Background: Herpes zoster of the head and neck commonly presents with Ramsay Hunt syndrome. However, vesicular eruptions may occur on the pharyngeal or laryngeal area with multiple lower cranial-nerve (CN) palsy. Case Report: We report on the case of a 54-year-old man with herpes zoster of the pharynx and larynx with multiple CN palsy and persistent hiccups. He initially developed progressive dysphagia, hoarseness, and persistent hiccups (CN IX and X). After admission, Dizziness, hearing impairment, and peripheral facial palsy (CN VII and VIII) were complicated. The results of a polymerase chain reaction test of saliva and vesicular fluid from the ear and throat were strongly positive for varicella zoster virus. The progression of CN palsy was in an ascending sequence. Conclusion: We suggest that the sequence of CN palsy may be either ascending or descending, depending on the initial site of involvement.
Background: Hashimoto's encephalopathy is a poorly understood syndrome consisting of heterogeneous neurological symptoms and high serum antithyroid antibody titers, typically responding to steroids. More clinical series studies are required to characterize the clinical, laboratory and imaging features, and outcomes, especially in the Chinese population. Methods: We analyzed the clinical, laboratory, and imaging features and outcomes of thirteen consecutive patients with Hashimoto's encephalopathy diagnosed in Xuan Wu Hospital, Beijing from 2005 to 2010 retrospectively. Results: Cognitive impairment (84.6%) and psychiatric symptoms (38.5%) were the most frequent symptoms. Seizures (30.8%) and myoclonus (7.7%) were less common than previously described. Three (23.1%) patients showed abnormal signals in hippocampus or temporal lobe, which were believed related to their memory disorders or seizures. MRI changes showed resolution paralleling clinical improvement in one patient. Among eight patients who received steroid therapy, five patients recovered, one patient improved with residual deficits, and two patients relapsed or had no effect. Among five non-steroid treated patients, three patients experienced stable remission with antiepileptic drugs or general neurotrophic therapy, and two patients experienced continuous deterioration. Conclusions:Most patients with Hashimoto's encephalopathy showed good response to steroids. Some patients improved without steroid therapy. Considering its reversible course, we recommend that Hashimoto's encephalopathy should always be in the differential diagnosis while evaluating disorders of the central nervous system.
The pulmonary artery catheter is recommended to be placed in the exact location to obtain correct values. We present a case of a pulmonary artery catheter recording continuous cardiac output, even after its tip ended up outside the ruptured right ventricle. An 83-year-old female was scheduled for an emergency operation due to aortic dissection. Preoperative echocardiography showed normal heart with tamponade. In the operating room, insertion of an introducer was uneventful. A pulmonary artery catheter was smoothly inserted, showing typical changes in the pressure waveform. But the pulmonary arterial pressure increased and its waveform dampened soon after. Hypotension and tachycardia occurred, and continuous cardiac output was similar to initial values. After cardiotomy, the surgeon found a laceration of posterior part of the right ventricular wall and the protruding distal tip of pulmonary artery catheter. Repair of ruptured wall and dissected aortic arch was done under hypothermic cardiopulmonary bypass. Weaning from bypass and postoperative recovery were uneventful. In conclusion, the shape of the pulmonary arterial pressure waveform and the ability to measure continuous cardiac output are not indicative of the exact location of the pulmonary artery catheter. We suggest the routine confirmation of the pulmonary artery catheter in correct location by transesophageal echocardiography.
Persistent left superior vena cava (PLSVC) is a common venous anomaly of the thorax and usually drains into the right atrium. Less often it drains into the left atrium and has previously been related to ischemic stroke. We report a case of PLSCV that founded during ischemic stroke evaluation in a 77-year-old woman which was detected on transesophageal echocardiography (TEE) and transcranial Doppler ultrasonography (TCD) with saline agitated test and computed tomography.Key words: Persistent left superior vena cava; Cerebra infarction; Saline agitation test; Paradoxical embolism; Transcranial Doppler ultrasonography; Transesophageal echocardiography Persistent left superior vena cava (PLSVC) is a congenital thoracic venous malformation. In most cases, it drains into the right atrium via the coronary vein without causing any clinical manifestations. Very rarely, however, it may drain into the left atrium directly or via the unroofed coronary sinus, producing a right-to-left shunt, putting the patient at high risk of hemodynamic instability, syncope, embolism, or brain abscess. [1][2][3] We report a case of a persistent left superior vena cava draining into the left atrium in a patient with left pontine infarction, which was not detected by transcranial Doppler ultrasonography (TCD) using agitated saline test with microbubbles from right antecubital vein , but was diagnosed on contrast transesophageal echocardiography (TEE) and computed tomography (CT). CaseA 77-year-old right-handed woman presented to the emergency room with symptoms of right-sided weakness and dysarthria that had occurred 5 hours before admission. Her vital signs on admission were: BP 110/70 mmHg, pulse 88 beats/min, and temperature 36.6℃. She was diagnosed with hypertension 10 years ago. Her social and family history was
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