OpenMed/multicare-articles huggingface dataset:
Hashimoto's encephalopathy with cerebellar ataxia as the main symptom: A case report and literature review
Authors: Chunxiao Wei, Yanxin Shen, Weijie Zhai, Tianling Shang, Zicheng Wang, Yongchun Wang, Mingxi Li, Yang Zhao, Li Sun
Journal: Front Neurol (2022)
Keywords: hashimoto's autoimmune thyroiditis, hashimoto's encephalopathy, antithyroid antibodies, ataxia, autoimmune thyroiditis
MeSH terms: Case Reports

Hashimoto's encephalopathy (HE), also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), has a variety of clinical manifestations, with various neuropsychiatric characteristics, including tremors, transient aphasia, seizures, altered consciousness, myoclonus, cognitive impairment, and psychiatric manifestations. The hallmark presenting feature is a non-specific encephalopathy characterized by alteration of mental status and consciousness ranging from confusion to coma and impaired cognitive function, while those with cerebellar ataxia as the main manifestation is rare. We reported a case of Hashimoto's encephalopathy with cerebellar ataxia as the main manifestation, elevated anti-thyroid antibodies (anti-TPO/TG), and normal thyroid function. The symptoms of cerebellar ataxia improved after steroid treatment. Meanwhile, we reviewed the clinical features of 20 representative cases of HE with cerebellar ataxia as the core symptoms. In conclusion, based on our case findings and literature review, the diagnosis of HE should be suspected in cases of encephalopathy without an obvious cause, to quickly start an effective treatment.
Community as locus for health formal and non-formal education: the significance of ecological and collaborative research for promoting health literacy
Authors: Sofia C Pais, Mariana Rodrigues, Isabel Menezes
Journal: Front Public Health (2014)
Keywords: children and adolescents, collaborative approaches, formal and non-formal education, health literacy, methodological pluralism

The World Health Organization (2002) considers that a balance between government, community, and individual action is necessary for health education and promotion, recognizing that non-governmental organizations, local groups, and community institutions are central in this process. This argument reinforces the idea that individuals should be empowered and encouraged to make use of accurate health-related information. This paper highlights the potential of a socio-political perspective for the development of health literacy within children and adolescents and presents two studies conducted in two daily life contexts: a community organization and a school. Both studies are based on methodological pluralism and collaborative research approaches and explore the promotion of health knowledge in formal and informal settings. Study 1 is based on a mixed methodology, using focus group discussions and questionnaires with children and youth with chronic diseases to explore the perceived impact of their participation in support associations. Study 2 presents four intensive case-studies in schools where adolescents used community profiling, a participatory research methodology, to explore health rights and access to healthcare in both a historical and prospective vision. The results enable a deeper understanding on how powerful tool ccommunity resources can be for individual and collective empowerment on health issues.
Clinical features, angio-architectural phenotypes, and treatment strategy of foramen magnum dural arteriovenous fistulas: a retrospective case series study
Authors: Zhipeng Xiao, Weizhen Gao, Hongyu Zhou, Xiaohua Zhang, Jiong Dai, Jieqing Wan, Liemei Guo
Journal: Front Neurol (2023)
Keywords: hybrid angio-surgical suite, dural arteriovenous fistula, foramen magnum davf foramen magnum, myelopathy, subarachnoid hemorrhage

Background:
The rarity and complex angioarchitecture of foramen magnum dural arteriovenous fistulas (DAVFs) make its treatment difficult and controversial. We aimed to describe their clinical features, angio-architectural phenotypes, and treatments, through a case series study.
Methods:
We first retrospectively studied cases of foramen magnum DAVFs treated in our Cerebrovascular Center, and then reviewed the published cases on Pubmed. The clinical characteristics, angioarchitecture, and treatments were analyzed.
Results:
A total of 55 patients were confirmed with foramen magnum DAVFs, which included 50 men and 5 women, with a mean age of 52.8 years. Most patients presented with subarachnoid hemorrhage (SAH) (21/55) or myelopathy (30/55), depending on the venous drainage pattern. In this group, 21 DAVFs were supplied by only the vertebral artery (VA), three by only the occipital artery (OA), three by only the ascending pharyngeal artery (APA), and the remaining 28 DAVFs were supplied by two or three of these feeding arteries. Most cases (30/55) were treated with only endovascular embolization, 18 cases (18/55) with only surgical disconnection, five cases (5/55) with combined therapy, and two cases rejected treatment. The angiographic outcome of complete obliteration was achieved in most patients (50/55). In addition, two cases of foramen magnum DAVFs were treated by us in a Hybrid Angio-Surgical Suite (HASS) with good outcomes.
Conclusions:
Foramen magnum DAVFs are rare and their angio-architectural features are complicated. The treatment option (microsurgical disconnection or endovascular embolization) should be weighed carefully, and combined therapy in HASS could be a more feasible and less invasive treatment option.
Juxta-adrenal schwannoma presenting as a giant adrenal tumor: A case report and a literature review
Authors: Maher Abdessater, Mohammad El Mokdad, Jerome Gas, Walid Sleiman, Patrick Coloby, Stephane Bart
Journal: Int J Surg Case Rep (2018)
Keywords: adrenal tumor, case report, misdiagnosis, retroperitoneal schwannoma

