RESUMEN
Background: Aluminium encephalopathy results from exposure to aluminium from occupational, recreational, and environmental sources. Movement disorders, cerebellar ataxia, pyramidal tract signs, dementia, microcytic anemia and bone disease are typical manifestations. Case Report: A 55-year-old woman had clinical manifestations, persistent hyperaluminemia without magnetic resonance imaging (MRI) scan changes of toxic encephalopathy following a prolonged exposure to marine grade paints containing 30% aluminium. Chelation therapy with ethylenediaminetetraacetic acid (EDTA) demonstrated decreased levels of aluminemia and significant neurological improvement over time. Discussion: This diagnosis should be entertained in patients with movement disorders, cerebellar ataxia, pyramidal signs, and dementia of unknown etiology. Highlights: Aluminium encephalopathy (AE) is a neurological syndrome caused by aluminium neurotoxicity. Manifestations include cognitive impairment, motor dysfunction, microcytic anemia and bone disease. This case illustrates AE with hyperaluminemia associated with chronic exposure to industrial paints and clinical and biochemical reversibility after chelation therapy with ethylenediaminetetraacetic acid. Movement disorders are highlighted.
Asunto(s)
Encefalopatías , Demencia , Trastornos del Movimiento , Aluminio/toxicidad , Demencia/inducido químicamente , Demencia/diagnóstico por imagen , Demencia/tratamiento farmacológico , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Trastornos del Movimiento/diagnóstico por imagen , Trastornos del Movimiento/etiologíaRESUMEN
We describe a case of a biphasic anaphylactic reaction that occurred in a young woman soon after the ingestion of soy milk that led to her hospitalisation. Early recognition and appropriate treatment led to a successful outcome of this life-threatening condition. Challenges encountered in the care of this common illness are highlighted. There is a need for an increase in public awareness on dangerous allergic reactions caused by allergens present in food products in public use, thereby facilitating primary preventative measures to minimise its occurrence. Healthcare stakeholders need to implement measures of contemporary preventative medicine and efficient therapeutic protocols to safeguard the public welfare concerning this global health problem where appropriate interventions can reduce morbidity and mortality. Trial registration numbers NCT02991885 and NCT02851277.
Asunto(s)
Anafilaxia/tratamiento farmacológico , Hipersensibilidad a los Alimentos/tratamiento farmacológico , Salud Global , Leche de Soja , Adulto , Femenino , Humanos , Adulto JovenRESUMEN
Background: Subacute sclerosing panencephalitis (SSPE) is a disease of childhood and adolescence, but can affect adults. Rapidly progressive cognitive decline, seizures including myoclonic jerks, spasticity, ataxia, visual disturbances, and incontinence are typical manifestations. Case report: A 62-year-old woman who presented with rapidly progressive dementia and myoclonus was diagnosed with SSPE. There was resolution of the movement disorder with clonazepam and valproic acid treatment and some amelioration of cognitive decline after 3 months of therapy with interferon alfa and isoprinosine. Discussion: With the recent rise in measles cases worldwide, any increased incidence of SSPE would require vigilance for early interventions.
Asunto(s)
Demencia/diagnóstico por imagen , Progresión de la Enfermedad , Mioclonía/diagnóstico por imagen , Panencefalitis Esclerosante Subaguda/diagnóstico por imagen , Demencia/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Mioclonía/complicaciones , Panencefalitis Esclerosante Subaguda/complicaciones , Factores de TiempoRESUMEN
We report a case that illustrates how chronic migraine headaches and multiple dental pathologies caused severe and long-standing cranial pain that affected the quality of life of a man for more than 35 years. His case was investigated at several settings including the neurology outpatient clinic of the hospital without a definitive diagnosis or resolution. After investigations, multiple oral pathologies including two occult dental abscesses were diagnosed. Once both affected teeth and associated abscesses were surgically removed, with subsequent antibiotic therapy the headaches resolved.
