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.

Cerebral Neuroschistosomiasis Presenting as a Brain Mass.

Neuroschistosomiasis is a rare manifestation of schistosomal infections presenting with cerebral and spinal cord involvement. We reported a case of a 31-year-old woman who presented with a history of headache, dizziness, and nausea. Brain MRI with contrast showed features suggestive of brain lesion with edema, and a serology test for Schistosoma was positive. She was diagnosed with neuroschistosomiasis and treated with intravenous steroids followed by praziquantel resulting in a significant regression of the brain mass. Cerebral neuroschistosomiasis is a rare complication of Schistosoma infection, and clinicians should consider it among the differential diagnosis of unexplained brain lesions.

The utility of testing erythropoietin level in polycythemia diagnosis.

OBJECTIVES: Polycythemia vera (PV) is classically thought to be associated with low erythropoietin (EPO) levels. Here, we present a review of the utility of using EPO levels in diagnosing polycythemia. METHODS: We conducted a systematic literature review of the Medline data through Pubmed and Google Scholar. We included the articles which described confirmed PV associated with elevated EPO level. Our search strategy included the following terms in Pubmed (((polycythemia vera[MeSH Terms]) OR (jak2 protein tyrosine kinase[MeSH Terms])) OR (Myeloproliferative Disorders[MeSH Terms])) AND (Erythropoietin[MeSH Terms]), and 'polycythemia vera with erythropoietin' in Google Scholar. RESULTS: Our research yielded four cases of PV with elevated EPO levels. The most common symptom was a headache. Thrombotic phenomena happened in a single case in the form of Budd-Chiari syndrome. The mean Hb level was 20.2 gm/dl, and the EPO level was 213 mlU/mL. DISCUSSION: Although PV is usually associated with low EPO levels, high levels do not exclude this diagnosis. Workup should include testing for JAK2 mutation and bone marrow biopsy in the presence of suggestive signs and symptoms. Novel biomarkers are also being proposed to aid in the diagnosis. CONCLUSION: Although elevated EPO levels suggest secondary causes of polycythemia, cases where elevated EPO levels were associated with an underlying PV are reported in the literature, and we have summarized a review of them. Workup for polycythemia should include JAK2 mutation testing if signs and symptoms suggest PV even if EPO is elevated.

Knowledge, attitude and practice of medical students towards COVID19 in Sudan: A cross sectional study among 19 universities.

Background: Since December 2019, an outbreak of severe respiratory infection (COVID-19) emerged in the city of Wuhan in China. The knowledge, awareness and practice of medical students toward COVID-19 pandemic is of most importance as it demonstrates their preparedness to deal with this pandemic. The objective of this study is to assess the knowledge, awareness and practice of medical students in Sudan universities about COVID 19. Methodogy: This is a cross-sectional study conducted on 19 universities that have medical schools in Sudan. Data from at least 100 medical students from each university were included in the study. Data were collected using an online questionnaire in April 2020. Statistical analysis was conducted using the Statistical Package for Social Science software, version 25. Results: About 2603 medical students from 19 universities were included. Overall good knowledge and practice were demonstrated by the medical students (88.9%) and (78.6%), respectively. Respondents who answered that the most common clinical symptoms of COVID-19 were the main combination of dry cough, fatigue and fever were (27.7%), and the first initial symptom was headache were (48.3%.). (60.2%) Wear medical masks, (95%) said that avoiding crowded places protects against the spread of COVID-19, and (50.7%) have confidence that Sudan can win the battle against the COVID-19. Finally, (68.8%) agreed that COVID-19 will finally be successfully controlled. Conclusion: This study has found that medical students in Sudan demonstrated good knowledge and good practice toward Covid19.

Non-immune Intravascular Hemolytic Anemia, an Unusual Presentation of Severe Vitamin B-12 Deficiency.

Vitamin B12 deficiency is a multifactorial condition, with a wide range of clinical presentations from mild to severe anemia and anemia-related neurological deficits. Hemolysis is a unique cause but has increasingly been recognized lately as a possible B12 deficiency presentation. Our patient presented with hemolytic anemia, for which extensive workup has excluded the common hemolysis etiologies. Therefore, it was attributed to B12 deficiency and improved significantly after treatment. Our case highlights the significance of this unusual presentation and its clinical implementation.

