OpenMed/multicare-articles huggingface dataset:
A Seizure and Hemiplegia following Contrast Exposure: Understanding Contrast-Induced Encephalopathy
Authors: Bhargavi Donepudi, Steven Trottier
Journal: Case Rep Med (2018)
MeSH terms: Case Reports

Contrast-induced encephalopathy is a rare, reversible phenomenon known to occur after intravenous or intra-arterial contrast exposure. This report describes a case involving a 73-year-old female admitted for an elective thoracic aortic aneurysm repair. During the procedure, a large volume of nonionic iodinated contrast was necessary for arteriography. Postoperatively, the patient developed seizure activity followed by left-sided hemiplegia. Computed tomography (CT) of the brain without contrast and magnetic resonance imaging (MRI) were negative for acute stroke but did show residual contrast surrounding the brain. Antiepileptic medications were administered with resolution of the seizure activity. The patient was treated with supportive management and improved to baseline over the next seven days. This case demonstrates a rare, nonionic iodinated contrast-induced encephalopathy with seizure activity and transient hemiplegia. The unique imaging findings differentiate it from other neurologic conditions.
Complete Ectopia Cordis: A Case Report and Literature Review
Authors: Simon Pius, Halima Abubakar Ibrahim, Mustapha Bello, Mohammed Bashir Tahir
Journal: Case Rep Pediatr (2017)
MeSH terms: Case Reports

Ectopia cordis is a congenital heart exposure defined as complete or partial protrusion of heart through ventral defect in the thoracoabdominal wall alone or with other viscera in cases of pentalogy of Cantrell. This condition was first described by Haller et al. in 1706; since then many advances have been made. Diagnosis of ectopia cordis is done prenatally in well-equipped health facility by antenatal ultrasound scan so that early diagnosis and management plan can be initiated. The index case was delivered to uneducated rural family and admitted at 3 days of life and survived for seven days, even though most literatures state that majority died within four days even with surgery. So, in view of this, we presented this case report to deliberately draw the attention of paediatrician/obstetrician to the fact that even though this condition is rare, proactive search and diagnosis should be made and early treatment should be instituted, so that such a child may be salvaged.
Atypical clinical presentation of systemic juvenile idiopathic arthritis or Still's disease: a report of two cases
Authors: Emeline Tiogouo, Paul Eloundou, Hermine Moukodi, Leo Fozeu, Guy Sadeu Wafeu
Journal: Pan Afr Med J (2020)
Keywords: child, still’s disease, arthritis, fever
MeSH terms: Adrenal Cortex Hormones / administration & dosage, Arthritis, Juvenile / diagnosis, Methotrexate / administration & dosage, Case Reports, Antirheumatic Agents / administration & dosage, Arthritis, Juvenile / drug therapy, Arthritis, Juvenile / physiopathology, Child, Child, Preschool, Drug Tapering, Humans, Male, Adrenal Cortex Hormones, Antirheumatic Agents, Methotrexate

Juvenile idiopathic arthritis (JIA) constitutes a group of arthritis of unknown origin that begins before the age of 16 years. Still´s disease is the systemic form of this condition. Its clinical presentation is marked by fever, rash and sometimes joint pain, in the absence of evidence of another aetiology of the fever. We present the cases of two boys aged 4 and 10 years admitted for fever, with a cerebral origin for the first and no infectious site for the second. Fever persisted after antimalarial treatment and adequate antibiotics. Ferritinaemia, elevated sedimentation rate, lactate dehydrogenase (LDH), triglycerides, and increased serum transaminases, all in the absence of evidence of other inflammatory or malignant diseases were suggestive of Still's disease. Both children received a corticosteroid therapy with progressive dose reduction associated to methotrexate during treatment. Fever disappeared within a few hours after initiation of corticosteroid therapy, with considerable improvement in clinical state. To the best of our knowledge, these cases are among the rare cases of childhood Still disease reported in sub-Saharan Africa. These cases highlight the importance of investigating non-infectious causes of persistent fever in children, in a context of infectious disease endemicity.
Endodontic Management of Teeth Juxtaposed to Haemangioma
Authors: Rekha Chandra Mani, Anchu Rachel Thomas, Premkumar Elavarasu, Vijay Venkatesh
Journal: Case Rep Dent (2017)
MeSH terms: Case Reports

