Seyed Farshad Allameh
Vol 6 No 6 (2021): November-December
Cerebral Autosomal Dominant Arteriopathy with Sub-Cortical Infarcts and Leukoencephalopathy (CADASIL) is a rare autosomal genetic disorder that affects the brain’s small vessels. It is recognized among the leading causes of stroke in the young.
This is a case report of a 35-year-old female with underlying migraine with auras who presented with recurrent cryptogenic strokes. She presented no vascular risk factors or any family history of neurological disease. An investigation into her presentation leads us to a diagnosis of CADASIL following typical subcortical and deep white matter changes seen on her Magnetic Resonance Imaging (MRI).
Diagnosing and managing pelvic pain during pregnancy is often challenging. This pain can be obstetrical, gynecological, or non-obstetrical_non-gynecological. Ovarian torsion, known as the consequence of ovarian twisting on its supporting ligaments, is one of the causes of gynecological pelvic pain that can occur during pregnancy and cause emergencies. However, early detection can preserve the ovaries and preserve the patient's current and future fertility. Surgery is the gold standard for the diagnosis and treatment of ovarian torsion. It is important to choose the best surgical technique (laparoscopy or laparotomy) to reduce possible complications during and after surgery. Our case is a 7-8 weeks pregnant woman who underwent laparoscopic surgery with an ovarian mass of 85*152 mm and an acute abdomen. It was found that the mass has caused 1260 degrees rotation in the patient's left adnexa. The results during and after surgery, as well as the condition of the mother and baby, were favorable.
Endometriosis is among the most frequent causes of appendiceal intussusception. However, there are limited data about this condition. Still, clinical manifestations, diagnosis, and treatment are the same in almost all cases due to accidental implantation of endometrial tissue inside the appendiceal wall. Finally, the only choice of treatment is appendectomy.
Here we describe a middle-aged woman with vague pelvic pain that underwent a laparoscopic cystectomy, and during surgery, we came across a mass-like appendix. The pathology report declared that some endometrial tissue inside the appendix confirms the diagnosis of appendiceal intussusception due to endometriosis.
An elderly woman aged 66 presented to a general hospital with left-sided facial paresis, bilateral lower limb weakness, and back pain. After undergoing clinical assessments and investigations, she was diagnosed and treated as a case of acute stroke. Two weeks later, she was repatriated to our hospital for neuro-rehabilitation. Unconvinced, we revisited her clinical history and, after a thorough physical examination, made a clinical diagnosis of Guillain- Barre Syndrome (GBS), i.e., confirmed by electrophysiological studies. She was treated with intravenous immunoglobulin and made a complete recovery 6 weeks later.
This case highlights an infrequent presentation of GBS as a stroke-mimic. It re-emphasizes the need to maintain a high index of clinical suspicion for similar expressions, especially in busy acute medical units. Such cases are easily missed if basic clinical skills, such as good history- taking and thorough physical examination, are glossed over. Despite time constraints, these skills are indispensable in clinical practice.
Coronavirus Disease 2019 (COVID-19) is an ongoing pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Patients with infective endocarditis (IE) and COVID-19 can present similar signs and symptoms; thus, it may be difficult for clinicians to diagnose such infections. This report presented a patient diagnosed with IE and co-infected with COVID-19. This case highlights that every physician should consider COVID-19 infection when evaluating patients with IE.
Basidiobolomycosis is a rare invasive fungal infection, usually causing subcutaneous infection. Medical literature has rarely reported gastrointestinal and disseminated infections. We report a case of hepatic basidiobolomycosis in an immunocompetent 12-year-old girl from Iran who presented with fever, abdominal pain, and loss of appetite. She had a history of abdominal trauma two months prior. We found a mass in the left lobe of the liver; thus, an ultrasound- guided biopsy was performed. Basidiobolomycosis was diagnosed through pathological findings. Accordingly, a prolonged course of antifungal agents was prescribed, and the patient’s symptoms improved.
Gastrointestinal basidiobolomycosis is a rare fungal infection that rarely only affects the liver. Clinical manifestations may mimic malignant tumors, hepatic abscess, hepatic cyst, inflammatory bowel disease, or even the phlegmon of appendicitis. In tropical regions, fungal infections like basidiobolomycosis should be considered through differential diagnosis. Usually, long-term antifungal therapy and surgical resection are required. If diagnosed late, the disease presents a high mortality rate. However, our patient was diagnosed and treated early; therefore, she could recover.
