BMJ case reports
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We report a case of two patients with foot drop due to peroneal nerve infarct as early sign of two different forms of primary systemic vasculitides: a predominantly small-vessel p-antineutrophil cytoplasmic antibody-positive vasculitis (microscopic polyangiitis) and a predominantly medium-vessel vasculitis (polyarteritis nodosa).
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Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinicoradiological entity with varied aetiologies and having a typical course of evolution. We present a case of MERS evaluated with diffusion-weighted and diffusion tensor imaging along with various conventional sequences of MRI. At the time of presentation, the lesions in the splenium of corpus callosum and bilateral cerebral white matter showed diffusion restriction with reduced apparent diffusion coefficient and no reduction in fractional anisotropy (FA) values on diffusion tensor imaging; on follow-up diffusion restriction completely resolved with normalisation of the apparent diffusion coefficient. The normal to slightly increased FA values in the lesions may indicate that MERS is a non-degenerative disorder.
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Case Reports
Pitfall in lung ultrasound: 'pseudo B-line' seen in both hydropneumothorax and in a cup of coffee.
One of the lung ultrasound (LUS) signs which can be used to exclude the presence of pneumothorax is the B-line artefact. The presence of a B-line artefact indicates that the two pleural blades are in contact. Most of the research describing LUS for the diagnosis of pneumothorax is limited to pneumothorax without concomitant pleural effusion. This case report presents how a B-line was visualised using LUS in a patient with hydropneumothorax and, in addition, a simple model is used to provide a possible explanation on this phenomenon.
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Summary A 19-year-old woman with asphyxiation complicated by cardiac arrest, following an unsuccessful suicide attempt by hanging, developed an uncommon complication of trauma-induced thyroid storm. She was initially admitted to the intensive care unit intubated and mechanically ventilated for postcardiac arrest management. ⋯ Treatment with β-blockers and a thionamide resulted in the eventual resolution of her thyroid storm state and normalisation of her thyroid function. We conclude that traumatically induced thyroid storm should be considered in all hypermetabolic patients following blunt neck injuries including hanging, and that traditional treatment of hyperthyroidism can be successfully applied.
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New onset refractory status epilepticus (NORSE) is a neurological emergency and difficult to treat condition. We report a case of involuntary movements resulting from thiopentone sodium infusion during the management of refractory status epilepticus. A young woman was admitted with fever and NORSE in the neurology intensive care unit. ⋯ While on thiopentone sodium, she developed involuntary twitches involving her upper limbs and face with EEG showing no evidence of ongoing status epilepticus. Because of the temporal relationship with thiopentone infusion, we tapered the dose of thiopentone sodium, which resulted in the disappearance of the movements. The patient recovered well with no recurrence of the seizures during the hospital stay.