Vascular anomalies are localized defects in the vasculature that may or may not be present at birth. There are many types of vascular anomalies with different aetiology and clinical picture and, therefore, require the combined expertise of medical, radiological, and surgical specialities for its diagnosis and management. The term "haemangioma" is used as a common generic label to incorporate all types of vascular malformations. In this report, we describe a case of two maxillary premolars, requiring endodontic therapy, in close proximity to a haemangioma. The challenges encountered in the diagnosis and management of the case are discussed.
A dengue infection without bleeding manifestations in an adult with immune thrombocytopenic purpura
Authors: N D B Ehelepola, M B K Gunawardhana, T N Sudusinghe, S K D Sooriyaarachchi, S P Manchanayake, K L R Kalupahana
Journal: Trop Med Health (2016)
Keywords: case report, dengue, immune thrombocytopenic purpura, platelet count, prednisolone, sri lanka
MeSH terms: Case Reports

Background:
Dengue is the most prevalent and fast spreading arboviral infection affecting people. No specific drug is available to treat dengue. Thrombocytopenia with potential of serious hemorrhages is one of the hall mark features of dengue. Immune thrombocytopenic purpura is an autoimmune disease causing thrombocytopenia. If a patient with that gets dengue, we expect severe thrombocytopenia with bleeding manifestations. Only a handful of such cases were reported before, and they were managed in different ways.
Case presentation:
A 30-year-old Sinhalese man recently diagnosed of immune thrombocytopenic purpura and on prednisolone was presented on the fourth day of fever, head ache, arthralgia, myalgia, and nausea. We started standard symptomatic dengue management and continued prednisolone. Dengue IgM and IgG antibody tests became positive. He was monitored by physical signs and serial full blood counts as the mainstay of monitoring. The patient never developed clinical bleeding manifestations and recovered.
Conclusions:
Considering the huge population at risk of dengue, generating more evidence on the topic and formulation of effective, simple guidelines to manage dengue in children and adults with immune thrombocytopenic purpura is going to be beneficial for many patients in the future.
Case Report: Robot-assisted laparoscopic nephron-sparing surgery for a renal abscess mimicking a tumor
Authors: Shun Wang, Xiangyi Liang, Di Pan, Jianqing Zhang, Kun Chen, Kehua Jiang, Tao Li
Journal: Front Oncol (2022)
Keywords: ra-nss, antibiotic therapy, distinguish, renal abscess, renal tumor
MeSH terms: Case Reports

The differential diagnosis of renal tumors and abscesses is crucial owing to their different treatments. Although antibacterial administration and radiological examination are excellent means for distinction, misdiagnosis is common and may lead to severe consequences, such as the need for nephrectomy. Here, we report a case involving a 52-year-old Asian woman with a renal mass for which a differential diagnosis was challenging. The mass persisted after administration of intravenous antibiotic therapy for 1 month. A computed tomography scan indicated an inflammatory lesion, whereas magnetic resonance imaging suggested a diagnosis of a tumor. Despite these indications, a right renal abscess was suspected during robot-assisted laparoscopic surgery, and nephron-sparing surgery was performed, which allowed confirmation of the final pathological result by biopsy specimen. Postoperatively, the mass gradually decreased in size after antibiotic therapy for a further month. This case, in which a renal abscess mimicked a tumor and the patient almost underwent a nephrectomy, highlights the need for caution in establishing therapeutic schedules for patients with inaccurate diagnoses. The management strategies for such patients must be reviewed and improved.
Transient Loss of Consciousness Associated With Severe Hypocalcemia and QT Prolongation Due to Primary Hypoparathyroidism in an Adolescent Girl
Authors: Masafumi Miyao, Yoshihiro Aoki, Naoto Mizushiro, Reiko Kitazawa, Chizuko Nakamura
Journal: Cureus (2023)
Keywords: adolescent, calcium, electrocardiography, emergency medicine, hypocalcemia, hypoparathyroidism, pediatrics, qt prolongation, seizure, syncope
MeSH terms: Case Reports

As hypocalcemia is uncommon, serum calcium levels are not routinely measured in many emergency medicine clinics. We report a case of an adolescent girl with a transient loss of consciousness due to hypocalcemia. A 13-year-old healthy girl had a syncopal episode complicated with numbness in the extremities. On admission, she was fully conscious, but hypocalcemia and QT prolongation were noted. After careful consideration of the possible etiologies, the patient was diagnosed with acquired QT prolongation due to primary hypoparathyroidism. The patient's serum calcium levels were controlled by activated vitamin D and calcium supplementation. Primary hypoparathyroidism-associated hypocalcemia can cause QT prolongation and neurological complications, even in previously healthy adolescents.
Therapeutic potential of umbilical cord mesenchymal stromal cells transplantation for cerebral palsy: a case report
Authors: Liming Wang, Haijie Ji, Jianjun Zhou, Jiang Xie, Zhanqiang Zhong, Ming Li, Wen Bai, Na Li, Zijia Zhang, Xuejun Wang, Delin Zhu, Yongjun Liu, Mingyuan Wu
Journal: Case Rep Transplant (2013)

