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Central Neuropathic Pain Syndromes
Chronic pain is common in patients with neurologic complications of a central nervous system insult such as stroke. The pain is most commonly musculoskeletal or related to obligatory overuse of neurologically unaffected limbs. However, neuropathic pain can result directly from the central nervous system injury. Impaired sensory discrimination can make it challenging to differentiate central neuropathic pain from other pain types or spasticity. Central neuropathic pain may also begin months to years after the injury, further obscuring recognition of its association with a past neurologic injury.
Source: Mayo Clinic Proceedings - March 1, 2016 Category: Internal Medicine Authors: James C. Watson, Paola Sandroni Tags: Symposium on pain medicine Source Type: research

82-Year-Old Woman With Acute-Onset Left-Sided Weakness
An 82-year-old woman with a history of type 2 diabetes mellitus, hyperlipidemia, and hypertension presented to the emergency department with sudden onset of left arm and leg weakness. She was sitting in church when she developed left-sided posterior neck and shoulder pain, followed 1 hour later by sudden-onset dense left-sided weakness. Emergency medical services were called, and they activated the prehospital stroke-notification protocol. The patient arrived at the emergency department approximately 30 minutes after the onset of the weakness.
Source: Mayo Clinic Proceedings - December 31, 2019 Category: Internal Medicine Authors: Ronstan Lobo, Adam P. Sawatsky Tags: Residents ’ clinic Source Type: research

28-Year-Old Man With Joint Pain
A 28-year-old man presented to the emergency department with right shoulder pain that radiated to the right arm as well as pain of the right hip and lower back. His medical history is significant for sickle cell disease (SCD) with the HbSS genotype (homozygous for the S globin). He had a hemorrhagic stroke in the setting of venous sinus thrombosis 2 years earlier with no persisting neurologic deficits as well as osteonecrosis of bilateral hips and right knee requiring right total hip arthroplasty and right total knee arthroplasty.
Source: Mayo Clinic Proceedings - June 1, 2022 Category: Internal Medicine Authors: Emily B. Butts, Albert Bui, Razvan M. Chirila Tags: Residents ’ clinic Source Type: research

54-Year-Old Woman With Altered Mental Status and Abdominal Pain
A 54-year-old woman was transferred to our medical center with altered mental status, abdominal pain, and hypotension. Her medical history included type 2 diabetes mellitus, hypertension, hyperlipidemia, active tobacco use, prior cholecystectomy, and a recent stroke. One month earlier, she presented to an outside facility with right-sided facial weakness and numbness. Brain magnetic resonance imaging (MRI) at that time revealed multiple small lacunar-type infarcts. Computed tomography (CT) angiography of the head and neck, 48-hour Holter monitoring, and transesophageal echocardiography did not reveal an embolic source.
Source: Mayo Clinic Proceedings - June 29, 2022 Category: Internal Medicine Authors: Caroline L. Matchett, Nikita Rafie, Jacob C. Jentzer Tags: Residents ’ Clinic Source Type: research

Hypertriglyceridemia-Induced Pseudo –High Anion Gap Metabolic Acidosis Manifesting as Ischemic Stroke
Hypertriglyceridemia is a metabolic disorder characterized by elevated levels of triglycerides in the bloodstream.1 The underlying causes are multifactorial and range from metabolic syndrome and genetic predisposition to lifestyle choices.1 The management of hypertriglyceridemia usually involves a combination of lifestyle modifications, control of low-density lipoprotein and high-density lipoprotein levels, and pharmacotherapy when necessary.1 The clinical presentation is predominantly asymptomatic; however, some patients present with abdominal pain, nausea, vomiting, and pancreatitis.
Source: Mayo Clinic Proceedings - September 1, 2023 Category: Internal Medicine Authors: Abdul R. Akkawi, Mason Fawcett, Abhiram Challa, Timothy Nguyen, Jennifer Jackson, Richard Muraga Tags: Letter to the editor Source Type: research