Hypoglycemic hemineglect a stroke mimic.

Acute hypoglycemia may mimic acute ischemic stroke, but to our knowledge this has never been reported as transient hemineglect syndrome. We present a 60-year-old male with known diabetes mellitus who was brought to the hospital as a stroke alert. The patient had undetectable glucose levels upon arrival of emergency medical services (EMS), therefore hypertonic glucose was given. On our assessment in the emergency department (ED)he turned his head to the right side, looking to the right to answer questions when addressed on his left side. The extinction and neglect assessment revealed left-sided extinction on double tactile and visual stimulation. CT perfusion of the brain showed a decreased perfusion in the right cortical area. Given the unclear last known normal, urgent brain magnetic resonance imaging (MRI) was performed; stroke was excluded. The patient was admitted to the Intensive Care Unit where glucose was closely monitored. Electroencephalogram showed absence of seizure or postictal activity. The following morning, the patient returned to baseline and was able to recall the event. The episode was attributed to the severe hypoglycemia because of a recent medication change.

Autosomal dominant GDAP1 mutation with severe phenotype and respiratory involvement: A case report.

Charcot Marie Tooth (CMT) is a heterogeneous group of genetic disorders characterized by progressive motor and sensory neuropathy. CMT is a multi-gene disorder with several possible mutations responsible for a wide range of clinical presentations. A specific mutation of the ganglioside-induced-differentiation-associated protein 1 (GDAP1) gene is associated with the axonal subtype of CMT (CMT2K) which is inherited in an autosomal dominant fashion, as well as the demyelinating subtype (CMT4A) which is inherited in an autosomal recessive pattern. Phenotypic disease expression is largely dependent on these inheritance patterns. While the autosomal recessive form (CMT4A) exhibits severe disease with an early onset, the autosomal dominant variant (CMT2K) tends to have milder phenotypes and a later onset. We describe an atypical presentation of a patient with severe CMT2K with rapidly progressive polyneuropathy, respiratory failure, and dysphonia. We suggest that this case will inspire further evaluation of disease heterogeneity and variants.

Recurrent Cardioembolic Strokes Due to Marantic Endocarditis As the Initial Presentation of Colorectal Adenocarcinoma.

Metastases to the brain from primary colorectal carcinoma are rare. Existing literature describing cranial nerve palsy from metastatic colorectal cancer is scattered. To our knowledge, we are the first to describe the combination of CN deficits V, VII, and XII as the initial presentation of colorectal malignancy. The authors present the case of a patient with no past medical history who presented with multiple cranial nerve deficits of the right trigeminal, facial, and hypoglossal nerves. MRI of the brain revealed a mass in Meckel's cave, which explained the involvement of the trigeminal nerve (CN V) but not the facial (CN VII) and hypoglossal (CN XII) nerves. Further workup revealed multiple cardioembolic strokes caused by nonbacterial thrombotic endocarditis (NBTE). Extensive workup for the cause of his NBTE and subsequent cerebrovascular events revealed colorectal adenocarcinoma.

Seizures in systemic lupus erythematosus: A scoping review.

Systemic lupus erythematosus is a systemic autoimmune disease that affects the central nervous system, either by direct neuronal damage, injury to brain vessels, or by pathogenic mechanisms indirectly induced by immune mechanisms related to the production and deposition of immune complexes. The prevalence of explicit episodes of seizures among SLE patients, varies from 2 to 8%. In some cases, patients with positivity for antiphospholipid or anti-ß2 glycoprotein antibodies are found to be more prone to exhibit seizures compared to seronegative patients, other subjects at risk are carries of gene abnormalities codifying for ion channels. The exclusion of vasculitis or thrombosis is required for accurate treatment, imaging studies and alternative sequences are mandatory in patients with known SLE who present with a seizure. Several statements regarding SLE-related seizure remain to be decoded. In this scoping review we analyzed published information about prevalence, pathogenesis, clinical characteristics, diagnostic and therapeutic SLE patients that manifest a seizure, our objective is to provide with useful information for prompt diagnosis and individualized treatment.

Frecuencia y distribución de enfermedades periodontales asociadas a placa bacteriana en pacientes que acuden a una clínica universitaria / Frequency and distribution of periodontal diseases associated to dental plaque in patients who come to an university clinic

