The American journal of emergency medicine
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Hashimoto's Encephalopathy (HE) is a rare form of autoimmune encephalopathy associated with Hashimoto's thyroiditis in which patients experience cognitive impairment and various neurologic symptoms. We present a case of a young female that presented to the emergency department with urinary retention, and was ultimately diagnosed with HE. Examination was significant for direction-changing and vertical nystagmus (direction-changing nystagmus describes a phenomenon where the fast beat changes with the direction of gaze), hyperreflexia, clonus, and Babinski and Hoffman's reflexes (all upper motor neuron (UMN) signs). ⋯ To our knowledge, urinary retention in the presence of other UMN signs has not been reported in association with HE; nor has this patient's type of nystagmus. Emergency physicians should be aware of this condition and can play an important role by considering it when neurologic findings are not explained by infectious, toxic, metabolic, or structural etiologies. Although relatively rare, if detected and treated early HE can have a good prognosis.
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Comment Letter
Some questions on Shenfu injection for patients with sepsis.
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Case Reports
Spontaneous coronary artery dissection in a young woman with polycystic ovarian syndrome.
Polycystic ovarian syndrome (PCOS) affects 4% to 12% of women in reproductive age, representing a clinical condition that could predispose to cardiovascular diseases. We report a case of a 34-year-old woman with PCOS, presenting with chest pain, onset two days before, and ST segment-elevation myocardial infarction. ⋯ The patient was discharged in medical therapy after 5days. This is the first observation of spontaneous coronary artery dissection occurring in a PCOS patient.