Coronaviruses (CoVs) are single-stranded RNA viruses described for >50 years. Novel coronavirus (SARS-Coronavirus-2: SARS-CoV-2) emerged in Wuhan and has spread globally. Coronavirus Disease 2019 (COVID-19) symptoms are primarily pulmonary (fever, dry cough, fatigue, pneumonia); however, other organs can be affected, including the gastrointestinal tract, kidneys, liver, heart, and brain.
Pediatric COVID-19 is milder than the adult’s type. Children with severe disease often have an underlying co-morbidity, such as chronic lung disease or immunosuppression.
SARS-CoV-1, MERS-CoV, HCoV-OC43, and HCoV-229E are associated with neurological complications. Neurological manifestations of COVID-19 are not well understood in adults or children, and these manifestations are not rare. The number of patients with neurological manifestations has been increasing Recently, especially in the third peak of the disease.
Early diagnosis and timely management may lead to a better outcome. There are limited reports of neurological complications in the pediatric population. Further studies are required for early diagnosis and better results. We reported the third case of encephalitis in children without any respiratory or gastrointestinal manifestation.
A 7-year-old male was admitted with fever and loss of consciousness. He presented no respiratory or gastrointestinal symptoms. He reported no medical history and history of substance abuse. Laboratory findings confirm that neurological manifestations might be expected in covid-19 infections, despite the absence of respiratory symptoms. The patient was treated, and the level of consciousness was gradually improving. Supportive treatment and outpatient follow-up were recommended.
Giant Cell Fibroma (GCF) is a benign rare fibrous lesion that predominantly occurs on the mandibular gingiva. Clinically, it is presented as a sessile or pedunculated mass that frequently occurs in the third decade with a slight female predilection. The lesion is usually characterized by stellate and multinucleated fibroblasts located in the lamina propria near the overlying epithelium and radiographically treated as a benign lesion.
A 20-year-old female was referred to the Oral and Maxillofacial Medicine Department of Semnan Dental School, with the chief complaint of tooth displacement and gingivitis. Clinical examination revealed maxillary protrusion, mouth breathing, localized gingivitis in the interdental areas of the papilla of the lateral and canine teeth; also alveolar bone with pus discharge in the right mandibular premolar area. Radiographically, the lesion leads to the bone resorption and linguistic movement of the teeth in the right side of Mandible. There were no root resorption and no bone expansion. Gentle scaling and root planning, biopsy, and second premolar extraction were performed. The presence of the giant fibroblasts in superficial connective tissue confirmed the diagnosis of Giant Cell Fibroma. At the follow-up session, tissue repair was accomplished, and the first premolar was immobile and was no longer loose.
Nevertheless, further studies are required to investigate the precise nature of the mono or multinucleated cells, i.e., atypical fibroblasts that illustrate degenerative and functional changes. Moreover, a high index of suspicion and appropriate analytical examination is required for distinct lesions to achieve a proper diagnosis and suggest an appropriate treatment.
Spontaneous thrombosis of the renal artery is extremely rare. It presents as an acute abdomen and is often underdiagnosed. Clinicians need to be aware of this rare disease for timely diagnosis and treatment. We present a case of a 60-year-old male without previous health conditions presenting with unremitting acute pain abdomen, nausea, and vomiting. Ultrasonography was reported unremarkable. A contrast-enhanced Computed Tomography (CT) scan of the abdomen demonstrated a thrombosed right renal artery with a right renal infarct. The purpose of this case report is to put forth this rare entity as a cause of acute abdomen to provide a timely diagnosis and treatment for such patients.
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a disease that affects babies in which the platelet count is decreased because the mother's immune system attacks her fetus platelets. A low platelet count increases the risk of bleeding in the fetus and newborn. FNAIT is the leading cause of severe thrombocytopenia in the fetus and neonate. The most serious complication of FNAIT is intracranial hemorrhage, which occurs in 10-20% of symptomatic infants. If the bleeding occurs in the brain, there may be long-term effects. The Pathophysiology of atraumatic fetal subdural hematoma (SDH) remains unknown and is extrapolated from SDH of shaken baby syndrome in infants (1, 2). Detailed prenatal investigation is crucial to elucidate the underlying etiology, which may be associated with a better prognosis. We present a case of antenatally diagnosed SDH secondary to FNAIT that was normal up to one month after follow-up.
Seyed Farshad Allameh
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