OpenMed/multicare-articles huggingface dataset:
False positive angiographic aneurysm of the anterior segment of the M1 bifurcation of the middle cerebral artery: a case report
Authors: Wen Xiao, Xiaolin Hou, Dingjun Li, Dongdong Yang
Journal: Front Neurol (2023)
Keywords: cta, dsa, mra, false-positive aneurysm, middle cerebral artery (mca), occluded stump
MeSH terms: Case Reports

Occlusion of an intracranial arterial branch, resulting in a false positive aneurysm on vascular imaging, is extremely rare, with only a few reports in the literature and mostly in the posterior circulation artery or the middle cerebral artery (MCA) bifurcation. We report a case of a 69 years-old woman with a subacute infarct lesion in the left frontal lobe, for whom both computed tomographic angiography (CTA) and digital subtraction angiography (DSA) of the cerebral vessels showed aneurysms in the anterior segment of the M1 bifurcation of the middle cerebral artery (MCA) and in the bifurcation of the MCA. The aneurysm in the MCA bifurcation was found during craniotomy, whereas the anterior segment of the M1 bifurcation had intact branch vessels with severe atherosclerosis and no aneurysm was present. The branch vessel of M1 was presumed to be atherosclerotic occlusion resulting in the distal vessels without contrast filling on CTA and DSA, and only the occluded stump at the beginning of the vessel was filled with contrast, showing an aneurysm-like morphology, which was very confusing. This case highlights to neurologists that the diagnosis of aneurysm by cerebrovascular CTA or DSA must be carefully differentiated to avoid misdiagnosis, especially if the unruptured aneurysm is in an uncommon location in combination with ischemic cerebrovascular disease.
Atypical Neuroleptic Malignant Syndrome With Type 2 Respiratory Failure Treated With Non-invasive Ventilation
Authors: Simon Farrugia, Sarah Bonello, Yanika Gatt, Martin V Balzan
Journal: Cureus (2024)
Keywords: antidopaminergic medications, atypical neuroleptic malignant syndrome, non-invasive ventilation, rigidity, type 2 respiratory failure
MeSH terms: Case Reports

Neuroleptic malignant syndrome (NMS) is characterized by hyperthermia, severe rigidity, and autonomic instability that is life-threatening if not treated promptly by intensive supportive care. However, there have been numerous reports of "atypical NMS" where the diagnostic criteria of NMS are only partially satisfied. We present a case of an elderly male who presented with atypical NMS secondary to antidopaminergic drug administration which precipitated acute respiratory failure. Our patient exhibited features of severe rigidity and autonomic instability, without hyperthermia. He developed tachypneic hypoventilation with type 2 hypercapneic respiratory failure which was treated with non-invasive ventilation (NIV). The patient recovered after three days with resolution of rigidity and was transferred to a normal medical ward on oxygen via a facemask, where he gradually improved. This study highlights that non-invasive ventilation may have a role in treating respiratory failure in mild to moderate cases of atypical NMS, avoiding the need for intubation.
Foreign body aspiration and mucormycosis: a case report
Authors: Hamed Mehdinezhad, Reza Mohseni Ahangar, Mohammad Golparvar Azizi, Mohammad Ghasemian, Zahra Yari, Elham Jafarian, Ali Tavakoli Pirzaman
Journal: Front Med (Lausanne) (2023)
Keywords: covid-19, foreign body aspiration, hemoptysis, mucormycosis, rigid bronchoscopy
MeSH terms: Case Reports

