Internal medicine
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Case Reports
Reversible Brain Atrophy in Cryptogenic New-onset Refractory Status Epilepticus: A Case Report.
Cryptogenic new-onset refractory status epilepticus (C-NORSE) is a neurologic emergency condition characterized by refractory status epilepticus (RSE) of unknown cause. Brain atrophy in a setting of C-NORSE is usually irreversible. ⋯ Her cognitive function also gradually improved, with a reduction in seizure frequency. Early initiation of intensive immunotherapy with anti-seizure medications may have minimized irreversible brain damage associated with RSE, resulting in a relatively good outcome.
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Case Reports
Nerve Ultrasonography for the Diagnosis and Evaluation of Neuralgic Amyotrophy: A Case Report.
Neuralgic amyotrophy (NA) is a peripheral nervous system disorder involving multifocal distribution. Although nerve ultrasonography has shown potential for detecting NA lesions, no established detection method exists for distal forearm NA. A 59-year-old man presented with weakness of the muscles innervated by the left posterior interosseous nerve (PIN), median nerve (MN), anterior interosseous nerve (AIN), and ulnar nerve (UN), following severe left shoulder pain. This case suggests that nerve ultrasonography can help accurately diagnose distal forearm NA.
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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder sometimes accompanied by ovarian teratoma. However, the concept of encephalitis without anti-NMDAR antibodies successfully treated with ovarian teratoma resection and immunotherapy has not been established. ⋯ Case 2 presented with brainstem encephalitis similar to Bickerstaff's encephalitis. Although both patients tested negative for anti-NMDAR antibodies, the recovery of the neurological function and good prognosis following tumor resection with immunotherapy indicated a close association between these diseases and ovarian teratoma.
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A 38-year-old man was taken to hospital with generalized clonic seizure. Brain magnetic resonance imaging (MRI) showed multiple ring-enhancing lesions centered in the left frontoparietal lobe. ⋯ The lesions worsened after anti-tuberculosis drugs were administered, which we considered to be a paradoxical response and continued treatment. A genetic diagnosis of M. tuberculosis using FFPE specimens is useful for diagnosing tuberculoma.
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We treated a case of gastroesophageal varices due to decompensated liver cirrhosis associated with Wilson's disease. The varicose veins penetrated the paraesophageal vein. We performed endoscopic variceal ligation (EVL) on the perforating vein and endoscopic injection sclerotherapy distally. ⋯ We performed EVL and stopped the bleeding. However, the next day, she vomited blood again and developed hemorrhagic shock. We were able to achieve hemostasis and save the patient's life with combination therapy consisting of percutaneous transhepatic obliteration and Sengstaken-Blakemore tube placement.