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Coma Or Disorientation Or Altered Sensorium

Rajesh Verma, Soumik Sarkar, Ravindra Kumar Garg, Hardeep Singh Malhotra, Praveen Kumar Sharma, Sandeep Saxena
Background: Vision impairment, blindness in particular is a devastating complication in patients with Tubercular meningitis. However information regarding ophthalmological manifestation and its impact on vision is sparse in the literature. This study evaluated the spectrum of ophthalmological manifestations in tuberculous meningitis, including retinal nerve fiber layer thickness assessment by optic coherence tomography and its correlation with visual and clinical outcome. Material and methods: This was a prospective observational study done from October 2015 to March 2017...
February 5, 2019: QJM: Monthly Journal of the Association of Physicians
Vladimir Miskovic, Steven Jay Lynn, Jeffrey O Bagg, Jourdan J Pouliot, Matt Ríos, Jirí Wackermann
Destructured sensory fields, involving homogenous stimulation with little or no time-varying structure, provide a fertile ground for testing hypotheses about predictive coding in the human brain. Extended exposure to sensory patterns that deviate substantially from the statistics of natural environments can elicit a bewildering range of perceptual phenomena, up to and including vivid oneiric imagery. We illustrate how this large variety of perceptual effects can be understood as the experiential counterpart of auto-generated neuronal dynamics, unconstrained by parameters that tune the waking sensorium...
January 19, 2019: Neuroscience and Biobehavioral Reviews
Krishna Dahiya, Seema Rohilla, Kriti Agarwal, Mahesh Rathod, Archit Dahiya
Objective: To correlate the Magnetic Resonance Imaging findings and clinical presentation in patients of eclampsia. Materials and methods: This one year prospective study was conducted in the HDU of Department of Obstetrics and Gynecology, PT.B.D.Sharma, PGIMS, Rohtak .A total of 50 women with eclampsia (both antepartum and postpartum) were divided into two groups: a) study group patients with abnormal MRI b) control group: b) control group: patients with normal MRI.Comparison was done using chi-square test and unpaired student 't' test...
March 2018: Journal of Family & Reproductive Health
Angeliki Giannopoulou, Sajjad Ahmad, Chandranath Sarkar, Atul Kalhan
A 46-year-old woman was admitted with tonic-clonic seizures. She was noticed to be withdrawn and low in mood for few months. She had reduced level of consciousness with hyper-reflexia and myoclonus. Metabolic, vasculitic, autoimmune, paraneoplastic and septic screen were normal. Lumbar puncture showed raised protein in the cerebrospinal fluid but the cytology, bacterial and viral screens were negative. A CT of the head revealed global brain swelling consistent with encephalitis which was empirically treated with antibiotics and antiviral therapy...
January 14, 2019: BMJ Case Reports
Chirag Punatar, Kunal Jadhav, Vikash Kumar, Vinod Joshi, Sharad Sagade
INTRODUCTION: We studied the value of neutrophil:lymphocyte ratio (NLR) in predicting the success of nephron-sparing procedures in management of emphysematous pyelonephritis. METHODS: In this single-center retrospective study, patients underwent nephron-sparing procedures between 2007 and 2014. Severity was graded by Huang-Tseng classification. Thrombocytopenia, acute renal failure (ARF), shock, altered sensorium, and admission NLR were evaluated for predictive value for successful outcomes...
2019: Permanente Journal
Vivek Sood, Navin Pattanashetti, Shefali Gupta, Shivprakash M Rudramurthy, Raja Ramachandran, K L Gupta
Although rare, both Cladophialophora bantiana ( C. bantiana ) and Toxoplasma gondii have been known to be associated with brain abscess in renal transplant recipients (RTRs), however co-infection has never been reported till date. In the present case, 40 years old renal transplant recipient on curtailed immunosuppressive therapy presented with progressive headache and altered sensorium. The computed tomography of head showed multiple ring-enhancing discrete lesions in the left frontal lobe, with moderate perilesional oedema...
March 2019: Medical Mycology Case Reports
Darshan Lal, Arunodaya R Gujjar, Nandagopal Ramachandiran, Ammar Obaidi, Sunil Kumar, Mortada El-Tigani, Faizal Al-Azri, Abdullah R Al-Asmi
Objectives: Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman. Methods: This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes...