Cerebral palsy is the most common motor disability in childhood. In current paper, we first report our clinical data regarding administration of umbilical cord mesenchymal stem cells (MSCs) transplantation in treatment of cerebral palsy. A 5-year-old girl with cerebral palsy was treated with multiple times of intravenous and intrathecal administration of MSCs derived from her young sister and was followed up for 28 months. The gross motor dysfunction was improved. Other benefits included enhanced immunity, increased physical strength, and adjusted speech and comprehension. Temporary low-grade fever was the only side effect during the treatment. MSCs may be a safe and effective therapy to improve symptoms in children with cerebral palsy.
Thrombotic Thrombocytopenic Purpura due to Checkpoint Inhibitors
Authors: Alexey Youssef, Nawara Kasso, Antonio Sergio Torloni, Michael Stanek, Tomislav Dragovich, Mark Gimbel, Fade Mahmoud
Journal: Case Rep Hematol (2018)
MeSH terms: Case Reports

Ipilimumab is a monoclonal antibody that enhances the efficacy of the immune system by targeting a cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), which is a protein receptor that downregulates the immune system. Nivolumab is also a humanized monoclonal antibody that targets another protein receptor that prevents activated T cells from attacking the cancer; this receptor is called programmed cell death 1 (PD-1). The FDA approved ipilimumab combined with nivolumab as a frontline therapy for patients with metastatic melanoma or renal cell carcinoma and as a second-line therapy for patients with microsatellite instability-high (MSI-H) metastatic colon cancer. Immune-related adverse events such as autoimmune colitis, pneumonitis, hepatitis, nephritis, hypophysitis, and thyroiditis may occur during or weeks to months after therapy. We report a case of thrombotic thrombocytopenic purpura (TTP) in a patient with metastatic renal cell carcinoma following one cycle of ipilimumab and nivolumab. Only one case report of ipilimumab-induced TTP exists in the medical literature. With the wide use of immunotherapy to treat cancers, physicians need to be aware of this rare immune-related adverse event.
Perforation as a rare presentation of gastric gastrointestinal stromal tumours: a case report and review of the literature
Authors: J R A Skipworth, A E E Fanshawe, M J West, A Al-Bahrani
Journal: Ann R Coll Surg Engl (2014)
MeSH terms: Gastrointestinal Stromal Tumors / complications, Intestinal Perforation / etiology, Stomach Neoplasms / complications, Case Reports, Review, Anastomosis, Roux-en-Y, Female, Gastrectomy / methods, Gastrointestinal Stromal Tumors / surgery, Humans, Intestinal Perforation / surgery, Middle Aged, Stomach Neoplasms / surgery

Introduction:
Gastrointestinal stromal tumours (GISTs) are the most common connective tissue neoplasms of the gastrointestinal tract, the most common clinical presentation of which is with abdominal pain or gastrointestinal bleeding.
Methods:
We describe a case of a perforated gastric GIST as well as reviewing the relevant published literature.
Results:
A 51-year-old woman presented to the acute assessment unit with a 1-day history of severe epigastric pain on a background of longstanding reflux symptoms. Radiological investigation demonstrated a perforated mass in the gastric antrum and the patient subsequently underwent an emergency distal gastrectomy. She recovered well postoperatively and was discharged home. Her condition remains stable six months following surgery. Histological analysis revealed the perforated lesion to be a GIST. A PubMed search suggests that this is the first English report to describe a perforated gastric GIST. Six further published reports (written in English or with an English abstract) describing the presentation of small bowel GISTs with perforation are reviewed.
Conclusions:
We present the first English report of a perforated gastric GIST. More common presentations include abdominal pain and gastrointestinal bleeding. Although rare, GISTs should be considered in the differential diagnoses of perforated gastrointestinal masses.
Removal of the Retained Ventricular Catheter Using the Endoscopic Monopolar Instrument
Authors: Julia Pereira Muniz Pontes, Pedro Henrique Costa Ferreira-Pinto, Elington Lannes Simoes, Thaina Zanon Cruz, Jefferson Trivino Sanchez, Flavio Nigri
Journal: Case Rep Surg (2021)
MeSH terms: Case Reports

