The authors present a case of Lemierre's syndrome that is an uncommon septic thrombophlebitis of the internal jugular vein. A 31-year-old man developed pharyngeal pain one month before hospital admission when he suffered from a severe headache and painful swelling of the left side of his neck. He was diagnosed with tonsillitis. Contrast-enhanced computed tomography and magnetic resonance imaging of the neck revealed the presence of an occlusive thrombosis of the left internal jugular vein and an inflamed mesopharynx. His symptoms and the jugular vein thrombus showed remarkable improvement after administration of antibiotic and anticoagulation therapy. No pulmonary embolism or other metastatic infection were observed. It was suggested that accurate diagnosis during early treatment is essential to obtain a successful prognosis for Lemierre's syndrome.
We report a case of intestinal obstruction due to intramural hematoma of the duodenum following therapeutic endoscopy for a bleeding duodenal ulcer in a patient with liver cirrhosis. A 44-year-old man was admitted to our hospital with severe epigastralgia, nausea and tarry stool.
We report a rare case of massive and recurrent bleeding from ileal varices in a patient with hepatitis C virus-positive liver cirrhosis. A 66-year old woman, who had undergone laparotomy and blood transfusion 36 years before (because of an extrauterine pregnancy) and endoscopic sclerotherapy for esophageal varices 1 year previously, was admitted to our hospital with loss of bright red blood per rectum. The bleeding was massive and recurrent, and frequent blood transfusions were required. Endoscopic studies failed to find the bleeding site. In the venous phase of selective superior mesenteric angiography, mesenteric varices in the lower part of the abdominal cavity were observed. Laparotomy was performed to control the repeated bleeding which had lasted for more than 1 month. Varices communicating with the right ovarian vein were found on the ileal wall and segmental resection of the ileum was performed. Histological examination demonstrated a massive varicose vein and several dilated veins in the submucosa. The patient's postoperative course was favorable, with no hemorrhagic events during a follow-up of more than 6 months after surgery. Ileal varices should be considered in the diagnosis of a patient who presents with lower gastrointestinal bleeding and portal hypertension.
A 70-year-old woman developed left hypoglossal nerve palsy, a right hemiparesis sparing the face, and a typical left Wallenberg's syndrome. These symptoms resulted from a lesion in the left half of the medulla oblongata, suggesting Babinski-Nageotte syndrome, a rare cerebrovascular disease. This is the first case of ischemic infarction in the territory of the left vertebral artery and posterior inferior cerebellar artery demonstrated on magnetic resonance imaging. Severe bilateral lesions of the distal vertebral arteries demonstrated on digital subtraction angiography may have contributed to the development of this syndrome. (Stroke 1991^2:272-275) I n 1902, Babinski and Nageotte 1 first reported three autopsy cases characterized by symptoms due to an ischemic lesion of the medulla oblongata involving the unilateral lateral and medial areas of the medulla. -3 The identity of this syndrome has not been clearly established, and the distribution of the vascular disease is still under discussion. Only a few cases have been described up to now.We report a typical case of Babinski-Nageotte syndrome in a patient with an ischemic lesion in the medulla oblongata shown on magnetic resonance imaging (MRI). Cerebral angiography revealed severe stenosis and occlusion of the vertebral arteries.Case Report A 70-year-old woman who had suffered from hypertension and diabetes mellitus for 20 years was admitted to St. Mary's Hospital on April 8, 1989, because of a sudden headache, vomiting, and rightsided weakness. On admission, her blood pressure was 180/120 mm Hg and her pulse was regular at 72/min, but her breathing was severely irregular with markedly decreased movement of the right chest wall. Soon after arriving at the hospital, spontaneous respiration ceased and she lapsed into a coma. Artificial ventilation was started, and her level of consciousness quickly improved to drowsy. Her eyes deviated to the right for a few days, and the left cornea] reflexes were diminished. Her pupils were Received July 18, 1990; accepted October 19, 1990. slightly anisocoric (left < right), but the light reflexes were prompt. She had a right hemiparesis with decreased deep tendon reflexes. The movement of her soft palate and tongue could not be examined.No sensory impairment was apparent. On admission, her leukocyte count was 12,100/mm 3 , erythrocyte count 506xl0 4 /mm 3 , hemoglobin concentration 16.1 g/dl, hematocrit 48.8%, platelet count 24.0xl0 4 /mm 3 , and serum glucose concentration 281 mg/dl. Blood gas studies on room air revealed hypoventilation; Po 2 was 48.7 mm Hg, Pco 2 40.8 mm Hg, and pH 7.336. Cardiomegaly was observed on a chest roentgenogram (cardiothoracic ratio 64%). Cranial computed tomography on day 3 showed a low-density area in the left dorsal hemisphere of the cerebellum. An additional infarcted area in the left half of the medulla oblongata was revealed by MRI on day 19. Obstruction or blood flow stagnation in the left vertebral artery was also suggested by MRI (Figure 1, top). There were no lesions in the bilat...
The authors present hemodynamic and autonomic features of recurrent and episodic neurally mediated syncope in a man with lung cancer involving afferent vagus. He revealed extreme hypotension with bradycardia occurring during sitting or standing. A head-up tilt test also induced syncope. However, syncope attacks no longer occurred 2 weeks after admission. Alternatively, the paralyses of the left recurrent laryngeal nerve and the left phrenic nerve developed. It is suggested that the lung cancer involved upper rootlets of the left vagus and caused transient hypersensitivity of baroreceptor function that resulted in neurally mediated syncope.
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