OpenMed/multicare-articles huggingface dataset:
Quantitative analysis of pupillometry in isolated third nerve palsy
Authors: Hyeong Min Kim, Hee Kyung Yang, Jeong-Min Hwang
Journal: PLoS One (2018)
MeSH terms: Oculomotor Nerve Diseases / diagnosis, Reflex, Pupillary, Research Support, Non-U.S. Gov't, Aged, Female, Humans, Light, Male, Middle Aged, Oculomotor Nerve Diseases / pathology, Oculomotor Nerve Diseases / physiopathology, Pupil / physiology, Retrospective Studies

Objectives:
To objectively assess pupillary involvement according to various etiologies of acquired isolated third nerve palsy using automated pupillometry, and evaluate the efficacy of digital pupillometry in discriminating compressive lesions from microvascular ischemic third nerve palsy.
Design:
Retrospective, observational case series.
Methods:
A total of 171 subjects were included in this study, consisting of 60 subjects with presumed microvascular ischemic third nerve palsy, 51 with non-ischemic third nerve palsy, and 60 controls whose pupillary light responses were measured using a dynamic automated pupillometer. Subjects with non-ischemic third nerve palsy were divided into subgroups according to their etiology; inflammatory and compressive groups including tumor and aneurysm. Pupillometry parameters including minimum and maximum pupil diameters, constriction latency and ratio, maximum and average constriction velocities and dilation velocity were noted. The diagnostic ability of pupillometry parameters for discriminating compressive vs microvascular ischemic third nerve palsy was evaluated. The inter-eye difference of the involved eye and the uninvolved fellow eye was calculated to adjust for individual variability.
Results:
Among all parameters, reduced pupillary constriction ratio was the most specific parameter for detecting non-ischemic third nerve palsy, as a large inter-eye difference beyond the normative range of controls was found in 0% of ischemic, 20% of inflammatory and 60% of compressive third nerve palsy. With the diagnostic criteria using inter-eye differences of 1) minimum pupil diameter > 0.45 mm, or 2) pupillary constriction ratio < -7.5% compared to the fellow eye, the sensitivity and specificity for diagnosing compressive third nerve palsy were 95% and 88%, respectively. In the compressive group, positive correlations were found between the degree of external ophthalmoplegia and constriction ratio (r = 0.615, p<0.001), average constriction velocity (r = 0.591, p = 0.001) and maximum constriction velocity (r = 0.582, p = 0.001).
Conclusions:
Abnormal pupillary constriction ratio was highly specific for detecting compressive third nerve palsy, although the sensitivity was not high. Digital pupillometry demonstrated relatively good performance for discriminating compressive lesions from microvascular ischemic third nerve palsy.
Iterative Rupture of the Patellar Tendon: A Case Report of an Original Technique for Revision Reconstruction Using an Adjustable Loop and an Artificial Ligament
Authors: N Bouguennec, P Colombet
Journal: Case Rep Orthop (2018)
MeSH terms: Case Reports

Chronic rupture of the patellar tendon is a severe injury that leads to dramatic functional consequences including lack of extension and walking difficulty. Surgery is the gold standard to treat this type of injury, but revision reconstructions are problematic because an ipsilateral graft was often harvested for the initial surgery. Because fibrotic tissues on the patellar tendon need to be debrided, another graft must be added to reinforce the tendon. We reported the case of a former semiprofessional handball player, a 29-year-old man who presented an iterative rupture with the fracture of the transverse patellar tunnel 6 months after reconstruction using a semitendinosus graft and suture repair. We performed revision reconstruction surgery using an artificial ligament placed between the extensor mechanism and the tibia for extra-articular reinforcement to maintain extensor mechanism continuity. Two adjustable loops were also used to repair the patellar tendon tear. At 2-year follow-up, the patient was able to resume the practice of handball at a competitive level with good clinical and functional results. This technique can therefore be used as a salvage procedure for chronic iterative rupture of the patellar tendon.
A Constellation of Rare Findings in a Case of Goldenhar Syndrome
Authors: Mitesh Bedi, Rakesh Kumar Jain, Vipin Kumar Barala, Abhimanyu Singh, Hiranmayi Jha
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

