RESUMO
A 54-year-old man was referred to the acute medical unit with a suspected stroke after presenting to his general practitioner with altered speech, left sided facial droop and confusion. The patient had a new right sided swelling on the lateral aspect of his head but did not report any history of trauma. Imaging revealed a 9.2 cm nail entering via the right parietal bone with associated acute haemorrhage. After further discussion with the patient, he disclosed a suicide attempt with a nail gun 5 days prior to presentation. The nail was successfully removed by the neurosurgical team and the patient received rehabilitation and psychiatric assessment on the brain injury unit before going home.
Assuntos
Lesões Encefálicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Tentativa de Suicídio , Lesões Encefálicas/psicologia , Diagnóstico Diferencial , Corpos Estranhos/psicologia , Traumatismos Cranianos Penetrantes/psicologia , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Antibacterianos/administração & dosagem , Linezolida/administração & dosagem , Obesidade/complicações , Úlcera/complicações , Úlcera/tratamento farmacológico , Adulto , Antibacterianos/farmacocinética , Celulite (Flegmão)/complicações , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/microbiologia , Humanos , Linezolida/farmacocinética , Masculino , Resultado do Tratamento , Úlcera/diagnóstico , Úlcera/microbiologiaRESUMO
We report a case of atrial fibrillation (AF) refractory to medical management. The patient had previously undergone extensive gastric and small bowel surgery. Subsequently we demonstrated malabsorption of administered anti-arrhythmics as the cause of her refractory AF. Malabsorption, even to lesser degrees and from other causes should be considered in cases of unexplained therapeutic refractoriness.
