1/15. Sensorineural hearing loss as the initial manifestation of polyarteritis nodosa.A 74-year-old male was referred for the sudden onset of bilateral sudden deafness. The patient had no history of any disease or trauma to the head. Pure tone audiometry revealed bilateral moderate, to severe, sensorineural hearing loss. Auditory brain stem responses (ABRs) showed normal peak and interpeak latencies. These audiological findings suggested that his hearing loss could be attributed to inner ear lesions. However, we felt an alternative explanation for this sudden deafness was likely to exist because the patient also had a month-long fever of unknown origin (FUO) and weight loss of 5 kg/month. Using the criteria of The American College of rheumatology, we made the diagnosis of polyarteritis nodosa (PAN). serum MPO-ANCA was positive (x 661). For treatment, the patient was begun on prednisolone and cyclophosphamide. Nine months later, fever, hypertension, nephritis, pneumonitis, and arthritis had completely resolved, the MPO-ANCA became negative (MPO-ANCA < x 10). Furthermore, his hearing improved.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/15. Subglottic hemorrhage following translaryngeal needle aspiration. Report of a case.A patient experienced an acute, brisk, endolaryngeal hemorrhage following an attempt at translaryngeal aspiration of tracheobronchial secretions. The bleeding was probably due to injury of the perforating branch of the cricothyroid artery or vein. The hemorrhage was controlled by a subglottic pack and tracheostomy.- - - - - - - - - - ranking = 0.23830183942693keywords = injury (Clic here for more details about this article) |
3/15. Thirty two years old patient with adult Still's disease.adult Still's disease is characterized by diverse clinical and laboratory findings, which may lead to errors in the differential diagnosis, and possible injury of the patient's health due to wrong therapeutic management. In the following case report, we describe a case of a 32-year old patient with fever of unknown etiology. The final diagnosis of Morbus Still adultorum was determined five months after his first check-up. The course of the disease was complicated by acute hepatitis caused by drug toxic damage. We have applied immunosuppressive therapy with very good clinical and laboratory responses. (Ref. 9.)- - - - - - - - - - ranking = 0.23830183942693keywords = injury (Clic here for more details about this article) |
4/15. thallium-201 accumulation in a patient with brain abscess.A 57-year-old man was admitted to our hospital because of high fever and generalized tonic seizure. Brain magnetic resonance imaging (MRI) delineated multiple abnormal intensity areas. thallium-201 (201Tl) scintigraphy revealed abnormal uptake in the brain. The imaging findings did not allow definitive exclusion of brain tumor, even though brain abscess was the more strongly suspected diagnosis. As the patient improved, the multiple abnormal intensity areas in the brain on MRI and the abnormal areas of accumulation on 201Tl scintigraphy were reduced, and eventually completely disappeared. A final diagnosis of brain abscess was therefore made. Since relatively few studies have reported 201Tl accumulation in cases of brain abscess, we report here our patient in whom the changes in the accumulation of 201Tl in a brain abscess were observed over time.- - - - - - - - - - ranking = 11keywords = brain (Clic here for more details about this article) |
5/15. Hyperpyrexia in catatonic states.A patient with an underlying brain disease and catatonia associated with fever of unknown origin, who responded to ECT is presented. The role of dopamine in the basal ganglia in the etiology of catatonic states and its possible relationship to the symptomatology of the patient and his response to ECT is discussed.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
6/15. herpes simplex virus infection limited to the brainstem.Focal meningoencephalitis is commonly caused by herpes simplex virus infection, which typically affects temporal or frontal lobes, and carries a mortality rate of 70% if untreated. On rare occasions, however, the infection is restricted to the brain stem. polymerase chain reaction analysis of cerebrospinal fluid is the gold standard for the diagnosis of herpes simplex encephalitis. A 46-year-old male was admitted to the hospital with a three-day history of headache and fever up to 39 degrees C. cerebrospinal fluid findings were in accordance with aseptic meningitis. On the third hospital day, the patient presented with double vision followed by confusion, and gaze paresis developed. The condition rapidly progressed from stupor to coma. A second examination of cerebrospinal fluid revealed a low glucose level (1.2 mmol/l) and cefotaxime with ampicillin were started empirically. All cerebrospinal fluid specimens were negative for bacteria and fungi. serum IgG antibodies for herpes simplex virus type 1 were found with no intrathecal specific antibody synthesis. A polymerase chain reaction analysis of cerebrospinal fluid sample performed on the seventh day of his illness was negative for herpes simplex virus 1 and 2. A computer tomography scan of the brain did not show any abnormality. Despite antimicrobial and supportive intensive care, the condition of the patient progressively deteriorated and he died on the 11th day after admission. An autopsy revealed hemorrhagic