Background:
Ventriculoperitoneal shunt (VPS) remains the main treatment for hydrocephalus. However, VPS revision surgery is very common. Here, we present a case in which the retained ventricular catheter was removed using the endoscopic monopolar instrument.
Methods:
We report a case of a 28-year-old female who presented with VPS obstruction. She had two previous shunt revision surgeries due to shunt obstruction. Eleven years after the last one, she presented an abdominal pseudocyst that indicated a total system removal. During VPS revision surgery, a retained ventricular catheter was observed. The endoscopic monopolar instrument was introduced into the retained catheter under direct view. Coagulations in a back-and-forth movement were applied to release inner catheter adhesions. After these steps, the catheter was removed, and a new one was placed through the same route.
Results:
The catheter was removed without complications, confirmed by the postoperative cranial computed tomography. The patient remained asymptomatic.
Conclusion:
The described technique was effective and avoided ventricular bleeding. Further studies are necessary to validate this method.
Full-mouth rehabilitation of a patient with cleidocranial dysplasia using immediately loaded basal implant-supported fixed prostheses: A case report
Authors: Abdelnasir G Ahmad, Motaz Osman, Fadia Awadalkreem
Journal: Int J Surg Case Rep (2019)
Keywords: basal implants, case report, cleidocranial dysplasia, immediate loading, implant-supported prostheses

Introduction:
Cleidocranial dysplasia (CCD) is a rare congenital disease characterised by generalised skeletal and orofacial defects. The dental rehabilitation of patients with CCD is a case-sensitive procedure requiring a multidisciplinary approach.
Presentation of case:
A 24-year-old woman presented with the skeletal and oral manifestations of CCD, including multiple poorly erupted and impacted teeth. The patient was very depressed and rejected orthodontic treatment; therefore, we formulated a treatment plan involving extraction of all impacted and poorly erupted teeth under general anaesthesia, followed by fabrication and delivery of transitional complete dentures for cosmetic, functional, and psychological benefits. Three months later, 14 screw basal implants were inserted in the maxillary and mandibular jaws and subjected to immediate loading with fixed prostheses 3 days later. At the 3-year follow-up visit, the patient expressed satisfaction with the aesthetic and functional aspects of the prostheses and presented with excellent oral health.
Discussion:
The timing of diagnosis, patient's age, willingness to undergo the planned treatment, and treatment duration are valuable considerations for establishing an appropriate treatment plan for the oral manifestations of CCD.
Conclusion:
To our knowledge, this is the first report on basal implant-based full-mouth rehabilitation in a patient with CCD. Basal implant-supported prostheses may be useful for patients with CCD who present with a limited bony foundation after tooth removal. The treatment requires lesser time than orthodontic treatment, eliminates the need for bone grafting, spares the patient from ill-ﬁtting dentures, reduces the overall cost, and improves the quality of life.
A case of musical preference for Johnny Cash following deep brain stimulation of the nucleus accumbens
Authors: Mariska Mantione, Martijn Figee, Damiaan Denys
Journal: Front Behav Neurosci (2014)
Keywords: deep brain stimulation, musical preference, nucleus accumbens, obsessive-compulsive disorder, reward system

Music is among all cultures an important part of the live of most people. Music has psychological benefits and may generate strong emotional and physiological responses. Recently, neuroscientists have discovered that music influences the reward circuit of the nucleus accumbens (NAcc), even when no explicit reward is present. In this clinical case study, we describe a 60-year old patient who developed a sudden and distinct musical preference for Johnny Cash following deep brain stimulation (DBS) targeted at the NAcc. This case report substantiates the assumption that the NAcc is involved in musical preference, based on the observation of direct stimulation of the accumbens with DBS. It also shows that accumbens DBS can change musical preference without habituation of its rewarding properties.
Clinical Application of Liquid Biopsy in Targeted Therapy of Metastatic Colorectal Cancer
Authors: Jörg Trojan, Susanne Klein-Scory, Christine Koch, Wolff Schmiegel, Alexander Baraniskin
Journal: Case Rep Oncol Med (2017)
MeSH terms: Case Reports

