Internal medicine
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A 16-year-old boy presented with sudden left homonymous hemianopsia followed by right ocular and occipital pain. Arterial spin labeling (ASL), a non-contrast magnetic resonance imaging technique used to evaluate perfusion, showed a decrease in cerebral blood flow in the right occipital lobe. ⋯ ASL revealed a decreased cerebral blood flow in the left occipital lobe. We ultimately diagnosed the patient with first-time migraine with aura, in which cortical spreading depression was visualized as decreased cerebral blood flow using ASL.
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Total pancreatectomy results in complete loss of insulin and glucagon. Sensor-augmented pumps (SAPs) allow fine-tuning of the basal insulin rate, which helps avoid both hypo- and hyperglycemic events. ⋯ Furthermore, we observed a sudden drop in blood glucose levels without insulin, which may have been due to glucose effectiveness. Our case is valuable in arguing the concept of glucose effectiveness in the absence of insulin and glucagon.
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Case Reports
A Japanese Family Meeting the Clinical Diagnostic Criteria for MEN1 with a MEN1 Variant of Uncertain Significance.
Multiple gastroenteric, pancreatic, and pituitary neuroendocrine neoplasms (NENs) were diagnosed in a 74-year-old man with a history of primary hyperparathyroidism (PHPT). Germline testing demonstrated a variant of MEN1 (c.1694T>A, p. ⋯ During surveillance of the son, multiple pancreatic tumors suggestive of NENs were detected. The pathogenicity of the current MEN1 variant was re-evaluated as likely pathogenic, based on additional family data.