Unraveling Nonketotic Hyperglycemia Hemichorea-Hemiballismus Syndrome: A Case Report of Diagnosis and Management.

Nonketotic hyperglycemia hemichorea-hemiballismus syndrome (NHH) is an uncommon neurological condition linked to poorly managed diabetes mellitus (DM). It presents with spontaneous, erratic movements that impact just one side of the body. Our case of NHH was of a 76-year-old female with uncontrolled type 2 DM, ischemic heart disease, and dilated cardiomyopathy. Despite previous treatment for similar symptoms, the patient developed left-sided choreo-ballistic movements. Despite difficulties obtaining clear magnetic resonance imaging (MRI) due to involuntary movements, the image revealed T1 hyperintense signals in the right lentiform nucleus and subtle signals in the left lentiform nucleus and external capsule. Management included insulin, tetrabenazine, haloperidol, lorazepam, and other adjunctive therapies, resulting in symptom resolution by the fourth day. This case underscores the importance of considering NHH in patients with uncontrolled DM presenting with abnormal movements, highlighting the challenges in imaging due to involuntary movements and emphasizing the need for aggressive glycemic control and treatment strategies.

Measurement of Optic Nerve Sheath Diameter by Bedside Ultrasound in Patients With Traumatic Brain Injury Presenting to Emergency Department: A Review.

The aim of this review article is to outline the effectiveness of using bedside ultrasound to measure the optic nerve sheath diameter (ONSD) in order to identify variations in intracranial pressure (ICP) and subsequently avoid the complication of secondary brain injury in patients with traumatic brain injury (TBI), who are admitted to an emergency department (ED). Reputable publications and numerous studies demonstrate the problem's exponential rampancy and pervasiveness. In a TBI patient, the emergence of secondary brain damage has been recognized as a serious emergency. It is believed that secondary brain damage is caused by an abnormally high ICP. High levels of ICP can be measured using both invasive and non-invasive approaches. ONSD measurement via bedside ultrasound has been identified as a quick, useful technique to be used in the ED to avoid potential morbidity and mortality owing to secondary brain injury.

Cerebral Venous Sinus Thrombosis (CVST): A Clinically Significant Neurological Condition.

Cerebral venous sinus thrombosis (CVST), a rare but deadly disorder, causes papilledema as well as a number of frequent clinical symptoms, including excruciating headaches, focal seizures, and paralysis on one or both sides of the body. In this intriguing case study, we present the clinical narrative of a 45-year-old man who sought medical attention due to severe headaches persisting for two days. Concurrently, he experienced an abrupt onset of tingling and numbness in his left upper arm. Remarkably, magnetic resonance venography (MRV) revealed an absence of the sigmoid sinus, left transverse sinus, left jugular vein, and superior sagittal sinus, adding complexity to the diagnostic puzzle. Despite this anomaly, conventional brain MRI findings appeared normal. The patient reported a significant reduction in headache intensity following treatment, which included a year-long course of anticoagulant therapy. Subsequently, he gradually regained his health, underscoring the importance of multidisciplinary approaches in managing such challenging cases. This example emphasizes the significance of considering CVST while developing a differential diagnosis of various neurological disorders. Given the vast spectrum of clinical symptoms associated with CVST, it should be taken into account as a potential causative factor in a number of neurological illnesses, in order for patients to experience the best outcomes, quick diagnosis, and quality care.

Severe Amitraz Poisoning: A Case of Successful Emergency Intervention.

