Bilateral posterior cerebral artery territory infarction in a SARS-Cov-2 infected patient: discussion about an unusual case.

In time of SARS-Cov2 pandemic, neurologists need to be vigilant for cerebrovascular complications of Covid-19. We present a case of bilateral occipito-temporal infarction revealed by a sudden cortical blindness with haemorrhagic transformation after intravenous thrombolysis in a diabetic patient infected by Covid-19. Differential diagnoses are discussed in front of this unusual presentation and evolution.

Expeditious exclusion of acute coronary syndrome diagnosis by combined measurements of copeptin, high-sensitivity troponin, and GRACE score.

BACKGROUND: High-sensitivity troponin (HS-TnT) combined with copeptin have been proposed to expedite the diagnostic exclusion of acute myocardial infarction. The Global Registry of Acute Coronary Events (GRACE) has been validated and recommended by the European Society of Cardiology as a prognostic score in the management of acute coronary syndrome (ACS) without ST-segment elevation (non-ST+) on the electrocardiogram. Our study examined whether a low GRACE score (<108) combined with negative HS-TnT (<14 ng/L) and copeptin (<14 pmol/L) reliably exclude the diagnosis of non-ST+ ACS, including non-ST-segment elevation myocardial infarction and unstable angina. METHODS: This observational, prospective study included patients presenting with chest pain lasting <6 hours, consistent with non-ST+ ACS. Blood was collected early for measurements of copeptin and HS-TnT. The negative predictive value of combined copeptin, HS-TnT, and GRACE score was calculated in the diagnosis of non-ST+ ACS. The thresholds of positivity were 14 ng/L for HS-TnT, 14 pmol/L for copeptin and 108 for the GRACE score. RESULTS: Among 247 patients retained in the analysis, the diagnosis of ACS was made in 50 (20.4%), including 39 non-ST-segment elevation myocardial infarction and 11 unstable angina. The negative predictive value of combined HS-TnT, copeptin and GRACE score was 99%. CONCLUSION: A negative copeptin associated with a negative HS-TnT in a patient presenting with a low GRACE score expedited the diagnostic exclusion of non-ST+ ACS.

[Bioclinical comparison of two high sensitivity cardiac troponin I assays: Siemens ADVIA Centaur versus Mitsubishi PathFast]. / Comparaison bioclinique de deux techniques de dosages de troponine I cardiaque de haute sensibilité : Siemens ADVIA Centaur versus Mitsubishi PathFast.

High-sensitivity troponin has become an essential emergency biomarker for diagnosing or ruling out an ACS. The establishment of a point of care biology related to the reorganization and fusion of laboratories raise a question about transferability of results between techniques. In this study, we propose to compare the bioclinical performances of high-sensitivity troponin measured by two different techniques on laboratory immunoanalyzer (Siemens Advia Centaur XPT) and on point of care device (Mitsubishi Pathfast). The assay of high-sensitivity troponin (n = 90 patients), according to our study, show consistent clinical results with both method.

An Addison disease revealed with a serious hyponatremia.

We present the case of an Addison's disease revealed by a serious hyponatremia. The serum concentration of ACTH and 21-hydroxylase antibodies were increased and lead to the diagnosis. The cortisol blood level was lowered but required to take into account the stress induced by the hospitalisation of the patient. Addison's disease is characterized by the destruction of the adrenal cortex. Autoimmune adrenalitis is the main cause of adrenal insufficiency. Treatment involves normalisation of sodium concentration and corticosteroids replacement. With a good patient compliance, the survival rate of Addisonian patient is similar to that of the normal population. Management of patient requires vigilance because of the occurrence of others autoimmunes diseases during patient life.

[Renin-secreting tumour: about a new diagnosed case during pregnancy]. / Tumeur à rénine. A propos d'un nouveau cas diagnostiqué au cours d'une grossesse.

A 29 year-old female patient developed severe arterial hypertension in the beginning of her second pregnancy. Investigations performed at 16 weeks of amenorrhea showed hypokaliemia in relation to severe hyperreninism: plasma active renin was 25 fold normal value, 94% as prorenin (prorenin representing 94% of total renin). Radiological investigations including ultrasonography and MRI disclosed an homogenous and avascular tumor in the right kidney. Its ablation confirmed renin tumor, and allowed recovery from HTA and continuation of pregnancy. This is the 75th reported case in the literature, enabling to make a new statement about diagnostic and therapeutic procedures, which are modified during pregnancy by contra-indication to X-rays and renin-angiotensin-aldosteron axis inhibitors.

[Gitelman syndrome: a crucial role of laboratory medicine for the diagnosis]. / Le syndrome de Gitelman : un diagnostic avant tout biologique.

We described a case of Gitelman syndrome. A 56-year-old healthy man presented with facial paralysis. Initial laboratory tests revealed hypokalemia. Despite potassium supplements, kaliemia remains at low levels. Further investigations showed urinary potassium wasting, hypomagnesemia and hypocalciuria. Diagnosis of Gitelman syndrome has been confirmed by molecular diagnosis with identification of a composite heterozygote mutation on SLC12A3 gene. One of the mutations on exon 1 SCL12A3 gene wasn't yet known. In the patient family, the same genetic disorder has been found in the sister. Treatment and follow up schedule were proposed to patient.