Artery of Percheron infarction: a rare cause of somnolence in a patient with sepsis and atrial fibrillation.

Artery of Percheron (AOP) occlusion is a rare cause of ischemic stroke characterized by bilateral para-median thalamic infarcts. It usually presents with altered mental status, hyper-somnolence and ocular movement disorders. Here, we report a case of cardio-embolic AOP infarction in a 72-year-old man with sepsis and new-onset atrial fibrillation. Early diagnosis is challenging, but diffuse-weighted magnetic resonance imaging demonstrates the lesion in the acute setting. Anticoagulation therapy was started and patient's mental status gradually improved.

Disseminated blastomycosis in a 36-year-old immunocompetent male from Chicago, IL.

Blastomycosis is a fungal infection caused by Blastomyces species. This infection is endemic to North America particularly states bordering the Mississippi, Ohio and St Lawrence Rivers, and the Great Lakes but also occurs worldwide. While the most common site of infection is the lung, it can also manifest in the bones, skin and central nervous system. Blastomycosis is a great masquerader and it can present in a manner difficult to distinguish from bacterial pneumonia, tuberculosis (TB), histoplasmosis or carcinoma. Here, we describe a 36-year-old male with disseminated blactomycosis infection who presented with right arm weakness. Initial diagnostic evaluation was cofounded by a previous concern for TB; however, broncho-alveolar lavage confirmed Blastomyces spp. Pulmonary and brain lesions markedly improved after Amphotericin and Itraconazole.

Novel developments in stress cardiomyopathy: From pathophysiology to prognosis.

Stress cardiomyopathy (SC) is characterized by transient left ventricular (LV) wall motion abnormalities typically involving the apex with preserved basal contractility, chest discomfort, ST-T ischemic changes and elevated cardiac markers with normal or non-flow limiting coronary artery lesions. It represents an important differential diagnosis of Acute Coronary Syndromes caused by atherosclerotic vessel occlusion; most commonly, Tako-tsubo occurs in postmenopausal women after physical or emotional stress. While the exact mechanism of SC remains controversial, various hypotheses have been suggested concerning the vascular, central nervous and endocrine system participation where catecholamines, particularly epinephrine, seem to play a major role. Hormonal, genetic and psychiatric conditions may also define the risk of susceptibility in some groups affected by SC. Long-term survival data are limited with mortality occurring predominantly in the first year after diagnosis usually related to non-cardiac illnesses. Echocardiography promises to become a useful tool to correctly identify SC patients at high risk for complications.