OpenMed/multicare-articles huggingface dataset:
Management of Cerebral Herniation Secondary to Lead Encephalopathy: A Case Report
Authors: Somnath Das, Felicia Hataway, Hunter S Boudreau, Yasaman Alam, Jordan A George, William Rushton, Sukhshant Atti, Manmeet Kaur, Marshall T Holland
Journal: Front Neurol (2022)
Keywords: intracranial pressure, lead encephalopathy, lead toxicity, neurocritical care, ventriculostomy
MeSH terms: Case Reports

Background:
Adult lead encephalopathy is a rare but critical condition to recognize in modern healthcare settings. Few reports have described the medical and neurosurgical management of severe adult lead encephalopathy.
Case presentation:
A 22 year old woman presented with severe headache, anemia, vomiting, 40-lb weight loss, and constipation. At the time of presentation, she had extensive colonic radiopaque material and a serum lead concentration of 87 mcg/dl (normal <10). She rapidly developed anisocoria requiring emergent ventriculostomy insertion. Following CSF diversion, ICP mitigation, and lead chelation, she considerably improved in <2 weeks.
Conclusion:
We report one of the few instances of successful surgical and medical management of adult lead encephalopathy. Dedicated neurocritical care and neurosurgical teams are necessary in conjunction with toxicology in order to manage the advanced sequalae of severe lead poisoning.
Atypical Presentation of Hirayama Disease Involving the Cervico-Thoracic Segment Causing Diagnostic Dilemma: A Case Report
Authors: Sanket Mishra, Deepankar Satapathy, Nego Zion, Udeepto Lodh
Journal: Cureus (2023)
Keywords: hirayama disease, juvenile muscular atrophy, lower motor, monomelic amyotrophy, thoracic spine
MeSH terms: Case Reports

Hirayama disease, also known as monomelic amyotrophy, usually affects young males who initially experience increasing muscle weakness and atrophy of the distal upper limb before experiencing a sudden plateauing of symptom progression a few years later. It is a form of cervical myelopathy characterized by self-limiting, asymmetrical lower motor weakness of the upper limbs affecting the hands and forearms. This condition is brought on by the cervical dural sac and spinal cord being abnormally displaced forward during neck flexion, which causes the anterior horn cells to atrophy. However, research into the precise process is ongoing. Patients presenting with such features with additional atypical symptoms, like back pain, weakness, atrophy and paresthesia of lower extremities cause a diagnostic dilemma. We describe a case of a male patient, age 21, who complained of weakness in both upper limbs mostly on the hand and forearm muscles along with weakness and deformity in both lower limbs. He was diagnosed with atypical Cervico-thoracic Hirayama disease and treated.
Dynamic change of intestinal duplication in an adult patient: a case report and literature review
Authors: Abhishek Shah, Jimin Du, Yutian Sun, Dianbo Cao
Journal: Case Rep Med (2012)

Intestinal duplication in an adult is an uncommon congenital abnormality because only minority of cases present in adulthood. More than 80% of cases occur before the age of two years as an acute abdomen, bowel obstruction or other complications associated with it. Duplication has two types, either cystic or tubular. Here, we report a case of an adult who was diagnosed preoperatively on CT scan as tubular intestinal duplication. CT images showed change in the morphology of the cystic mass after one week of antibiotics administration. On histopathological analysis, the resected duplicated segment had esophageal epithelium in addition to the intestinal gland. So far, we found no report describing CT findings of dynamic change of ileal duplication in the English literatures.
A modified technique of two-staged extensor tendon reconstruction in zones 6-8 in a patient with absent palmaris/plantaris tendons: A case report
Authors: Mohammad M Al-Qattan, Saad A Al Mohrij
Journal: Int J Surg Case Rep (2019)
Keywords: extensor tendon, reconstruction, technique, two-staged

