BMJ case reports
-
The management of patients with acute stroke regarding treatment of thromboembolism is supported by a limited evidence base. We present the case of a 55-year-old female patient who initially presented with an ischaemic cerebral infarct with haemorrhagic transformation. ⋯ The patient was successfully discharged to a specialist centre for on-going stroke rehabilitation with no additional neurological impact. Despite the limited evidence base we believe this case highlights that thrombolysis can be used in select patients with haemorrhagic transformation of stroke and serious thromboembolic complications to achieve a positive outcome.
-
Case Reports
An ECG changed the life of a young boy: a case of arrhythmogenic right ventricular dysplasia.
Arrhythmogenic right ventricular dysplasia (ARVD) is a progressive condition with the right ventricular myocardium being replaced by fibrofatty tissue. It is a hereditary disorder mostly caused by desmosome gene mutations. ⋯ Clinical presentation is usually related to ventricular tachycardias, syncope, presyncope or ventricular fibrillation leading to cardiac arrest, mostly in young people and athletes. We report a case of a 17-year-old boy from Turkey, who was referred to our cardiology department for an ECG, required of him prior to joining a football team.
-
Case Reports
Management of an unusual case of iatrogenic parotid sialocele using an infant feeding tube: a novel approach.
Injuries to the parotid duct and parenchyma resulting in swelling in the cheek region commonly present in maxillofacial practice. Sialocele is a discrete collection of saliva in a subcutaneous cavity that can be iatrogenic, idiopathic or the result of post-traumatic injuries to the duct or parenchyma, presenting as a salivary pseudocyst or retention cyst. We present an unusual case of parotid sialocele following surgery for sialolithiasis which presented with progressive painless swelling in the preauricular region of 9 months duration. Treatment included surgical exploration under local anaesthesia and draining the cavity by keeping the opening patent using an infant feeding tube.
-
A 90-year-old man was transferred to a geriatric evaluation and management (GEM) unit for management of hypoactive delirium following a pneumonia and acute myocardial infarction complicated by septic shock. He was found to have central hypothyroidism and hypoadrenalism leading to the diagnosis of hypopituitarism. Cerebral imaging confirmed this was secondary to a pituitary haemorrhage. ⋯ Hypoactive forms of delirium in particular can be difficult to detect and therefore remain undiagnosed. While this patient's delirium was likely multifactorial, his hypopituitary state explained much of his hypoactivity. His drowsiness, bradycardia, hypotension and electrolyte imbalance provided clinical clues to the diagnosis.