Introduction:
Retroperitoneal schwannomas (RS) are rare, benign tumors that originate in the neural sheath. Juxta-adrenal schwannomas may be misdiagnosed with giant adrenal tumors. This article reports the case of a RS that presented as an asymptomatic adrenal mass in a 50 Y.O female.
Presentation of case:
An abdominal ultrasound of our asymptomatic patient showed right adrenal lesion of 9 cm of diameter. Endocrinological evaluation was negative. The patient was considered to have a non-secreting right adrenal mass confirmed by adrenal scan. We began a right laparoscopic trans peritoneal adrenalectomy, but when we discovered intra operatively that the wall of the IVC and the renal vein were very adherent to the mass which had a lot of small vessels that were bleeding, we converted to open surgery that allowed us to remove the mass safely. The operative time was 200 min, the blood loss was 850 cc and the patient was discharged uneventfully on the sixth day after surgery.
Discussion:
Although we thought that we removed a huge adrenal tumor from the retroperitoneum of our patient, the pathological exam revealed a RS that comprises the adrenal gland which was normal. Preoperative establishment of diagnosis is difficult in case of RS that can be misdiagnosed, especially when they stick to other structures (the adrenal in our case).
Conclusion:
Complete surgical resection is the treatment of choice for RS and open surgery is the safest option when we have big tumors. Histology and Immunohistochemistry confirms the diagnosis that can be easily missed preoperatively.
In Acute IgA Nephropathy, Proteinuria and Creatinine Are in the Spot, but Podocyturia Operates in Silence: Any Place for Amiloride?
Authors: H Trimarchi, M Paulero, R Canzonieri, A Schiel, A Iotti, C Costales-Collaguazo, A Stern, M Forrester, F Lombi, V Pomeranz, R Iriarte, T Rengel, I Gonzalez-Hoyos, A Muryan, E Zotta
Journal: Case Rep Nephrol (2017)
MeSH terms: Case Reports

IgA nephropathy is the most frequent cause of primary glomerulonephritis, portends erratic patterns of clinical presentation, and lacks specific treatment. In general, it slowly progresses to end-stage renal disease. The clinical course and the response to therapy are usually assessed with proteinuria and serum creatinine. Validated biomarkers have not been identified yet. In this report, we present a case of acute renal injury with proteinuria and microscopic hematuria in a young male. A kidney biopsy disclosed IgA nephropathy. Podocyturia was significantly elevated compared to normal subjects. Proteinuria, renal function, and podocyturia improved promptly after steroids and these variables remained normal after one year of follow-up, when steroids had already been discontinued and patient continued on valsartan and amiloride. Our report demonstrates that podocyturia is critically elevated during an acute episode of IgA nephropathy, and its occurrence may explain the grim long-term prognosis of this entity. Whether podocyturia could be employed in IgA nephropathy as a trustable biomarker for treatment assessment or even for early diagnosis of IgA nephropathy relapses should be further investigated.
Tramadol-Induced Mood Elevation in a Patient with No Previous Psychiatric History
Authors: Mugtaba Osman, Mashael Mustafa
Journal: Case Rep Psychiatry (2018)
MeSH terms: Case Reports