and necrotic brainstem meningoencephalitis, and herpes simplex virus type 1 infection was confirmed by hybridization in situ. herpes simplex virus encephalitis carries a mortality rate of 70% if untreated. The atypical location of the infection, as well as an atypical clinical manifestation with negative radiological and microbiological tests, could be the reasons for false diagnoses and mistreatment. Many authors advocate the use of empiric acyclovir in any patients with unexplained encephalopathy, since delay in treatment may greatly affect outcome. We describe a patient who died due to a herpes simplex virus 1 encephalitis affecting the brainstem, where nucleic acids were found post mortem by in situ hybridization. On rare occasions, the herpes simplex viral infection, as well as clinical manifestations and pathological changes, is restricted solely to the brainstem.- - - - - - - - - - ranking = 9keywords = brain (Clic here for more details about this article) |
7/15. Reverse Shapiro's syndrome--an unusual cause of fever of unknown origin.Reverse Shapiro's syndrome was first described by Hirayama et al. in a girl with periodic hyperthermia associated with complete agenesis of the corpus callosum. Here we report another such case in a 9-month-old girl presenting with fever of unknown origin since the age of 7 months. On examination, she had mild hypotonia with delayed developmental milestones. No other neurological or physical abnormalities were noted. The cause of her prolonged fever of unknown origin was investigated and all results were negative. Her brain magnetic resonance images showed agenesis of the corpus callosum. On the basis of the previous literature, we suggest that the periodic hyperthermia of this girl was caused by dopaminergic denervation of the hypothalamic thermoregulatory center. Treatment with dopamine agonists (levodopa plus carbidopa) failed to control the hyperthermia.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
8/15. A clinical report of adverse health effects due to bed sharing in two children with spinal cord injury and traumatic brain injury.This paper explores the possibility that bed sharing may carry particular risks for children with special healthcare needs (CSHCN). Two cases of CSHCN who may have sustained adverse health effects from bed sharing are described. These two case reports indicate that CSHCN may be particularly susceptible to risks associated with bed sharing. Healthcare providers for CSHCN may need to inquire about patients' sleeping arrangements and, when bed sharing is acknowledged, provide counseling regarding the potential risks and benefits. They may need to monitor more closely for adverse events when bed sharing is a factor and should consider reporting health problems that may have occurred in concurrence with bed sharing.- - - - - - - - - - ranking = 5.9064147154154keywords = brain, injury (Clic here for more details about this article) |
9/15. Fibroproliferative phase of ARDS. Clinical findings and effects of corticosteroids.Most patients with adult respiratory distress syndrome (ARDS) survive the initial insult which caused respiratory failure only to succumb later to sepsis caused by nosocomial pneumonia or to pulmonary fibrosis. Clinical criteria and analysis of the tracheal aspirate are notoriously inadequate for establishing a diagnosis of ventilator-associated pneumonia. We implemented a comprehensive diagnostic protocol to determine the cause of sepsis in ARDS patients who had been ventilated for more than three days and who had no bronchoscopic evidence of pneumonia. Nine patients with late ARDS who had fever (89 percent), leukocytosis (89 percent), a new localized infiltrate (78 percent), purulent tracheal secretions (89 percent), low systemic vascular resistance (50 percent), and marked uptake of gallium in the lungs (100 percent) had no source of infection identified. Open-lung biopsy specimens from seven patients showed the fibroproliferative phase of diffuse alveolar damage and confirmed absence of pneumonia. Treatment with prolonged high doses of corticosteroids was associated with a marked and rapid improvement in lung injury score (p less than 0.003 at five days). Our findings indicate that the fibroproliferative process occurring in the lungs of patients with late ARDS gives rise to clinical manifestations identical to those of pneumonia and is potentially responsive to steroid treatment.- - - - - - - - - - ranking = 0.23830183942693keywords = injury (Clic here for more details about this article) |
10/15. fever of unknown origin following traumatic brain injury.Fever is a common complication of a traumatic brain injury, occurring during both the acute-care phase and the rehabilitation phase of recovery. The aetiology of fever in this population may remain obscure because of the presence of cognitive confusion associated with post-traumatic amnesia interfering with history taking and the difficult physical examination. We present a case where recovery from a traumatic brain injury was complicated by a fever of unknown origin that proved to be secondary to lateral sinus thrombophlebitis. This case emphasises the importance of a thorough knowledge of the differential diagnosis for fever that is unique to the traumatic brain injury population.- - - - - - - - - - ranking = 8.6681128759885keywords = brain, injury (Clic here for more details about this article) |
| | Next -> |