OpenMed/multicare-articles huggingface dataset:
Freezing More than Gait: A Case Report of Freezing of Urination (FOU) in Parkinson's Disease
Authors: Mengyuan Xu, Tao Chen, Caifei Yang, Xu Meng, Qingyun Peng, Xiaoguang Lei
Journal: Parkinsons Dis (2020)

Freezing of gait (FOG) is a disabling phenomenon that is described by patients with Parkinson's disease (PD). Not only gait may be involved in the freezing phenomenon, but also some nonmotor symptoms, such as freezing of urination (FOU) in this case. The characters of urinary dysfunctions in this case resemble "off" freezing: (1) abrupt difficulty in starting or continuing in urination; (2) the urinary dysfunctions fluctuated with medication state; and (3) the urinary dysfunctions could be alleviated dramatically by an external cueing. Urinary dysfunctions in this patient (and maybe more PD patients) are associated not only with the classical "nonmotor symptoms" but also the freezing phenomenon. FOU could be a part of the spectrum of freezing symptoms. The subtypes of the freezing phenomenon will shed light on the PD pathophysiology and clinical treatment.
The locus of impairment in English developmental letter position dyslexia
Authors: Yvette Kezilas, Saskia Kohnen, Meredith McKague, Anne Castles
Journal: Front Hum Neurosci (2014)
Keywords: developmental dyslexia, migration errors, orthographic input lexicon deficit, orthographic-visual analysis deficit, phonological output deficit, substitution errors

Many children with reading difficulties display phonological deficits and struggle to acquire non-lexical reading skills. However, not all children with reading difficulties have these problems, such as children with selective letter position dyslexia (LPD), who make excessive migration errors (such as reading slime as "smile"). Previous research has explored three possible loci for the deficit - the phonological output buffer, the orthographic input lexicon, and the orthographic-visual analysis stage of reading. While there is compelling evidence against a phonological output buffer and orthographic input lexicon deficit account of English LPD, the evidence in support of an orthographic-visual analysis deficit is currently limited. In this multiple single-case study with three English-speaking children with developmental LPD, we aimed to both replicate and extend previous findings regarding the locus of impairment in English LPD. First, we ruled out a phonological output buffer and an orthographic input lexicon deficit by administering tasks that directly assess phonological processing and lexical guessing. We then went on to directly assess whether or not children with LPD have an orthographic-visual analysis deficit by modifying two tasks that have previously been used to localize processing at this level: a same-different decision task and a non-word reading task. The results from these tasks indicate that LPD is most likely caused by a deficit specific to the coding of letter positions at the orthographic-visual analysis stage of reading. These findings provide further evidence for the heterogeneity of dyslexia and its underlying causes.
Extreme Hyponatremia Complicated by Osmotic Demyelination in a Previously Healthy Young Individual
Authors: Nicholas Quigley, Alexandre P Garneau, Ludwig Haydock, Paul Isenring
Journal: Can J Kidney Health Dis (2022)
Keywords: addison disease, extreme hyponatremia, osmotic demyelination
MeSH terms: Case Reports