An 18-month-old child presented with right macrostomia, bilateral preauricular skin tags, bilateral CTEV, squint in bilateral eyes, thoracic vertebral anomalies, right sided aortic arch, and associated left pulmonary agenesis. The patient did not have any associated respiratory symptoms. Ipsilateral pulmonary agenesis is considered as a rare association with Goldenhar syndrome and a case of contralateral pulmonary aplasia has been described as an even rarer association.
A Delayed Diagnosis of Hemorrhagic Shock in a Patient with Alcoholic Cirrhosis and Ascites on Bedside Ultrasound
Authors: Madeline Bach, Julian Choi, Rory A Smith, Sarkis Arabian
Journal: Case Rep Crit Care (2019)
MeSH terms: Case Reports

Undifferentiated shock is a common and challenging problem in critical care. We present a case of hemorrhagic shock due to splenic and hepatic lacerations diagnosed by bedside paracentesis, initially misclassified as septic shock due to suspected spontaneous bacterial peritonitis (SBP). Case. A 47-year old man with a history of reported alcoholic cirrhosis and ongoing heavy alcohol use was brought to the emergency room after a syncopal event. He was found to be anemic (hemoglobin 9.9 g/dl) and hypotensive with a blood pressure of 64/34. Despite crystalloid infusion he remained hypotensive and required vasopressor support with norepinephrine. Bedside ultrasound revealed moderate ascites and as there was no evidence of active bleeding, his shock was attributed to sepsis due to SBP. A bedside paracentesis was performed which revealed gross blood. A repeat hemoglobin returned at 4.4 g/dl. Massive transfusion protocol was initiated and interventional radiology was emergently consulted due to concerns for intraabdominal hemorrhage; general surgery deemed the patient too unstable for surgical intervention. Angiogram revealed a splenic laceration and possible hepatic laceration, both embolized successfully. Internal medicine practitioners should keep the differential of hemorrhagic shock due to intraabdominal organ injury in mind for patients with undifferentiated shock.
Clostridium difficile Enterocolitis and Reactive Arthritis: A Case Report and Review of the Literature
Authors: Michela Cappella, Fabrizio Pugliese, Andrea Zucchini, Federico Marchetti
Journal: Case Rep Pediatr (2016)

Reactive arthritis is a rare complication of Clostridium difficile enterocolitis, especially in children. We review the 6 pediatric cases published in the English and non-English literature and discuss their clinical presentation, outcome, treatment, and pathophysiology. We also report the seventh case of Clostridium difficile reactive arthritis in a 6-year-old boy who was treated with amoxicillin-clavulanate for 10 days because of an upper respiratory infection. After the antibiotic course, the child developed at the same time diarrhea with positive stool culture for Clostridium difficile and an asymmetric polyarthritis. Nonsteroidal anti-inflammatory drugs and metronidazole completely resolved the pain, joint swelling, and diarrhea. After twelve months of follow-up there has been no recurrence. This report confirms the self-limiting course of Clostridium difficile reactive arthritis. Clostridium difficile testing in children with gastrointestinal symptoms and acute onset of joint pain should be always considered.
Metastatic extrapulmonary small cell carcinoma to the cerebellopontine angle: a case report and review of the literature
Authors: Debebe Theodros, C Rory Goodwin, Genevieve M Crane, Jason Liauw, Lawrence Kleinberg, Michael Lim
Journal: Case Rep Oncol Med (2015)

Extrapulmonary small cell carcinomas (EPSCC) are rare malignancies with poor patient prognoses. We present the case of a 63-year-old male who underwent surgical resection of a poorly differentiated small cell carcinoma, likely from a small intestinal primary tumor that metastasized to the cerebellopontine angle (CPA). A 63-year-old male presented with mild left facial paralysis, hearing loss, and balance instability. MRI revealed a 15 mm mass in the left CPA involving the internal auditory canal consistent with a vestibular schwannoma. Preoperative MRI eight weeks later demonstrated marked enlargement to 35 mm. The patient underwent a suboccipital craniectomy and the mass was grossly different visually and in consistency from a standard vestibular schwannoma. The final pathology revealed a poorly differentiated small cell carcinoma. Postoperative PET scan identified avid uptake in the small intestine suggestive of either a small intestinal primary tumor or additional metastatic disease. The patient underwent whole brain radiation therapy and chemotherapy and at last follow-up demonstrated improvement in his symptoms. Surgical resection and radiotherapy are potential treatment options to improve survival in patients diagnosed with NET brain metastases. We present the first documented case of skull base metastasis of a poorly differentiated small cell carcinoma involving the CPA.
Early Onset Preeclampsia and Intrauterine Growth Restriction: A Case Report
Authors: Fahimah A Almuhaytib, Nihad A AlKishi, Zainab M Alyousif
Journal: Cureus (2023)
Keywords: early onset, hellp, iugr, preeclampsia, proteinuria
MeSH terms: Case Reports

