Recurrent clonazepam withdrawal delirium in a postoperative neurosurgical patient: a case report

2021 ◽  
Vol 14 (6) ◽  
pp. e240804
Author(s):  
Eric William Lutz ◽  
Christopher Hines
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Spinal Surgery ◽  
Preoperative Planning ◽  
Middle Aged ◽  
Liaison Psychiatry ◽  
Neurosurgical Patient ◽  
Benzodiazepine Withdrawal

We present a case of benzodiazepine withdrawal delirium in a middle-aged man undergoing spinal surgery. Benzodiazepines were stopped prior to surgery and on postoperative day 4, the patient exhibited significant paranoia, hyperarousal and ideas of reference. Patient’s symptoms resolved after reintroduction of his benzodiazepines. It is important to include benzodiazepine withdrawal in the differential diagnosis for acute delirium even in those patients taking low or moderate doses. Benzodiazepine withdrawal delirium typically responds rapidly to restarting benzodiazepines. In patients with known discontinuation issues, early consultation with consult-liaison psychiatry and preoperative planning for early medication re-initiation is paramount.

scholarly journals A large ovarian steroid cell tumor‐not otherwise specified with a unique combination of benign and malignant features as a challenging cause of oligomenorrhea and hirsutism in a 21‐year‐old Syrian female: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sawsan Ismail ◽  
Munawar Hraib ◽  
Rana Issa ◽  
Thanaa Alassi ◽  
Zuheir Alshehabi
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Virgin Female ◽  
Cell Tumor ◽  
Diagnostic Methods ◽  
Unique Combination ◽  
Ovarian Steroid ◽  
Not Otherwise Specified ◽  
Steroid Cell Tumor ◽  
Rare Category

Abstract Background Ovarian steroid cell tumors represent a rare category of sex cord-stromal tumors that constitute less than 0.1% of all ovarian tumors. These neoplasms are classified into three main subtypes according to the cell of origin: Leidyg cell tumors, stromal luteomas, and steroid cell tumors not otherwise specified (SCTs-NOS). The latter subtype is defined as a neoplasm of an uncertain lineage that mostly affects middle-aged women, whereas it’s rare in younger ages. Case presentation We report a case of a 21-year-old virgin female who presented to our hospital with complaints of mild abdominal pain, hirsutism, and oligomenorrhea for more than a year. Before her current admission, the patient had attended an external gynecologic clinic where she had been prescribed oral contraceptives to regulate her periods. Nevertheless, on presentation to our institution, physical examination revealed abdominal tenderness with a palpable pelvic mass and mild hirsutism in the thigh. Ultrasonography demonstrated a large left ovarian mass measuring 154 × 104 mm, and compressing the uterus. Therefore, a unilateral salpingo-oophorectomy was performed, and interestingly, pathologic examination of the large aforementioned mass alongside with immunohistochemical correlation revealed the diagnosis of a large ovarian steroid cell tumor-not otherwise specified with a unique combination of benign and malignant features. Conclusions Although ovarian steroid cell tumors represent a rare category, they must be considered in the differential diagnosis for mild virilization symptoms in young females due to the importance of early diagnosis and management. In this manuscript, we aimed to present the first case report from Syria that highlights the crucial role of detailed morphological examination for challenging cases despite the difficulties in differential diagnosis, and the absence of ancillary techniques. Furthermore, we managed to discuss a brief review of diagnostic methods, histological characteristics, and treatment recommendations.

Orofacial Manifestations Assisting the Diagnosis of Cowden Syndrome in a Middle-Aged Patient: Case Report and Literature Overview

2021 ◽  
Author(s):  
Sebastião Silvério Sousa-Neto ◽  
José Alcides Almeida de Arruda ◽  
Allisson Filipe Lopes Martins ◽  
Lucas Guimarães Abreu ◽  
Ricardo Alves Mesquita ◽  
...  
Keyword(s):  
Case Report ◽  
Cowden Syndrome ◽  
Aged Patient ◽  
Middle Aged ◽  
Patient Case ◽  
Literature Overview

scholarly journals Cerebral fat embolization with paroxysmal sympathetic hyperactivity syndrome and septic shock at high altitude: a case report and literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Min Li ◽  
Gang Zhu ◽  
Hao Guo ◽  
Shun Nan Ge ◽  
Guo Dong Gao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Differential Diagnosis ◽  
Case Report ◽  
Literature Review ◽  
High Altitude ◽  
Fat Embolism ◽  
Neurological Rehabilitation ◽  
Case Presentation ◽  
Sympathetic Hyperactivity ◽  
Paroxysmal Sympathetic Hyperactivity

AbstractBackgroundCerebral fat embolism (CFE) syndrome at high altitude was rare complicated with paroxysmal sympathetic hyperactivity (PSH) syndrome and septic shock. It is a challenge to differential diagnosis and treatment at high altitude.Case presentationThis case presents a CFE with PSH and septic shock of a 23-year-old man occurred at high altitude of 3800 m above sea level, transferred by airplane successfully and cured in the department of neurosurgery, Xi’an Tangdu Hospital.ConclusionsIt is key that CFE with PSH can be rapid diagnosed and treatment bundles of septic shock should be initiated as soon as possible. Early neurological rehabilitation played an important role for good outcome.

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