by Sharad Samson Rajmani, Ahmed Al Azri, Neeraj Salhotra, Samit Biniwale, Bashar Al Tunbi and Faraz Qayyum Khan
Original Research
The excision of lesions around motor strip amounts to profound morbidity in term of neurodeficit in postoperative period. Use of navigation and motor strip mapping, connectome study preoperatively for better surgical outcome are useful tools to minimize the neurodeficit specially in patients who are not a candidate for the awake craniotomy. We present our three patients who underwent brain mapping in the excision and gave good postoperative outcome.
American Journal of Medical Case Reports. 2019, 7(11), 301-304. DOI: 10.12691/ajmcr-7-11-10
Pub. Date: September 10, 2019
6695 Views792 Downloads1 Likes
by Pramod Theetha Kariyanna, Denis Yusupov, Benjamin Ramalanjaona, Apoorva Jayarangaia, Mohammed Al-Sadawi and Isabel. M. McFarlane
Original Research
Patients with human immunodeficiency virus (HIV) are at higher risk for coronary artery disease, due to accelerated atherosclerosis resulting from chronic inflammation, the prevalence of cardiovascular risk factors and the side effects of highly active antiretroviral therapy (HAART). The Wellens’ pattern is an electrocardiographic (ECG) finding that represents critical proximal left anterior descending (LAD) coronary artery stenosis that, that when is not promptly treated, can lead to extensive anterior wall myocardial infarction and death. Very few cases of Wellens’ syndrome in HIV positive patients have been reported. We present a case of Wellens’ syndrome in a 38-year-old male with HIV on HAART and hyperlipidemia, as his only traditional cardiovascular risk factor. Recognition of the characteristic biphasic T-waves in V2 and V3 on ECG in the setting of typical angina and elevated troponin levels directed the clinicians to proceed with an emergent cardiac catheterization and percutaneous coronary intervention with drug eluting stent placement in the proximal left anterior descending artery (LAD). Physicians should recognize Wellens’ syndrome as it indicates critical LAD stenosis requiring intervention. HIV positive patients can present with Wellens’ sign at a younger age, indicating premature coronary artery disease (CAD) in this population.
American Journal of Medical Case Reports. 2019, 7(11), 297-300. DOI: 10.12691/ajmcr-7-11-9
Pub. Date: September 06, 2019
8898 Views1764 Downloads
by Nawal Al-Kindi, Paraj Hasmukhbhai Shah, Naryan A, Seif Al-Abri and Amina Al Jardani
Case Report
We describe the case of a 47 years old Sri Lankan man living in Oman with melioidosis and the resultant occupational risk of exposure to 5 laboratory staff members to the causative agent, Burkholderia pseudomallei. Widely reported as an endemic disease in tropical and subtropical areas, B. pseudomallei was imported to Oman by our patient who had risk factors of diabetes mellitus and alcoholic cirrhotic liver disease. Microbiological and biochemical tests identified the gram negative bacillus, B. pseudomallei, in the patient’s blood sample. Five laboratory workers had occupational exposure to Burkholderia pseudomallei and received post-exposure prophylaxis. Our report highlights the importance of early suspicion of the infection and managing the patient with the correct international protocols for melioidosis especially for patients with severe sepsis and septic shock in the Intensive Care Unit (ICU). Furthermore, the importance of increased awareness among laboratory personnel and the need for good laboratory practices is reported. Furthermore, improved surveillance is essential to guide early diagnosis and prompt treatment.
American Journal of Medical Case Reports. 2019, 7(11), 292-296. DOI: 10.12691/ajmcr-7-11-8
Pub. Date: September 02, 2019
6095 Views594 Downloads
by Corey S. Ellis, Hayden L. Smith and Lisa A Veach
Case Report
Tumor necrosis factor α inhibitors (TNFα-i) are a commonly prescribed class of medications for the treatment of inflammatory bowel disease. With the increasing use of this medication class, some uncommon adverse effects have been reported. We present a case of a young male recently prescribed adalimumab for Crohn’s disease who developed aseptic meningitis with associated focal partial seizures.
American Journal of Medical Case Reports. 2019, 7(11), 289-291. DOI: 10.12691/ajmcr-7-11-7
Pub. Date: September 01, 2019
5760 Views1425 Downloads
by Tariq Sharman
Case Report
Ehlers-Danlos syndrome (EDS) is a heterogeneous group of inherited connective-tissue disorders characterized by joint hypermobility, cutaneous fragility, and hyperextensibility. The collagen defect has been identified in at least six of the many types of Ehlers-Danlos syndrome. Changes in the mechanical properties of the bronchial airways and lung parenchyma may trigger the observed increased tendency of the airways to collapse and lung atelectasis. This is a case of a 33 year old Caucasian female who presented with acute hypoxic respiratory failure secondary to persistent right lower lobe atelectasis despite optimal medical management, pulmonary toilet, and multiple bronchoscopies. She also had an incidental finding of lung arteriovenous malformation (AVM) which can occur in EDS patients.
American Journal of Medical Case Reports. 2019, 7(11), 284-288. DOI: 10.12691/ajmcr-7-11-6
Pub. Date: August 28, 2019
7939 Views1428 Downloads2 Likes
by Hatice Çelik Tuğlu, Önder Öztürk, Merve Ergün, Mustafa Karabacak, Veysel Atilla Ayyıldız and Ahmet Akkaya
Case Report
Background: Scimitar syndrome is a rare constellation of congenital conditions pertaining to partial anomalous pulmonary venous return to the inferior vena cava, which may associate with variable right lung hypoplasia, right pulmonary artery hypoplasia, pulmonary sequestration together with the presence of aortopulmonary collaterals from the descending aorta towards the right lung. Depending on the severity of the defect, it can present as early as in neonatal period or occasionally later in life. In many cases, there are also other associated cardiac anomalies. Case characteristics: 23-year-old woman with recurrent episodes of breathlessness and wheezing symptoms since her childhood. Computed tomography angiogram revealed right pulmonary veins draining into inferior vena cava through a single vein with a single ostium diagnosed as Scimitar syndrome. Outcome: Successfully managed with surgical correction. Message: Scimitar syndrome should be considered in adulthood with asthma symptoms if it is not under control.
