BMJ case reports
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Case Reports
Paraneoplastic neurological syndrome as initial presentation of pulmonary adenocarcinoma.
Paraneoplastic neurological syndromes are defined as remote effects of cancer that are not caused by the tumour and its metastasis, or by infection, ischaemia or metabolic disruptions. The author reports a 63-year-old Caucasian woman presenting with slowly progressing cognitive deficits. Initial workup failed to reveal any obvious cause of her cognitive deficits. ⋯ Cerebrospinal fluid analysis revealed the presence of anti-Hu antibody and a diagnosis of limbic encephalitis was made. Limbic encephalitis is an inflammatory process localised to structures of the limbic system that produces cognitive impairment along with other neuropsychiatric symptoms. This case highlights the importance of considering paraneoplastic syndromes in patients presenting with cognitive deficits.
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The case of a 26-year-old woman who was 23 weeks pregnant is described; the patient presented, on a weekend, to the emergency department (ED) with left groin pain. There were few clinical signs of deep venous thrombosis (DVT) but ED ultrasound (US) showed a left external iliac vein thrombus. ⋯ The patient was admitted to the hospital and started on low-molecular-weight heparin. A formal radiology department US performed the next week confirmed the diagnosis of DVT.
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Wernicke's encephalopathy (WE) is a reversible neurological emergency caused by thiamine deficiency. Prolonged vomiting in pregnancy results in thiamine depletion. ⋯ Prompt administration of thiamine is important for preventing the occurrence of sequelae in the mother and for improving the fetal prognostic. We report a case of WE induced by hyperemesis gravidarum with a good maternal and fetal outcome.
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Case Reports
Massive calcium channel blocker overdose: intravenous insulin and glucose as a therapy.
We describe a case of massive overdosage with cardiac medications that proved resistant to conventional support, including fluid replacement, inotropes, mechanical ventilation, cardiac pacing and haemofiltration. The use of a high-dose insulin and glucose infusion proved to be beneficial in the acute management although the patient has been left with significant impairment of cardiac function.
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Case Reports
Cortical blindness and posterior reversible encephalopathy syndrome in an older patient.
Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity. It associates, to varying extents, neurological symptoms such as headaches, confusion, seizures and visual alterations from haemianopsia to cortical blindness. ⋯ PRES can be caused by various heterogeneous factors, such as hypertension, side effect of drug therapies, eclampsia, sepsis or autoimmune diseases. The authors report here the case of an 86-year-old woman, presenting totally regressive cortical blindness and seizures, with compatible imaging.