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1.
BMJ Case Rep ; 17(9)2024 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-39277192

RESUMEN

Postoperative urinary retention is a common consequence of pelvic surgeries. It is often related both to the nature of surgery and the medication used in the perioperative period. Adhesive arachnoiditis (AA) is a rare condition, which has various clinical presentations ranging from back pain to disabling neurological deficits. Numerous aetiologies for AA have been described in the literature, one such noted is spinal anaesthesia. We report a patient who presented with isolated bladder dysfunction in the form of urinary retention after spinal anaesthesia. She was evaluated and diagnosed with AA as the cause of her urinary retention. AA was complicated by raised intracranial pressure. She was treated with corticosteroids and acetazolamide, following which she made a full recovery. We would like to highlight this rare presentation, as well as lay emphasis on the early evaluation of seemingly anticipated symptoms such as postoperative urinary retention.


Asunto(s)
Aracnoiditis , Complicaciones Posoperatorias , Retención Urinaria , Humanos , Retención Urinaria/etiología , Femenino , Aracnoiditis/etiología , Complicaciones Posoperatorias/etiología , Anestesia Raquidea/efectos adversos , Acetazolamida/uso terapéutico , Hipertensión Intracraneal/etiología
2.
BMJ Case Rep ; 16(12)2023 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-38087488

RESUMEN

Primary Sjogren's syndrome (pSS) is an autoimmune connective tissue disorder with multisystem manifestations. We here report a previously healthy woman who presented with autonomic dysfunction in the form of severe dizziness without any apparent sensory neuropathy. Detailed history and examination revealed the signs and symptoms of Sjogren's syndrome such as constipation and dry eyes and mouth, following which anti-SSA and SSB antibodies were found to be positive. Finally, a diagnosis of pSS was established after ruling out all the other causes of autonomic dysfunction in addition to the clinical and laboratory evidence. The patient was treated with the maximum doses of midodrine and fludrocortisone, yet no progress was noticed. Hence, a trial of steroids was started and she showed a significant clinical improvement. Our patient presented with pure autonomic failure associated with Sjogren's syndrome, making it an extremely rare entity.


Asunto(s)
Enfermedades del Sistema Nervioso Autónomo , Midodrina , Síndrome de Sjögren , Femenino , Humanos , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/diagnóstico , Síndrome de Sjögren/tratamiento farmacológico , Enfermedades del Sistema Nervioso Autónomo/diagnóstico , Enfermedades del Sistema Nervioso Autónomo/tratamiento farmacológico , Enfermedades del Sistema Nervioso Autónomo/etiología , Fludrocortisona/uso terapéutico , Midodrina/uso terapéutico
3.
BMJ Case Rep ; 16(11)2023 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-37923333

RESUMEN

Decompensated liver disease is associated with alterated haemostasis that can either lead to spontaneous bleeding or development of thrombosis. Alcohol consumption coupled with advanced liver disease favours spontaneous bleeding. There have been only few documented cases of spontaneous muscle haematoma (SMH) in patients with cirrhosis. The pathogenesis of SMH is hypothesised to be multifactorial and it has been seen in patients on anticoagulation or with haemostatic disorders. We report a case of alcohol-related cirrhosis presenting with an expanding, voluminous haematoma in the intermuscular plane between the trapezius and the teres major muscles. This patient also had a retroperitoneal haemorrhage, clinically evidenced by the Grey Turner's and Cullen's signs. Haemorrhage was confirmed radiologically by CT. The patient was managed in an intensive care facility and treated with multiple blood products, including packed red blood cells, fresh frozen plasma and cryoprecipitates. However, as his clinical condition deteriorated, he required surgical intervention by incision and drainage, followed by evacuation. Early identification of coagulopathy and aggressive treatment are essential in these cases of cirrhosis to avoid unfavourable outcomes.


Asunto(s)
Hematoma , Hepatopatías , Masculino , Humanos , Hematoma/etiología , Hematoma/complicaciones , Hemorragia/complicaciones , Cirrosis Hepática/complicaciones , Hepatopatías/complicaciones , Músculos
4.
BMJ Case Rep ; 12(8)2019 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-31420419

RESUMEN

Addison's disease is a common endocrinopathy often diagnosed in patients presenting with hyponatraemia. Cerebellar ataxia as a presentation of hyponatraemia is extremely rare. A 42-year-old man presented with vomiting, fever, ataxic gait and scanning type of dysarthria. Clinical examination revealed signs suggestive of isolated cerebellar involvement. Patient was found to have severe hyponatraemia and serum cortisol was found to be extremely low while MRI brain was found to be normal. Corticosteroid therapy was initiated and cerebellar ataxia was resolved following normalisation of sodium levels.


Asunto(s)
Enfermedad de Addison/diagnóstico , Ataxia Cerebelosa/diagnóstico , Hiponatremia/diagnóstico , Enfermedad de Addison/complicaciones , Adulto , Ataxia Cerebelosa/complicaciones , Diagnóstico Diferencial , Humanos , Hiponatremia/etiología , Masculino
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