American Journal of Medical Case Reports. 2019, 7(11), 280-283. DOI: 10.12691/ajmcr-7-11-5
Pub. Date: August 28, 2019
7317 Views1144 Downloads
by Ignazio Condello and Giuseppe Speziale
Case Report
Redo cardiac surgery represents a clinical challenge due to a higher rate of perioperative morbidity and mortality. Mitral valve (MV) reoperations can particularly be demanding in patients with patent coronary grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation. In this article we describe technique to manage systemic hyperkalemia in 68-year-old man who underwent bioprosthetic mitral valve replacement, already undergone coronary artery bypass grafting 13 years, come in our clinic to aggravated dyspnea caused by severe stenosis of the mitral valve. Because cross-clamping would have a high risk of stroke owing to severe calcification of the ascending aorta systemic hyperkalemia and continuous blood perfusion can guarantee adequate myocardial protection particularly in the case of patent grafts, decreasing potential lesions due to demanding clamp placing.
American Journal of Medical Case Reports. 2019, 7(11), 277-279. DOI: 10.12691/ajmcr-7-11-4
Pub. Date: August 27, 2019
7139 Views1298 Downloads37 Likes
by Salem Bouomrani, Souad Yahyaoui, Mouna Guermazi and Nesrine Regaïeg
Original Research
Introduction:Gastrointestinal symptoms are common in systemic lupus erythematosus (SLE) and are often difficult to interpret. Specific lupus involvement (lupus enteritis) typically affects the jejunum and ileum, whereas colonic and rectal involvement remains rare. Lymphocytic colitis (LC) associated with SLE remains exceptional and unusual. We report an original observation of LC occurring in a 35-year-old patient with SLE. Case report: 35-year-old woman, having in her medical history a Hashimoto thyroiditis diagnosed for four years and a SLE diagnosed for three years, consulted for chronic fluid diarrhea, not improved by symptomatic treatment, and associated for two weeks with rectorrhagia. Somatic examination, basic biological tests, stool culture and parasitological stool examination were without abnormalities. Colonoscopy revealed a diffuse minimal inflammatory colitis interesting the entire colon, and the pathological examination of multiple biopsies led to the diagnosis of isolated LC. She was treated with 5-amino-salicylate with good evolution. Conclusion: Our observation is, to our knowledge the third reporting the association of LC with SLE; it is characterized in addition by the young age of occurrence. This association once again comforts the hypothesis of a common pathophysiology to these two diseases mainly involving genetic predisposition, HLA susceptibility, immune disorders, and environmental factors.
American Journal of Medical Case Reports. 2019, 7(11), 274-276. DOI: 10.12691/ajmcr-7-11-3
Pub. Date: August 21, 2019
6700 Views1467 Downloads
by Jeffrey Song and Tariq Sharman
Case Report
Yohimbine is an Indoloquinolizidine alkaloid derived from the bark of the African tree Pausinystalia johimbe, as well as from the bark of the unrelated South American tree Aspidosperma quebracho-blanco. It is commonly sold as a dietary supplement for the purpose of enhancing libido, weight loss and natural bodybuilding aids. Yohimbine has high affinity for the α2-adrenergic receptor, moderate affinity for the α1 receptor, dopamine D2 receptor, and weak affinity for the dopamine D3 receptors and some of the serotonin receptors. Depending on dosage, Yohimbine can either increase or decrease systemic blood pressure (through vasoconstriction or vasodilation, respectively). We present a 51-year-old male who presented with substernal chest pressure and the sensation of a “pounding heart” after starting Yohimbine as a dietary supplement. He was found to have type II myocardial injury characterized by elevated troponin levels. We propose that the mechanism for this was 1) elevation of blood pressure and sinus tachycardia causing myocardial ischemia due to increased myocardial oxygen demand and supply mismatch, 2) cardiac norepinephrine release causing direct non-ischemic norepinephrine mediated myocardial injury and 3) increased sympathetic outflow mediated coronary vasoconstriction and spasm causing ischemia.
American Journal of Medical Case Reports. 2019, 7(11), 271-273. DOI: 10.12691/ajmcr-7-11-2
Pub. Date: August 14, 2019
6577 Views1229 Downloads3 Likes
by Mohammed Al-Sadawi, Muhammad Ihsan, Arismendy Nunez Garcia, Jason M. Lazar, Robert Poston, Murad Almasri, Haytham Aboushi and Samy I. McFarlane
Case Report
Aorta–right atrial tunnel is a rare entity characterized by a vascular fistula, which connects one of the sinuses of Valsalva in the ascending aorta and the right atrium. It is frequently associated with congestive heart failure. This abnormality is usually diagnosed by echocardiography or CT angiography. It requires immediate intervention due to high risk of complications as congestive heart failure. In this report, we present a case of a 33-year old female with no significant past medical history presents to the hospital with progressive shortness of breath found to have a congenital Aorta–right atrial tunnel.
American Journal of Medical Case Reports. 2019, 7(11), 267-270. DOI: 10.12691/ajmcr-7-11-1
Pub. Date: August 12, 2019
10906 Views1864 Downloads