BMJ case reports
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Patent foramen ovale (PFO) as a cause of cryptogenic stroke from paradoxical embolisation remains a controversial issue. The optimal care between medical and surgical management of these patients for the attending clinician remains a conundrum. We report a case of cryptogenic stroke in a woman aged 59, with a PFO, concomitant venous thrombosis and cryptogenic stroke. The case highlights the difficulty in diagnosing and managing such patients, particularly as recent evidence challenges the clinical practice of percutaneous closure and pathophysiological rationale.
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Cysticercosis is the most common parasitic infection of the central nervous system. Cysticercosis infrequently affects the spine, but when it does, it can present with symptoms similar to other more common spinal diseases. ⋯ Initially, the patient was misdiagnosed as tuberculoma on the basis of cerebrospinal fluid examination and CT scan of brain and was being treated with antitubercular therapy. Later on the patient developed quadriparesis which was investigated and diagnosed to be disseminated neurocysticercosis.
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Acute encephalitis is a life-threatening condition. A wide variety of infectious agents are implicated and in many patients no cause is found. ⋯ The authors report a case of severe acute encephalitis as a primary presentation of HIV infection in which introduction of highly active antiretroviral treatment resulted in clinical recovery. This case highlights the need to consider HIV infection in the differential diagnosis of treatable viral encephalitis.
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Case Reports
Paraneoplastic neurological syndrome as initial presentation of pulmonary adenocarcinoma.
Paraneoplastic neurological syndromes are defined as remote effects of cancer that are not caused by the tumour and its metastasis, or by infection, ischaemia or metabolic disruptions. The author reports a 63-year-old Caucasian woman presenting with slowly progressing cognitive deficits. Initial workup failed to reveal any obvious cause of her cognitive deficits. ⋯ Cerebrospinal fluid analysis revealed the presence of anti-Hu antibody and a diagnosis of limbic encephalitis was made. Limbic encephalitis is an inflammatory process localised to structures of the limbic system that produces cognitive impairment along with other neuropsychiatric symptoms. This case highlights the importance of considering paraneoplastic syndromes in patients presenting with cognitive deficits.
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A 38-year-old woman presented with shock and severe abdominal pain. Abdominal CT scanning demonstrated massive ascites, which was highly suggestive of haemoperitoneum. ⋯ Urgent operative treatment with ligation of a ruptured ovarian varix successfully controlled the bleeding. She eventually made a full recovery.