Introducción: La enfermedad periodontal‡ afecta los tejidos de soporte del diente y ocupa el segundo lugar dentro de las alteraciones orales de mayor prevalencia, misma que se caracteriza por ser una alteración infecciosa e infl amatoria, puede ser localizada o generalizada y a su vez aguda o crónica. Objetivo: Determinar la frecuencia y distribución de la enfermedad periodontal asociada a placa bacteriana en pacientes que acuden a atención estomatológica en una clínica universitaria. Material y métodos: Estudio observacional, prolectivo, transversal y descriptivo en 73 pacientes, con un promedio de edad de 38.5 (± 9.6) años; 34% (25) del sexo masculino y 66% (48) del femenino. Se valoró PDB con el índice de O'Leary y enfermedad periodontal con el índice periodontal de Russell. Resultados: La prevalencia de PB fue de 100%, con un índice de O'Leary de 74.2% (IC95% 64-84). La prevalencia de gingivitis para el total de la población fue de 25% (IC95% 15.1-34.9) y de periodontitis de 75% (IC95% 65.1-84.9). En el análisis de regresión lineal simple se encontró asociación ­débil a moderada­ entre presencia de PB y la enfermedad periodontal; para edad, el modelo explica para > 30 años (r = 0.384) 15% de la asociación y para los menores de esa edad (r = 0.440) 19%; por sexo, el modelo permite explicar en el caso del masculino (r = 0.557) 31% de la asociación y para el femenino (r = 0.354) sólo 13%. Conclusiones: La PB tiene el papel más importante en la aparición de la enfermedad periodontal; sin embargo, no es el único elemento que interviene para su desarrollo, porque no todas las colonias formadoras de bacterias dentro de la cavidad oral son afi nes a los tejidos periodontales. Esta enfermedad está asociada a múltiples factores de riesgo biológicos, sistémicos y socioeconómicos, entre otros. Su combinación puede variar el curso y agresividad de la enfermedad (AU)

Introduction: Periodontal disease affecting the supporting tissues of the tooth and occupies the second place in the most prevalent oral disorders, characterized for being an infectious and infl ammatory disorder, it can be localized or generalized and, in turn, acute or chronic. Objective: To determine the frequency and distribution of periodontal disease associated to dental plaque (DP) in patients attending stomatologic care at a university clinic. Material and methods: An observational, prolective, transverse and descriptive study in 73 patients, with a mean age of 38.5 (± 9.6) years; 34% (25) males and 66% (48) females. PDB was assessed with the O'Leary index and periodontal disease with the Russell periodontal index. Results: The prevalence of DP was 100%, with an O'Leary index of 74.2% (IC95% 64-84). The prevalence of gingivitis for the total population was 25% (IC95% 15.1-34.9) and 75% periodontitis (IC95% 65.1-84.9). In the simple linear regression analysis, a weak-to-moderate association was found between the presence of DP and periodontal disease; according to age, the model explains for the > 30 years (r = 0.384) 15% of the association and below said age (r = 0.440) 19%; by sex, the model allows to explain in the case of male (r = 0.557) 31% of the association, and for female (r = 0.354) only 13%. Conclusions: PB has the most important role in the appearance of periodontal disease, however, it is not the only element that intervenes for its development; because not all bacteriaforming colonies within the oral cavity are related to periodontal tissues. This disease is associated with multiple biological, systemic and socioeconomic risk factors, among others, its combination can vary the course and aggressiveness of the disease (AU)

Optic Neuropathy Secondary to Polyarteritis Nodosa, Case Report, and Diagnostic Challenges.

PURPOSE: To describe a case of optic neuropathy as a primary manifestation of polyarteritis nodosa (PAN) and discuss diagnostic challenges. METHODS: Case report. RESULTS: A 41-year-old Hispanic man presented with a 2-day history of reduced visual acuity in his left eye. Physical examination revealed a complete visual field loss in the affected eye. Best-corrected visual acuity (BCVA) in the left eye was hand motion, and fundus examination revealed a hyperemic optic disk with blurred margins, swelling, retinal folds, dilated veins, and normal size arteries. BCVA in the right eye was 20/20; no anomalies were seen during examination of the fundus. The patient was started on oral corticosteroids and once the diagnosis of PAN was made, cyclophosphamide was added to the treatment regimen. Six months later, the patient recovered his BCVA to 20/20 in his left eye. CONCLUSION: Rarely does optic neuropathy present as a primary manifestation of PAN; nevertheless, it represents an ophthalmologic emergency that requires expeditious anti-inflammatory and immunosuppressive treatment to decrease the probability of permanent visual damage. Unfortunately, diagnosing PAN is challenging as it necessitates a high index of suspicion. In young male patients who present for the first time with diminished visual acuity, ophthalmologists become cornerstones in the suspicion of this diagnosis and should be responsible for continuing the study until a diagnosis is reached to ensure rapid commencement of immunosuppressive treatment.

Immune Reconstitution Inflammatory Syndrome and Cytomegalovirus Pneumonia Case Report: Highlights and Missing Links in Classification Criteria and Standardized Treatment.

BACKGROUND: Cytomegalovirus (CMV) pulmonary involvement is rarely associated with IRIS; therefore, limited information is available. CASE PRESENTATION: Here, we describe the case of a 43-year-old HIV-infected male who developed an unusual case of IRIS after cytomegalovirus (CMV) pneumonia. Clinically there was a progressive and paradoxical worsening of respiratory distress, despite being treated for CMV after initiation with antiretroviral therapy. Chest X-ray revealed disseminated infiltrates in both lungs; chest CT-scan showed generalized lung involvement and mediastinal adenopathy. Pulmonary biopsy confirmed CMV pneumonia with the observation of typical viral inclusions on pneumocytes. CONCLUSIONS: CMV pneumonia can be associated with the development of IRIS requiring treatment with immunosuppressant's and immunomodulatory drugs.