RESUMO
A 40-year-old female with a history of type 1 diabetes mellitus and solitary pancreas transplant, presented with pancreatic graft rejection 1-year post-transplant. Incidentally, a 1.1 cm right lower lobe cavity was identified during her workup. Given the augmentation of immunosuppression, voriconazole was empirically started for possible invasive pulmonary aspergillosis. As the patient was a painter, this resulted in a significant change in the colors of her paintings. Ultimately, she was diagnosed with pulmonary coccidioidomycosis and her visual disturbances resolved after the voriconazole was changed to fluconazole. Voriconazole causes visual disturbances in 20%-30% of the patients most commonly phototopsias; dyschromatopsias typically involving the tritan axis have also been reported. This case illustrates well the potential impact of voriconazole on spectral sensitivity and color perception.
Assuntos
Antifúngicos/efeitos adversos , Coccidioidomicose/tratamento farmacológico , Transtornos da Visão/induzido quimicamente , Voriconazol/efeitos adversos , Adulto , Arte , Cor , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Tomografia Computadorizada por Raios X , Triazóis/uso terapêuticoRESUMO
Some nonmotor symptoms (NMS) of Parkinson's disease (PD) have been shown to increase the risk of developing dementia. A total of 52 PD patients without dementia at baseline were examined for NMS over 36 months. Mini-Mental State Examination, Dementia Rating Scale-2, and caregiver-derived (Clinical Dementia Rating) scores were employed to rate patients as having either clear progression or not. Some 20 of 48 participants (41.7%) had clear cognitive decline. Univariate binary regression analysis was statistically significant for age (odds ratio [OR] (CI 95%)=1.24, 1.07-1.45, p=0.006) and orthostatic hypotension (OH) (OR (CI 95%)=4.91, 1.24-19.5, p=0.024). Multivariate analysis showed that only age (OR (CI 95%)=1.19, 1.0-1.41, p=0.05) and OH (OR (CI 95%)=5.57, 1.0-30.97, p=0.05) were correlated with an increased risk of cognitive decline. The presence of OH at baseline may be a significant predictor of progression to dementia in PD.
Assuntos
Demência/etiologia , Hipotensão Ortostática/complicações , Hipotensão Ortostática/etiologia , Doença de Parkinson/complicações , Idoso , Transtornos Cognitivos/complicações , Transtornos Cognitivos/etiologia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Escalas de Graduação PsiquiátricaAssuntos
Leucoencefalopatias , Paralisia Supranuclear Progressiva , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Humanos , Cápsula Interna/diagnóstico por imagem , Paralisia , Paralisia Supranuclear Progressiva/complicações , Paralisia Supranuclear Progressiva/diagnóstico por imagemAssuntos
Traumatismos do Nervo Facial/etiologia , Hipertensão Intracraniana/etiologia , Trombose dos Seios Intracranianos/complicações , Traumatismos do Nervo Facial/diagnóstico por imagem , Feminino , Humanos , Hipertensão Intracraniana/diagnóstico por imagem , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Trombose dos Seios Intracranianos/diagnóstico por imagem , Adulto JovemRESUMO
Liquid crystal display (LCD) screens refresh at a rate of 60 times per second, which can be perceived by concussed individuals who have photosensitivity, leading to computer intolerance. A non-LCD computer screen that refreshes at a much lower rate could relieve this photosensitivity and computer screen intolerance in patients with post-concussion syndrome (PCS). Twenty-nine patients with PCS, computer intolerance, and photosensitivity performed a reading task for a maximum of 30 min, with an LCD computer or a non-LCD device, and were given a comprehension test after completion of the reading task. The Sport Concussion Assessment Tool 3 was administered before and after each reading task. Symptom scores, amount of time spent reading, and performance on the comprehension tests were compared between the two devices. Patients also completed a self-report questionnaire of their subjective experience. The LCD screen computer produced significantly greater symptom exacerbation (median difference = 5, W = 315, p < 0.01) and a greater number of symptoms (median difference = 1, W = 148, p < 0.01) than the non-LCD screens. The non-LCD screen resulted in a longer symptom-free reading time (median = 48 sec, W = 147, p < 0.01), but not a greater number of words read (median = 281, W = 148, p = 0.098). Females were more likely to have greater symptom exacerbation with the LCD screen (U = 14.0, p < 0.01). No significant difference was found in performance on the comprehension test. Subjective reports showed that the non-LCD experience was more favorable, and most patients stated they would recommend this device for other patients with PCS. This study is the first to show the clinical utility of non-LCD screen computers in the management of photosensitivity and computer screen intolerance in patients with PCS. The non-LCD screen computer has the potential to facilitate return-to-work or return-to-school in concussed individuals.