European journal of case reports in internal medicine
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Eur J Case Rep Intern Med · Jan 2020
Effectiveness of Tocilizumab in a COVID-19 Patient with Cytokine Release Syndrome.
Cytokine release syndrome (CRS) is a systemic inflammatory response that can be triggered by many factors such as infections. CRS in patients with coronavirus disease 2019 (COVID-19) is life-threatening and can occur very rapidly after COVID-19 diagnosis. Tocilizumab (TCZ), an interleukin-6 (IL-6) inhibitor, may ameliorate the CRS associated with severe COVID-19 and thus improve clinical outcomes. We present a case of life-threatening CRS caused by COVID-19 infection successfully treated with TCZ.
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Severe COVID-19 may predispose to both venous and arterial thrombosis. We describe a patient with acute ischaemic stroke while suffering from COVID-19 and respiratory failure, necessitating mechanical ventilation. Deep sedation may delay diagnosis.
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Eur J Case Rep Intern Med · Jan 2020
Urea Treatment of Syndrome of Inappropriate Antidiuretic Hormone Secretion Secondary to Amyotrophic Lateral Sclerosis.
Amyotrophic lateral sclerosis (ALS) rarely presents with hyponatraemia caused by syndrome of inappropriate antidiuretic hormone secretion (SIADH). We present a patient with hyponatraemia of multifactorial aetiology, in whom, after withdrawal of the drugs that contributed to this ionic alteration, SIADH secondary to ALS was confirmed. After initiating treatment with urea, sodium levels were normalized.
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Eur J Case Rep Intern Med · Jan 2020
Cardiopulmonary Resuscitation Induced Consciousness A Case Report in an Elderly Patient.
Cardiopulmonary resuscitation-induced consciousness is a rarely described and often misunderstood phenomenon, although it can be encountered. High quality cardiopulmonary resuscitation (CPR) may lead a patient to recover consciousness while in cardiac arrest. The authors present the case of an 89-year-old male patient who received CPR after a cardiac arrest. ⋯ These movements immediately stopped during chest compression pauses. Physical restraint was used in order to be able to continue with the CPR algorithm, but sedation may be the best approach. Guidelines on how to identify and manage these cases need to be developed.
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Eur J Case Rep Intern Med · Jan 2020
Symptomatic Pneumocephalus as a Complication of Lumbar Epidural Anaesthesia.
Lumbar epidural anaesthesia is a commonly used technique for analgesia during labour. One of the rare complications of this technique is pneumocephalus. ⋯ Pneumocephalus is the presence of air in the intracranial cavity and its development after spinal or epidural anaesthesia is extremely infrequent.Headache that occurs in the setting of lumbar epidural anaesthesia should not be labelled as post-dural puncture headache.The suspicion of pneumocephalus, based on the characteristics of the headache, should be maintained to obtain an emergent brain CT scan.