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Volume 8, Issue 6

Hemichorea-Hemiballismus as an Unusual Presentation of Hyperosmolar Hyperglycemic Syndrome
Case Report
Diabetes mellitus can lead to a diverse array of systemic complications. Poorly managed hyperglycemia can result in serious neurological consequences ranging from peripheral neuropathy to seizures and coma. A rare neurologic disorder seen in acute decompensated type 2 diabetes mellitus (T2DM) is hemichorea-hemiballismus (HCHB). HCHB is a movement disorder primarily associated with cerebrovascular accidents of infarct or hemorrhagic origin. It is a condition that can occur in a diabetic patient, especially when no other signs or symptoms of hyperglycemia are present. It is urgent to recognize HCHB movement disorder quickly as it may be the only presenting sign of hyperglycemia and can alert medical personnel to a possible hyperosmolar hyperglycemic state (HHS). We report an unusual case of HCHB in a patient with HHS, whose only presenting sign was unilateral hyperkinesis, which completely resolved after adequate blood glucose control. Prompt treatment and management of hyperglycemia yields an excellent prognosis in HCHB.
American Journal of Medical Case Reports. 2020, 8(6), 159-161. DOI: 10.12691/ajmcr-8-6-6
Pub. Date: April 05, 2020
4076 Views690 Downloads1 Likes
Primary Erythromelalgia Complicated by Cellulitis: A Case Report and Review of Literature
Case Report
Background: Erythromelalgia is a rare disease with increasing incidence. It manifests as episodic painful red extremities triggered by heat. External cooling provides temporary symptomatic relief but may lead to complications such as cellulitis. Management includes trigger control, behavioral therapy and pain management. Case Presentation: A 47-year-old African American male presented to the hospital with worsening bilateral lower extremity pain for three months. It was episodic, triggered by running and associated with erythema and swelling. Patient used cold water immersion and air conditioning for pain relief. One week prior to presentation, he developed painful blisters on his feet. On presentation, vital signs were stable, patient was afebrile. Acute infection was ruled out and he was discharged with outpatient rheumatology follow up for erythromelalgia. He returned one week later with worsening symptoms. CT scan of lower extremities indicated bilateral cellulitis. Patient was managed by medicine, dermatology, rheumatology, and podiatry for cellulitis, fungal infection, trench foot and primary erythromelalgia with antibiotics, antifungals, gabapentinoids and behavioral therapy. His infection resolved and pain improved. He was discharged with outpatient rheumatology follow up. Discussion: Erythromelalgia is a highly debilitating disease with episodes of burning erythematous extremities triggered by increase in skin temperature. Patients seek pain relief by excessive external cooling. Pathophysiology involves gain of function mutation in voltage gated sodium channels causing autoregulatory dysfunction of skin. Underlying disease mechanisms are ambiguous and may involve unidentified genetic components and unknown triggers. It is a clinical diagnosis. Therapy requires a multidisciplinary approach. Complications should be promptly addressed given attention next to symptomatic relief. There is a lack of disease specific treatment and complete remission is unlikely. Our patient responded well to gabapentinoids and behavioral therapy.
American Journal of Medical Case Reports. 2020, 8(6), 153-158. DOI: 10.12691/ajmcr-8-6-5
Pub. Date: April 05, 2020
4151 Views531 Downloads1 Likes
Left Main Coronary Aneurysm: A Rare but a Serious Cause of Acute Myocardial Infarction
Case Report
Left main coronary artery (LMCA) aneurysms are rare with incidence of 1 in 1000 cases among patients undergoing coronary angiography. Coronary artery aneurysm is defined as coronary arterial segment dilation > 1.5 fold greater than normal adjacent coronary segments. Atherosclerosis is the primary cause of coronary aneurysms but also has been reported in other conditions like arterial vasculitis (e.g., Kawasaki disease, Takayasu arteritis), or infection (e.g., syphilis, mycosis). LMCA aneurysms are especially associated with serious complications including thrombosis, distal embolization, spontaneous rupture or dissection or even sudden cardiac death. The optimal treatment for LMCA aneurysm is still controversial and the available results have been based mainly on case reports and not on controlled trials. The lack of consensus about managing LMCA is not the only challenge here. The lack of individualized treatment or precision medicine in this area makes managing these cases at bedside even more challenging.
American Journal of Medical Case Reports. 2020, 8(6), 150-152. DOI: 10.12691/ajmcr-8-6-4
Pub. Date: April 05, 2020
3727 Views486 Downloads
New Diagnosis of Myasthenia Gravis Following Magnesium Replacement
Case Study
A 29-year-old female G2P2 with a past medical history of hyperthyroidism and depression was admitted for 2-months of progressively worsening weakness of her bilateral upper and lower extremities. Initial investigations were unremarkable, and the patient’s weakness improve the next morning. The patient was thought to have a Somatoform Disorder and was planned for home discharge, however on the day of discharge her magnesium was 1.2 mg/dL. After repletion, she developed seizure-like activity and respiratory failure, requiring mechanical ventilation and transfer to the ICU. In ICU, patient received another dose of replacement magnesium that caused another seizure, code blue and re-intubation. Subsequent lab work revealed reactive Acetylcholine receptor antibodies and subsequent chest imaging demonstrated thymoma, confirming a diagnosis of Myasthenia Gravis in Crisis. The patient improved following plasma exchange and was discharged home with outpatient follow up.
American Journal of Medical Case Reports. 2020, 8(6), 148-149. DOI: 10.12691/ajmcr-8-6-3
Pub. Date: April 02, 2020
1133 Views506 Downloads
Cranial Migration of Ventriculo Peritoneal Shunt: An Unusual Complication
Case Report
Ventriculoperitoneal shunt insertion is a common neurosurgical procedure performed by the surgeons. Complications are numerous but total cranial migration of the shunt is a rare thing to happen. We herewith one case of ours who underwent ventriculoperitoneal shunt for hydrocephalus encountered this complication and was managed accordingly.
American Journal of Medical Case Reports. 2020, 8(6), 140-142. DOI: 10.12691/ajmcr-8-6-1
Pub. Date: April 02, 2020
3644 Views366 Downloads
Right-sided Aortic Arch with Aberrant Left Subclavian Artery in a Pregnant Female: A Case Report and Literature Review
Case Report
Right-sided aortic arch with aberrant left subclavian artery is a rare variant of vascular anatomy. Three types of right-sided aortic arches are described and classified based on the arrangement of the aortic arch vessels, the presence or absence of congenital heart abnormalities, the relationship of the aortic arch to the trachea and esophagus, as well as the presence or absence of a complete or incomplete vascular ring. On review of the existing literature, 31 case reports were found with a spectrum of clinical presentation sand outcomes. In this case report, we highlight a case of a young female in her early 20’swho presented with choking spells, shortness of breath along with intermittent dysphagia since childhood. She was otherwise healthy and pregnant at 26 weeks gestational age. A Computed tomography scan with angiography (CTA) of the thorax was performed to rule out a pulmonary embolism (PE) however surprisingly, a right-sided aortic arch with aberrant left subclavian artery was revealed instead. Subsequently, an extensive literature review was carried out to better understand clinical presentation sand treatment strategies for this rather rare disorder.
American Journal of Medical Case Reports. 2020, 8(6), 143-147. DOI: 10.12691/ajmcr-8-6-2
Pub. Date: April 01, 2020
4514 Views651 Downloads