The Journal of the Louisiana State Medical Society : official organ of the Louisiana State Medical Society
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This article provides a review of various conditions causing sudden, painless vision loss. The conditions of amaurosis fugax, central retinal artery occlusion (CRAO), central retinal vein occlusion (CRVO), vitreous hemorrhage, ischemic optic neuropathies (ION), posterior cerebrovascular accidents, and retinal detachment (RD) are discussed. The history, physical, pathophysiology, and treatment of each disease state are discussed along with possible preventative measures for each. An emphasis is made on early ophthalmologic involvement for potential vision restoration and the importance of a thorough history and physical for all patients with ocular complaints.
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We present a case of a young girl complaining of headaches in whom a hypointense area was found in the pituitary gland with a standard magnetic resonance (MR) image of the head. This finding did not agree with clinical symptoms, so a dedicated MR of the sellar region was obtained. We determined that the supposed mass was artifact caused by volume averaging. ⋯ Increased slice thickness leads to increased volume averaging and decreased resolution. Dedicated MR uses thinner 3D slices to reconstruct an image and thus has better spatial resolution than standard MR. We emphasize the need of dedicated MR to evaluate pituitary lesions.
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Vitamin B12 is important for normal nervous system functioning, and deficiencies are associated with various neurological abnormalities. We present a case of an 18-year-old woman who presented with significant neurological sequelae, but only mild hematologic abnormalities and normal vitamin B12 levels. ⋯ The measurement of MMA and homocysteine levels provides much more sensitive tests, but even these tests do not completely rule out a deficiency. Although, the traditional treatment for vitamin B12 deficiency has been intramuscular cobalamin injections, recent studies have shown that oral cobalamin may be as efficacious.
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Case Reports
Mycobacterium avium complex pulmonary disease: management options in HIV-negative patients.
We present a case series and review of the literature of the management options in non-HIV-infected patients with Mycobacterium avium complex pulmonary disease (MAC-PD) with a focus on treatment failure and drug resistant disease. ⋯ MAC has protean pulmonary manifestations, especially in those with no recognizable impairments in their immune system. Drug treatment, however, remains difficult with high failure rates and poor long-term sputum conversion. This case series is based on our clinical experience highlighting treatment options and the often unrecognized morbidity and mortality of severe, progressive MAC-PD. It underscores the need for increased awareness of MAC-PD and MDRMAC and the difficulties encountered in their management.