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266 A drowsy patient: beyond the familiar territory
A 72-year-old man was brought to the hospital after he was found unresponsive at home by his wife who reported that he has been sleepy in the last few days. He has a background of hypertension, myocardial infarct, and osteoarthritis. His medications include anti-hypertensive and morphine sulphate. On examination, he was drowsy with GCS fluctuating between 9–11 but maintaining his airways. He was moving all four limbs; pupils were small and unequal but reactive to light. Planter reflexes were downgoing. Opioid toxicity was suspected and treated with naloxone without any response. The CT head scan showed no acute patho...
Source: Journal of Neurology, Neurosurgery and Psychiatry - May 27, 2022 Category: Neurosurgery Authors: Oo, A., Khine, N. Tags: Poster Presentations Source Type: research

Valacyclovir and Acyclovir Neurotoxicity With Status Epilepticus
We present the case of a 52-year-old man with hypertension, diastolic congestive heart failure, end-stage renal disease on hemodialysis 3 times a week and a remote history of a hemorrhagic stroke who presented to the emergency department with a vesicular rash on his left arm. The rash was observed to be in a dermatomal distribution, and a diagnosis of herpes zoster was made. The patient was discharged home on valacyclovir 1 g 3 times a day for a duration of 7 days. The patient took 2 doses of valacyclovir before presenting to the hospital again with irritability and hallucinations. Over the next several days, the patient's...
Source: American Journal of Therapeutics - January 1, 2016 Category: Drugs & Pharmacology Tags: Case Reports Source Type: research

Cerebral microbleeding in varicella-zoster viral meningitis: An early sign of vasculopathy?
A 75-year-old man undergoing chemotherapy for prostate cancer for 3 months presented with headache after having blisters in his left ear canal and auricle. His body temperature at presentation was 38°C. Neurologic examination revealed nuchal stiffness and left peripheral facial palsy. We also noted leukocytopenia (2,000/µL) and elevated serum C-reactive protein (8.51 mg/dL). CSF analysis showed no erythrocytes, elevated leukocytes (640/µL; 3% monocytes, 97% neutrophils), an increased protein level (473 mg/dL), and slightly decreased glucose level (51 mg/dL, serum glucose 120 mg/dL). Brain MRI and magnetic r...
Source: Neurology - March 3, 2014 Category: Neurology Authors: Ohtomo, R., Shirota, Y., Iwata, A., Shimizu, J., Tsuji, S. Tags: MRI, Other cerebrovascular disease/ Stroke, Vasculitis, Viral infections CLINICAL/SCIENTIFIC NOTES Source Type: research

Herpes-Simplex Virus 2: A New Player in Cerebral Vasculitis (P03.259)
CONCLUSIONS: The spectrum of atypical CNS manifestations related to HSV is emerging. We report a case of cerebral vasculitis, which was masked by the initial presentation as thalamic hemorrhage and followed by an encephalitic syndrome and multifocal ischemic stroke. The work-up revealed HSV-2 as a new and treatable cause of infectious vasculitis.Supported by: JS is supported by a scientific fellowship from the European Federation of Neurological Societies.Disclosure: Dr. Sellner has nothing to disclose. Dr. Wunderlich has nothing to disclose. Dr. Förschler has nothing to disclose. Dr. Nadas has nothing to disclose. Dr...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Sellner, J., Wunderlich, S., Forschler, A., Nadas, K., Hemmer, B., Zepper, P. Tags: P03 Infections I Source Type: research

Infectious Diseases: Images in Clinical Medicine
Editor: V. Dimov, M.D., Cleveland ClinicHypoglossal Nerve Palsy during Meningococcal Meningitis. NEJM, 10/2014.Herpes Zoster Involving the S1 Dermatome. NEJM, 05/2014.Tinea Faciei. NEJM, 05/2014.Disseminated Cryptococcosis in a CLL patient. 05/2014.Scrofuloderma due to Mycobacterium tuberculosis. NEJM, 06/2012.Leonine Facies in Lepromatous Leprosy. NEJM, 04/2012.Intestinal Infestation with Ancylostoma ceylanicum. NEJM, 03/2012.Kerion celsi form of tinea capitis caused by a T-cell hypersensitivity reaction. NEJM, 03/2012.Eye can see a nest of worms! Thelazia callipaeda. Lancet, 03/2012.Madura Foot. NEJM, 01/2012.Paragonimia...
Source: Clinical Cases and Images - August 22, 2009 Category: General Medicine Tags: Images Infectious Diseases Source Type: news