Over the course of the Coronavirus disease 2019 (COVID-19) pandemic, numerous complications have been documented. In this report, we have detailed an unexpected complication of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that occurred in a 73-year-old female patient who was simultaneously afflicted with mucormycosis and another unanticipated problem. Due to the lack of recovery of the patient after receiving mucormycosis treatment and continued fever, cough and hemoptysis, bronchoscopy was performed for her. During bronchoscopy, we encountered a foreign body that was the cause of the patient's fever, cough, and hemoptysis. Rigid bronchoscopy was performed and the foreign body was removed from the left main bronchus. The lack of a favorable treatment response after administering antifungal therapy suggested that the presence of a foreign body could potentially act as an underlying nidus, thus influencing the suboptimal therapeutic outcome. Mucormycosis is usually characterized by distinct radiological patterns. However, this case did not present predictable imaging findings, further complicating the diagnostic process associated with this invasive fungal infection.
Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation of the Musculocutaneous Nerve for Refractory Antecubital ElbowPain-Brief Technical Report and Illustrative Case Report
Authors: Quinn Tate, Guilherme Ferreira-Dos-Santos, Darrell Vydra, Nuno Ferreira-Silva, Sahil Gupta, Mark Friedrich B Hurdle
Journal: Can J Pain (2023)
Keywords: pain medicine, neuromodulation, peripheral nerve stimulation, peripheral neuropathy, ultrasound
MeSH terms: Case Reports

Chronic pain following distal biceps rupture (DBR) is often nonspecific in that it may arise due to the injury, subsequent surgical repair, or a combination of factors, making the painful symptoms challenging to treat. Peripheral nerve injury in the setting of DBR most commonly affects the musculocutaneous nerve or one of its terminal branches and may lead to chronic neuropathic pain involving the elbow and lateral/radial aspect of the forearm. In this brief technical report, we describe an ultrasound-guided (USG) technique for percutaneous implantation of a peripheral nerve stimulator (PNS) targeting the musculocutaneous nerve, along with an illustrative case report of successful treatment of chronic refractory pain following DBR utilizing this technique. Six months postimplantation, the patient reported a greater than 60% baseline pain intensity reduction, and no complications were noted.
High-Concentration Insulin Glargine Overdose: Polyphasic Patterns of Blood Insulin Levels
Authors: Hitomi Tsunashima, Hiroaki Takada, Hiroki Shiojima, Hisashi Yoneyama, Eijyu Hasegawa
Journal: Cureus (2024)
Keywords: glargine, high concentration insulin, insulin overdose, lantus, u300 glargine
MeSH terms: Case Reports

In the treatment of diabetes mellitus, there is a growing trend towards using high-concentration insulin, with Lantus XR (Bridgewater, NJ: Sanofi-Aventis U.S. LLC), which has a drug concentration three times higher than that of conventional Lantus (100 U/mL; Bridgewater, NJ: Sanofi-Aventis U.S. LLC), being a prominent example. This type of high-concentration insulin is known for its smaller injection volumes, leading to a slower absorption rate and maintenance of more consistent blood insulin levels. When administered in high doses, the pharmacological effects of insulin are generally prolonged; however, insulin glargine overdose rarely occurs, and its pharmacokinetics remain unclear. We encountered a case of an insulin overdose in a 19-year-old female patient, who had self-injected glargine (Lantus XR) 1,350 units and aspart (NovoRapid; Bagsværd, Denmark: Novo Nordisk A/S) 600 units. We measured blood glucose and insulin levels over time. Bimodal peaks in blood insulin levels were observed, and we adjusted high doses of intravenous infusion with a 50% glucose solution until the blood insulin levels returned to the normal range. Consequently, the patient was treated without inducing severe hypoglycemia. U300 glargine overdose may lead to both a multimodal elevation in blood insulin levels and prolonged hypoglycemia compared to U100 glargine. Therefore, monitoring blood insulin levels and adjusting treatment accordingly may contribute to safer patient management. This study represents the initial documentation of blood insulin levels measured in a U300 glargine overdose patient, revealing a bimodal peak.
Redescending Stomach: A Rare and Potentially Lethal Complication of Gastric Herniation
Authors: Sam Verrept, Mathieu Lefere, Yves De Bruecker
Journal: J Belg Soc Radiol (2024)
Keywords: fundus redescent, gastric herniation, gastric pneumatosis, ischemia, obstruction, strangulation
MeSH terms: Case Reports