Splenic Infarctions in Polycythaemia Vera are Not Always a Catastrophe.

Splenic infarction can occur as an infrequent thrombotic manifestation in polycythaemia vera (PV) and is usually catastrophic. We describe the case of a middle-aged woman who was diagnosed with PV 3 months before she presented to the emergency department with acute limb ischaemia. A splenic infarction detected on diagnostic imaging during her hospital stay was treated conservatively with modification of her hydroxyurea dose along with pain management, without the need for surgery. LEARNING POINTS: Multiple splenic infarctions are an uncommon presentation in polycythaemia vera.Patients can present with vague abdominal pain, so a high index of suspicion is necessary and diagnosis is usually radiological.Splenic infarction in polycythaemia patients can be treated successfully with hydroxyurea and pain management with aspirin.

A Rare Case of COVID-19 Associated With Autoimmune Hemolytic Anemia, Thrombocytopenia and Acute Kidney Injury.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has numerous effects on different systemic organs other than the lungs. In this case report, we look at the presentation of a young female who was diagnosed with autoimmune hemolytic anemia (AIHA), kidney injury and thrombocytopenia during coronavirus disease 2019 (COVID-19) infection. She recovered well without the need for steroids. As demonstrated by this case, COVID-19 infection can be associated with the development of AIHA. The purpose of this report is to indicate that COVID-19 can present unusually with different clinical manifestations enough to require hospitalization.

An Unusual Presentation of Vitamin B12 Deficiency Associated With Massive Splenomegaly, Hemolytic Anemia, and Pancytopenia: A Case Report.

Deficiency of vitamin B12 usually presents with symptoms of anaemia or neurological dysfunction. We report a case of a young lady who was found to be vitamin B12 deficient with massive splenomegaly, haemolytic anaemia, and pancytopenia. She was thoroughly investigated for other causes of similar presentation. Her symptoms and blood count drastically improved after two weeks of therapy with vitamin B12 supplementation. After reviewing the literature on unusual cases of vitamin B12 deficiency, our case is a very interesting read as it serves as a reminder for health care providers to be alert for these manifestations, which can be treated by simply replacing vitamin B12.

Treatment Failure of Cerebral Venous Thrombosis With Rivaroxaban: A Case Report and Narrative Review.

Direct oral anticoagulants (DOACs) are approved for the treatment and prevention of venous thromboembolism (VTE), with multiple advantages they offer over the older available anticoagulant drugs. Cerebral vein thrombosis (CVT) is an uncommon type of stroke that is usually associated with intracerebral hemorrhage (ICH), for which early anticoagulation is still recommended to prevent thrombus expansion, to facilitate recanalization, and to prevent the development of deep vein thrombosis (DVT) and pulmonary embolism (PE). DOACs' use for the treatment of CVT is an area of clinical equipoise, and hence it is still not recommended especially in the acute phase. This case report presents a patient who was on a therapeutic dose of rivaroxaban after an episode of CVT. He developed another CVT that was evident on an intracranial CT (CT) venogram. This was considered a therapeutic failure of DOACs, specifically rivaroxaban, in preventing the recurrence of CVT. Such observation might add to the existing yet scarce body of evidence regarding the use of DOACs in the anticoagulation management of CVT.

Late-Onset Euglycemic Diabetic Ketoacidosis in a Patient With Massive Stroke Requiring Decompressive Craniectomy: A Case Report.

Euglycemic diabetic ketoacidosis (DKA) is a well-recognized adverse effect associated with the use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors. Early recognition of this medical emergency and timely intervention can prevent the notorious consequences of this serious complication. However, this form of DKA can easily be masqueraded by normal serum glucose levels. This article describes a 49-year-old man diagnosed with type 2 diabetes mellitus (DM) on dapagliflozin who presented with a large right-sided middle cerebral artery (MCA) stroke complicated by euglycemic DKA, developed 72 hours after stopping the drug. This case is unique considering that dapagliflozin's half-life is only 12.9 hours, and the body completely eliminates it within 72 hours. But our patient developed DKA features after the elimination window. Hence, this case highlights the importance to consider euglycemic DKA in the presence of ketonemia and metabolic acidosis in a patient who is a chronic SGLT-2 inhibitor user even if the drug was discontinued several days before the patient's presentation.