scholarly journals A rare case of varicella zoster virus encephalitis in a 16 years old unvaccinated girl

2021 ◽  
Vol 1 (1) ◽  
pp. 7-11
Author(s):  
Abdul Wali Khan ◽  
Abad Khan ◽  
Muhammad Ishaq ◽  
Irfan Ullah ◽  
Marhami Fahriani
Keyword(s):  
Emergency Department ◽  
Rare Case ◽  
Altered Mental Status ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
The Body ◽  
Persistent Fever ◽  
Varicella Zoster ◽  
Appropriate Treatment ◽  
Unvaccinated Girl

We reported a 16-year-old girl, with diffuse vesicular rashes all over the body, presented to the emergency department with altered mental status, irritability, persistent fever and one episode of a generalized tonic-clonic seizure. After thorough evaluation and investigations, the case was a varicella zoster-associated encephalitis in an unvaccinated patient. Appropriate treatment was initiated, the patient was then shifted to the critical care and subsequently discharged with no sequelae. Early diagnosis and treatment should be emphasized as they play an important role in the clinical outcome of chickenpox-associated encephalitis.

A rare case of chickenpox induced myoclonus

2021 ◽  
Vol 18 (2) ◽  
pp. 61-63
Author(s):  
Navgeet Mathur ◽  
Medha Mathur ◽  
Anjana Verma
Keyword(s):  
Case Report ◽  
Male Patient ◽  
Therapeutic Approach ◽  
Rare Case ◽  
The Body ◽  
Varicella Zoster ◽  
Appropriate Treatment ◽  
Neurological Features ◽  
Infective Etiology ◽  
Csf Examination

In presence of abnormal neurological features, infective etiology should be kept as one of the differential diagnoses. This case report was about 38 years old male patient who presented with fever with blister-like rashes in centripetal distribution over the body and myoclonus. CSF examination showed the presence of varicella-zoster Ig M antibodies. Diagnosis of chickenpox induced myoclonus was made. Appropriate treatment recovered the patient completely. This case report highlighted the clinical spectrum of chickenpox as well as the possible pathogenesis and diagnostic, therapeutic approach of this uncommon entity.

scholarly journals Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
T. M. Skipina ◽  
S. Macbeth ◽  
E. L. Cummer ◽  
O. L. Wells ◽  
S. Kalathoor
Keyword(s):  
Emergency Department ◽  
Metabolic Acidosis ◽  
Mental Status ◽  
Rare Case ◽  
Liver Function Tests ◽  
Altered Mental Status ◽  
Potassium Citrate ◽  
Metabolic Encephalopathy ◽  
History Of ◽  
Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

A rare case of generalized tonic‐clonic seizure related to paclitaxel infusion

2019 ◽  
Vol 44 (6) ◽  
pp. 974-976 ◽  
Author(s):  
Oyintayo Ajiboye ◽  
Nair Renu ◽  
Olisa Ezegwu ◽  
Ishaan Vohra ◽  
Muhammed Talha Ayub
Keyword(s):  
Rare Case ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure

scholarly journals Body-Packing: A Rare Diagnosis to Keep in Mind

2020 ◽  
Author(s):  
Maria Joao Gomes ◽  
Ana João ◽  
Inês Bargiela
Keyword(s):  
Surgical Intervention ◽  
Exploratory Laparotomy ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
The Body ◽  
Laboratory Findings ◽  
Body Packing ◽  
Gastrointestinal Obstruction ◽  
Rare Diagnosis ◽  
Systemic Drug

Body packing was first described in 1973 and refers to the intracorporeal concealment of illegal drugs, which are swallowed or placed in anatomical cavities and/or body orifices. The body packer can be asymptomatic or can have signs of systemic drug toxicity (neurological, cardiac, abdominal, renal and cutaneous) due to rupture of the packet(s) or symptoms of gastrointestinal obstruction or perforation. The diagnosis is established based on a suggestive history, findings on physical examination and laboratory findings and/or imaging. The vast majority of patients are asymptomatic and are treated conservatively. However, complex situations may require surgical intervention. We present a case of a 50-year-old man who was admitted in the emergency department with a generalized tonic-clonic seizure and vomiting with plastic film, which raised the suspicion of foreign body ingestion, confirmed by imaging and laboratory tests. He underwent exploratory laparotomy to remove the packages.

scholarly journals Seizure following the Use of the COX-2 Inhibitor Etoricoxib

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Valentina Arnao ◽  
Marianna Riolo ◽  
Brigida Fierro ◽  
Paolo Aridon
Keyword(s):  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Epileptic Seizures ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Generalized Seizures ◽  
Appropriate Treatment ◽  
History Of ◽  
Cox 2 ◽  
Cox 2 Inhibitors

We describe a case of epileptic seizures occurring after the use of a COX-2 inhibitor. A 61-year-old man was admitted to our department because of a generalized tonic-clonic seizure. EEG showed generalized slowdown of the activity. Neuroimaging and blood samples studies did not evidence alterations, but a careful pharmacological history revealed that the patient had taken the COX-2 inhibitor etoricoxib to treat lumbago few days before the onset of clinical symptoms. No seizures were reported after etoricoxib discontinuation and an EEG resulted to be normal two months after this. Conclusion. Knowing the pharmacological history of a patient is important for understanding the clinical presentation and selecting appropriate treatment. This is, to the best of our knowledge, the first reported case of generalized seizures associated with the use of COX-2 inhibitors.

