While the clinical presentation of systemic sarcoidosis is well established, identification of isolated neurologic sarcoidosis remains a diagnostic challenge. Isolated neurologic sarcoidosis, or neurosarcoidosis, presents in a manner that is often indistinguishable from other neurological diseases. Common clinical features include headache, encephalopathy, gait disturbance, seizure, behavioral abnormalities, sleep difficulties, loss of appetite, cranial mononeuropathy (including visual, auditory, and vestibular dysfunction), myelopathy, radiculopathy, myopathy, and peripheral neuropathy. While probable diagnosis requires only evidence of inflammation on cerebrospinal fluid studies or magnetic resonance imaging, tissue biopsy with pathologic findings of noncaseating granulomas is required for definitive diagnosis. We present the case of a 54-year-old male with headache, episodic confusion, and gait disturbance attributed to probable neurologic sarcoidosis.
Purpose: SARS-CoV-2 (COVID-19) has continued to be a public health emergency, affecting almost 450 million people worldwide, with a disproportionate significant disease burden in the elderly community. Our main purpose of this study was to provide population specific prognostic markers upon description of demographic factors, clinical characteristics, diagnostic variables, treatment characteristics and outcome variables in critically ill geriatric patients with acute hypoxic respiratory failure due to COVID-19 infection. Methods: This is a retrospective chart review of 165 patients admitted to a single institution’s medical and cardiovascular intensive care unit between the dates of March 01, 2020 and December 31, 2020. Inclusion criteria was patients age greater than or equal to 65 years, documented positive COVID-19 polymerase chain reaction test result and a diagnosis of acute hypoxic respiratory failure. Our primary end point evaluated the rate of mortality in relation to multiple variables during intensive care unit admission. Results: Of 165 patients, 45 patients were excluded. Of the remaining 120 patients, 41 were females and 79 were males. Four independent risk factors are significantly associated with higher odds of mortality for the concerned population: presence of solid tumor (AOR: 0.002, 95% CI: <0.001, 0.31), maximum value of PaCO2 (AOR: 1.094, 95% CI: 1.029, 1.163), Charlson comorbidity index (AOR: 2.962, 95% CI: 1.59, 5.52), and use of diuretics (AOR: 0.015, 95% CI: <0.001, 0.49). Conclusion: Certain factors were found to be poor prognostic markers during intensive care unit admission, which may predict a higher rate of mortality in those patient populations.
Coronavirus disease 2019 (COVID-19) was a novel virus that originated in China in November 2019 and is most known for its respiratory compromise; however, many patients have experienced vascular thrombosis as sequelae of COVID-19. It is thought that the virus causes endothelial cell damage and increased platelet and leukocyte adhesion, causing a hypercoagulable state. While the most common presentation of hypercoagulability associated with COVID-19 is venous thrombosis, there are reports of patients who present with acute limb ischemia. We present a case of acute leg ischemia in an otherwise asymptomatic patient with no atherosclerotic risk factors.
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