Introduction:
The indications for two-staged extensor tendon reconstruction are rare and only 14 previously reported cases were found in the literature. In these cases, silicone rods are inserted in the first stage. Few months later, the palmaris longus / plantaris tendon grafts are usually used to replace the silicone rods.
Case report:
we encountered a patient with major defects of the extensor tendons of all fingers extending from the proximal one third of zone 6 to zone 8. The patient had no palmaris or plantaris tendons. We utilized a modified technique of reconstruction using the split flexor carpi radialis as the tendon graft and the flexor carpi ulnaris as the motor tendon. At final follow-up, there was full active extension of the fingers. However, there was limitation of wrist flexion because of the harvesting of both wrist flexors.
Discussion:
We describe a modified technique of two-staged extensor tendon reconstruction which may be used in patients with absent palmaris/ plantaris tendons.
Conclusion:
In patients with absent palmaris/ plantaris tendons and major defects of the extensor tendons of all fingers, the use of split flexor carpi radialis is an adequate alternative for reconstruction and gives a good functional outcome.
Photobiomodulation Therapy for the Symptoms Related to Temporomandibular Joint Disk Displacement
Authors: Piotr A Regulski, Kazimierz T Szopinski, Špela Levičnik-Höfferle
Journal: Case Rep Dent (2023)
MeSH terms: Case Reports

Pain related to temporomandibular disorders (TMD) is a common problem that can significantly influence a patient's quality of life. Laser photobiomodulation (PBM) has been reported as a promising method in medicine for wound and bone healing, pain relief, and treatment of the temporomandibular joint (TMJ). Our clinical case aimed to demonstrate the effectivity of PBM using 1064 nm Nd:YAG laser for the treatment of pain and restricted mandible movement in a patient with anterior disk displacement of the left TMJ, using subjective (pain on visual analogue scale - VAS) and objective outcome measures [dynamic magnetic resonance imaging (MRI)]. PBM was performed on the left condyle in four sessions using a 1064 nm Nd:YAG laser with a flat-top handpiece. Results after 10 weeks showed an increase in mouth opening and a painless joint on palpation, with no reported adverse effects. An MRI of the TMJ confirmed the left disk displacement, however, with no signs of inflammation or effusion and with less pronounced disk deformity as compared with the first MRI examination. Use of PBM with Nd:YAG laser may be an efficient method for the management of orofacial pain in patients with acute and chronic TMJ disk displacements and may reduce the recovery time.
Phonological reduplication in sign language: Rules rule
Authors: Iris Berent, Amanda Dupuis, Diane Brentari
Journal: Front Psychol (2014)
Keywords: lexical decision, phonology, reduplication, rules, sign langauge

Productivity-the hallmark of linguistic competence-is typically attributed to algebraic rules that support broad generalizations. Past research on spoken language has documented such generalizations in both adults and infants. But whether algebraic rules form part of the linguistic competence of signers remains unknown. To address this question, here we gauge the generalization afforded by American Sign Language (ASL). As a case study, we examine reduplication (X→XX)-a rule that, inter alia, generates ASL nouns from verbs. If signers encode this rule, then they should freely extend it to novel syllables, including ones with features that are unattested in ASL. And since reduplicated disyllables are preferred in ASL, such a rule should favor novel reduplicated signs. Novel reduplicated signs should thus be preferred to nonreduplicative controls (in rating), and consequently, such stimuli should also be harder to classify as nonsigns (in the lexical decision task). The results of four experiments support this prediction. These findings suggest that the phonological knowledge of signers includes powerful algebraic rules. The convergence between these conclusions and previous evidence for phonological rules in spoken language suggests that the architecture of the phonological mind is partly amodal.
Narrative reconstruction therapy for prolonged grief disorder-rationale and case study
Authors: Tuvia Peri, Ilanit Hasson-Ohayon, Sharon Garber, Rivka Tuval-Mashiach, Paul A Boelen
Journal: Eur J Psychotraumatol (2016)
Keywords: cbt, narrative reconstruction, pgd, ptsd, bereavement, case study

Background:
Prolonged grief disorder (PGD) is a potentially disabling condition affecting approximately 10% of bereaved people. It has been suggested that the impaired integration of the loss memory, as expressed in recurrent memories of the loss and disorganization of memory, is involved in the development of PGD. Narrative reconstruction (NR), originally designed for the treatment of posttraumatic stress disorder (PTSD) in an integrative therapy module, and consisting of exposure to the loss memory, detailed written reconstruction of the loss memory narrative and an elaboration of the personal significance of that memory for the bereaved, has been shown to be effective in the treatment of intrusion symptoms.
Objective:
In light of findings that cognitive behavior therapy (CBT), including cognitive restructuring and exposure, is effective in the treatment of PGD, we suggest the implementation of a somewhat novel therapy module, NR, for the treatment of intrusive phenomena in bereaved patients.
Method:
The rationale for the implementation of NR for PGD and a case study of the treatment of a woman suffering from PGD after the death of her father are presented. Therapy took place in a university outpatient training clinic.
Results:
Evaluations conducted before and after treatment and at a 3-month follow-up demonstrated the effectiveness of NR in reducing symptoms of PGD and depression. The analysis of spontaneous narratives recorded before and after treatment showed an increased organization of the narratives.
Conclusions:
This case report demonstrates an adaptation of NR for the treatment of PGD. The results provide preliminary support for the effectiveness of NR for PGD. The significance of the study and its limitations are discussed.
Surgical Management of a Rare Case of Congenital DoubleUpper Lip
Authors: Adit Srivastava, Ajit Parihar, Romesh Soni, M C Shashikanth, T P Chaturvedi
Journal: Case Rep Med (2011)
MeSH terms: Case Reports