Preeclampsia is a life-threatening illness during pregnancy. The main signs of preeclampsia are high blood pressure and proteinuria. Most cases of preeclampsia occur in the third trimester after 32 weeks and affect nulliparous women. Preeclampsia can lead to many serious complications, including the death of both the mother and fetus. In this case report, we reported a case of a 34-year-old Saudi woman, gravid 6 para 4 + 1 abortion, at 22 weeks by ultrasonography (US). Complained of a rare condition of early preeclampsia with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and intrauterine growth restriction (IUGR) due to placental insufficiency in the second trimester of pregnancy This pregnancy was terminated due to maternal risks. In conclusion, we can consider the importance of blood pressure screening in the early stages of pregnancy in the first or second trimester.
A Fatal Sepsis Caused by Hyaluronate Knee Injection: How Much the Medical History and the Informed Consent Might Be Important?
Authors: F Manfreda, G Rinonapoli, A Nardi, P Antinolfi, A Caraffa
Journal: Case Rep Orthop (2017)
MeSH terms: Case Reports

The incidence of Osteoarthritis (OA) is gradually increasing worldwide due to two main reasons: longer life expectation and increased functional demand. Several treatment options have been proposed for this disease. Conservative treatment has the goal to improve the quality of life, reduce pain, and prevent the progression of the disease. Hyaluronate viscosupplementation is one of the most used infiltrative treatments for OA, but, despite its common use, clinical efficacy is still under question. Though adverse reactions for this medical option are actually rare, septic arthritis is a very scaring complication. We present a case report of a 59-year-old man who has been submitted to only one knee hyaluronate injection and consequently reported a severe septic arthritis and systemic sepsis, which lead to the death of the patient. We recommend producing correct guidelines for a clean aseptic procedure of injection to obtain proper consensus from the patient and to pay attention to his clinical history and comorbidities before acting any kind of invasive treatment, including joint injection.
Primary Sjögren's syndrome with renal tubular acidosis and central pontine myelinolysis: An unusual triad
Authors: Zibya Barday, Malcolm Masikati, Nicola Wearne, Brian Rayner, Bianca Davidson, Kathleen Jane Bateman, Erika Jones
Journal: Clin Nephrol Case Stud (2023)
Keywords: sjögren’s, central pontine myelinolysis, kidney, renal tubular acidosis
MeSH terms: Case Reports

Primary Sjögren's syndrome (pSS) is a complex, multisystem autoimmune disorder. It is characterized by lymphocytic infiltration of the exocrine glands. In the setting of pSS, the presence of systemic disease is an important prognostic determinant, but involvement of the kidney is uncommon. The triad of pSS, distal renal tubular acidosis (dRTA), and central pontine myelinolysis (CPM) is rare and potentially fatal. A 42-year-old woman presented with dRTA, profound hypokalemia, and CPM characterized by progressive global quadriparesis, ophthalmoplegia, and encephalopathy. Sjögren's syndrome was diagnosed based on sicca symptoms, clinical features, and strongly positive anti-SSA/Ro and anti-SSB/La autoantibodies. The patient responded well to electrolyte replacement, acid-base correction, corticosteroids, and subsequent cyclophosphamide therapy. Early recognition and appropriate treatment resulted in good kidney and neurological outcomes in this case. This report highlights the need to consider the diagnosis of pSS in unexplained dRTA and CPM, as it has a favorable prognosis if recognized and managed timeously.
Bilateral Internal Carotid Artery Dissection as a Possible Complication in a patient with Covid-19 infections and coughing
Authors: Mohammad Ghorbani, Abolghasem Mortazavi, Ghazwan Lafta, Mahdi Kadkhodazadeh Asl, Reza Bahrami, Farhad Rahbarian
Journal: Caspian J Intern Med (2022)
Keywords: covid-19, carotid stenting, cough, stroke, dissection
MeSH terms: Case Reports