Large gastric hernias are common and usually cause minor symptoms. Rarely, complete intrathoracic herniation of the stomach is complicated by strangulation. The underlying mechanism can be gastric volvulus or the less recognized phenomenon of gastric fundus redescent. We describe a case where this rare but potentially lethal complication of gastric herniation is present. Additionally, we show that gastric pneumatosis, a sign associated with ischemia, can be initially visualized on a plain chest radiograph in this setting. Teaching point: Redescent of the fundus is a possible, but unrecognized cause of gastric strangulation in intrathoracic stomachs.
Variant of the terrible triad of the elbow, a CASE report with a review of the literature
Authors: F Lamnaouar, A Rajaallah, A Rafaoui, A Messoudi, M Rahmi, M Rafai
Journal: Int J Surg Case Rep (2024)
Keywords: column theory, complex dislocation fractures, elbow, instability, ring theory, stiffness, terrible triad variants
MeSH terms: Case Reports

Introduction:
The terrible triad described by Hotchkiss in 1996 is a complex lesion of the elbow, following a trauma combining forced valgus and external rotation. It is a lesion that puts the elbow at risk of developing complications such as instability, stiffness, or synostosis of the proximal radio-cubital joint.
Case report:
We report the case of a patient who suffered a closed trauma to the right elbow following a fall onto the palm of the hand with a valgus lateral rotation mechanism. The lesion assessment showed a B2 fracture of the distal humerus (AO classification) with a line splitting the capitulum in the frontal plane, a type 3 coronoid process fracture (Morrey/Odriscoll classification), and a posterolateral elbow dislocation. The surgical treatment followed the same principles as for the terrible triad, with a reconstruction of the lateral column by osteosynthesis of the humeral palate, followed by an internal approach for osteosynthesis of the coronoid process, with the restoration of a stable elbow without laxity in the frontal plane.
Discussion:
On the basis of the lesion mechanism, column theory, and the schematization of the constituent elements of elbow stability in a ring, certain lesions can be placed in the same box as the terrible triad of the elbow, which also complies with the same therapeutic implications.
Conclusion:
Our observation underlines the possibility of the existence of lesions other than those described by Hotchkiss, which would have the same consequences: an unstable elbow with the risk of evolving into chronic instability or stiffness and whose management accepts the same management.
The FGG c.952G>A variant causes congenital dysfibrinogenemia characterized by recurrent cerebral infarction: a case report
Authors: Anna Ying, Yuanlin Zhou, Chunyue Wang, Tao Wang, Xuan Zhang, Shanshan Wang, Shaofa Ke, Yuyan Bao, Yang Liu, Feng Wang
Journal: Front Neurol (2024)
Keywords: fgg gene, c952g>a, cerebral infarction, congenital dysfibrinogenemia, fibrinogen
MeSH terms: Case Reports