Tramadol is a powerful analgesic medication with antidepressant effects like venlafaxine. Hypomanic features were reported in patients with psychiatric history of mood disturbance when tramadol was prescribed for them. However, it is extremely rare to notice such mood-elevating effect in patients who have no previous psychiatric history. We report on the observation of a distressing mood-elevating effect for tramadol in a patient with no previous psychiatric history. We present the case of a 26-year-old female patient who developed accelerated flow of speech, overactivity, and difficulty in sleeping following intake of tramadol 50 mg dose. These symptoms resolved four hours later and recurred as she retook tramadol. The patient has no history of mood disorder or any other psychiatric comorbidity. Clinicians should exercise caution when prescribing tramadol.
A case-report of widespread pulmonary embolism in a middle-aged male seven weeks after asymptomatic suspected COVID 19 infection
Authors: Mats Beckman, Sven Nyrén, Anna Kistner
Journal: Thromb J (2020)
Keywords: covid-19, ground-glass, male, pulmonary embolism
MeSH terms: Case Reports

Background:
Pulmonary embolism (PE) is seen in high frequency in hospital-treated patients with Covid-19. We present a case of suspected Covid-19 with long-term dyspnea and widespread PE.
Case presentation:
A 51- year old male, with no prior medical history, no medication, and non-smoker arrived at the emergency department with exercise induced dyspnea during 4-5 weeks and for the last 48 h dyspnea at rest. Seven weeks before hospitalization, he felt difficulties taking deep breaths for some days but no other symptoms. Oxygen saturation at rest was 93%. Troponin T was 1200 mg/L (ref < 15 mg/L). CT angiography revealed widespread bilateral segmental pulmonary embolism. Additional findings were ground glass opacities that could match Covid-19. The patient tested negative for SARS -CoV-2. Full dose tinzaparin was given for 2 days in hospital, followed by apixaban for 6 months. Recovery has been uneventful so far.
Conclusions:
Long-term breathing difficulties might be relatively common after non-hospitalized symptomatic Covid-19. The frequency of PE in this group is unknown. We report a case of suspected covid-19 with widespread PE and a long history of dyspnea but no other symptoms. In our case slight hypoxia and laboratory testing indicated significant disease, which was proven with contrast angiography. This case shows that PE is a differential diagnosis in non-hospitalized symptomatic Covid-19 with persisting breathing problems.
A novel deletion in 2q24.1q24.2 in a girl with mental retardation and generalized hypotonia: a case report
Authors: Orazio Palumbo, Pietro Palumbo, Teresa Palladino, Raffaella Stallone, Leopoldo Zelante, Massimo Carella
Journal: Mol Cytogenet (2012)

Background:
Chromosomal imbalances, recognized as the major cause of mental retardation, are often due to submicroscopic deletions or duplications not evidenced by conventional cytogenetic methods. To date, interstitial deletion of long arm of chromosome 2 have been reported for more than 100 cases, although studies reporting small interstitial deletions involving the 2q24.1q24.2 region are rare. With the widespread clinical use of comparative genomic hybridization chromosomal microarray technology, several cryptic chromosome imbalances have outlined new genotype-phenotype correlations and isolated a number of distinctive clinical conditions.
Results:
here we report on a girl with mental retardation and generalized hypotonia. A genome-wide screen for copy number variations (CNVs) using single nucleotide polymorphisms (SNPs) array revealed a 7.5 Mb interstitial deletion of chromosome region 2q24.1q24.2 encompassing 59 genes, which was absent in parents. The gene content analysis of the deleted region and review of the literature revealed the presence of some genes that may be indicated as good candidate in generating the main clinical features of the patient.
Discussion:
the present case represents a further patient described in the literature with an interstitial deletion of chromosome 2q24.1q24.2. Our patient shares some clinical features with the previously reported patients carriers of overlapping 2q24 deletion. Although more cases are needed to delineate the full-blown phenotype of 2q24.1q24.2 deletion syndrome, published data and present observation suggest that hemizygosity of this region results in a clinically recognizable phenotype. Considering these clinical and cytogenetic similarities, we suggest the existence of an emerging syndrome associated to 2q24.1q24.2 region.
S. gallolyticus Aortic Valve Endocarditis with Mitral Valve Leaflet Aneurysm
Authors: S Poddi, I Tropea, G Faggian, S De Feo, M Zordan, A Rungatscher
Journal: Case Rep Cardiol (2022)
MeSH terms: Case Reports

S. gallolyticus is one of the pathogenic agents of endocarditis, and mitral valve aneurysm is a rare but potentially devastating complication. We present a case of S. gallolyticus aortic valve endocarditis with concomitant anterior mitral valve leaflet aneurysm. Patient underwent surgery before aneurysm perforation, and postoperative course was uneventful. Time of surgery is crucial to avoid severe complications due to aneurysm rupture.
Unusual Presentation of Bilateral Radiation-Induced Angiosarcoma of the Breast
Authors: Umesh Jayarajah, Kavinda Nagodavithane, Oshan Basnayake, Sanjeewa Seneviratne
Journal: Case Rep Oncol Med (2020)
MeSH terms: Case Reports

