Agitation and somnolence by bilateral paramedian thalamic infarct.

Key Clinical Message: Bilateral thalamic infarction in paramedian artery territory may present with severe acute illness, confusion, coma and memory impairment. However, subtle clinical presentation as in our case should alert the clinician to consider such a diagnosis as it can be associated with good prognosis. Abstract: Bilateral thalamic infarct is a rare form of stroke. Mostly thalamic infarcts are unilateral. In most cases, bilateral thalamic infarction leads to cognitive dysfunction, opthalmoparesis, conscious impairment, behavioral disturbance, and corticospinal dysfunction. Here, we describe the case of a 75-year-old male patient who presented to the emergency department of our hospital with agitation and somnolence for one day. He had poorly controlled hypertension. There was no previous history of stroke, diabetes mellitus, hyperlipidemia, known cardiac disease, or smoking history. There was no seizure, recent headache, or visual disturbance. The patient was somnolent and not oriented to time, person, or place. Neurological examination did not show any focal weakness or vertical eye movement restrictions. Other systemic examinations, including those of the respiratory and cardiovascular systems, were unremarkable. Extensive laboratory investigations excluded potential metabolic, infectious, endocrine, or toxic etiologies. The patient did not have any recent history of drug misuse, including benzodiazepines. Brain MRI with diffusion-weighted imaging showed an acute bilateral thalamic infarct. Cerebral angiography was unremarkable. The patient was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg daily, and haloperidol 5 mg twice daily for agitation. After two weeks of intrahospital treatment, his condition improved (consciousness and orientation massively improved).

Lateral medullary syndrome: uncommon form of brainstem stroke.

Lateral medullary syndrome (LMS) is a less common form of a brainstem stroke. It is the result of occlusion of the posterior inferior cerebellar artery (PICA). It is caused by atherosclerosis, thrombosis, or emboli from another source. Case Presentation: A 60-year-old male patient presented to the emergency department with vertigo, vomiting, slurred speech, hiccups, and left-side weakness associated with paresthesia for 1 day. He had a past medical history of uncontrolled hypertension and a smoking habit. The neurological examination revealed ataxia, and left hemiparesis associated with paresthesia. A cranial nerve examination revealed slight right-sided ptosis, mouth deviation, and loss of sensory sensation on the right side of the face. Brain MRI showed right medullary infarct consistent with LMS. Electrocardiogram, echocardiography, and vertebral artery color Doppler were normal. He was admitted to the neurology ward and was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg, neuroprotective agents, and antihypertensive treatment. After 6 days of medical treatment, his condition has improved massively (dysarthria and dysphagia disappeared). He was discharged for physical rehabilitation. Clinical Discussion: LMS (Wallenberg syndrome) is one of the brainstem stroke syndromes caused by occlusion of PICA. Vertigo, vomiting, dysphagia, dysarthria, ipsilateral ataxia, Horner's syndrome, and contralateral hemiparesis define this syndrome. Brain MRI is necessary for diagnosis alongside clinical syndrome. Conclusion: LMS is a rare form of brainstem stroke and carries a favorable prognosis if early hospitalization and treatment is applied. Brain MRI, including diffusion sequence, is the most useful diagnostic tool for detecting LMS.

Spontaneous Bilateral Basal Ganglia Hemorrhage Due to Severe Hypertension.

Introduction: The basal ganglia, which comprise many subcortical nuclei, constitute an integrated functional unit of the brain. Spontaneous hemorrhage of the basal ganglia is mostly unilateral and secondary to uncontrolled hypertension. Simultaneous bilateral basal ganglia hemorrhage (SBBGH) is very rare. So far, only 40 cases have been documented so far. Case Presentation: Here, we report a 37-year-old man with a past medical history of uncontrolled hypertension who was brought to the emergency department due to severe headache, worsening confusion, and right-sided weakness for 2 days. An urgent non-contrast brain CT performed immediately revealed bilateral intracerebral hemorrhage (ICH) of the same age in the basal ganglia. On admission, blood pressure was 220/120. Other vital signs were normal. The patient was admitted to the ICU, IV antihypertensive and antiedema medications were given. After clinical improvement, he was transferred to the neurology ward on the fifth day. After another 5 days in the neurology inpatient ward, the patient clinically improved and was referred to the rehabilitation department. Conclusion: Due to the rarity of SBBGH, it is particularly interesting to report this remarkable case of a man with simultaneous spontaneous bilateral ganglia hemorrhage secondary to uncontrolled hypertension.

Loss of Taste and Smell are Common Clinical Characteristics of Patients with COVID-19 in Somalia: A Retrospective Double Centre Study.

PURPOSE: The purpose of this study was to identify the common clinical presentations and the evidence on the presence of ageusia and anosmia as an emerging coronavirus disease 2019 (COVID-19) symptom to better inform in both COVID-19 patients and clinicians. PATIENTS AND METHODS: As part of a double-institutional collaboration coordinated by doctors, this study retrospectively collected and analyzed the clinical characteristics of 60 patients with COVID-19 pneumonia between April 1 and April 20, 2020. Pregnant women and patients taking anti-cancer drugs had been excluded from the study. Data from each institution's electronic medical record had been obtained. RESULTS: Sixty patients who had RT-PCR positive for COVID-19 were included in this study; of these patients, all of them had unknown exposure to COVID-19. The mean (SD) age was 45.7 (13.5) years, and 42 were men (70%). Of these patients, 80% had at least ageusia or anosmia. The most common symptoms at the onset of illness were cough (75%), fever (71.3%), myalgia or fatigue (53.3%), anosmia (loss of smell) (40%), ageusia (loss of taste) (28.3%), sore throat (25%), shortness of breath (16.7%), headache (16.7%), and GI symptoms (diarrhea, nausea, vomiting and loss appetite) (16.7%). A total of 68.3% of COVID-19 infected patients had reported either loss of taste or smell, and about 33.3% of them had only loss of smell, while 23.3% of them had impaired taste, and 11.7% of COVID-19 infected patients had both taste and smell loss. CONCLUSION: During the epidemic period of SARS-CoV-2 infection, when presenting patients with ageusia and anosmia, physicians should consider COVID-19 pneumonia as a differential diagnosis to achieve early identification, avoid the delayed diagnosis, and prevention of transmission.