Non-ketotic hyperglycaemic hemichorea-hemiballismus (NHHH) is commonly seen among elderly Asian women with type 2 diabetes mellitus. Here, we present a case of a 16-year-old Filipina with type 1 diabetes mellitus who is poorly compliant to her medications and subsequently developed right hemichorea-hemiballismus (HH). She was initially admitted with hyperglycaemia but was negative for ketonuria or metabolic acidosis. Neuroimaging showed bilateral lentiform nuclei and left caudate hyperdensities on CT and T1-weighted hyperintensity on MRI. Blood glucose was controlled with insulin. Haloperidol and clonazepam were started for the HH with gradual resolution of symptoms in 6 weeks. This is the fifth reported case of NHHH seen among the paediatric age group. NHHH in the paediatric population is clinically and radiographically similar to NHHH seen among adults. Correction of hyperglycaemia results in clinical improvement and radiographic resolution of lesions but persistent cases may necessitate specific treatment targeted towards the abnormal movements.
Objective
We aimed to determine the incidence, risk factors, and outcomes of unplanned
extubation among adult patients.
Methods
We conducted a prospective cohort study of adult intubated patients admitted
to the charity wards of a government tertiary teaching hospital in the
Philippines. Patients managed in both intensive care and nonintensive care
settings were included. Patients were followed-up until discharge or until
seven days postextubation.
Results
The outcomes of the 191 included patients were planned extubation (35%),
unplanned extubation (19%), death (39%), and discharge against advice (7%).
Competing risk regression showed that male sex (Crude OR: 2.25, 95%CI: 1.10
- 4.63) and age (Crude OR 0.976, 95%CI: 0.957 - 0.996) were significant
baseline factors. The night shift (Crude OR: 24.6, 95%CI: 2.87 - 211) was
also consistently associated with more unplanned extubations. Among
postextubation outcomes, reintubation (unplanned extubation: 61.1%
versus
planned extubation: 25.4%), acute respiratory
failure (unplanned extubation: 38.9%
versus
planned
extubation: 17.5%), and cardiovascular events (unplanned extubation: 8.33%
versus
planned extubation: 1.49%) occurred
significantly more often among the unplanned extubation patients. Admission
in an intensive care unit was not associated with a lower risk of unplanned
extubation (Crude OR 1.15, 95%CI: 0.594 - 2.21).
Conclusion
Many intubated patients had unplanned extubation. Patients admitted in
nonintensive care unit settings did not have significantly higher odds of
unplanned extubation.
Serotonin syndrome is due to excess serotonin in the nervous system. We document a case of an elderly Parkinson disease patient who has been neurologically stable on rasagiline and escitalopram for 1 year but developed serotonin syndrome after intake of an ethanol-containing homeopathic medication. The patient presented with seizures, autonomic dysfunction and neuromuscular hyperexcitability. Maintenance medications were discontinued, hydration, sedation and respiratory support were provided with resolution of the symptoms. The combination of escitalopram and ethanol, both metabolized by the cytochrome P450 enzyme system can lead to serotonin syndrome. Our case highlights the importance of drug interactions in patients taking several medications. Additionally, the intake of medicines, may it be conventional or homeopathic medicine, without the guidance of a trained and competent physician, may lead to serious consequences for the patient.
Binswanger disease (BD) involves injuries to the brain small vessels, resulting to gradually progressive subcortical ischemia. This disorder manifests with dementia, gait abnormalities, upper motor signs and parkinsonism, and presents as extensive, confluent, bilateral cerebral white matter hyperintensities in the MRI. Cases of BD typically manifests with vascular risk factors, such as hypertension and multiple strokes. We report a unique case of a Filipino patient whom we have diagnosed with BD presenting with no cardinal signs of parkinsonism, but with generalized choreiform movement disorder and without a history of hypertension and symptomatic strokes. To our knowledge, this is the first report presenting an adult patient with subcortical leukoaraiosis of Binswanger type associated with a hyperkinetic movement disorder.
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