We present a case of a 78-year-old African-American man with a history of hypertension, and with no prior history of seizure. The patient presented with hypertensive urgency as well as stroke such as symptoms of confusion, seizure, postictal confusion, left hemianopsia and hyponatraemia. MRI findings were suggestive of posterior reversible encephalopathy syndrome (PRES). The patient was treated with appropriate medications with the resolution of his stroke-like symptoms. This case report discusses a patient with PRES, in the setting of hyponatraemia, and how prompt recognition may prevent permanent neurological sequela such as epilepsy.
Signet ring cell carcinoma (SRCC) is a subtype of adenocarcinoma. It can arise in different organs including stomach, colon, bladder, prostate and breast. The vast majority of SRCC found in the pulmonary system is metastatic. Primary disease to the lungs is rare. The main feature of this type of malignancy is mucin-producing cells. It has been reported that out of 3500 cases of pulmonary adenocarcinoma, five cases had features of SRCC.
Objectives. We describe a rare case of nonalcoholic Marchiafava-Bignami disease (MBD) in the setting of malnourishment after gastric bypass. Methods. A 44-year-old nonalcoholic Caucasian woman with malnutrition after gastric bypass presented with 2 weeks of weakness. The patient acutely became stuporous. Brain magnetic resonance imaging showed lesions in the corpus callosum and internal capsules consistent with MBD. After 10 days of treatment, the patient had resolution of her encephalopathy with return to baseline mental function, with radiological improvement. Results. MBD is a rare neurological disorder seen in alcoholics and can rapidly progress to coma or death. Our patient was successfully treated with a regimen typically used in alcoholics. We discuss the relevant literature supporting this regimen. Conclusions. This case demonstrates that since the pathophysiological etiology of the disease is malnutrition, MBD patients can be effectively treated with this regimen regardless of the underlying cause.
In the present case a 30-year-old African American man was admitted with fever and chills secondary to two large hepatic abscesses diagnosed on an ultrasound. The patient was started on antibiotics after blood cultures were drawn. Initially the abscess was drained and showed dramatic improvement upon repeat imaging. The blood cultures revealed Gram-negative rods that were identified as Fusobacterium necrophorum. At that time the patient was switched to levofloxacin and metronidazole based on sensitivities. On this new antibiotic regime the patient improved dramatically. After just 5 days the patient was discharged home on oral antibiotics and was scheduled to follow-up in 1 week. In the present case we present a healthy 30-year-old man with no significant co-morbidities who developed a hepatic abscess from F necrophorum but successfully recovered after appropriate antibiotic treatment.
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