Congenital double lip is a rare developmental anomaly which usually involves the upper lip. It may occur in isolation or as a part of Ascher's syndrome. The occurrence of double lip may result in facial deformity especially when patient attempts to talk, smile, or even try to show the teeth. It affects esthetics and also interferes with speech and mastication. Although surgery may be undertaken to facilitate speech and mastication, majority of cases are operated for cosmetic reasons. A case of congenital double upper lip which was surgically treated for cosmetic reason is reported.
An unusual cause of chronic diarrhea: plastron appendicitis
Authors: Bilal Katipoğlu, Gökhan Yırgın, Burak Furkan Demir, İhsan Ateş
Journal: Gastroenterol Hepatol Bed Bench (2019)
Keywords: plastron appendicitis, appendicitis, chronic diarrhea
MeSH terms: Case Reports

Chronic diarrhea is defined as diarrhea that lasts longer than four weeks. Etiology of chronic diarrhea includes inflammatory bowel disease, malabsorption syndromes, irritable bowel disease, chronic parasitic infections, bacterial toxins, drugs and motility disorders. Plastron appendicitis is an abscess formation that occurs when the appendix is surrounded by the omentum following perforation of acute appendicitis. The cases usually present with abdominal pain, nausea, vomiting, and abdominal mass. Chronic diarrhea is a rare finding. In this study, we explore a case of a 63-year-old man who had diarrhea and intermittent abdominal pain for 3 months and underwent a diagnosis of plastron appendicitis as a result of the investigations.
Monoclonal Gammopathy of Undetermined Significance (MGUS) in a Man with Fragile X-associated Tremor/Ataxia Syndrome
Authors: Tanjung A Sumekar, Aneel A Ashrani, Tri I Winarni, Randi J Hagerman
Journal: Case Rep Genet (2011)
MeSH terms: Case Reports

We report the clinical presentation and laboratory findings of a 69-year-old man with fragile X-associated tremor ataxia syndrome (FXTAS), a progressive neurodegenerative disorder, who was noted to have monoclonal gammopathy of undetermined significance (MGUS), a plasma cell proliferative disorder and a precursor disease of multiple myeloma. Both MGUS and FXTAS are associated with microRNA (miRNA) dysregulation. We speculate that individuals with FXTAS may be predisposed to MGUS and further studies are warranted regarding this association.
Pott's Disease in a 2-Year-Old Child Treated by Decompression and Anterior-Posterior Instrumented Fusion
Authors: Mehmet Nuri Erdem, Cem Sever, Mehmet Fatih Korkmaz, Sinan Karaca, Ferit Kirac, Mehmet Tezer
Journal: Case Rep Orthop (2014)

Introduction. Paraplegia and kyphotic deformity are two major disease-related problems of spinal tuberculosis, especially in the early age disease. In this study a 2-year-old boy who underwent surgical decompression, correction, and 360° instrumented fusion via simultaneous anterior-posterior technique for Pott's disease was reported. Case Report. A 2-year-and-9-month-old boy presented with severe back pain and paraparesis of one-month duration. Thoracic magnetic resonance imaging demonstrated destruction with a large paraspinal abscess involving T5-T6-T7 levels, compressing the spinal cord. The paraspinal abscess drained and three-level corpectomy was performed at T5-6-7 with transthoracic approach. Anterior instrumentation and fusion was performed with structural 1 autogenous fibula and rib graft using screw-rod system. In prone position pedicle screws were inserted at T4 and T8 levels and rods were placed. Six months after surgery, there was no weakness or paraparesis and no correction loss at the end of follow-up period. Discussion. In cases of vertebral osteomyelitis with severe anterior column destruction in the very early child ages the use of anterior structural grafts and instrumentation in combination with posterior instrumentation is safe and effective in maintenance of the correction achieved and allows efficient stabilization and early mobilization.
Break the Spasm with Succinylcholine, but Risk Intraoperative Awareness with Undiagnosed Pseudocholinesterase Deficiency
Authors: Danny D Bui, Shyamal R Asher
Journal: Case Rep Anesthesiol (2020)
MeSH terms: Case Reports

