Cerebral venous sinus thrombosis remains a diagnostic challenge courtesy to its variable degree of presentation and low level of clinical suspicion. We report a rare case of cerebral venous sinus thrombosis presenting as a complication of alcohol intoxication. Symptoms of cerebral venous sinus thrombosis are likely to remain camouflaged in alcoholics making the task for the clinician more so difficult. Strong suspicion should remain in any alcoholics with persistent neurologic features. A 52-year-old gentleman presenting with delirium, seizure, and a persistent headache was found to have multiple cerebral venous sinus thrombosis. After ruling out all the possible risk factors eventually we came into the conclusion of the role of alcohol inducing this catastrophic condition. He was treated with anticoagulant resulting in prompt resolution of his symptoms. Anti-coagulation was discontinued after 3 months and the patient continues to remain asymptomatic after 6months of regular follow-up.
This is a rare case of development of bi-lateral chylous pleural effusion (containing parenteral nutrition material) along with pneumomediastinum due to punctured left subclavian vein following insertion of a peripherally inserted central venous catheter (PICC) line. Parenteral nutrition is usually preferred for patients unable to tolerate enteral feeding. Due to hypertonicity of the total parenteral nutrition material, it is usually administered via internal jugular or subclavian vein which have a rapid blood flow; therefore, resulting in adequate mixing. Literature studies are yet to clearly explain the communications between two pleural cavities; therefore, development of bilateral pleural effusions in association with pneumomediastinum makes this case more intriguing. We present the journey of a 43-year-old woman who required insertion of bilateral chest drains, followed by sternotomy and repair of the left subclavian vein after she was found in hypoxic respiratory failure 2 days following insertion of PICC line into her left subclavian vein.
Lymphohematogenous spread of mycobacterium tuberculosis to multiple organs presents a complex diagnostic challenge to any physician. A holistic and vigilant approach is required in the quest to diagnose disseminated tuberculosis causing adrenal failure. Although tuberculosis can affect various endocrine glands of the body yet adrenal remains the most common.[1] It is also the fifth most common site for extra-pulmonary tuberculosis.[2] The incidence of tuberculous Addison’s disease has lowered courtesy of anti-tubercular medications accounting for only 7-20% of cases.[1] Here we showcase a rare incidence where a 39 years old gentleman with no constitutional symptoms and no known co-morbidities presenting with neck pain went into adrenal crisis and eventually was found to be due to disseminated tuberculosis which affected his lungs, adrenal glands, cervical spine, and brain.
Pneumomediastinum is defined as the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema [1]. Pneumomediastinum can be categorized as spontaneous (SPM) or traumatic. Traumatic pneumomediastinum is caused by blunt or penetrating trauma to the chest, or iatrogenic injury, such as that produced by thoracic surgery. Mechanical ventilation is a common cause of barotrauma and pneumomediastinum. Pneumomediastinum caused by mechanical ventilation is often considered a type of traumatic pneumomediastinum, rather than SPM (UpToDate).
We report a case of spontaneous pneumomediastinum, pneumothorax and surgical emphysema in a 20-year-old patient with COVID-19. He was managed conservatively.
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