1/8. Usefulness of magnetic resonance spectroscopy for diagnosis of hepatic encephalopathy in a patient with relapsing confusional syndrome.magnetic resonance spectroscopy allows the assessment of several metabolites in brain tissue. In patients with hepatic encephalopathy, this technique shows a rise in glutamine and a decrease in myoinositol in brain tissue. However, the role of magnetic resonance spectroscopy in the diagnosis of hepatic encephalopathy is not known. We report the case of a patient with a relapsing confusional syndrome who underwent magnetic resonance spectroscopy. Previously, hepatic encephalopathy was ruled out because of the negative results of a transjugular liver biopsy and normal hepatic venous pressure gradient. The results of magnetic resonance were characteristic of hepatic encephalopathy. Abdominal computed tomography demonstrated large portosystemic shunts associated with cirrhosis of the liver. This case shows that magnetic resonance spectroscopy is an useful technique for the diagnosis of hepatic encephalopathy in selected cases, such as those without clinical signs of cirrhosis and/or large portosystemic shunts.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/8. Posterior leukoencephalopathy in a girl with acute haemorrhagic leukoencephalitis.In children, posterior leukoencephalopathy is frequently associated with hypertensive encephalopathy, anticancer chemotherapy, treatment with immunosuppressive drugs in patients with organ transplantation, transfusion or human immunodeficiency virus infection. Posterior leukoencephalopathy in these children appears as a complicating illness and resolves once precipitating factor (e.g. cancer chemotherapy) is removed. Here we are reporting a fatal case of acute haemorrhatic leukoencephalitis in a 13 year old girl, imaging abnormalities are also suggestive of posterior leukoencephalopathy. Posterior leukoencephalopathy in our patient possibly, is a part of post-infectious haemorrhagic leukoencephalitis, rather than because of ischaemia or cerebral oedema secondary either to abrupt increase in blood pressure or following administration of immunosuppressive drugs.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/8. confusion as the presenting manifestation of vertebral osteomyelitis: a case report.A 44-year-old patient presented with increasing confusion. He was first diagnosed as having intermittent pressure hydrocephalus but a further evaluation showed CSF pleocytosis and hypoglycorrhachia. Five weeks later, his physical examination was unrevealing. Nuclear imaging techniques were conflicting, with negative gallium- and indium-labelled white blood cells scans but a Tc scan pointing towards a vertebral infection. A well-demarcated lesion in the T9 vertebral body, demonstrated by CT scan, confirmed the diagnosis of vertebral osteomyelitis. Although we were unable to recover the causative organism, antibiotic treatment for presumed staphylococcal osteomyelitis resulted in full recovery. This case indicates that vertebral osteomyelitis may cause significant meningeal inflammation even in the absence of epidural or subdural abscess. We recommend that in patients with meningitis without a clear etiology vertebral osteomyelitis should be considered and pursued with CT scannings of the vertebrae, a procedure that can yield positive findings even when other scanning modalities are negative.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/8. Mental confusion in the elderly.Etiologies of confusion are discussed, including vascular, infectious, toxic-metabolic, tumorous, convulsive, and vitaminologic. Other diverse conditions are reviewed, including normal-pressure hydrocephalus.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/8. Sexual intercourse as a precipitating factor of transient global amnesia.A Japanese female case of transient global amnesia (TGA), who developed an amnesic episode after sexual intercourse, is reported. The mechanism of how TGA in the present case is precipitated by sexual intercourse could be explained by the elevated blood pressure during sexual intercourse that drops rapidly, causing a temporal ischemia in the distribution of the basilar artery. Furthermore, the importance of sexual intercourse as a precipitating factor of TGA is stressed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/8. Early, fatal disseminated intravascular coagulation in a patient with 60 per cent burns.A 23-year-old, previously fit and healthy young man was admitted to the West Midlands Regional burns Unit at the Birmingham Accident Hospital, with 60 per cent body surface area burns and smoke inhalation. On arrival, he was briskly tachycardiac, hypotensive and disorientated. He was admitted to the intensive care unit, intubated and started on intermittent positive pressure ventilation. Despite prompt commencement of resuscitation and the infusion of enormous volumes of colloids, the patient remained oliguric. He soon developed severe haemorrhage from his gastrointestinal, urinary and respiratory tracts. He required several units of blood, but was persistently hypotensive. His condition deteriorated rapidly despite intensive supportive measures. He developed metabolic acidosis, refractory hypotension and died anuric, 20 h later. The post-mortem examination showed the presence of disseminated intravascular coagulation and adult respiratory distress syndrome.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/8. A confused man with rapid respiration.A 71-year-old man presented with incoherent, slurred speech, auditory hallucinations, and tachypnea. According to the neighbor who called for emergency medical service, the man had appeared to be in good health the day before. On admission, his blood pressure was normal.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/8. Acute delirium as a manifestation of obstructive sleep apnea syndrome.Cognitive deficits and psychiatric manifestations such as depression and psychosis have been associated with obstructive sleep apnea (OSA) syndrome. We report a patient with OSA admitted to our center because of acute delirium of sudden onset at night, during sleep, and which impelled the patient to jump out of the window of his home. After exhaustive study, no other causes were found for the delirium, which resolved when nasal continuous positive airway pressure (nCPAP) was initiated. We believe that it is clinically important to be aware of this association, since it identifies a new, treatable cause of delirium.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |