Non-Contrast-Enhancing Glioma Mimicking Acute Ischemic Stroke Within Three Hours of Onset.

Intravenous thrombolytic therapy is recommended within 3 hours of onset of acute ischemic stroke. However, stroke mimics create challenges because of time pressures. We describe a case of an undiagnosed glioma, a rarely reported condition, that was nearly treated with thrombolytic therapy. A 71-year-old man presented to the emergency department with sudden left gaze preference, right-sided hemiplegia, and global aphasia, which suggested a large infarction in the left hemisphere. The thrombolytic protocol was started at once. However, noncontrast computed tomography (CT) of the brain, CT angiography, and CT perfusion were essentially normal. Later, magnetic resonance imaging of the brain demonstrated a diffuse intracerebral lesion. The patient was found to have an undiagnosed diffuse glioma, whose initial neurologic symptoms mimicked acute stroke within 3 hours of onset. Cerebral neoplasms are an absolute contraindication for thrombolysis therapy. Several brain tumors are rarely seen on a brain CT scan. The mismatch between neurologic examination and brain perfusion imaging may suggest a stroke mimic in some cases.

Epidemiology and factors associated with mortality of thyroid storm in Taiwan: a nationwide population-based study.

Thyroid storm is a rare and life-threatening disease. However, its prevalence, incidence, and mortality rate in Chinese population are unknown. We performed a retrospective study using the Taiwan Health and Welfare Data. Patients admitted owing to thyrotoxicosis were divided into thyroid storm group and non-thyroid storm group. We assessed thyroid storm prevalence, incidence, complications, and mortality rate. Multiple Cox regression was performed to estimate the hazard ratio for the mortality risk. Overall, 1244 thyroid storm patients and 83,874 thyrotoxicosis patients without thyroid storm were included. Most thyroid storm patients were female (67.9%) with ages ranging from 30 to 44 years (33.4%), and most thyroid storm cases occurred during the summer season. The prevalence of thyroid storm was 1.48% (1244/83,874). The incidence rate of thyroid storm was 0.55 per 100,000 persons per year and 6.28 per 100,000 hospitalized patients per year. The overall 14-, 28-, and 90-day mortality rates of thyroid storm patients were 5.23%, 6.59%, and 8.12%, respectively. Thyroid storm, older age, male, and underlying ischemic stroke, myocardial infarction, heart failure, kidney disease, atrial fibrillation, depression, chronic obstructive pulmonary disease, diabetes mellitus, cancer, end stage renal diseases were associated with a significantly higher risk of mortality. In conclusion, the 90-day mortality rate of thyroid storm was high and was commonly associated with multiorgan failure and shock. Therefore, clinical physicians should identify thyroid storm and treat it accordingly.

Risk of Cardiovascular Disease Due to General Anesthesia and Neuraxial Anesthesia in Lower-Limb Fracture Patients: A Retrospective Population-Based Cohort Study.

The purpose of this study was to analyze the relationship between elevated cardiovascular disease (CVD) risk and type of anesthesia by using the National Health Insurance Research Database (NHIRD) of Taiwan in a one-year follow-up period. We assessed whether general anesthesia (GA) or neuraxial anesthesia (NA) increased CVD occurrence in lower-limb fracture patients. Approximately 1 million patients were randomly sampled from the NHIRD registry. We identified and enrolled 3437 lower-limb fracture patients who had received anesthesia during operations conducted in the period from 2010 to 2012. Next, patients were divided into two groups, namely GA (n = 1504) and NA (n = 1933), based on the anesthetic technique received during surgery. Our results revealed that those receiving GA did not differ in their risk of CVD relative to those receiving NA, adjusted HR = 1.24 (95% CI: 0.80-1.92). Patients who received GA for more than 2 h also did not differ in their risk of CVD relative to those receiving NA for less than 2 h, adjusted HR = 1.43 (95% CI: 0.81-2.50). Moreover, in the GA group (i.e., patients aged ≥65 years and women), no significant difference for the risk of CVD events was observed. In conclusion, in our study, the difference in the risk of CVD between lower-limb fracture patients receiving NA and GA was not statistically significant. The incidence rate of CVD seemed to be more correlated with patients' underlying characteristics such as old age, comorbidities, or admission to the intensive care unit. Due to the limited sample size in this study, a database which reviews a whole national population will be required to verify our results in the future.

Pneumonia is an independent risk factor for pyogenic liver abscess: A population-based, nested, case-control study.

BACKGROUND: Bacteremic pneumonia is considered a potential cause of distal organ abscess formation. Therefore, we hypothesize that pneumonia is a risk factor for pyogenic liver abscess (PLA).The aim of this study is to explore the association between pneumonia and PLA. METHODOLOGY/PRINCIPAL FINDINGS: A nationwide, population-based, nested, case-control study was conducted using data from the Taiwan National Health Insurance Research Database. In total, 494 patients with PLA and 1,976 propensity score matched controls were enrolled. Conditional logistic regression was used to estimate adjusted odds ratios (aORs) in patients with exposure to pneumonia before PLA. After matched and adjusted for confounding factors including age, sex, urbanization, income, chronic liver disease, alcohol-related disease, biliary stone, chronic kidney disease, diabetes mellitus, chronic liver disease, and cancer, hospitalization for pneumonia remained an independent risk factor for PLA with an aORs of 2.104 [95% confidence interval (CI) = 1.309-3.379, p = 0.0021]. Moreover, the aORs were significantly higher among patients hospitalized for pneumonia within 30 days (aORs = 10.73, 95% CI = 3.381-34.054), 30-90 days (aORs = 4.698, 95% CI = 1.541-14.327) and 90-180 (aORs = 4.000, 95% CI = 1.158-13.817) days before PLA diagnosis. CONCLUSION: Pneumonia is an independent risk factor for subsequent PLA. Moreover, hospitalization for pneumonia within 180 days before PLA diagnosis was associated with an increased risk of PLA.

Spontaneous Rupture of Hepatocellular Carcinoma Mimicking ST-Segment Elevation Myocardial Infarction.

BACKGROUND: Several medical conditions that mimic ST-elevation myocardial infarction (STEMI) have been reported previously, but acute abdominal disease mimicking STEMI is rare. CASE REPORT: We report on a 72-year-old man who presented to the emergency department (ED) with epigastric pain. Meanwhile, STEMI with shock developed. Anticoagulation medication and emergent percutaneous coronary intervention (PCI) were arranged in a timely manner. However, hepatocellular carcinoma (HCC) rupture was the true cause of the ST-segment elevation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report highlights the fact that acute myocardial infarction is not the only cause of ST-segment elevation. HCC rupture should be one of the differential diagnoses.

Rupture of ectopic pelvic dysplastic kidney after blunt abdominal trauma presenting as left lower quadrant pain.

BACKGROUND: Ectopic pelvic dysplastic kidney is very rare. To our knowledge, there is no case report in the literature that discusses the diagnosis and management of ectopic pelvic dysplastic kidney in trauma. OBJECTIVES: To report an unusual organ injury after abdominal blunt trauma. CASE REPORT: A 23-year-old man presented to the Emergency Department with complaints of left lower quadrant pain after blunt abdominal trauma. Rupture of an ectopic pelvic dysplastic kidney was suspected from ultrasonography and then confirmed by a computed tomography scan. The patient was managed successfully with conservative therapy. CONCLUSIONS: The focused assessment with sonography for trauma examination is beneficial to hemodynamically stable blunt abdominal trauma patients because unusual organ injuries can be detected early.