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Treatment of Nocardial Brain Abscess in a Patient With Systemic Lupus Erythematosus and Idiopathic Thrombocytopenic Purpura: Case Report and a Review of the Literature.

Brain abscesses due to Nocardia species account for 1-2% of all cerebral abscesses, often in immunosuppressed individuals, with a mortality three times higher than other cerebral abscesses. Early diagnosis and management are vital for good outcomes. We report a case of a right frontal Nocardia brain abscess in an immunosuppressed 38-year-old female. She presented with headaches, confusion, memory deficits, and personality change. She remained systemically well, with normal inflammatory markers. She underwent two open surgical drainages, with excision of the abscess wall. She made an excellent …

Seronegative limbic encephalitis manifesting as subacute amnestic syndrome: a case report and review of the literature.

BACKGROUND: Limbic encephalitis (LE), a variant of autoimmune encephalitis, is inflammation of the limbic system of the brain. The disorder presents with subacute impairment of short-term memory, psychiatric manifestations, confusion and seizures. "Seronegative LE" is a challenging diagnosis in the absence of well-characterized autoantibodies. CASE PRESENTATION: A 33-year-old Kuwaiti woman with no relevant past history presented with subacute progressive amnesia of 6-month duration. Magnetic resonance imaging (MRI) showed bilateral hyperintensity of the limbic structures. An extensive workup …

[Paraneoplastic limbic encephalitis complicating pulmonary adenocarcinoma: a case report].

Limbic encephalitis (LE) is a rare disease often of paraneoplastic origin. It is frequently associated with bronchopulmonary cancer. Diagnos … rted a recent history of memory disturbances associated with depressed mood, anxiety and paroxysmal confusion. Metabolic screening and tests for detecting infection were normal and brain MRI suggested limbic encephalitis. The evolution was characterized by rapid disease progression; the patient died in about ten days.

Stiff Person Syndrome and Encephalitis with GAD Antibodies with Severe Anterograde Amnesia in an Adolescent: A Case Study and Literature Review.

Antiglutamic acid decarboxylase (GAD65) encephalitis is rare and few pediatric cases have been reported, with variable clinical presentations. A 14-year-old female adolescent was managed in our department. She had been treated for several months for drug-resistant temporal lobe epilepsy and gradually presented major anterograde amnesia with confusion. Upon her arrival at the University Hospital Centre, she showed a classical form of stiff person syndrome. The brain magnetic resonance imaging showed bitemporal hyperintensities and hypertrophy of the amygdala. The blood and cerebrospinal fluid w…

Bilateral Facial Nerve Palsy in a Young Woman From West Bengal: Do Not Forget Lyme Neuroborreliosis.

Borrelia burgdorferi can affect the nervous system in various ways, which can generate significant confusion and dilemma regarding diagnosis. From India, a country until recently known to be a nonendemic zone for Lyme disease, several cases and one study of Lyme neuroborreliosis have been published. The aim of this study was to describe a young woman with bilateral facial nerve palsy as the presenting manifestation of Lyme neuroborreliosis. We herein report a case of a lactating woman with acute onset progressive ascending flaccid tetraparesis that was preceded by a misdiagnosed bilateral faci…

Left Amyand's hernia associated with omphalocele.

INTRODUCTION: Amyand's hernia is defined as the presence of the cecal appendix inside the hernia sac. It is usually located on the right sid … classification. In left-sided hernias, prophylactic appendectomy is recommended to avoid diagnostic confusion in case of appendicitis.

A unique finding of the basilar artery.

Variants of the posterior intracranial circulation are important for surgeon, interventionalists and radiologists. Herein, a unique configuration of the basilar artery is reported. A 54-year-old man with a history of COPD, hypothyroidism, smoking, and hyperlipidemia presented to an outside institution with nausea, confusion, altered mental status, and ataxia. The patient was evaluated for stroke. Imaging revealed rotation of the basilar apex of 180 degrees, fetal configuration of the posterior communicating artery, right posterior cerebral artery filling from the left vertebral artery, and dup…

Antibody-negative autoimmune encephalitis as a complication of long-term immune-suppression for liver transplantation.