Radiation-induced sarcoma of the breast is an iatrogenic malignancy that occurs secondary to radiotherapy, which is most commonly given following breast conservation surgery. It has an incidence of 3.2 per 1,000 patients at 15 years and is associated with a poor prognosis. We report a 62-year-old female with a history of bilateral breast conservation surgery and radiotherapy 5 years ago presenting with bilateral angiosarcoma. This case report highlights the importance of considering radiation-induced angiosarcoma of the breast as a differential diagnosis in a patient with recurrent breast neoplasms. The challenges in the management with recent evidence on new treatment modalities are discussed.
Premature Ejaculation after Lithium Treatment in a Patient with Bipolar Disorder
Authors: Pedro Amadeu Almeida, Filipa Caldas, Inês Homem de Melo, Ana Maria Moreira, Gustavo França Santos
Journal: Case Rep Psychiatry (2023)
MeSH terms: Case Reports

Lithium has proven its efficacy in treating bipolar disorder. Severe side effects caused by lithium, including renal and endocrine outcomes, have already been amply documented. The impact of lithium on sexual function, however, is less well known. A 33-year-old man, with no past medical history, diagnosed with bipolar disorder, developed premature ejaculation after short-term use of lithium. The dose of lithium was reduced, leading to a rapid clinical resolution. Retrospectively, lithium-induced premature ejaculation was deemed the most likely diagnosis. Premature ejaculation is a rare side effect of lithium. Changing the time of medication administration and lowering dose could be considered as alternatives. Given lithium's pharmacological profile, it is likely that the pathophysiologic mechanism behind premature ejaculation is altered levels or altered serotonin receptor sensitivity in the ejaculatory modulating centers of the central nervous system. Given the reluctance to spontaneously report sexual adverse effects, clinicians should be aware of this possible side effect.
Case Report: Colorectal cancer metastasis to a cervical lymph node - an unusual source of a neck lump
Authors: Oliver J Wright, Anthony Bashyam, Lisa Pitkin, Silvana Di Palma
Journal: F1000Res (2020)
Keywords: cervical lymph node, colorectal cancer, metastatic caecal adenocarcinoma, neck lump, otolaryngology
MeSH terms: Adenocarcinoma / pathology, Colorectal Neoplasms / pathology, Lymphatic Metastasis, Case Reports, Aged, Female, Humans, Lymph Nodes / pathology

Colorectal cancer (CRC) is the third most common cancer worldwide, and approximately 25% of patients already have metastases at the time of diagnosis. The most common metastatic sites for CRCs are the liver, lung, bone and brain and peritoneum. Cervical lymph node metastases in CRC are rare, particularly in the absence solid organ involvement. Here we present a case of a 73-year-old female patient who, following resection of a poorly differentiated caecal adenocarcinoma, re-presented four years later with a left level IV lymph node which was ultimately found to contain metastatic adenocarcinoma.
A Novel BTK Gene Mutation in a Child With Atypical X-Linked Agammaglobulinemia and Recurrent Hemophagocytosis: A Case Report
Authors: Shu-Ping Han, Yung-Feng Lin, Hui-Ying Weng, Shih-Feng Tsai, Lin-Shien Fu
Journal: Front Immunol (2019)
Keywords: bruton's tyrosine kinase, x-linked agammaglobulinemia, hemophagocytic lymphohistiocytosis, intravenous immunoglobulin, primary immunodeficiency disease
MeSH terms: Agammaglobulinaemia Tyrosine Kinase / genetics, Agammaglobulinemia / genetics, Genetic Diseases, X-Linked / genetics, Lymphohistiocytosis, Hemophagocytic / genetics, Case Reports, Research Support, Non-U.S. Gov't, Child, Humans, Male, Mutation, Agammaglobulinaemia Tyrosine Kinase, BTK protein, human, Bruton type agammaglobulinemia

