Läkartidningen
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Review Case Reports
[A recently acknowledged state with great variation in severity. NMDAR encephalitis frequently misinterpreted as psychiatric illness].
Since first described less than ten years ago, anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is now recognized as one of the most common causes of autoimmune encephalitis. The disorder is more common in women (80%), where it is frequently associated with an underlying ovarian teratoma. Most patients with anti-NMDAR encephalitis develop a multi-stage illness that progresses from initially psychiatric symptoms to subsequent mnemonic disturbances, seizures, dyskinesias, catatonia and even coma. ⋯ Outcome is likely to be improved with prompt diagnosis and early treatment. Here we describe a hospital-based case series of six patients that illustrate the wide clinical spectrum of the condition. The series also includes one severely ill patient with treatment-refractory disease who was hospitalized with invasive ventilation for seven months, and eventually responded to a combination of rituximab, cyclophosphamide and bortezomib.
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The majority of patients who present to the Emergency Department with vertigo suffer from benign conditions. However, a few percent of these patients have life-threatening conditions, such as a cerebellar stroke. ⋯ There is no role for computed tomography in the evaluation of patients with isolated acute vestibular syndrome in the Emergency Department. For patients with benign paroxysmal positional vertigo, simple reposition maneuvers are effective for symptom relief.
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The present legal definition of the term research creates problems with what can be considered for ethical vetting by the Research Ethical Review Board. The Ethical Review Act should be revised in order for student projects involving patients or quality assurance in healthcare to be accepted for ethical vetting by the Board.
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Severe IgE-mediated allergic reactions to penicillins are rare but might be fatal. Because some studies demonstrated a high risk of cross-sensitivity to cephalosporins and carbapenems it has been recommended to avoid these antibiotics in patients with suspected hypersensitivity to penicillins. ⋯ The new knowledge has implications for the choice of therapy for bacterial infections in patients with a history of penicillin hypersensitivity, because alternative antibiotic regimens are often inferior to beta-lactam antibiotics. The aim of the present review is to present existing knowledge on cross-sensitivity between beta-lactams, as well as to discuss the management of patients with suspected allergic reactions to these antibiotics.