The American journal of emergency medicine
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Case Reports
Good outcome after intravenous thrombolysis for acute stroke in a patient under treatment with dabigatran.
The novel oral anticoagulants (NOACs) are indicated for stroke and systemic embolism prophylaxis in patients with nonvalvular atrial fibrillation (AF). Very few cases of intravenous recombinant tissue plasminogen activator (IV rt-PA) in patients under treatment with NOACs have been described. ⋯ We describe an unusual case of treatment IV rt-PA for acute ischemic stroke in a patient receiving dabigatran for AF. The decision to treat the patient with IV rt-PA was based on the combination of normal coagulation times with the long time elapsed after the last dose of dabigatran, when the drug effect was predictably residual.
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Neurocysticercosis is the most frequent neuroparasitosis and is caused by Taenia solium larvae (cysticerci). Its most common presenting feature is seizure, although it may present as headache,focal deficits, hydrocephalous, or as features of raised intracranial pressure. ⋯ A diagnosis of cysticercotic encephalitis was made, which is a syndrome of encephalitis with clinical and radiologic evidences of diffuse cerebral edema caused by parenchymal cysticercosis. It is important for the clinicians to be aware of this medical emergency requiring urgent attention as delay may lead to fatal outcome.
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Universal human immunodeficiency virus (HIV) screening was recommended in 2012, and major improvements in HIV testing have occurred in the past decade, but identification of HIV infected individuals remains inadequate in the United States. We report the case of a seronegative HIV-infected man who despite clinical and laboratory findings of acquired immunodeficiency syndrome,repeatedly tested nonreactive to third-generation HIV enzyme immunoassays (EIAs) and Western blot testing. ⋯ The fourth-generation HIV EIA was positive presumably because it detects p24 HIV antigen as well as antibodies, unlike rapid HIV tests and third-generation HIV EIAs. This case highlights not only the importance of frontline providers to understand the different testing methodologies for HIV screening and their limitations but the importance of clinical suspicion as well.
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The objectives of this study are to estimate the prevalence of weakness and fatigue visits in older emergency department (ED) patients, to compare demographics and resource use in these patients with those without these complaints, and to determine their ED diagnoses and disposition. ⋯ Weakness and fatigue are common in older ED patients. These patients undergo more tests and procedures, and most are admitted.
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Case Reports
A misdiagnosis of clonorchiasis as gallstone, leading to an unnecessary cholecystectomy: a case report.
This case report describes an unusual presentation of Clonorchissinensis infection. In this rare case, a clonorchiasis infection that had been latent for decades was misdiagnosed as acute calculous cholecystitis. Exploratory surgery and a cholecystectomy were performed. Therefore,in the course of diagnosis of hepatic and gall diseases, we cannot neglect parasite infections such as clonorchiasis.