Asunto(s)
Antibacterianos/uso terapéutico , Cefalea/diagnóstico , Trastornos Migrañosos/diagnóstico , Absceso Periapical/diagnóstico , Calidad de Vida/psicología , Odontalgia/diagnóstico , Cefalea/etiología , Cefalea/fisiopatología , Cefalea/psicología , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/etiología , Trastornos Migrañosos/fisiopatología , Trastornos Migrañosos/psicología , Salud Bucal , Absceso Periapical/complicaciones , Absceso Periapical/fisiopatología , Absceso Periapical/psicología , Radiografía Dental , Factores de Tiempo , Extracción Dental , Odontalgia/complicaciones , Odontalgia/fisiopatología , Odontalgia/psicología , Resultado del TratamientoRESUMEN
A 56-year-old Afro-Trinidadian woman with a history of a carbidopa-levodopa resistance Parkinsonian-like syndrome for 2 years, presented with acute onset spastic quadriplegia and decreased responsiveness. Diagnosis involved clinical and MR-imaging correlation consistent with a large left posterior fossa meningioma. Surgical removal of the tumor led to complete reversibility of the neurological manifestations associated with cerebellar tonsillar herniation beyond the foramen magnum and mass effect on the brainstem, cerebellum and midbrain regions. Pathological findings were typical of a meningioma. This case demonstrates the association of a large left posterior fossa meningioma and carbidopalevodopa resistant parkinsonism in an Afro-Trinidadian woman who presented with acute onset acute quadriplegia and decreased responsiveness. This case reminds clinicians that patients with dopa unresponsiveness and/or acute neurological deficit or deterioration should be worked up for other possible causes and adds to the literature on the association of parkinsonism and intracranial space occupying lesions.
Asunto(s)
Infecciones por VIH/complicaciones , Midriasis/virología , Neurosífilis/virología , Tabes Dorsal/virología , Pupila Tónica/virología , Adulto , Infecciones por VIH/microbiología , Infecciones por VIH/patología , Humanos , Masculino , Midriasis/patología , Neurosífilis/patología , Tabes Dorsal/patología , Pupila Tónica/patologíaRESUMEN
Background: Myoclonic jerks are due to sudden, brief, involuntary muscle contractions, positive myoclonus, or brief cessation of ongoing muscular activity, negative myoclonus, and may be difficult to recognize. Case Report: We describe an immunocompetent, adult, male patient with sleep-related, multifocal, myoclonic jerks and neurotoxoplasmosis with abnormal cerebrospinal fluid but normal brain imaging. There was complete resolution of the myoclonus with antitoxoplasmosis therapy after 1 week, and no relapse after 1 year. Discussion: Neurotoxoplasmosis may be subtle in presentation, difficult to diagnose, and more common than realized, and it is being increasingly implicated in epileptogenesis in humans.
Asunto(s)
Mioclonía/diagnóstico , Toxoplasmosis Cerebral/diagnóstico , Adulto , Animales , Gatos , Exposición a Riesgos Ambientales , Humanos , Masculino , Mioclonía/tratamiento farmacológico , Toxoplasmosis Cerebral/tratamiento farmacológicoAsunto(s)
Cardiotónicos/efectos adversos , Dopamina/efectos adversos , Epinefrina/efectos adversos , Gangrena/inducido químicamente , Paro Cardíaco/tratamiento farmacológico , Adulto , Reanimación Cardiopulmonar , Dopamina/administración & dosificación , Quimioterapia Combinada , Epinefrina/administración & dosificación , Dedos , Humanos , Infusiones Intravenosas , Masculino , Dedos del PieAsunto(s)
Linfoma de Burkitt/diagnóstico por imagen , Infecciones por VIH/diagnóstico , Hepatitis B/diagnóstico , Neoplasias Hepáticas/diagnóstico por imagen , Adulto , Coinfección , Progresión de la Enfermedad , Resultado Fatal , Humanos , Biopsia Guiada por Imagen , Masculino , Tomografía Computarizada por Rayos X , Carga ViralRESUMEN
We report a case of a 22-year-old female student nurse who presented to hospital with an acute neuro-ophthalmological syndrome characterized by papilledema, ataxia, ophthalmoplegia and headache after a single first time use of 150 mg medroxyprogesterone intramuscular injection. Clinical, laboratory, radiological and ophthalmological investigations were in keeping with the diagnosis of idiopathic intracranial hypertension but lumbar puncture did not show a raised cerebrospinal fluid pressure suggesting a forme fruste of this entity. Her neuro-ophthalmological clinical features responded well to acetazolamide and diagnostic/therapeutic lumbar puncture. Full recovery was achieved three months after medroxyprogesterone usage. Health care providers must be aware of this adverse drug reaction.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Carcinoma de Células Escamosas/complicaciones , Neoplasias del Pene/complicaciones , Amputación Quirúrgica , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Diagnóstico Tardío , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Neoplasias del Pene/patología , Neoplasias del Pene/cirugíaRESUMEN
We report a patient driven home care system that successfully assisted 24/7 with the management of a 68-year-old woman after a stroke-a global illness. The patient's caregiver and physician used computer devices, smartphones and internet access for information exchange. Patient, caregiver, family and physician satisfaction, coupled with outcome and cost were indictors of quality of care. The novelty of this basic model of teleneurology is characterised by implementing a patient/caregiver driven system designed to improve access to cost-efficient neurological care, which has potential for use in primary, secondary and tertiary levels of healthcare in rural and underserved regions of the world. We suggest involvement of healthcare stakeholders in teleneurology to address this global problem of limited access to neurological care. This model can facilitate the management of neurological diseases, impact on outcome, reduce frequency of consultations and hospitalisations, facilitate teaching of healthcare workers and promote research.
