A 14-year-old female patient presented with generalized body weakness and difficulty walking. Further history revealed growth and pubertal delay. On examination there was wrist widening, bowing of legs with breast, and pubic hair of tanner stage 2. Serum and urine investigations presented diagnoses of Fanconi syndrome associated with hypophosphatemic rickets with low LH and FSH levels and normal prolactin. MRI showed a normal-sized pituitary gland without any mass lesion. The patient was started with phosphorus, magnesium, and calcium supplements with 25(OH)D.
Background
Penetrating trauma to the brain is a rare mode of self-harm in individuals with depressive psychosis. It may have variable presentations ranging from intact neurological status to non-survivable damage and the subjects may be surprisingly apathetic to pain. It is even unusual for such an injury to have an excellent prognosis despite coming late to clinical attention.
Case presentations
We report two cases of patients with psychotic depression who attempted suicide by hammering nails into their heads. On imaging, deep penetration within the brain parenchyma was noted; however, neither case had any neurological deficit or symptoms attributable to brain trauma.
Conclusions
Self-inflicted penetrating brain injuries with peculiar objects such as nails are rarely encountered in practice. They need prompt management for their removal and addressing the underlying mental health illnesses.
Budd-Chiari syndrome is a rare medical condition that affects one in a million people and can be caused by various thrombotic and non-thrombotic factors. In rare instances, multiple factors may contribute to its development, with coagulation factor deficiencies being a less commonly implicated cause. This case report presents a case of BCS associated with protein C deficiency and antiphospholipid syndrome (APLS). The patient is a 30-year-old woman who was brought in due to sudden abdominal distension. She had a three weeks history of intractable vomiting and loose stools. There was also a history of repeated miscarriages. The laboratory findings revealed slightly elevated liver enzymes, a positive Anti-β2 GPI screening, moderately decreased Protein C level and activated protein C resistance/FV Leiden. The patient was discharged after 21 days of inpatient treatment with symptomatic improvement.
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