August 2018: Sultan Qaboos University Medical Journal
Harsh Sahu, Mouna Bidarguppe Manjunath, Animesh Ray, Naval Kishore Vikram
Neuroleptic malignant-like syndrome is a rare but potentially fatal complication of sudden withdrawal of dopaminergic drugs. Clinical features are similar to that of neuroleptic malignant syndrome (NMS) like hyperthermia, autonomic dysfunction, altered sensorium, muscle rigidity; but instead of history of neuroleptic use, there is history of withdrawal of dopaminergic drugs. Laboratory examination generally show elevated creatine phosphokinase levels and may show elevated total leucocyte count. Thrombocytopaenia has been very rarely reported with NMS but it has not been reported with NM-like syndrome...
December 3, 2018: BMJ Case Reports
Nasheeda Saeed, Ching Soong Khoo, Rabani Remli, Zhe Kang Law, Petrick Periyasamy, Syazarina Sharis Osman, Hui Jan Tan
Leptospirosis is a spirochetal zoonotic disease with a wide clinical spectrum, often underdiagnosed especially when presented as an acute neurological manifestation. We report a case of a 24-year-old man with serologically positive leptospirosis, who presented with altered sensorium, seizures and subsequently developed cortical blindness. His brain MRI revealed bilateral occipital and later parietal lobe cerebritis.
2018: Frontiers in Neurology
Dan-Hua Mao, Jing-Kun Miao, Xian Zou, Na Chen, Lin-Chao Yu, Xin Lai, Meng-Yuan Qiao, Qi-Xiong Chen
Background: Neonatal bacterial meningitis is a severe infection with high mortality and morbidity. It is necessary to identify factors associated with a high risk of a poor prognosis so that we can prevent them with more appropriate treatments. This study was performed to summarize the prognostic factors known to predict adverse outcomes in neonatal bacterial meningitis. Methods: The Medline/PubMed, Cochrane Library and Embase databases were searched for studies of prognostic risk factors in neonates with bacterial meningitis...
2018: Frontiers in Neurology
Kanchana S Pillai, Trupti H Trivede, Nivedita D Mozlick
Background: :Hyponatremia is defined as serum sodium level <135 meq/L. It is the most common electrolyte abnormality seen in hospital admissions worldwide. The proportion is even higher in the ICU setting. A wide variety of factors influence the outcome of the hyponatremic patient. Present study is designed to approach to analyse etiology, clinical features, co-morbid factors, severity of hyponatremia, rate of correction, and impact of treatment on outcome of these diverse group of patients in ICU...
May 2018: Journal of the Association of Physicians of India
Ritesh Kumar, Surinder Thakur, Rajesh Bhawani, Anil Kanga, Asha Ranjan
Background: Scrub typhus is a re-emerging zoonotic rickettsial infection. Mortality is approximately 15% in some areas due to missed or delayed diagnosis. There had been only few studies on the markers for the severity of the disease, so this study has been planned to provide the knowledge regarding various aspects of scrub typhus in adult age group to detect early signs of severity . Methods: All the patients more than 18 years of age admitted with febrile illness with positive IgM ELISA for scrub typhus with or without eschar were included in the study...
May 2018: Journal of the Association of Physicians of India
Sushil Khanal, Subhash Prasad Acharya
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a reversible clinical and neurological entity. There are varieties of comorbid conditions which are associated with PRES. Chronic obstructive pulmonary disease (COPD) is a rare predisposing factor for the development of PRES. CASE PRESENTATION: A 55 year old female who was being treated for acute exacerbation of COPD developed altered sensorium and multiple episodes of seizure. Characteristic imaging findings and associated clinical symptoms led us to a diagnosis of PRES in our patient...
October 31, 2018: BMC Neurology
Anitha Swamy, Ratnakar Gogineni, Animesh Ray, Milind Jha, Smita Manchanda, Sudheer Arava, Rakesh Kumar, Kiran Kumar Dvs, Harsh Sahu, Piyush Ranjan, Ranveer S Jadon, Naval K Vikram, Rita Sood
A 56 year old lady, presented to our institute with six months history of low grade fever, generalized weakness, decreased food intake and fluctuating sensorium. Initial investigations revealed hypercalcemia, renal dysfunction and anemia. Initial working diagnosis of likely underlying hematological malignancy such as lymphoma or multiple myeloma (MM) was kept after hyperparathyroidism was ruled out. Her skeletal survey revealed lytic lesions in the skull, bone marrow aspirate showed 12% plasma cells and beta-two microglobulin level was markedly elevated...
