Clinical medicine (London, England)
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Transient amnestic syndromes are fascinating clinical entities and there are several subtypes. Transient global amnesia (TGA) is characterised by sudden onset of anterograde amnesia with repetitive questioning, lasting less than 24 hours. The pathophysiology of TGA involves the medial temporal lobes and hippocampi. ⋯ We describe the first reported case of transient reversible amnesia directly attributable to acute demyelination. This case reminds us that multiple sclerosis relapses may present with acute cognitive impairment rather than the more classical physical symptoms. This is an important learning point in terms of appropriate management and eligibility for disease-modifying drugs.
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In this article, we report on a 22-year-old patient with myocardial infarction, which was the initial manifestation of polycythaemia vera. The awareness of myeloproliferative disorders as possible underlying disease - especially in young patients presenting with myocardial infarction - is crucial for clinical management, as a missed diagnosis can worsen the patient's further prognosis.
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A 58-year-old Chinese woman with well controlled type 1 diabetes mellitus presented with acute and progressive bilateral lower limb weakness. Investigations revealed severe hypokalaemia (1.3 mmol/L) and hypophosphataemia (<0.32 mmol/L) with rhabdomyolysis and electrocardiogram changes, without other concurrent biochemical abnormalities. Immediate intravenous and oral potassium and phosphate replacement was initiated with objective improvement in weakness with replenished electrolyte levels. ⋯ A computerised tomography scan showed atrophy of her salivary glands and a skin lesion biopsied by her GP in the past had been histologically characterised as anetoderma. The constellation of these findings and subsequent positive anti-SSA/SSB levels confirmed her diagnosis of primary Sjögren's syndrome (PSS). PSS has a wide spectrum of renal involvement and should be a differential diagnosis when investigating interstitial nephritis and electrolyte abnormalities, particularly in patients with coexisting autoimmune conditions.