Rationale:
Severe hyponatremia can lead to dramatic complications whether it is treated or not. At times, it may be very severe (serum Na concentration: NaS < 115 mmol/L) or even extreme (NaS < 105 mmol/L)a and its cause difficult to identify, especially in younger individuals with no history of water disorders. The case presented herein illustrates these points quite eloquently and leads us to believe that the current recommendations for the treatment of very severe hyponatremia require some fine-tuning.
Presenting concerns:
A 26-year-old man was admitted to our intensive care unit for a NaS of 88 mmol/L in the absence of obvious extracellular fluid volume contraction. He had been experiencing vomiting, diarrhea, fatigue, and excessive thirst for the past 6 weeks and minor neurological symptoms just before admission. Laboratory tests at presentation also showed a urine osmolarity of 697 mOsm/L and urine Na of 40 mmol/L.
Diagnoses:
The presenting concerns were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH) manifesting as extreme, yet mildly symptomatic hyponatremia. At the same time, they did not point toward a specific cause initially.
Interventions:
The patient was treated through water restriction, subcutaneous desmopressin, and various intravenous (IV) fluids. Our goal had been to increase NaS at a rate of 4 to 6 mmol/L/day and required the amount of NaCl and free water perfused hourly to be readjusted constantly. Access to water also had to be opposed as the patient was unable to tolerate his thirst.
Outcomes:
During the first 6 days, the rate of NaS correction achieved was ~6 mmol/L/day. The patient improved initially but at the end of day 6, he experienced severe extrapontine osmotic demyelination (with widespread pyramidal and extrapyramidal deficits) that did not respond to intravenous immunoglobulin and NaS relowering. A little more than 3 weeks later, he began to develop low blood pressure and a subfebrile state that revealed secondary to severe Addison disease. The water disorder and insatiable thirst subsided gradually upon replacing the deficient hormones but the neurological disorder went on to become permanent and highly disabling.
Teaching points:
(1) Very severe hyponatremia should always be handled as an emergency and monitored stringently in view of its potential to cause irreparable damage. (2) Because it is a major risk factor for osmotic demyelination, it should probably be corrected at a rate of less than 4 mmol/L/day especially if it is in the extreme range, chronic, or of unknown duration. (3) It can be a presenting manifestation of Addison disease.
Adult ileo-ileo-caecal intussusception: case report and literature review
Authors: Sanjeev Singhal, Anu Singhal, Pankaj K Arora, Rahul Tugnait, Bishwanath Tiwari, Pawan Malik, Ankur Subhash Dhuria, Vineet Varghese, Mriganka Deuri Bharali, Singh Chandrakant, Pushkar, Vishnu Panwar, Amit Ballani, Neeti Gupta, Vijay Kumar Ramteke
Journal: Case Rep Surg (2012)

Adult intussusception is a rare entity accounting for only 5% of all intussusceptions and causes approximately 1% of all adult intestinal obstructions. Unlike paediatric intussusceptions which are usually idiopathic, there is usually a lead point pathology which might be malignant in up to 50% cases. We present an unusual case of adult intussusception which was not diagnosed on any investigation including computerized tomographic (CT) scan and magnetic resonance imaging (MRI). It was a case of ileo-ileo-cecal intussusception caused by a large lipoma 38 mm × 43 mm × 61 mm. It was treated by emergency laparotomy for acute intestinal obstruction. A conservative resection with ileostomy was performed with good postoperative recovery.
Local autologous platelet rich plasma injection combined with platelet rich fibrin filling as the main treatment for refractory wounds: A case series
Authors: Xiang Liu, Xiangjun Li, Wei Wei, Xiang Zhang, Zheng Fang, Zixiu Chen, Pingxiang Chen, Haihong Li
Journal: Front Surg (2023)
Keywords: autologous, platelet rich fibrin, platelet rich plasma, refractory wounds, wound repair

Refractory wounds are a major global health problem that not only affects the quality of life, but also causes significant physical, psychological and economic burdens. How to promote wound healing has become the main goal of clinicians. To evaluate the safety and efficacy of local autologous platelet rich plasma (PRP) injection combined with platelet rich fibrin (PRF) filling as the main treatment for refractory wounds. In the study, autologous PRP and PRF were prepared from whole blood. Twelve patients, each having a refractory wound, were included. The wounds were debrided first to remove necrotic and infected tissues, and then were given once or twice local PRP injection combined with PRF filling treatment. The total healing time (the time from admission to wound healing) and the healing time after PRP/PRF combined treatment (the time from PRP treatment to wound healing), as well as the adverse events were recorded. The results showed that the wound duration before the combination treatment was 10.48 ± 3.66 weeks, and the mean area/volume (for sinus or fistula) of the wounds was 8.23 ± 2.67 cm2/9.54 ± 2.13 cm3 (for sinus or fistula). All wounds healed after once or twice PRP/PRF combined treatment. The total healing time was 26.91 ± 8.01 days, and the healing time after the combined treatment was 16.36 ± 7.47 days. No adverse events were reported during the treatment and follow-up period. Our case series demonstrate the safety and synergistic effectiveness of local autologous PRP injection combined with PRF filling as the main treatment for refractory wounds. Platelet concentrates is not only an adjuvant treatment for chronic wounds, but a potential substitute for chronic wounds, especially in sinuses and fistulas.
Autism in early childhood: an unusual developmental course-three case reports
Authors: Michal Cohen-Ophir, Tsophia Castel-Deutsh, Emanuel Tirosh
Journal: Case Rep Psychiatry (2012)

