RESUMO
Purpura fulminans (PF) is a rapidly fatal disorder predominantly encountered in patients with an acquired deficiency of physiologic anticoagulants due to severe sepsis and septic shock with disseminated intravascular coagulation (DIC). This consumptive process eventually leads to widespread thrombosis, hemorrhagic necrosis, and gangrene. Rapid identification followed by aggressive management of the underlying etiology with a multidisciplinary team is critical to prevent long-term organ dysfunction, disability from amputation, and death. While bleeding is a common finding in DIC, anticoagulation must be considered if PF is present. We report a case of Escherichia coli--associated emphysematous pyelitis leading to bacteremia, septic shock, and PF with small- and medium-sized vessel thrombosis and acral ischemia.
Assuntos
Ascite/etiologia , Ascite/fisiopatologia , Carcinoma de Células de Transição/diagnóstico , Carcinoma de Células de Transição/fisiopatologia , Metástase Neoplásica/fisiopatologia , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/fisiopatologia , Neoplasias Urológicas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/diagnóstico , Neoplasias Urológicas/diagnóstico , Neoplasias Urológicas/fisiopatologiaRESUMO
BACKGROUND: Tremors may be difficult to classify. CASE REPORT: An 83-year-old male presented with an unusual left wrist tremor. The tremor could be reproducibly elicited by making a fist or carrying a weighted object (e.g., a shopping bag, bottle of water) of approximately 1â lb or more, and it intensified with heavier weights. The tremor was difficult to classify, although it shared features with isometric tremor. DISCUSSION: This specific presentation of tremor has not been reported previously. We hope that the detailed description we provide will aid other neurologists who encounter this or similar tremors in their clinics.
Assuntos
Tremor Essencial/tratamento farmacológico , Moduladores GABAérgicos/uso terapêutico , Ácido gama-Aminobutírico/análogos & derivados , Adulto , Estudos Cross-Over , Método Duplo-Cego , Determinação de Ponto Final , Tremor Essencial/fisiopatologia , Humanos , Pregabalina , Estudos Prospectivos , Resultado do Tratamento , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
Essential tremor (ET) is one of the most common tremor disorders in the world. Despite this, only two medications have received Level A recommendations from the American Academy of Neurology to treat it (primidone and propranolol). Even though these medications provide relief to a large group of ET patients, up to 50% of patients are non-responders. Additional medications to treat ET are needed. This review discusses some of the methodological issues that should be addressed for quality clinical drug development in ET.