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Neurología/métodos , Servicios de Salud Rural , Población Rural , Accidente Cerebrovascular/terapia , Telemedicina/métodos , Anciano , Manejo de la Enfermedad , Femenino , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Trinidad y TobagoAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Imagen por Resonancia Magnética , Trastornos del Movimiento/complicaciones , Trastornos del Movimiento/diagnóstico por imagen , Toxoplasmosis Cerebral/diagnóstico por imagen , Adulto , Antibacterianos/uso terapéutico , Antiprotozoarios/uso terapéutico , Terapia Antirretroviral Altamente Activa , Humanos , Masculino , Trastornos del Movimiento/tratamiento farmacológico , Penicilinas/uso terapéutico , Toxoplasmosis Cerebral/complicaciones , Toxoplasmosis Cerebral/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol , Grabación de Cinta de Video , Adulto JovenRESUMEN
A 29-year-old previously healthy woman, a doctor, was diagnosed with remitting relapsing multiple sclerosis after fulfilling McDonald's criteria for the diagnosis of definite multiple sclerosis. Despite 22 months of immunomodulatory treatment, the feasibility of continuing to train in a stressful specialty of medicine became an ethical and practical dilemma. Fitness for practice and career advancement among doctors with illnesses or having cognitive and physical decline from disease and/or ageing is a global problem. The need for addressing this issue in a compassionate and comprehensive manner is discussed. Cognitive and physical fitness are required in doctors and other healthcare workers since medical errors/adverse events are commonplace in medical practice. The public welfare is equally important in this global problem.
Asunto(s)
Anestesiología , Internado y Residencia , Esclerosis Múltiple Recurrente-Remitente , Inhabilitación Médica , Adulto , Anestesiología/educación , Anestesiología/normas , Evaluación de la Discapacidad , Femenino , Humanos , Trinidad y TobagoAsunto(s)
Fenómeno de la Extremidad Ajena/etiología , Coma Hiperglucémico Hiperosmolar no Cetósico/complicaciones , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Leucoaraiosis/patología , Imagen por Resonancia Magnética , Anciano , Fenómeno de la Extremidad Ajena/sangre , Fenómeno de la Extremidad Ajena/fisiopatología , Femenino , Humanos , Coma Hiperglucémico Hiperosmolar no Cetósico/sangre , Coma Hiperglucémico Hiperosmolar no Cetósico/fisiopatología , Infusiones Intravenosas , Resultado del Tratamiento , Grabación en VideoRESUMEN
BACKGROUND: Knowledge on human papillomavirus (HPV) genotype distribution in recurrent respiratory papillomatosis (RRP) is essential to assess the impact of HPV vaccine. It is provided information for Colombia. METHODS: In all, 189 RRP primary cases diagnosed between 1985 and 2009 were identified from 5 pathology laboratories of Cali and Medellin, Colombia. HPV DNA testing in 129 cases that fulfilled inclusion criteria (available paraffin blocks, amplifiable DNA, and confirmed histologic diagnosis of RRP) was performed by the SPF-10/LiPA25 assay (version 1). RESULTS: Of all cases 36.1% were juvenile (<12 years old) and a majority of adults were males (p = .09); 95% of cases were HPV positive. HPV 6, 11, and 16 contributed to 69%, 27.1%, and 7.8% of all HPV positive cases. Twelve cases (9.3%) showed multiple infections; 8 of these were HPV 6 or 11 positive. CONCLUSIONS: HPV prophylactic vaccine including HPV 6 and 11 may have a major impact against RRP.