RESUMEN
The artery of Percheron (AOP) is a variant of the posterior cerebral circulation where a single branch of either posterior cerebral artery supplies both paramedian territories of the thalami. A stroke of the AOP has become a neurodiagnostic conundrum due to its relative rarity and vague symptoms, and, hence, a missed opportunity for recanalization treatment. The classical presentation of AOP stroke is the triad of altered mental status, vertical gaze palsy, and memory impairment. Here, we describe a retrospective case review of a 59-year-old male presenting with confusion and slurred speech with subsequent symptoms such as blepharospasm and bradyphrenia. The initial computed tomography of the head failed to recognize the bilateral thalamic infarct which was established on day three on brain magnetic resonance imaging. Because the patient was out of the therapeutic window for thrombolysis, dual antiplatelet therapy was started. The patient made a rapid recovery to near-baseline function and was discharged to rehab services. This case is unique with the clinical presentation of both blepharospasm and bradyphrenia being rarely found in the literature. The shared insult to the basal ganglia-thalamocortical circuits may have caused both symptoms. Physician awareness of these subtle findings can increase awareness, earlier diagnosis, and treatment of bilateral thalamic lesions and AOP strokes.
RESUMEN
Hepatic dysfunction in the setting of infectious mononucleosis has been documented in the literature. However, clinically significant jaundice and direct hyperbilirubinemia are rarely associated with this infection. In the instance of undetermined underlying diagnosis and hepatic enzyme derangement, this may pose a diagnostic challenge. Furthermore, several diagnostic tests may be indicated, which could potentially increase resource consumption in any hospital setting. This case report aims to remind physicians that infectious mononucleosis may be a cause of hyperbilirubinemia, which does not usually require further complex testing other than monitoring and supportive therapy.