Autistic spectrum disorder (ASD) is typically characterized by either an emerging and gradual course or developmental regression in early childhood. The versatile clinical course is progressively acknowledged in recent years. Children with developmental disorders in general are referred to the Child Development Center for a multidisciplinary assessment, investigation, treatment and followup. We report three infants with an initial diagnosis of developmental delays, recovery of normal development following intervention in a multidisciplinary center, and subsequent regression into classic autism following their discharge from the program. An extensive medical workup was noncontributory. This unusual presentation, to our knowledge not reported previously, should be recognized by professionals involved in child development and psychiatry.
Atypical Salmonellosis in a Horse: Implications for Hospital Safety
Authors: Kristina L Rothers, Eileen S Hackett, Gary L Mason, Brad B Nelson
Journal: Case Rep Vet Med (2020)
MeSH terms: Case Reports

A 17-year-old Quarter Horse mare was evaluated for colic of 24-hour duration. Clinical signs and diagnostic evaluation were consistent with duodenitis-proximal jejunitis. The horse's clinical condition deteriorated despite medical treatment and was euthanized. Aerobic culture collected from small intestinal ingesta was positive for Salmonella enterica subsp. enterica serovar Hadar. Salmonella sp. is commonly implicated in nosocomial infections in equine veterinary hospitals usually through feces containing the organism. Considering Salmonella sp. was cultured from the jejunal luminal contents and the large volume of nasogastric reflux that was evacuated in this case, a perceived risk of Salmonella sp. transmission from infected gastric reflux to other hospitalized cases was realized. Infectious agent biosecurity precautions should be undertaken in horses with nasogastric reflux to prevent hospital-acquired transmission.
Managing Anesthesia for a Patient with Takayasu Illness
Authors: Gabriela Freitas, João Luiz Guerra, Cesar Henrique Fornero, Marina Delgado
Journal: Case Rep Anesthesiol (2023)
MeSH terms: Case Reports

This article intended to provide an overview of the anesthetic management for a patient with Takayasu arteritis, an uncommon and challenging disease. Despite the limited literature, it becomes more evident that there is no right answer for all patients. Considering that, it is important to take into account the severity and specific features of the underlying disease to decide the best anesthetic approach. In this context, an adequate preoperative assessment focusing on cardiovascular function becomes essential. Adequate cardiovascular monitoring is also essential in the intraoperative period. A multidisciplinary team should be involved in the perioperative period to provide the best care possible and improve patient outcomes. This case illustrates a successful hysterectomy in a patient with Takayasu arteritis, pointing out the pathophysiologic considerations and discussing the means to reduce the perioperative risk. The particularities described in this case report may help other physicians choose the best strategy when facing challenging patients similar to the one described.
Acute liver failure due to radiographically occult infiltration of urothelial cancer
Authors: Valentina Tosatto, João Cabral Pimentel, Cristiano Cruz, André Almeida, Matteo Boattini
Journal: Autops Case Rep (2021)
Keywords: biopsy, neoplasms, palliative care
MeSH terms: Case Reports