Autoimmune encephalitis is a rare spectrum of disease that can be a complication of chronic immunosuppression. Diagnosis often requires the … splant recipient taking tacrolimus for prevention of chronic rejection who presented with 5 days of confusion, lethargy and lightheadedness. He was diagnosed with AbNAE after an extensive workup and recovered fully after high-dose corticosteroids. Our case highlights the importance of recognising the association between chronic immunosuppression and autoimm …

[Severe delirium after GHB abuse].

BACKGROUND: The management of benzodiazepine-resistant GHB withdrawal requires careful consideration of GHB pharmacodynamics. CASE PRESENTATION: A young woman was admitted with tachycardia, confusion, agitation and delusions the day after attempting to quit a daily, high-dose GHB habit. A total of 225 mg of diazepam had no effect. She was sedated with propofol and intubated. An extubation attempt after 24 hours was followed by recurrence of delirium. After reintubation she required high doses of propofol, alfentanil and dexmedetomidine to maintain sedation for two days. Baclofen and diazepam …

Safety and Tolerability of an Innovative Virtual Reality-Based Deep Breathing Exercise in Concussion Rehabilitation: A Pilot Study.

To examine the safety and tolerability of a virtual reality-based deep breathing exercise for children and adolescents who are slow to recov … icipants reported significant decreases in stress (r =.57), tension (r =.73), fatigue (r =.73), and confusion (r =.67), with large effect sizes, following the deep breathing exercise. Conclusion: A brief, virtual reality-based deep breathing exercise is worthy of additional study as a rehabilitation component for children and adolescents with prolonged conc …

An exploratory evaluation of the potential pulmonary, neurological and other health effects of chronic exposure to emissions from municipal solid waste fires at a large dumpsite in Olusosun, Lagos, Nigeria.

Open municipal solid waste (MSW) combustion is a major emission source of particulate air pollution, polycyclic aromatic hydrocarbons, and m … hiteness of fingers (2.614), headaches (2.725), memory problems (2.869), tremor/cramps (2.748), and confusion (3.033) among other symptoms. These results indicate adverse health impacts of chronic exposure to MSW combustion emission.

Case report of persistent elevation of βhCG in a nonpregnant woman: A diagnostic puzzle.

Detectable serum levels of beta subunit of human chorionic gonadotropin (βhCG) in nonpregnant, perimenopausal women bring confusion in both clinician and patient and could lead to unnecessary diagnostic and therapeutic procedures. A 45-year-old woman with the continuous elevation of βhCG underwent hysteroscopy, two laparoscopic surgeries, two explorative uterine cavity curettages and three cycles of cytostatic therapy. No ultrasonographic, macroscopic or histological signs of pregnancy, both uterine and ectopic or gestational trophoblastic disease were found. Both radiographic and computed tom…

An Unusual Acute Cyanide Intoxication.

Suicide with cyanides is relatively rare but highly lethal. The lethal oral dose of cyanide salts is 200 mg, and concentrations >3 mg/L may be potentially lethal. The symptoms of poisoning are predominating in the central nervous system and cardiovascular system. We report the case of a 43-year-old goldsmith man who presented with self-poisoning by cyanide salt ingestion. Patient's symptoms included confusion, cardiac arrhythmias, hyperkalemia, leukocytosis, metabolic acidosis with high anion gap, hypotension, and then hypertension. The cause of the patients poisoning was not initially diagnos…

Varicella-Zoster Meningitis With Hypoglycorrhachia in an Immunocompetent Patient Presenting With Disseminated Varicella-Zoster Infection.

Varicella-zoster virus (VZV) infection is rarely reported in immunocompetent hosts. We report the case of a 40-year-old male who presented w … dache. Given his migraine history, he overlooked the headache. He then developed fever, followed by confusion and was brought to the ED for further evaluation. CT head was unremarkable. Lumbar puncture revealed aseptic meningitis. This case highlights the unusual presentation of disseminated VZV infection in an immunocompetent host. It stresses the importan …

Analysis of Tuberculosis Meningitis Pathogenesis, Diagnosis, and Treatment.

