Service de néphrologie et hypertension, Département de médecine interne, CHUV, 1011 Lausanne.
Published: February 2019
AI Article Synopsis
Article Abstract
Prescribing intravenous fluids in a hospital setting is a task that each clinician has to endorse in an everyday practice. This task is universal to the point that it is often undervalued, or even neglected during clinical teaching. However, one shouldn't underestimate the risks related to excessive fluid administration, of which the clinician often doesn't know the exact composition. Literature about persistent fluid overload in hospital is scarce. This complex condition should however be given the attention it deserves. Indeed, it seems to be associated with increased costs and an excess in morbidity and even mortality.
Spinal cord sarcoidosis, an uncommon manifestation of neurosarcoidosis, presents diagnostic and therapeutic challenges because the condition is rare and has diverse clinical manifestations that can mimic other conditions such as multiple sclerosis and neuromyelitis optica spectrum disorder. A middle-aged African American female with a history of idiopathic intracranial hypertension and hydrocephalus with ventriculoperitoneal shunt presented with progressive, predominantly left-sided gait instability, weakness, and paresthesia. Cerebrospinal fluid showed lymphocytosis, red blood cells, elevated oligoclonal bands, and elevated kappa free light chains, concerning for multiple sclerosis.
Objective: Autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A) is a novel steroid sensitive autoimmune disease, without a diagnostic consensus. The purpose of this study was to improve early GFAP-A diagnosis by increasing awareness of key clinical characteristics and imaging manifestations.
Methods: Medical records of 13 patients with anti-GFAP antibodies in serum or cerebrospinal fluid (CSF) were reviewed for cross-sectional and longitudinal analysis of clinical and magnetic resonance imaging (MRI) findings.
Primary hyperparathyroidism (PHPT) typically presents with a spectrum of symptoms, including neuropsychiatric manifestations such as anxiety, depression, confusion, and, in severe cases, coma. While psychiatric symptoms are not uncommon in PHPT, acute psychosis is a rare presentation. In such cases, immediate control of serum calcium levels is crucial, and emergency parathyroidectomy may be required if medical management alone fails to control hypercalcemia.
A patient with reactivated varicella zoster virus (VZV) manifesting in the left-sided dermatome L3 and S2-S4 developed tonic spasms which morphed into myoclonic jerks, paresis, rigidity and hypoesthesia of the left leg. Later, stimuli-sensitive myoclonus progressed to affect the upper body and was accompanied by fever surges with high-frequency myoclonus, hypertensive derailment, dysphagia and other features of the brainstem with autonomic dysfunction. Cerebrospinal fluid tested positive for VZV, MRI showed no signs of myelitis and EEG was negative for epilepsy.
Esophageal injury is a serious complication following atrial fibrillation catheter ablation procedures. It may manifest as atrio-esophageal fistula, pericardio-esophageal fistula (PEF), or restricted perforation, with high mortality rate if left unoperated. Chest computed tomography with intravenous contrast is the mainstay of diagnosis; however, a definite imaging diagnosis is often delayed and may worsen patient outcomes.