Introduction:
Acute liver failure (ALF) due to diffuse infiltrating solid malignancy without any focal lesions on radiographic imaging is rare.
Case report:
A 70-year-old man was admitted due to mental confusion, abdominal pain, and ALF. Three years before, he had undergone a left nephrectomy for urothelial carcinoma followed by adjuvant chemotherapy. The abdominal computed tomography (CT) showed hepatomegaly and ascites. Ascitic fluid had transudate characteristics, with no malignant cells. Percutaneous liver biopsy (LB) showed diffuse liver infiltration of metastatic urothelial carcinoma. The patient rapidly deteriorated and died in a week due to ALF.
Discussion:
History of solid cancer and hepatomegaly and/or liver failure without other obvious explanation should encourage to perform LB.
Conclusion:
LB is warranted to avoid misdiagnosis, prolonged hospital stays, and delay in palliative care.
Unusual thalamic mass and subsequent gelatinous pseudocysts in an immunocompetent host: A case report
Authors: Apapatra Akiko Watanabe, Pasin Hemachudha, Wanakorn Rattanawong, Thanakit Pongpitakmetha
Journal: IDCases (2022)
Keywords: case report, cryptococcus, gelatinous pseudocyst, meningoencephalitis
MeSH terms: Case Reports

Cryptococcal meningoencephalitis often occurs in an immunocompromised host with several known neurological manifestations including space-occupying lesions, meningitis or meningoencephalitis. Here, we describe a 38-year-old previously healthy durian farm owner with cryptococcoma and subsequent development of cryptococcus gelatinous pseudocyst after receiving high doses of intravenous dexamethasone to treat mass lesion presumed to be a malignant process. An MRI scan of the head demonstrated a 2-cm heterogeneous solitary enhancing cystic lesion at the right thalamus. Progression of neurological deficit and another repeat imaging showing typical appearance of gelatinous pseudocyst. Lumbar puncture found markedly elevated pressure and cryptococcal antigen strongly positive confirming the diagnosis. He was immediately started on amphotericin B and flucytosine for cryptococcus meningoencephalitis with partial improvement in his vision. This report highlights consideration of cryptococcal infection in an immunocompetent host to avoid delays in diagnosis and treatment.
Hemifacial Spasm due to Compression of the Posterior Inferior Cerebellar Artery Aneurysm Treated with Botulinum Toxin Type-A: A Case Report
Authors: Azize Esra Gürsoy, Gülsen Babacan Yildiz, Adam Mehmet Gülhan, Mehmet Kolukisa
Journal: Case Rep Neurol Med (2012)

A 79-year-old female presented with five months history of progressive involuntary twitching movement on left face. Brain MR imaging revealed a heterogeneous T2 hyperintense lesion at left cerebellopontine angle. CT angiography showed a partially thrombosed saccular aneurysm of left PICA (posterior inferior cerebellar artery). The patient was treated with Botulinum toxin type A and almost total relief of symptoms was noticed during one month followup. Botulinium toxin injection is an effective symptomatic treatment option in nonsurgical secondary hemifacial spasm (HFS) cases.
Autoimmune Encephalitis With Autoimmune Diabetes: A Case of Horror Autotoxicus
Authors: Hussam Alkaissi, Jung-Hyun Lee, Samy I McFarlane
Journal: Cureus (2023)
Keywords: autoimmune encephalitis, autoimmunity, glutamic acid decarboxylase (gad) antibodies, seronegative autoimmune encephalitis, type 1 diabetes mellitus (t1d)
MeSH terms: Case Reports

Diagnosing autoimmune encephalitis relies on clinical, radiological, and serological studies. Several autoantibodies have been implicated and recognized, with dozens of potential targets identified in the past 20 years. Despite that progress, some patients with encephalitis present a diagnostic dilemma with a seronegative status. The presence of other autoimmune diseases in a patient with encephalitis should provide a clue to the autoimmune nature of a developing neurological syndrome (cognitive, psychiatric, behavioral, and catatonia). In this report, we describe the case of a young man with type 1 diabetes mellitus who was diagnosed with seronegative autoimmune encephalitis after presenting with catatonia. We describe the lengthy clinical course, the various therapeutic trials, and his clinical outcome and response to B-cell depleting agent. This study also discusses the potential pathophysiologic pathways, providing a rationale for the diagnostic workup and therapeutic options for autoimmune encephalopathy in this case presentation.
Dengue fever mimicking acute appendicitis: A case report
Authors: M E C McFarlane, J M Plummer, P A Leake, L Powell, V Chand, S Chung, K Tulloch
Journal: Int J Surg Case Rep (2013)
Keywords: acute abdomen, acute appendicitis, dengue fever, leucopenia