Background:
Congenital dysfibrinogenemia (CD) is a rare hereditary coagulation disorder resulting from mutations in fibrinogen genes. CD primarily presents with bleeding symptoms, but it can also lead to thrombotic events, including ischemic stroke.
Case presentation:
This report describes the case of a 52-year-old Chinese man who was admitted to the hospital twice due to recurrent cerebral infarction, characterized by sudden speech impairment and weakness in the right upper extremity. Brain MRI revealed multiple ischemic changes, predominantly in the left frontal and parietal lobes. Coagulation tests demonstrated reduced plasma fibrinogen (Clauss method), prolonged prothrombin time and thrombin time, and an elevated international normalized ratio. However, the ELISA assay indicated elevated levels of fibrinogen γ-chain protein. Despite a 2-month-old treatment regimen with aspirin, clopidogrel, and atorvastatin after the first hospitalization, the patient experienced a second ischemic stroke. Genetic analysis using whole-exome sequencing (WES) and Sanger sequencing identified a rare heterozygous missense variation, FGG c.952G>A (rs267606810), in both the stroke patient and his asymptomatic sister. Both individuals exhibited the same alterations in fibrinogen, characterized by reduced functional levels but increased antigenic protein. Subsequently, the patient was diagnosed with ischemic stroke associated with congenital dysfibrinogenemia.
Conclusion:
This case report expands the clinical phenotype spectrum associated with FGG c.952G>A (rs267606810) and underscores the significance of considering CD as a potential etiology for unexplained ischemic stroke, particularly in patients with a family history of coagulation disorders.
Case report: "Fur stole and turtleneck" and "halter-back" signs: an expanded wardrobe for dermatomyositis
Authors: Jonathan D Ho, Andrew T M Burton, Trimane McKenzie, Ciara Best, Andrea Clare-Lyn Shue, Stephanie Smith-Matthews, Kimone Fraser, Asana Anderson
Journal: Front Immunol (2024)
Keywords: autoimmune connective tissue disease, bullous dermatomyositis, cutaneous, dermatologic, dermatomyositis, shawl sign, skin of color
MeSH terms: Dermatomyositis / diagnosis, Case Reports, Adult, Aged, Aged, 80 and over, Autoantibodies / blood, Autoantibodies / immunology, Female, Humans, Male, Middle Aged, Skin / pathology, Autoantibodies, Amyopathic dermatomyositis

A diagnosis of dermatomyositis requires recognition of distinct patterns of skin disease in combination with, and sometimes without, muscle weakness. Often, a striking contrast between involved and uninvolved areas is observed. Familiar patterns include eyelid and midfacial eruptions, Gottron papules/sign, and upper back (shawl sign), central chest (V/open collar sign), and lateral thigh (holster sign) involvement. More recently, new specific antibody/phenotype-associated patterns have been reported. We describe a case series of two distinct patterns of skin involvement in six adult patients with both classical and amyopathic dermatomyositis. Three had paraneoplastic disease. All had intermediate to richly pigmented skin; five were of Afro-Caribbean and one was of Asian-Caribbean descent. Four were men, and two were women. Ages ranged from 41 to 89 years. All patients had concomitant hallmark signs (facial, hand, and/or trunk signs). Three were amyopathic. The first pattern involved a sharply demarcated, horizontally oriented hyperpigmented patch/thin plaque across the shoulders and upper chest, extending up the anterior neck. The second was the combination of the classical upper back shawl distribution with distinct mid-back sparing and diffuse involvement of the lower back. Named patterns help with the recognition of skin rashes in dermatomyositis. Based on the current lexicon describing items of apparel, we liken the first pattern to a "fur stole and turtleneck" sign and the latter to a "halter-back" or "reflected-shawl" sign. Biopsies revealed hyperkeratosis and interface dermatitis, often with epidermal atrophy, compatible with dermatomyositis. These patterns perhaps represent the coalescence of already well-described signs, photo-exacerbation, koebnerization, mechanical stretch, and other currently unclear factors contributing to patterning in dermatomyositis. Pattern distribution recognition is particularly valuable in individuals with richly pigmented skin who may lack typical violaceous erythema. The distinct demarcation led to the initial misdiagnosis of allergic contact dermatitis or other exogenous dermatitis in most of our patients. Further work involves evaluation of antibody phenotype and internal involvement associations. Limitations include lack of specific antibody panels and longitudinal follow-up data.
Case Report: Limbic encephalitis following treatment with durvalumab for small-cell lung cancer
Authors: Thomas T Moss, Knut Stavem, Astrid Aandahl, Anne S Gløersen, Bjørn H Grønberg, Kirill Neumann, Christian A Vedeler, Christofer Lundqvist
Journal: Front Immunol (2023)
Keywords: encephalitis, immunotherapy, adverse effects, diabetes, durvalumab, small-cell lung cancer
MeSH terms: Diabetes Mellitus, Encephalitis / complications, Limbic Encephalitis / chemically induced, Limbic Encephalitis / diagnosis, Lung Neoplasms, Small Cell Lung Carcinoma / drug therapy, Case Reports, Aged, Antibodies, Monoclonal / adverse effects, Autoantibodies, Humans, Male, gamma-Aminobutyric Acid, durvalumab, Antibodies, Monoclonal, Autoantibodies, gamma-Aminobutyric Acid

