Left Ventricular Noncompaction Cardiomyopathy Diagnosis in a Patient Presenting with Epileptic Seizure: A "Double-edged Sword".

Transient loss of consciousness (TLOC) is a common presentation to emergency departments and may be due to syncope or epileptic seizures. The distinction between both entities can be challenging. This case illustrates the need for a multidisciplinary team approach in TLOC to avoid misdiagnosis leading to improper treatment.

A Rare Case of Fahr's Syndrome in a Patient with Secondary Hypoparathyroidism and Neuropsychiatric Symptoms.

BACKGROUND: Fahr's syndrome, also known as basal ganglia calcification, is a rare neurodegenerative disorder characterized by radiological findings of symmetrical and bilateral idiopathic abnormal deposits of calcium in areas of the brain that control motor activity, including the basal ganglia and the cerebral cortex. There is neither a specific cure, nor a standard treatment for Fahr's syndrome and treatment is primarily symptomatic. Brain imaging has gained widespread use in order to support clinicians in diagnosing intracranial calcifications. CASE PRESENTATION: We present a case of an 83-year-old female patient who presented with symptoms of confusion, fever, nausea, and vomiting. Clinical diagnosis of Fahr's syndrome secondary to hypopathyroidism was based on the neuropsychiatric signs and symptoms, laboratory evidence of hypoparathyroidism, and radiological signs of calcifications in the basal ganglia. The patient improved following replacement therapy with calcium gluconate, followed by oral supplemental calcitriol. CONCLUSION: This case highlights the importance of considering organic causes when patients present with neuropsychiatric disturbances, especially following thyroidectomy.

Right drug, wrong dosage: insights from the PAVE-AF antithrombotic study in older patients with atrial fibrillation.

Optimal antithrombotic treatment of older patients is usually impeded by several prevailing misconceptions. The aim of our study was to assess the type, dosage and predictors of antithrombotic therapy in older patients with non-valvular atrial fibrillation (NVAF). PAVE-AF was a prospective, cross-sectional study, including NVAF patients ≥ 80 years from 30 participating centers. Demographic data, comorbidities and treatment patterns were documented in a single visit. Patients treated with non-vitamin K oral anticoagulants (NOACs) were further classified into three dosing categories (recommended, underdosing and overdosing). Among 1018 patients (85.4±4.0 years), 88.4% received anticoagulants (AC), 8% antiplatelets (AP) and 3.6% no treatment. The primary reason for AP administration was physician concern of bleeding followed by patient denial. Patients ≥90 years had two times greater probability to receive AP therapy compared to patients < 90 years. Among patients treated with AC, one third received vitamin K antagonists, while two thirds received NOACs [34.6% apixaban, 9.5% dabigatran and 22.6% rivaroxaban]. Independent predictors of AC prescription over AP or no treatment were low HAS-BLED score, hypertension, labile INR, permanent AF, absence of uncontrolled hypertension, prior stroke/systemic embolism, age and male gender. In total, 37% of NOAC recipients received inappropriate dosage, while the number of patients receiving recommended dosing differed significantly among NOAC subgroups (p < 0.001). In our study, a minority of older NVAF patients received AP or no therapy for stroke prevention. Among patients treated with anticoagulants, two thirds were on NOAC treatment, though with a considerable proportion of inappropriate dosing.