Amitraz poisoning is being increasingly seen in clinical practice, presenting physicians with challenges due to its rapidity of onset of severe clinical features, its similarity with organophosphate poisoning and the absence of specific antidotes. Early initiation and appropriate treatment are vital for favourable outcomes. Our case report is of a 40-year-old male who presented to us with grave clinical features following deliberate ingestion of Amitraz in a suicidal attempt. On arrival, he had bradycardia, hypotension, respiratory depression, and altered sensorium. Immediate administration of atropine stabilised his vital signs. Laboratory investigations revealed uncommon electrolyte imbalances, which were promptly corrected. The patient received supportive care in the intensive care unit (ICU), regained consciousness within three days, and was discharged after a week of hospitalisation. Despite the rapid onset and severity of symptoms caused by Amitraz poisoning, early intervention and supportive care can lead to a full recovery. This case underscores the importance of promptly recognising Amitraz poisoning and initiating treatment, its similarity with organophosphate poisoning and the role of atropine. Further research is needed to establish comprehensive management guidelines for tackling this emerging poisoning hazard.

Methemoglobinemia Following Indoxacarb Ingestion: A Unique Toxicological Presentation.

Indoxacarb, an oxadiazine insecticide, is known for its selective lethality by blocking neuronal voltage-dependent sodium channels. While primarily developed to target insect populations resistant to other pesticides, its toxicity in humans remains poorly understood. We present a case of methemoglobinemia resulting from indoxacarb ingestion, a rare manifestation of its toxic effects. A 38-year-old farmer attempted suicide by ingesting the insecticide, leading to cyanosis, hypoxemia, and characteristic arterial blood gas findings indicative of methemoglobinemia. Prompt diagnosis was challenging due to the absence of specific tests, necessitating clinical suspicion. Treatment with methylene blue and supportive therapy resulted in significant clinical improvement, highlighting the importance of early intervention in managing indoxacarb poisoning. This case underscores the need for increased awareness among healthcare providers regarding the potential toxic effects of indoxacarb. It emphasizes the importance of prompt recognition and treatment of methemoglobinemia in pesticide-related poisonings. Further research is warranted to elucidate the mechanisms underlying indoxacarb toxicity in humans and to optimize treatment strategies for affected individuals.

Delayed Manifestation of Massive Bilateral Sub-acute Subdural Hemorrhage.

Sub-acute subdural hematoma (SASDH) in the elderly is a challenging diagnosis given its insidious onset and nonspecific presentation, particularly following minor head trauma. This case report highlights the clinical features, diagnostic challenges, and management of SASDH in an elderly patient. A 72-year-old male presented with a five-day history of giddiness, headache, and balance issues, which began suddenly without a significant triggering event. His medical history was notable only for a minor fall approximately one month before presentation, after which he experienced no immediate or significant symptoms. An MRI at an outside hospital revealed bilateral frontoparietotemporal SASDHs with diffuse cerebral edema. The patient underwent a bilateral mini craniotomy for hematoma evacuation and was managed postoperatively with anti-seizure medications and supportive care, resulting in a satisfactory outcome. The diagnosis of SASDH requires a high index of suspicion, especially in the elderly, who may present with vague and progressive symptoms following minor head trauma. Early and accurate diagnosis via imaging, particularly MRI, is crucial for effective management. Surgical intervention, typically involving hematoma evacuation, significantly improves outcomes in patients with SASDH, underscoring the importance of timely surgical referral and treatment. Elderly patients presenting with unexplained neurological symptoms following even minor trauma should be evaluated for SASDH. Early recognition and intervention are crucial to prevent long-term morbidity and mortality in this vulnerable population.

Acute Presentation of Extra-Pulmonary Tuberculosis in the Emergency Department: A Case Report.

Pericardial effusion is a rare manifestation of tuberculosis (TB) that can present as a life-threatening emergency. It poses a diagnostic challenge, as its clinical presentation may mimic other more common causes of acute cardiac emergencies. Emergency physicians should maintain a high index of suspicion for tuberculosis, particularly in regions where the prevalence of the disease is high. This case report is about a 17-year-old girl who presented to the emergency room with dyspnea, chest discomfort, and hemodynamic instability consistent with cardiac tamponade. Urgent diagnostic procedures, including point-of-care ultrasound (POCUS) and pericardiocentesis, were crucial to the successful management of this patient.