Background:
Durvalumab is an immune checkpoint Inhibitor (ICIs) that is used in the treatment of malignant tumors, such as lung cancer and melanoma. ICIs are associated with immune-related adverse events including autoimmune encephalitis, although both paraneoplastic phenomena and ICI treatment may lead to autoimmunity.
Case presentation:
We describe a 72-year old male patient with small-cell lung cancer, who during adjuvant treatment with Durvalumab developed GABABR1 and GAD65 antibodies and both diabetes and autoimmune limbic encephalitis. Because he was followed prospectively as part of a treatment study, we had access to repeated serum samples and cognitive assessments over time prior to developing encephalitis and diabetes, in addition to later assessments. A high titer of GABABR1 antibodies appeared early, while GAD65 antibodies appeared later with a lower titer in parallel with the development of diabetes. As he subsequently developed clinical signs of encephalitis, verified by EEG and brain MRI, he also had CSF GABABR1 antibodies. Durvalumab was discontinued and steroid treatment with subsequent plasmapheresis were started, resulting in reduction of both CSF and serum antibody levels. Clinical signs of encephalitis gradually improved.
Conclusion:
This case illustrates the importance of being aware of possible serious autoimmune adverse reactions, including neurological syndromes such as encephalitis, when treating patients with high risk of para-neoplasia with ICIs. In addition, the case shows the development of autoantibodies over time.
Case report and literature review: Asymptomatic littoral cell angioma in a 3-year-old girl
Authors: Yanling Mou, Liucheng Yang, Jianjun Wang, Qinming Chen, Mengzhen Zhang, Xi Zhang, Rongying Tan, Djibril Adam Mahamat, Kai Wu
Journal: Front Pediatr (2024)
Keywords: children, diagnosis, littoral cell angioma, splenic tumor, treatment
MeSH terms: Case Reports

Background:
Littoral cell angioma (LCA) is an extremely uncommon benign vascular tumor of the spleen. Cases of LCA in infants are rarely reported, and due to the rarity of the tumor and non-specific symptoms, the diagnosis of LCA is often overlooked in clinical practice.
Case report:
We present a 3-year-old girl with pulmonary inflammation who was admitted to the hospital due to the discovery of a space-occupying lesion in the spleen. Pathology after splenectomy confirmed LCA, and there was no recurrence observed at the 5-month follow-up examination.
Conclusion:
LCA should be considered when a child shows asymptomatic splenomegaly, with antigen expression indicating dual positivity of endothelial and histiocytic markers. Laparoscopic splenectomy remains the primary method of treating LCA.
Case report: Suspecting guanine nucleotide-binding protein beta 1 mutation in dyskinetic cerebral palsy is important
Authors: Han-Byeol Choi, Yoonju Na, Jiwon Lee, Jeehun Lee, Ja-Hyun Jang, Jong-Won Kim, Jeong-Yi Kwon
Journal: Front Pediatr (2023)
Keywords: gnb1, case report, cerebral palsy, developmental delay, dystonia
MeSH terms: Case Reports

