This study reported the demographics, clinical characteristics, and treatment protocols of optic neuropathies in a neuro-ophthalmology specialty clinic at a tertiary referral center in Turkey during the past decade. The data may be useful in assessing the global status of optic neuropathies.
We want to present a patient with rhombencephalitis due to Listeria monocytogenes who was incorrectly diagnosed as having ischemic vertebrobasilar infarct because of diagnostic difficulties and died after progression in a short period of time.A man aged 49 years was transferred from an external institution to our clinic because he required treatment in intensive care. His medical history revealed pulmonary tuberculosis 5 years previously and oral aphtosis 3 months ago. He presented to the external center approximately a week ago with sudden-onset headache, imbalance, nausea, and vomiting; brain magnetic resonance imaging (MRI) demonstrated hyperintense lesions in T2-weighted images in the right middle cerebellar peduncle and left pontomedullary junction, which were believed to be ischemic in nature. His neurologic examinations revealed progressive diplopia, ataxia, and clouded sensorium, and he was referred due to intensive care unit. At his admission to our clinic he was drowsy, he opened his eyes with verbal stimulation, and cooperated to simple commands; orientation to place, time, and person was diminished. He had anisocoria with wider pupil diameter on the left, limitation of adduction and elevation in the left eye, and gaze palsy in all directions in the right eye. Muscle strength was 4/5 on the right. Subfebrile fever (37.4 °C) and tachycardia (pulse rate: 110/min, rhythmic) were detected. Liver and kidney function tests, electrolyte levels, and C-reactive protein were within normal limits, and there was mild leukocytosis (leukocyte: 13200/μL, neutrophils: 82%). The patient's clinical presentation progressed on the same day. He was opening his eyes after painful stimulus, he had no cooperation and verbal response, total ophthalmoparesis in the left eye, loss of bilateral light and gag reflexes, prominent quadriparesis on the right side and right half of the face, and there were focal seizures involving his right leg and arm. Repeated brain MRI showed T2A and fluid-attenuated inversion-recovery (FLAIR) hyperintensities in the left thalamic region, mesencephalon, left half of the pons, right brachium pontis, and bulbus. These lesions were thought to be suggestive of brainstem encephalitis or neuro-Behçet's disease. Lumbar puncture was performed and empiric antituberculosis, antiviral, antibacterial, and corticosteroid treatments were initiated. Biochemical tests of the cerebrospinal fluid (CSF) were as follows: protein: 122 mg/ dL, (normal: 15-45 mg/dL), Cl: 124 mEq/L (normal: 118-132 mEq/L), glucose: 52 mg/dL, and simultaneous blood sugar was 166 mg/dL. Direct examination of CSF revealed 50 leukocytes and 3-5 erythrocytes per power field. Fever became more prominent (39 °C) on the second day of his admission. The patient was intubated and mechanical ventilator support was initiated because of hypoxemia, hypercapnia, and decreased saturation. Under ceftriaxone, ampicillin, metronidazole, acyclovir, anti-tuberculosis, and corticosteroid treatments, the patient died on the 4 th day of admission due to septic ...
Ege Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı, İZMİR ÖZETAkut kolonik psödoobstrüksiyon, diğer adıyla Ogilvie Sendromu, saptanabilir herhangi bir mekanik obstrüksiyon olmadan kolonda gelişen akut dilatasyonun yol açtığı bir klinik durumdur. Erken tanı ve tedavi prognozu değiştirmektedir(1). 86 yaşında, sağ el dominant, erkek hasta, sağ orta serebral arter (OSA) anterior divizyon sulama alanında gelişen akut iskemik enfarkt nedeniyle nöroloji yoğun bakım ünitemize yatırıldı. Vital bulguları stabil seyreden, saturasyon düşüklüğü, elektrolit bozukluğu olmayan hastada, serebrovaskuler olayın onyedinci gününde batında distansiyon izlendi. 2 gündür gayta çıkışı olmayan hastanın rektal tuşede, rektumu boş saptandı. Lateral dekübit direkt batın grafileri çekildi. Sigmoid volvulustan şüphelenilen hastaya acil batın bilgisayarlı tomografisi çekildi. Batın BT'si ile de sigmoid kolonda mezoaksiyel volvulus düşünülen hastaya gastroenteroloji kliniğinde kolonoskopi yapıldı. Hepatik fleksuraya kadar ilerlendi. Volvulus görünümü izlenmedi. Kolonoskopi sonucunda hastada akut kolonik psödoobstrüksiyon (Ogilvie Sendromu) tanısı konuldu. Konservatif tedaviyle 24 saat sonra gayta çıkışı sağlandı. Bu olguyla, erken tanı ve tedaviyle mortalite ve morbiditesinin azaltılabildiği Ogilvie Sendromunun, serebral enfarktüs sonrası da görülebildiğine ve serebral enfarktüs sendromlu hastalarda batında distansiyon, konstipasyon gelişmesi halinde akılda bulundurulması gereken acil durumlardan biri olduğuna dikkat çekilmiştir. Anahtar Sözcükler: Ogilvie Sendromu, serebral enfarktüs, Pridostigmin, akut kolonik psödoobstrüksiyon, konstipasyon, kolonoskopi, A CASE REPORT OF OGILVIE'S SYNDROME IN AN ISCHEMIC STROKE PATIENT ABSTRACTAcute colonic pseudo-obstruction (ACPO), also known as Ogilvie's Syndrome, is a clinical condition with acute dilatation of the colon without a provable cause. Early recognition and treatment of the condition is important in order to improve the outcome(1). An 86 year old right handed male patient, with an acute ischemic infarction in the area supplied by the right middle cerebral artery (MCA) anterior divison, was internalised to our intensive care unit of Neurology Department. Seventeen days after onset of the stroke, the patient, whose vitals, blood electrolite levels and oxygene saturation kept stabile developed an abdominal distention. He didn't have any fecal excretion for 2 days and his rectum was found to be empty on the rectal touche' examination. His lateral decubit abdominal x-rays were suspicious for sigmoid volvulus. His abdominal CT was also suspicious for mesoaxial volvulus, so the patient underwent a colonoscopy at the gastro enterology department. The colonoscope has reached the hepatic flexure but no volvulus has been observed. As the result of the colonoscopy the patient is diagnosed as acute colonic pseudoobstruction(Ogilvie's Syndrome). With conservative treatment, fecal excretion has been provided in 24 hours. Here, we want to take attention that, Ogilvie's syndrome, in which early diagnosis an...
Combined central and peripheral nervous system demyelination (CCPD) is a fairly new concept and our knowledge is restricted to several case series and case reports. We aimed to contribute to the literature with our experiences in the management of a patient representing both chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multiple sclerosis (MS) features. A 32-year-male patient presented with neuropathic compaints for one year and recent onset of optic neuritis with central demyelinating lesions. Clinical, electrophysiological and radiological response was achieved with corticosteroid treatment and relapsed after cessation. His second simultaneous CCPD exacerbation did not respond on intravenous immunoglobulins (IVIG) but responded well on intravenous high dose corticosteroid. Previous studies reported inadequate responses to high-dose corticosteroids and IVIG in the majority of patients with CCPD. It's estimated to be a unique disease beyond MS and CIDP with heterogenous features. We suggest that awareness of this steroiddependent condition may improve our knowledge in the pathophysiology and management strategies.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.