X-linked agammaglobulinemia (XLA), caused by a mutation in the Bruton's tyrosine kinase (BTK) gene, is rarely reported in patients with recurrent hemophagocytic lymphohistiocytosis (HLH). This mutation leads to significantly reduced numbers of circulatory B cells and serum immunoglobulins in patients. Therefore, they exhibit repetitive bacterial infections since infancy, and immunoglobulin (Ig) replacement therapy is the primary treatment. HLH is a life-threatening condition with manifestations of non-remitting fever, hepatosplenomegaly, cytopenias, coagulopathy, lipid disorder, and multiple organ failure. It is caused by the immune dysregulation between cytotoxic T cells, NK cells, and histiocytes. The treatment is based on HLH-2004 protocol including immunotherapy, chemotherapy, supportive therapy, and stem cell transplantation. However, as we know more about the classification and pathophysiology of HLH, the treatment is modified. T-cell-directed immunotherapy is effective in patients with primary HLH, and strong immunosuppression is contraindicated in patients with severe ongoing infections or some primary immunodeficiency diseases (PIDs). Here, we report the case of a 7-year-old boy who presented with ecthyma gangrenosum and several episodes of pyogenic infections during childhood. At the age of 5 years, he exhibited cyclic HLH every 2-3 months. The remission of HLH episodes finally achieved after he received monthly Ig replacement therapy (400 mg/kg) at the 4th HLH. However, transient elevation of IgM was incidentally discovered after 6 cycles of monthly Ig replacement therapy. IgM-secreting multiple myeloma, Waldenström's macroglobulinemia, and lymphoma were excluded. The IgM levels then declined and returned to the normal range within a year. The patient and his parents received whole-genome sequencing analysis. It revealed a novel hemizygous c.1632-1G>A mutation in the BTK gene and XLA was diagnosed. XLA exhibits a spectrum of clinical and immunological presentations in patients. The identification of the mutation in the BTK gene contribute to an accurate diagnosis. Ig replacement therapy is the primary treatment for HLH in patients with XLA.
Emergency microsurgery for patients with soft tissue, skull, and dura complex defects after trauma: a case report
Authors: Masayuki Okochi, Yuzo Komuro, Kazuki Ueda
Journal: Case Reports Plast Surg Hand Surg (2019)
Keywords: dura, emergency, free flap, reconstruction, scalp
MeSH terms: Case Reports

We performed two emergency microsurgical dura, skull, and scalp complex reconstructions. We used the rectus abdominis flap with free fascia lata and the anterolateral thigh flap with vascularized fascia lata. To achieve good postoperative result, reconstruction should be performed before meningitis or wound infection.
A twisted tale-radiological imaging features of COVID-19 on 18F-FDG PET/CT
Authors: Hazel O'Neill, Simon Doran, Francesco Fraioli, Afshin Nasoodi
Journal: Eur J Hybrid Imaging (2020)
Keywords: 18f-fdg pet/ct, covid-19
MeSH terms: Case Reports

The COVID-19 pandemic has had a major impact on health care systems across the globe in a short period of time. There is a growing body of evidence surrounding the findings on hybrid imaging with FDG-PET/CT, and this case highlights the importance of molecular imaging in better understanding of the biomarkers of the disease which ultimately determine the success in building a model to predict the disease severity and monitoring the response to treatment.
Adverse clinical sequelae after skin branding: a case series
Authors: Shahzad Raza, Khalid Mahmood, Abdul Hakeem, Sylvie Polsky, Anna Haemel, Soniya Rai, Mahadi Ali Baig
Journal: J Med Case Rep (2009)

Introduction:
Branding refers to a process whereby third degree burns are inflicted on the skin with a hot iron rod or metallic object. Branding employs the phenomenon of "counter irritation," and is widely used by faith healers in developing countries for therapeutic purposes. Some methods, which are very crude and inhuman, carry a large risk of complications. The purpose of this study is to present a series of complications and to familiarize clinicians with this dangerous method of treatment.
Case presentation:
Four Pakistani patients, three male and one female, ranging from 25 to 60 years of age "branded" with a red hot iron rod for various medical reasons presented with severe medical complications to our tertiary care hospital. The mean duration between the procedure and presentation to the hospital was 6 days. At the time of admission, two patients had septic shock, one patient had cavernous sinus thrombosis and one patient had multiple splenic abscesses. All patients received standard care for wound management and systemic infections. Two patients eventually died during the course of treatment.
Conclusion:
Severe complications from branding are troublesome and the potential risks of this treatment outweigh its benefits. Globally, there is a great need for heightened awareness about the dangers of branding among patients and physicians, as this will have an important effect on patients who seek branding for various medical conditions.