Tuberculosis (TB) is the most prevalent infectious disease in the world. In recent years there has been a significant increase in the incide … ache, fever, or personality change, followed by protracted headache, stroke, meningismus, vomiting, confusion, and focal neurologic findings in two to three weeks. If untreated, mental status deteriorates into stupor or coma. Delay in the treatment of TBM results in, either death or substantial neurological morbidity. This review provides latest development …

Endobronchial fungal infection caused by Candida albicans with main bronchus obstruction: a case report.

Endobronchial fungal infection (EBFI) is a rare form of pulmonary fungal infection that especially affects immunocompromised patients. Furthermore, EBFI resulting in obstruction of the main bronchus is extremely rare. With the development of bronchoscopic techniques, rare cases of EBFI have been reported. A 68-year-old female was referred to the Department of Pulmonology for confusion and obtundation. The patient was diagnosed with septic shock due to acute pyelonephritis followed by obstructive EBFI. We performed bronchoscopic biopsy and endobronchial aspiration for culture. Biopsy showed yea…

Оценка клиентов, имеющих сексуальные одержимости

В этой главе рассматриваются наиболее важные соображения при оценке клиента с сексуальной одержимостью в рамках ОЦД. Клиенты, как правило, испытывают все большее чувство стыда в связи с симптомами и одержимостью причиной и значением одержимости, и эта глава служит руководством для терапевтов в ходе первоначальных консультаций. Также рассматриваются рекомендуемые стратегии оценки и полезные клинические инструменты с таблицей мер. Дифференцированный диагноз S-OCD против педофилического расстройства и путаницы в сексуальной идентичности контрастирует. Кроме того, приводятся примеры ОКР в связи со

Совпадение в аннотации оригинала
This chapter reviews the most important considerations when assessing a client with sexual obsessions within OCD (S-OCD). Clients typically … table of measures. Differential diagnosis for S-OCD versus pedophilic disorder and sexual identity confusion are contrasted. Also provided are examples of OCD surrounding transgender fears, bestiality fears, and S-OCD with psychosis. Clients with OCD are often undermedicated by their physicians, and so included is a review of medication options for OCD and …

Opsoclonus Myoclonus Syndrome: A Rare Manifestation of Dengue Infection in a Child.

Opsoclonus myoclonus syndrome (OMS) is an inflammatory neurological disorder, which is characterized by chaotic uncontrolled movements of the eyes and involuntary jerk-like movements of the body. Different modalities of treatment have been described in medical literature to treat OMS. Immunomodulatory treatment with either steroids or intravenous immunoglobulin has been considered. Our case was a 14-year-old boy who presented with fever, mild confusion, without any seizures or focal deficits. On examination, he had opsoclonus in his eyes and had cortical myoclonus in his hands and body. On eva…

Understanding the hepatitis B core positive liver donor.

The increasing number of patients on the Singapore national liver transplant waiting list and the lack of donor livers have necessitated a r … phylaxis significantly reduce the risk of hepatitis B viral reactivation. This article explains the confusion surrounding OBI and reviews current recommendations on how to manage such donor liver grafts.

Acute encephalopathy secondary to dabrafenib and trametinib in BRAF-positive metastatic adenocarcinoma of the lung.

Acute encephalopathy secondary to targeted therapy with BRAF inhibitors is uncommon. There are few case reports in patients with metastatic melanoma who received treatment with dabrafenib and trametinib, and developed acute confusion. The encephalopathy appears to resolve after the discontinuation of offending drug, with patient returning to their baseline mentation and functional ability. The mechanism of the encephalopathy has been unclear. Unlike posterior reversible encephalopathy syndrome, which has been reported with vemurafenib and cobimetinib combination in melanoma patients, there are…