Background. Colorectal cancers (CRC) shed DNA into blood circulation. There is growing evidence that the analysis of circulating tumor DNA can be effectively used for monitoring of disease, to track tumor heterogeneity and to evaluate response to treatment. Case Presentation. Here, we describe two cases of patients with advanced CRC. The first case is about a patient with no available tissue for analysis of RAS mutation status. Liquid biopsy revealed RAS-wild-type and the therapy with anti-EGFR (epidermal growth factor receptor) monoclonal antibody cetuximab could be initiated. In the second case, the mutational profile of a patient with initial wild-type RAS-status was continually tracked during the course of treatment. An acquired KRAS exon 3 mutation was detected. The number of KRAS mutated fragments decreased continuously after the discontinuation of the therapy with EGFR-specific antibodies. Conclusion. Liquid biopsy provides a rapid genotype result, which accurately reproduces the current mutation status of tumor tissue. Furthermore, liquid biopsy enables close monitoring of the onset of secondary resistance to anti-EGFR therapy.
Superficial Retinal Microvasculature and Choriocapillaris Alterations after Photodynamic Therapy in Chronic Central Serous Chorioretinopathy
Authors: Morteza Entezari, Iman Ansari, Alireza Ramezani, Humayoun Nikkhah, Parisa Mohammadi, Bahar Kheiri
Journal: J Ophthalmol (2022)

Purpose:
To compare superficial retinal vascular, choriocapillaris (CC), and choroidal thickness changes in chronic central serous chorioretinopathy (CSCR) patients after half-dose photodynamic therapy (PDT).
Method:
In this prospective interventional case series study, fifteen eyes of 14 patients with chronic CSCR undergoing half-dose PDT treatment were enrolled. All patients underwent enhanced depth imaging optical coherence tomography angiography (EDI-OCT) and optical coherence tomography angiography (OCTA) at baseline and 3 months after treatment. Best-corrected visual acuity (BCVA), superficial retinal vascular density, CC vessel density, foveal avascular zone (FAZ), central macular thickness (CMT), and choroidal thickness were compared.
Results:
Mean BCVA before and after PDT was 0.34 ± 0.26 and 0.19 ± 0.25 logMAR, respectively (p=0.011). Mean FAZ before treatment was 410.21 ± 117.00 μm2, which increased to 433.50 ± 116.76 μm2 (P=0.253). Mean vessel density at superficial capillary plexus (SCP) was 38.93 ± 11.12 at baseline, which increased to 39.04 ± 11.43 (P=0.886). Mean CC vessel density was 53.21 ± 4.14 at baseline, which significantly decreased to 51.85 ± 4.21 (P=<0.001). BCVA has no significant correlation with FAZ (P=0.282) and vessel density (P=0.0.241) at SCP. CMT significantly decreased from 380.87 ± 41.66 μ at baseline to 268.20 ± 28.07 μ at 3 months (P=0.132). We did not find any correlation between CMT and FAZ (P=0.040) and vessel density (P=0.686) at SCP. Mean subfoveal choroidal thickness reduced from 411 ± 171 μm before treatment to 372 ± 117 μm (P=0.106).
Conclusion:
PDT treatment can affect retinal and choroidal structural parameters, but we could not find any significant influence on retinal vascular parameters, including FAZ area and vessel densityonly mean CC vessel density and subfoveal choroidal thickness decreased.
Eight-year follow-up of a girl with McCune-Albright syndrome
Authors: Zehra Aycan, Aşan Önder, Semra Çetinkaya
Journal: J Clin Res Pediatr Endocrinol (2011)
Keywords: mccune-albright syndrome, aromatase inhibitor, bisphosphonate, follow-up
MeSH terms: Fibrous Dysplasia, Polyostotic / diagnosis, Fibrous Dysplasia, Polyostotic / physiopathology, Case Reports, Adolescent, Bone Density Conservation Agents / therapeutic use, Child, Female, Fibrous Dysplasia, Polyostotic / drug therapy, Follow-Up Studies, Humans, Bone Density Conservation Agents

McCune-Albright syndrome (MAS) is characterized by the triad of fibrous dysplasia (FD), cafe-au-lait spots and precocious puberty (PP). We report a 14-year-old girl with MAS who has been followed-up for 8 years. She was referred for multiple fractures and vaginal bleeding at age 5.9 years. She had peripheral PP, FD, and osteoporosis and was diagnosed as MAS. The patient was treated with aromatase inhibitors and bisphosphonates. She had no menses during aromatase inhibitor treatment. Her growth rate and bone maturation were in normal ranges while on treatment. She had one new fracture on the seventh year of follow- up in spite of bisphosphonate treatment.