Herein, we describe the case of a 43-month-old girl who presented with clinical manifestations of dyskinetic cerebral palsy (CP), classified as the Gross Motor Function Classification System (GMFCS) V. The patient had no family history of neurological or perinatal disorders. Despite early rehabilitation, serial assessments using the Gross Motor Function Measure (GMFM) showed no significant improvements in gross motor function. Brain magnetic resonance imaging showed nonspecific findings that could not account for developmental delay or dystonia. Whole-genome sequencing identified a heterozygous NM_002074.5(GNB1):c.239T>C (p.Ile80Thr) mutation in guanine nucleotide-binding protein beta 1 (GNB1) gene. Considering this case and previous studies, genetic testing for the etiology of dyskinetic CP is recommended for children without relevant or with nonspecific brain lesions.
Case report: Personalized triple phage-antibiotic combination therapy to rescue necrotizing fasciitis caused by Panton-Valentine leukocidin-producing MRSA in a 12-year-old boy
Authors: Brieuc Van Nieuwenhuyse, Mathilde Balcaen, Olga Chatzis, Astrid Haenecour, Emilien Derycke, Thierry Detaille, Stéphan Clément de Cléty, Cécile Boulanger, Leïla Belkhir, Jean-Cyr Yombi, Julien De Greef, Olivier Cornu, Pierre-Louis Docquier, Audrey Lentini, Renaud Menten, Hector Rodriguez-Villalobos, Alexia Verroken, Sarah Djebara, Maya Merabishvili, Johann Griselain, Jean-Paul Pirnay, Laurent Houtekie, Dimitri Van der Linden
Journal: Front Cell Infect Microbiol (2024)
Keywords: mrsa, panton and valentine leukocidin (pvl), bacteriophage, necrotizing fasciitis, pediatric intensive care unit, phage therapy
MeSH terms: Anti-Bacterial Agents / administration & dosage, Anti-Bacterial Agents / therapeutic use, Bacterial Toxins, Exotoxins / genetics, Fasciitis, Necrotizing / drug therapy, Fasciitis, Necrotizing / microbiology, Fasciitis, Necrotizing / therapy, Leukocidins, Methicillin-Resistant Staphylococcus aureus / drug effects, Phage Therapy / methods, Pseudomonas aeruginosa / drug effects, Staphylococcal Infections / drug therapy, Staphylococcal Infections / microbiology, Staphylococcal Infections / therapy, Case Reports, Child, Humans, Male, Stenotrophomonas maltophilia / drug effects, Treatment Outcome, Leukocidins, Exotoxins, Panton-Valentine leukocidin, Bacterial Toxins, Anti-Bacterial Agents

Maximal standard-of-care (SOC) management could not stop the life-threatening progression of a necrotizing fasciitis induced by Panton-Valentine Leukocidin-producing Methicillin-Resistant Staphylococcus aureus (MRSA) in a 12-year-old boy. Multi-route phage therapy was initiated along with antibiotics against Staphylococcus aureus, Pseudomonas aeruginosa and Stenotrophomonas maltophilia, eventually leading to full recovery with no reported adverse events.
Case report: Avoidant/restrictive food intake disorder after tonsillectomy
Authors: Gellan K Ahmed, Ahmed A Karim, Eman M Khedr, Khaled Elbeh, Amira Moheb, Marwa Abokresha, Nourelhoda A Haridy
Journal: Front Psychiatry (2024)
Keywords: avoidant/restrictive food intake disorder, child and adolescent psychiatry and psychotherapy, children, cognitive-behavioural therapy, psychopathology, tonsillectomy
MeSH terms: Case Reports

Background:
Avoidant Restrictive Food Intake Disorder (ARFID) is a newly classified eating disorder that requires further understanding of its presentation. There is no previous report of ARFID in a child post-tonsillectomy. ARFID may be a potential negative outcome for children following oropharyngeal surgery.
Case presentation:
A female child aged 10 years and 2 months presented with ARFID associated with depression, anxiety and nutritional deficiency following tonsillectomy. She had more difficulty in swallowing solids than fluids and had repeated vomiting and spitting food after chewing it. She became dehydrated and malnourished with a BMI of 10.5 and was misdiagnosed with myasthenic gravis.
Conclusions:
To our knowledge, this is the first case report of ARFID in a child post-tonsillectomy. We discuss the pathophysiology of ARFID, which remains elusive, and recommend psychiatric assessment when evaluating children post operative tonsillectomy.