Succinylcholine is a commonly used medication in all aspects of anesthetic care, and there are a number of known side effects and complications associated with its use. However, when succinylcholine is used emergently, anesthesia providers must remain vigilant to undiagnosed conditions that pose additional risks to patients. We report the use of succinylcholine to treat acute, refractory laryngospasm after extubation leading to prolonged neuromuscular paralysis. There are unique challenges presented by this case including the risk of anesthesia awareness with recall due to the cognitive biases that prevent the clinical diagnosis of pseudocholinesterase deficiency.
Pharmacological Management of Severe Neuropathic Pain in a Case of Eosinophilic Meningitis Related to Angiostrongylus cantonensis
Authors: Jennifer Busse, David Gottlieb, Krystal Ferreras, Jennifer Bain, William Schechter
Journal: Case Rep Anesthesiol (2018)
MeSH terms: Case Reports

Angiostrongylus cantonensis, the rat lungworm, is the most common infectious cause of eosinophilic meningitis and can be fatal. The parasite can be found throughout Southeast Asia and Pacific Islands and the global distribution is expanding. We present the case of a fourteen-year-old female who had previously traveled to Hawaii and developed severe neuropathic pain related to A. cantonensis infection refractory to gabapentin and pregabalin monotherapy, who was eventually managed with an ultralow dose ketamine infusion, methadone, and serotonin-norepinephrine reuptake inhibitor.
Two Paediatric Patients with Encephalopathy and Concurrent COVID-19 Infection: Two Sides of the Same Coin?
Authors: Katerina Vraka, Dipak Ram, Siobhan West, Wei Yen Evelyn Chia, Praveen Kurup, Gayathri Subramanian, Hui Jeen Tan
Journal: Case Rep Neurol Med (2021)
MeSH terms: Case Reports

There is increasing evidence that SARS-CoV-2 has neurotropic potential. We report on two paediatric patients who presented with encephalopathy during COVID-19 illness. Both patients had ADEM-like changes in their neuroimaging, negative SARS-CoV-2 RNA PCR in CSF, and paucity of PIMS-TS laboratory findings. However, the first patient was positive for serum MOG antibodies with normal CSF analysis, and the second had negative MOG antibodies but showed significant CSF lymphocytic pleocytosis. We concluded that the first case was a typical case of demyelination, which could have been triggered by different cofactors. In the second case, however, we postulated that the encephalopathic process was triggered by SARS-CoV-2, as no other cause was identified. With these two contrasting cases, we provide evidence that SARS-CoV-2-associated encephalitis can show ADEM-like changes, which can present during the postinfectious phase of COVID-19 illness. As ADEM is a relatively common type of postinfectious encephalitis in children, the distinguishing line between the two conditions of encephalitis and ADEM can be relatively fine. The development of more reliable diagnostic tools (e.g., anti-SARS-CoV-2 antibodies in CSF) might play an assisting role in the differentiation of these encephalopathic processes.
Immune-Mediated Autonomic Neuropathies following Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia
Authors: Abhishek Mangaonkar, Hassan Al Khateeb, Narjust Duma, Erik K St Louis, Andrew McKeon, Mrinal Patnaik, William Hogan, Mark Litzow, Taxiarchis Kourelis
Journal: Case Rep Hematol (2017)
MeSH terms: Case Reports

Background/aims:
Autonomic dysfunction (AD) after allogeneic stem cell transplant (SCT) is a rare occurrence and likely immune-mediated in etiology. There is limited literature on this topic and hence, we wish to briefly describe management of two cases at our institution and their outcomes.
Methods:
We retrospectively identified two patients with immune-mediated AD after SCT from our database. Immune-mediated AD was defined as AD secondary to an immune-mediated etiology without an alternative cause and responding to immunosuppression.
Results:
The first case is of a 32-year-old man with acute myeloid leukemia (AML) who underwent double umbilical cord allogeneic SCT. The second patient was a 51-year-old woman with secondary AML who underwent matched-related donor allogeneic SCT. Both underwent an extensive work-up for an underlying etiology prior to treatment with intravenous immunoglobulin (IVIG).
Conclusions:
AD after SCT is a rare yet significant clinical entity. A work-up of underlying etiology should be performed. IVIG is a treatment option for these patients.
Paget's Breast Disease: A Case Report and Review of the Literature
Authors: S Dubar, M Boukrid, Jean Bouquet de Joliniere, L Guillou, Quoc Duy Vo, A Major, N Ben Ali, F Khomsi, A Feki
Journal: Front Surg (2017)
Keywords: biopsy, breast paget’s disease, female breast cancer, imagery, sentinel lymph node biopsy, surgery
MeSH terms: Case Reports

