Facial Nerve Palsy in Hypertriglyceridemia-Induced Pancreatitis: A Case Report and Literature Review.

Acute pancreatitis is associated with multiple local or systemic complications in response to systemic inflammation that may eventually result in multi-organ failure. Neurological complications are uncommon in acute pancreatitis. Examples include cerebral hemorrhage, infarction, cerebral fat embolism, Wernicke encephalopathy, and cranial nerve (CN) palsy. Facial nerve palsy is a rare event in the setting of acute pancreatitis, with various theories about its etiology and pathophysiology. We report the case of a 46-year-old female who presented with acute pancreatitis secondary to hypertriglyceridemia. She developed right-sided facial palsy on the third day of admission. Her clinical condition improved with standard conservative medical management of acute pancreatitis. Facial nerve palsy improved after a short course of oral glucocorticoids, supportive measures, and physiotherapy. This case demonstrates a rare occurrence of facial nerve palsy in the setting of acute pancreatitis, although the etiopathology behind this manifestation remains unclear.

A Case of Leptomeningeal Carcinomatosis Manifesting With Vertigo in the Setting of Intracranial Hypertension.

Leptomeningeal carcinomatosis (LMC) is a rare condition where malignant cells infiltrate the leptomeninges of the central nervous system. We present a case of a 51-year-old male with stage IV adenocarcinoma of the lung who developed recurrent vertigo. The patient initially received a diagnosis of peripheral vertigo, but his symptoms worsened over time and were associated with headache, vomiting, and one episode of seizure. Upon readmission, based on his normal neuroimaging results, normal CSF examination with elevated opening pressure, and papilledema on fundoscopic examination, a diagnosis of pseudotumor cerebri was made. The result of CSF cytology revealed the presence of malignant cells confirming the presence of LMC. This case highlights the importance of considering LMC as a potential cause for unusual neurological symptoms in patients with advanced malignancy, particularly when other conditions like pseudotumor cerebri could obscure its presentation. It is crucial to rule out malignancy through CSF cytology in patients presenting with vertigo and/or other vestibulocochlear symptoms before making an alternative diagnosis that could present similarly.

A Rare Presentation of Artery of Percheron Infarct: A Case Report.

The artery of Percheron (AOP), a variation of the thalamic vasculature, supplies both the thalamus and the midbrain. An infarct in this area is characterized by wide neurological abnormalities, the most common of which are altered mental state, decreased degree of consciousness, and memory impairment. AOP infarcts tend to be missed during the initial computed tomography (CT) scan. The number of reports on AOP infarction has been increasing, highlighting the range of clinical presentations and challenges that clinicians can face. This case study discusses a 58-year-old male patient who was diagnosed with stroke in AOP territory without any clear neurological symptoms, and it serves as a model for patients with similar conditions.

Pure Isolated Internuclear Ophthalmoplegia as Presentation of Midbrain Ischemic Stroke: A Case Report.

Internuclear ophthalmoplegia (INO) is a condition characterized by impaired ocular movement, leading to an inability to perform coordinated lateral gaze, resulting in ophthalmoplegia. This impairment results from damage to the medial longitudinal fasciculus (MLF), which can occur because of various types of lesions localized in the pons or midbrain. In this case, we report on a 67-year-old man with multiple comorbidities who arrived at the emergency department with complaints of sudden dizziness and an unsteady gait. During the examination, he exhibited left INO, which was characterized by limited left eye adduction and multidirectional nystagmus of the right eye when performing right lateral gaze.

Comparison of the Effectiveness of Prolonged Infusion and Intermittent Infusion of Meropenem in Patients With Sepsis: A Meta-Analysis.

The aim of this study was to compare the clinical effectiveness of prolonged infusion and intermittent infusion of meropenem in patients with sepsis. This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. PubMed, Web of Science, Scopus, and the Cochrane Library were searched without any language or time restrictions, up to September 25, 2023. The primary outcomes assessed in this meta-analysis included clinical success and all-cause mortality. Other outcomes assessed in this study encompassed the mean length of ICU stay. Total eight studies met the eligibility criteria and were included in this meta-analysis. Pooled analysis showed that the clinical success rate was significantly higher in patients receiving prolonged infusion of meropenem compared to intermittent infusion (RR: 1.49, 95% CI: 1.30 to 1.70). All-cause mortality was 24% significantly lower in patients receiving prolonged infusion of meropenem compared to intermittent infusion (RR: 0.76, 95% CI: 0.60 to 0.96). The results suggest that prolonged infusion of meropenem could be a more effective and efficient treatment for sepsis patients. However, more randomized controlled trials are needed to confirm these findings and to establish the optimal dosing and administration schedule for prolonged infusion of meropenem.

Acute Pancreatitis Secondary to Intragastric Balloon: A Case Report and Literature Review.

Intragastric balloon (IGB) is a common minimally invasive procedure used for obesity management and weight reduction. It can be used alone, sequentially, with concomitant therapies, or as a bridge to longer-term weight-loss interventions, such as bariatric surgery. Although the insertion procedure is easy and generally well tolerated by patients, a few complications can occur with varying degrees of severity ranging from mild to severe and life-threatening. Acute pancreatitis is a rare complication of IGB but has been reported in the literature. We present a case in which the patient had a history of IGB insertion complicated by acute pancreatitis. The diagnosis of acute pancreatitis due to the IGB insertion was made after excluding other possible causes of acute pancreatitis. The patient was hospitalized and managed conservatively.

DVT as the Initial Presentation of Multiple Myeloma: A Rare Case Report and Literature Review.

Multiple myeloma patients are recognized to have a higher risk of venous thrombosis. The cause of this could be attributed to several risk factors, such as circulating prothrombotic microparticles, disease-specific variables, and alterations in coagulation and fibrinolysis factors. Recent research has revealed that these individuals also experience greater arterial thrombosis, including acute myocardial infarction and stroke. In this case report, we present the clinical profile and management of a 42-year-old patient who presented with signs and symptoms of deep venous thrombosis (DVT) and was diagnosed with multiple myeloma. The aim of this case report is to highlight a rare clinical presentation and diagnostic workup in a patient with multiple myeloma. Additionally, we discuss the possible factors provoking the development of DVT as a first presentation before treatment initiation and their possible mechanisms.