Background:
Cervical carotid dissection is one of the causes of ischemic stroke in young people. Most of the patients with carotid dissection do not have connective tissue diseases (Marfan syndrome, Ehlers-Danlos syndrome). It seems that dissection may occur without an obvious cause or may follow environmental injuries like vigorous neck movements, chiropractic manipulation, emesis, severe coughs, and some infections. We present a case of bilateral carotid dissection in a patient following coronavirus infection and severe coughs.
Case presentation:
A 38-year-old right-handed man presented with recurrent episodes of transient right hemiparesis and aphasia. He had a history of coronavirus infection and severe persistent, nonproductive cough 7 days before the onset of his symptoms. Carotid angiography showed tapered flame-like appearance in proximal segment of left ICA starting about 2 cm distal to the carotid bulb caused complete occlusion of left ICA and in right CCA angiography there is pseudo aneurysm in right cervical ICA just before the Petrous segment. In 3 months in follow up DSA there is evidence of complete occlusion of right pseudo aneurysm and recanalization of left ICA without stenosis.
Conclusion:
COVID-19 may have role in the processes that eventually led to CAD.
A case study of repetitive transcranial magnetic stimulation for cryptococcal meningitis combined with cognitive impairment
Authors: Yuanbiao Liu, Lei Fan, Xinlin Jiang, Yi Lu, Yige Li
Journal: Front Hum Neurosci (2022)
Keywords: cognitive impairment, cryptococcal meningitis, inflammatory cytokines, rehabilitation, repetitive transcranial magnetic stimulation
MeSH terms: Case Reports

Cryptococcal meningitis (CM) is a central nervous system disease caused by a novel Cryptococcus infection that leads to subacute or chronic inflammatory changes in the nervous system. In this study, we present the case of a woman aged 72 years with CM and severe cognitive impairment and disabilities. The cognitive assessment indicated that, although her cognitive function was impaired, especially executive function, it largely improved after receiving anti-infectious and repetitive transcranial magnetic stimulation, which can alter the membrane potential of the cortical nerve cells by triggering long-term potentiation and depression, modulating and releasing hormones, reducing the level of neuroinflammatory and peripheral blood cytokines, promoting nerve regeneration and synaptic remodeling, and changing the activity of the neural circuitry of the dorsolateral prefrontal cortex. We argue that this case provides a novel method of treatment for patients with CM in conjunction with cognitive impairments.
Nonoperative Management May Be a Viable Approach to Plexiform Neurofibroma of the Porta Hepatis in Patients with Neurofibromatosis-1
Authors: Natesh Yepuri, Rana Naous, Camille Richards, Dilip Kittur, Ajay Jain, Mashaal Dhir
Journal: HPB Surg (2018)

Background:
Plexiform neurofibroma (PNF) in the porta hepatis (PH) is an unusual manifestation of neurofibromatosis-1 (NF-1). Resection is often recommended given the risk of malignant transformation. We encountered a challenging case in clinical practice which prompted us to report our findings and perform a systematic review on the management of these tumors.
Methods:
We reported the case of a 31-year-old woman with NF-1 and PNF of the PH. PRISMA 2009 guidelines were followed for systematic review.
Results:
Our patient was found to have unresectable disease at exploration. After >5 years of follow-up, she continued to have stable disease on imaging. We identified 12 studies/case reports including 10 adult and 6 pediatric patients with PNF of PH. None of the 7 adult patients with NF-1 and PNF of PH underwent a successful tumor resection. All pediatric patients were managed with surveillance alone. All but one pediatric patient had NF-1. None of the reported cases of PNF of PH had malignant transformation.
Conclusion:
Our findings suggest that PNFs of PH in the setting of NF-1 are often unresectable and may have an indolent course. Surveillance alone may be a reasonable option in some patients; however, further studies are needed.
A rare case of thumb polydactyly with metacarpophalangeal joint synostosis
Authors: Michael Finsterwald, Sebastian Guenkel
Journal: Case Reports Plast Surg Hand Surg (2019)
Keywords: thumb duplication, wassel type iv, congenital thumb deformity, preaxial polydactyly, symphalangism, synostosis, thumb polydactyly
MeSH terms: Case Reports

We report on a rare case of thumb polydactyly with metacarpophalangeal joint synostosis in a 14-year old otherwise healthy boy. Our case can only be classified in the Rotterdam classification, was treated with resection of the hypoplastic radial component and yielded a very satisfactory outcome with a stable thumb.
ACE Inhibitor-Induced Angioedema of the Bowel
Authors: Tabitha Campbell, Bradley Peckler, Raleigh David Hackstadt, Austin Payor
Journal: Case Rep Med (2010)
MeSH terms: Case Reports