January 2018: Journal of the Association of Physicians of India
Edward C Kuan, Karam W Badran, Frederick Yoo, Naveen D Bhandarkar, Yarah M Haidar, Tjoson Tjoa, William B Armstrong, James N Palmer, Nithin D Adappa, Marilene B Wang, Maie A St John
OBJECTIVES/HYPOTHESIS: To describe rates of complications and mortality within 30 days of open anterior skull base surgery using a large, multi-institutional outcomes database. STUDY DESIGN: Retrospective cohort study. METHODS: The study included patients who underwent open anterior skull base surgery as listed in the American College of Surgeons National Surgical Quality Improvement Project database from 2007 through 2014. RESULTS: A total of 336 open anterior skull base surgeries were identified...
October 16, 2018: Laryngoscope
Farah Gul Khan, Syed Muhammad Zubair
BACKGROUND: Transformer oil is used in oil-filled transformers for its insulating as well as coolant properties. Transformer oil ingestion for attempted suicide is seldom heard of. Our patient's case presented us with a major diagnostic as well as treatment challenge because we encountered such a case for the first time and were totally unaware of the fact that methanol might make up the main component of an aged transformer oil. CASE PRESENTATION: A 19-year-old Pakistani/Asian man was brought to our hospital with altered sensorium...
October 10, 2018: Journal of Medical Case Reports
Manasvini Bhatt, Neha Rastogi, Manish Soneja, Ashutosh Biswas
Leptospirosis is a zoonotic disease commonly affecting the tropical countries. It may have protean clinical manifestations including hepatorenal dysfunction, myocarditis, pulmonary haemorrhage, meningitis, optic neuritis and rhabdomyolysis. Neurological manifestation of leptospirosis without the classical hepatorenal dysfunction is a rare entity. This complication of leptospirosis can present with diverse central and peripheral neurological presentations. The overlapping clinical manifestations with many common tropical pathogens often pose diagnostic dilemma and delay in definitive therapy may lead to adverse clinical consequences...
October 7, 2018: BMJ Case Reports
Asif Ali Hitawala, Piyush Garg, Abhay Jain, Ashish Nahar
We discuss a case of a 20-year-old female who presented with history of fever, vomiting, and decreased oral intake for 10 days followed by one episode of generalized tonic-clonic seizure and altered sensorium for 5-6 h. On arrival in the emergency room, she had Glasgow Coma Scale 3 (E1V1M1), both pupils fixed and dilated, low blood pressure, low oxygen saturation, and few gasping breaths. She appeared to be brain dead and was assumed to have a very poor prognosis. Investigations revealed severe hypokalemia...
September 2018: Indian Journal of Critical Care Medicine
Joe M Das, Mathew Abraham, Bevinahalli N Nandeesh, Suresh N Nair
Atypical teratoid rhabdoid tumor (ATRT) is a rare, highly malignant tumor of the central nervous system, commonly affecting children below 3 years of age, with around 300 cases reported in the literature. Suprasellar area is a very rare location for such tumor in the pediatric population, with technical difficulties in complete excision. Third ventricular ATRT is very rare. Here, we report the case of a 2-year-old male child who presented with lethargy and vomiting. He had features of raised intracranial pressure with reduced vision in both eyes...
July 2018: Asian Journal of Neurosurgery
Keerthana K Kumar, Premkumar Nattanamai
Cerebral fat embolism syndrome is a rare, but potentially lethal, complication that may arise from long bone fractures and/or orthopaedic surgery. Neurological symptoms are variable, and clinical diagnosis is difficult. We report the case of a 75-year-old woman who developed cerebral fat embolism four days after a right hip arthroplasty. Maintenance of intracranial pressure monitoring (ICP) within normal limits and cerebral tissue oxygenation monitoring (PbtO2) over 20 mmHg prevented secondary brain injury and resulted in a gradual improvement of the patient's sensorium...
July 26, 2018: Curēus
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