Paget's disease of the breast is a rare cancer. This typical clinical case illustrates the different epidemiological, clinical, histological, therapeutic, and evolving aspects of the disease. We report a case of Paget's disease in a 43-year-old woman who presented eczema of the nipple. Mammography and ultrasounds did reveal a lesion in situ. The patient was scheduled for mastectomy and sentinel node biopsy. She had chosen a radical bilateral surgery. The histological diagnosis was Paget's disease of the breast with a carcinoma in situ. There was no metastasis in either of the sentinel nodes. Paget's disease must be considered with the presence of a persistent eczematous involvement of the nipple, which does not respond to local treatment. Ultrasounds, mammography, and magnetic resonance imaging can allow searching an underlying cancer and guiding the surgical management. There is no evidence at this time that one of the two surgical techniques (conservative or mastectomy) would improve survival. The prognosis depends on the presence of a palpable mass and the invasiveness of the cancer.
Home-Based SCONETM Therapy Improves Symptoms of Neurogenic Bladder
Authors: Parag Gad, Hui Zhong, V Reggie Edgerton, Evgeniy Kreydin
Journal: Neurotrauma Rep (2021)
Keywords: neurogenic bladder, non-invasive spinal cord stimulation, overactive bladder, stroke, urodynamics

A wide range of dysfunction can occur after a stroke including symptoms such as urinary urgency, frequency, and urge incontinence. The Spinal Cord Neuromodulator (SCONETM) reactivates and retrains spinal neural networks. The present case study introduces initial evidence that home-based, self-administered SCONE therapy may be a safe and effective method of delivering this neuromodulation modality and may have the ability to minimize clinic visits, which is especially salient in today's public health environment.
Severe Thrombocytopenia Two Weeks Following Immunization with the Janssen Ad26.CoV2.S Vaccine
Authors: Bana Antonios, Markie Zimmer, Emma Herrman, Ramona Berghea
Journal: Case Rep Hematol (2022)
MeSH terms: Case Reports

Immune thrombocytopenia (ITP) has been associated with immunizations with various proposed mechanisms, including overactivation of the immune system and production of antibodies against circulating platelets. ITP has also been associated with several viral infections, including HCV, HIV, and most recently, active SARS-CoV-2 infection. Here, we present a case of a 52-year-old male with no past medical history who sought evaluation with his primary care physician for upper and lower extremity ecchymosis of one week duration. Outpatient laboratory studies were notable for severe isolated thrombocytopenia with platelet count of 8 × 10^9/L. Interestingly, he received the Johnson and Johnson COVID-19 vaccine 16 days prior to his presentation. Clinical work up and laboratory investigations led to the diagnosis of ITP.
Mutation in LEMD3 (Man1) Associated with Osteopoikilosis and Late-Onset Generalized Morphea: A New Buschke-Ollendorf Syndrome Variant
Authors: Benjamin Korman, Jun Wei, Anne Laumann, Polly Ferguson, John Varga
Journal: Case Rep Dermatol Med (2016)

Introduction. Buschke-Ollendorf syndrome (BOS) is an uncommon syndrome characterized by osteopoikilosis and other bone abnormalities, accompanied by skin lesions, most frequently connective tissue nevi. BOS is caused by mutations in the LEMD3 gene, which encodes the inner nuclear membrane protein Man1. We describe a unique case of osteopoikilosis associated with late-onset localized scleroderma and familial LEMD3 mutations. Case Report. A 72-year-old woman presented with adult-onset diffuse morphea and bullous skin lesions. Evaluation revealed multiple hyperostotic lesions (osteopoikilosis) suggestive of BOS. DNA sequencing identified a previously undescribed nonsense mutation (Trp621X) in the LEMD3 gene encoding Man1. Two additional family members were found to have osteopoikilosis and carry the same LEMD3 mutation. Conclusions and Relevance. We report a unique familial LEMD3 mutation in an individual with osteopoikilosis and late-onset morphea. We propose that this constellation represents a novel syndromic variant of BOS.