A Case of Steroid-Associated Expressive Aphasia.

Expressive aphasia (non-fluent aphasia) is characterized by the inability to produce words or sentences. The most common cause of expressive aphasia is stroke, usually due to thrombus or emboli in the middle cerebellar artery or internal carotid artery affecting Broca's area. We present an important, reversible, and previously undescribed cause of a purely expressive aphasia secondary to steroid use. A case of a steroid-induced expressive aphasia has not yet been described in the medical literature. Recognition of this presentation is critical to appropriate therapy and excess morbidity, particularly as steroid (dexamethasone) utilization has increased since the COVID-19 pandemic.

Paraplegia From a Spinal Epidural Abscess Caused by Pasteurella multocida.

Pasteurella multocida is a common cause of infection following bites or scratches caused by cats and dogs. It is a rarely reported and often overlooked pathogen. Typical presentation is a rapidly developing cellulitis at the infection site. Here we present a rare case of worsening lower extremity paraplegia due to a spinal epidural abscess caused by P. multocida. The patient was a 56-year-old female who had been experiencing several days of back pain, became septic and went on to develop paraplegia. Failure to improve prompted re-evaluation of the diagnosis with subsequent imaging notable for a spinal epidural abscess. Blood cultures grew P. multocida but were initially misidentified as Haemophilus influenzae and only with targeted antibiotic therapy and neurosurgical intervention did she begin to improve. Obtaining an animal history and knowing when to re-evaluate a diagnosis are essential skills for any clinician.

Identification of key signaling pathways induced by SARS-CoV2 that underlie thrombosis and vascular injury in COVID-19 patients.

The SARS-CoV-2 pandemic has led to hundreds of thousands of deaths and billions of dollars in economic damage. The immune response elicited from this virus is poorly understood. An alarming number of cases have arisen where COVID-19 patients develop complications on top of the symptoms already associated with SARS, such as thrombosis, injuries of vascular system, kidney, and liver, as well as Kawasaki disease. In this review, a bioinformatics approach was used to elucidate the immune response triggered by SARS-CoV-2 infection in primary human lung epithelial and transformed human lung alveolar. Additionally, examined the potential mechanism behind several complications that have been associated with COVID-19 and determined that a specific cytokine storm is leading to excessive neutrophil recruitment. These neutrophils are directly leading to thrombosis, organ damage, and complement activation via neutrophil extracellular trap release.

Ovarian hyperstimulation syndrome and thrombotic events.

Ovarian hyperstimulation syndrome (OHSS) is one of the most important complications of ovarian stimulation with severe morbidity and is still a threat to every patient undergoing ovulation induction. This manuscript reviews the current evidence regarding the relationship between OHSS and thromboembolism in infertile patients undergoing ovarian stimulation published in the world literature. The PubMed Database was searched for publications on reported cases of OHSS and thromboembolic phenomenon published between 1965 and 2013. One hundred and forty cases of OHSS and thromboembolic phenomena were retrieved. The vascular accident had already occurred in the first cycle of treatment among 119 women (85%), at early stage of OHSS in 43% and late stage in 57% of cases. Venous thrombotic events were recorded mostly in unusual sites, jugular, and subclavian veins, with 69 and 38 thrombotic events, respectively. Coagulation status was found at 86 of the 140 cases (61%). Fifty-three of the pregnant patients (68%) delivered singleton births and 47% had preterm deliveries, and termination of pregnancy was indicated in 11 cases (14%). The most serious complication associated with OHSS is thrombotic phenomena as shown in the present review of 140 cases, world data, on both arterial and venous side. Thromboprophylaxis should be initiated in patients with thrombophilia and who develop moderate-to-severe OHSS.