scholarly journals Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis presenting to the emergency department with status epilepticus

CJEM ◽  
2014 ◽  
Vol 16 (05) ◽  
pp. 425-428 ◽  
Author(s):  
Brodie Nolan ◽  
Katharina Plenk ◽  
David Carr
Keyword(s):  
Emergency Department ◽  
Status Epilepticus ◽  
Mental Status ◽  
Young Patients ◽  
Complete Recovery ◽  
Altered Mental Status ◽  
Emergency Physicians ◽  
Varicella Zoster ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis

ABSTRACT Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a recently described and underdiagnosed entity that typically affects young, previously healthy individuals. Patients usually present in phases, which may include refractory seizures, psychosis, unresponsiveness, and autonomic instability. The diagnosis of anti-NMDAR encephalitis is challenging; however, prompt diagnosis and early treatment can lead to complete recovery. The incidence of anti-NMDAR encephalitis may be as high as four times that of encephalitis from herpes simplex, varicella-zoster, and West Nile viruses; however, it remains an underrecognized disorder. Early initiation of immunotherapy in anti-NMDAR encephalitis has been found to improve patient outcomes. Because of this, emergency physicians must be vigilant and consider this diagnosis in patients with altered mental status in whom a toxicologic or other etiology is not suspected. Early consideration of this diagnosis can facilitate urgent neurology consultation and prevent diagnostic delays arising from psychiatric referrals. It is essential to consider this diagnosis in suspicious emergency department presentations, particularly young patients who present with altered mental status, psychosis, or new-onset seizure activity when other obvious causes are ruled out. Emergency physicians should discuss the possibility of empirical intravenous immunoglobulin administration with neurology consultants if anti-NMDAR encephalitis is suspected. We describe the case of a 20-year-old man with anti-NMDAR encephalitis who presented to the emergency department with status epilepticus.

Nervous System Emergencies

2019 ◽  
pp. 231-257
Author(s):  
Amy Briggs ◽  
Brandon Chalfin
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Nervous System ◽  
Altered Mental Status ◽  
Medical Emergency ◽  
Clinical Effects ◽  
Outpatient Management ◽  
Test Taking ◽  
Appropriate Treatment ◽  
Wide Range

Nervous system emergencies can present in a myriad of ways to the emergency department (ED). They affect children and adults alike. Common neurologic presentations include altered mental status, seizures, stroke, weakness, and headache. It is the emergency medicine physician’s duty, both in the ED and in test-taking situations, to pick up on clues in the presentation that help to ascertain which of these are a medical emergency requiring advanced imaging, expert consultation, and treatment and which require reassurance and outpatient management. This chapter presents questions related to the diagnosis, clinical effects, and most appropriate treatment of a wide range of these neurologic emergencies.

scholarly journals Bilateral pneumothoraces and pneumomediastinum complicating a generalized tonic-clonic seizure

CJEM ◽  
2008 ◽  
Vol 10 (02) ◽  
pp. 176-178 ◽  
Author(s):  
Helen Curran ◽  
John Ross
Keyword(s):  
Emergency Department ◽  
Literature Search ◽  
Pulmonary Complication ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Loss Of Consciousness ◽  
Convulsive Activity ◽  
Life Threatening ◽  
New Onset ◽  
Alveolar Edema

ABSTRACTPatients often present to the emergency department following a generalized tonic-clonic seizure, particularly of new onset. Complications associated with seizures usually arise from injuries sustained from loss of consciousness or during convulsive activity. This report describes a patient with an idiopathic seizure who developed postictal alveolar edema and delayed bilateral pneumothoraces and pneumomediastinum. A literature search revealed only 1 other case of this potentially life-threatening pulmonary complication from seizures.

Herpes Zoster in the Ulnar Nerve Distribution

2005 ◽  
Vol 30 (4) ◽  
pp. 355-357 ◽  
Author(s):  
G. S. ATHWAL ◽  
S. A. BARTSICH ◽  
A. J. WEILAND
Keyword(s):  
Herpes Zoster ◽  
Early Diagnosis ◽  
Ulnar Nerve ◽  
Lower Risk ◽  
Dorsal Root ◽  
The Body ◽  
Varicella Zoster ◽  
Chicken Pox ◽  
School Aged Children ◽  
Appropriate Treatment

Varicella zoster is a ubiquitous virus which usually affects school-aged children as Chicken Pox. While the initial disease is self-limiting and seldom severe, the virus remains in the body. It lies dormant in the dorsal root ganglia and reactivation may occur years later with variable presentations as Herpes Zoster, or Shingles. While Shingles is common, it rarely presents exclusively in the upper extremity. It is important that hand surgeons recognize the possibility of zoster infection, with or without a rash, when evaluating the onset of neuralgia in a dermatomal distribution in the upper limb. Early diagnosis allows rapid and appropriate treatment, with a lower risk of complications. We report on a case of Herpes Zoster isolated to the ulnar nerve distribution in a young woman.

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

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