Introduction:
Dengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy.
Presentation of case:
A 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus.
Discussion:
This unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery.
Conclusion:
This case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis.
Clival Defect Resulting in Spontaneous Cerebrospinal Fluid Rhinorrhea: Case Report and Review of Literature
Authors: Maryam Aljawi, Mahdi Shkoukani
Journal: Case Rep Otolaryngol (2023)
MeSH terms: Case Reports

Spontaneous cerebrospinal fluid (CSF) rhinorrhea develops in patients without any history of trauma. Multiple factors have been theoretically debated. Also, localizing the defect may result in a challenge for the rhinologist. The common locations are the cribriform plate and the lateral recess of the sphenoid. Clival CSF rhinorrhea is rare, and only few cases have been reported so far. A 52-year-old female presented to the otolaryngology clinic with 7 years of history of left-side clear fluid rhinorrhea as a drop, which progressed to be runnier after she had pneumonia with severe cough secondary to COVID-19 infection. CSF was confirmed by a beta-2-transferrin test. During the perioperative evaluation, she developed meningitis which was treated with IV ceftriaxone and IV vancomycin antibiotics. The magnetic resonance imaging (MRI) and computerized tomography (CT) scan showed clival defect with pseudomeningocele which was initially not easy to see on CT. The patient underwent an endoscopic approach to the skull base to repair the defect with a pedicled septal flap. Also, a lumbar drain with intrathecal fluorescein administration was utilized. The postoperative course was uneventful without any complications. There was no evidence of recurrence with a 9-month follow-up postoperatively.
Low grade appendiceal mucinous neoplasm mimicking an ovarian cyst: A case report
Authors: Abdulaziz Omar Alghamdi, Mohammed Yousef Aldossary, Morshed Alsawidan, Shoukry AlBahar
Journal: Int J Surg Case Rep (2020)
Keywords: appendix, mucocele, ovarian cyst
MeSH terms: Case Reports

Introduction:
Appendiceal mucocele (AM) is a very rare neoplasm with an incidence of 0.2-0.3% of all appendectomy specimens. AM usually defined as an intraluminal dilation of the appendix in response to mucin accumulation. The preoperative diagnosis is difficult and can be misdiagnosed to any of the other differential diagnosis especially in female patients. If it is suspected, imaging modalities and colonoscopy can be helpful as a guide for the right surgical approach.
Presentation of case:
A 41-year-old lady who found to have an appendicular tumor discovered incidentally on magnetic resonance imaging (MRI) of the abdomen during a follow-up in the referral hospital for persistent right lower quadrant abdominal pain with enlarging right ovarian cyst for 2 years. MRI revealed a sizeable cyst measuring 7 × 4 × 3 cm in the right iliac fossa (RIF) region with high suspicion of an AM. The patient was managed with open right limited hemicolectomy. The patient was diagnosed as a well-differentiated low-grade AM neoplasm with stage 0 (pTis, pN0, M0) based on the 8th edition of the American Joint Committee on Cancer (AJCC) Staging System. The patient had an uneventful recovery and advised for regular follow-up of at least 5 years.
Discussion:
AM is a very rare neoplasm. The imaging modalities that can be diagnostic methods are the abdominal ultrasonography (US), transvaginal US, abdominal computed tomography (CT) and abdominal MRI. Fine needle aspiration must be avoided as the risk of perforation is high that will lead to dissemination of the mucinous material causing a serious complication called pseudomyxoma peritonei. Laparotomy is superior on laparoscopy as the risk of perforation is lower in laparotomy.
Conclusion:
The presentation of AM is usually not specific, because of its anatomic position. Physicians should consider it in the differential diagnosis of persistent enlarging ovarian cyst or adnexal mass.