Angiotensin converting enzyme inhibitor ACEI-induced angioedema of the intestine is a rare occurrence and often unrecognized complication of ACEI. We present a case of a 45-year-old Hispanic female with angioedema of the small bowel progressing to facial and oral pharyngeal angioedema. Patients are typically middle-aged females on ACEI therapy who present to the emergency department with abdominal pain, nausea, vomiting, and diarrhea. This is a diagnosis of exclusion, and physicians must have a high index of suspicion to make the diagnosis. Symptoms typically resolve within 24-48 hours after ACE inhibitor withdrawal. Recognizing these signs and symptoms, and discontinuing the medication, can save a patient from unnecessary, costly, and invasive procedures.
Immune Thrombocytopenia Revealing Enriched IgG-4 Peri-Renal Rosai-Dorfman Disease Successfully Treated with Rituximab: A Case Report and Literature Review
Authors: Jerome Razanamahery, Sebastien Humbert, Jean-Francois Emile, Fleur Cohen-Aubart, Jean Fontan, Philippe Maksud, Sylvain Audia, Julien Haroche
Journal: Front Med (Lausanne) (2021)
Keywords: erdheim chester disease, rosai dorfman disease, histiocytosis, immune thrombocytopenia, rituximab
MeSH terms: Case Reports

Immune thrombocytopenia (ITP) is a rare autoimmune-mediated condition characterized by isolated thrombocytopenia (<100 G/L) after exclusion of other causes. Mostly primary, it is associated with hematological malignancy, autoimmune disorders, or infection in 20% of patients. It is exceptionally described in patients with histiocytosis, mostly in children (seven patients in literature). We report a case of a 69-year-old man with ITP leading to the diagnosis of histiocytosis. At ITP's diagnosis, the patient had elevated gamma-globulins leading to computed tomography showing bilateral peri-renal infiltration. The biopsy showed enriched IgG-4 peri-renal Rosai Dorfman disease with MAP2K1 mutation, although peri-renal infiltration is highly suggestive of Erdheim-Chester disease. This overlapping association was described in men with mutation in MAP2K1 gene. Macrophages are implicated in the pathophysiology of ITP in multiple ways, notably by the phagocytosis of opsonized platelets and their function of antigen-presenting cells able to stimulate autoreactive T cells. Histiocytic cells derivate from monocyte-macrophage lineage. Activation of macrophages in active histiocytosis is responsible for consequential platelet destruction in ITP associated histiocytosis. Finally, this case highlights a rare presentation of ITP revealing histiocytosis, both being efficiently treated with rituximab.
Acute Secondary Adrenal Insufficiency Misdiagnosed as Acute Cholecystitis
Authors: Moslem Sedaghattalab, Amir Hossein Doustimotlagh
Journal: Case Rep Endocrinol (2021)
MeSH terms: Case Reports

Hypopituitarism refers to insufficient secretion of the pituitary hormones. Patients with acute adrenocorticotropic hormone (ACTH) deficiency may be presented with fatigue, dizziness, orthostatic hypotension, hypoglycemia, nausea, vomiting, or nonspecific abdominal pain. This study described an unusual case of hypopituitarism in a patient who presented with general abdominal pain, abdominal tenderness, nausea, vomiting, hypotension, and hypoglycemia. At first, the patient was admitted with the diagnosis of acute cholecystitis, but after treatment of hypopituitarism and adrenal insufficiency, his symptoms resolved completely, without the need for surgery. Hypopituitarism and secondary adrenal insufficiency should be considered in the differential diagnosis of the patients who present with acute abdomen, hypotension, or hypoglycemia.
Symptomatic Supraventricular Tachycardia Resistant to Adenosine Therapy in a Patient with Chronic Theophylline Use
Authors: Seyedeh Maryam Hosseini, Muhammad Ajmal, Ranjith Shetty
Journal: Case Rep Cardiol (2021)
MeSH terms: Case Reports

Theophylline is a potent adenosine receptor antagonist with indirect adrenergic effects that can lead to arrhythmias and metabolic abnormalities such as hypokalemia. Therapeutic toxicity cases have declined over the years mainly due to decreased recommended therapeutic doses and overall decreased usage of this medication due to newer available COPD treatment options. We present a clinical case of symptomatic supraventricular tachycardia resistant to adenosine therapy in a patient with theophylline use. This case highlights the importance of comprehensive medication review in acute settings to aid in identifying the underlying etiologies and initiating prompt treatments. It also signifies the importance of reviewing chronic medications in each outpatient visits to ensure continued indication for their use and be able to change them to newer agents per guidelines whenever possible.