Asian Journal of Case Reports in Medicine and Health
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Nasopharyngeal Carcinoma with an Unusual Metastatic Presentation
No full textNasopharyngeal carcinoma usually presents with regional lymphadenopathy and involvement of lymph nodes follows a particular pattern. Parotid lymph node involvement is a rare phenomenon in nasopharyngeal carcinoma. The occurrence of parotid lymph node involvement has been reported in various studies and is approximately 1%. Here we present a case of a 55-year-old male, a case of nasopharyngeal carcinoma whose nasopharyngeal biopsy and scans were negative. Patient had recurrent level II node which was subjected to fine needle aspiration cytology (FNAC) and trucut biopsy which was suggestive of basal cell adenocarcinoma features favouring salivary gland primary. The patient underwent left-sided parotidectomy with lymph node dissection. On examination of the specimen one lymph node was positive for p16 and p40 which was suggestive of Epstein Barr aetiology. Then Epstien-Barr encoded RNA in situ hybridization (EBER ISH) was done which was in favour of Epstien Barr etiology. The patient was treated as a case of nasopharyngeal carcinoma with Epstein Barr virus (EBV) positive metastatic neck node. The patient then received external beam radiotherapy concurrent with cisplatin and is on follow up and doing well
Haemorrhagic Stroke Complicating Systemic Envenomation in Snake Bite: A Case Report and Literature Review
No full textIntroduction: Snakebite is a neglected tropical public health problem that is common in Nigeria. The occurrence of haemorrhagic stroke following snakebite envenomation is a rare medical emergency.
Aim: To describe the neurological complications that occurred after snakebite envenomation.
Methodology: This is a hospital-based case report of a 17-year woman who presented at the Emergency unit of Benue State University Teaching Hospital Makurdi Benue State Nigeria 18 days after snake bite with 10 days of progressive loss of consciousness and associated difficulty in opening the right eye, weakness of the left hemi-body, weeping spells and difficulty in swallowing with no background cardiovascular risk factor. She had been managed by a traditional medicine healer immediately after the snakebite.
Results: At presentation, she had Glasgow Coma Scale of 7/15, restlessness, and mildly pale with weeping spell and a healed scar on her right leg. Other neurological examinations revealed right ptosis, right oculomotor nerve palsy, upper motor neuron type of left facial nerve palsy (multiple cranial nerve palsies), aphasia and crossed hemiplegia indicating Weber’s syndrome (midbrain stroke syndrome). She made good clinical recovery of her neurologic deficits.
Conclusion: Our report highlights the need to suspect and exclude haemorrhagic stroke in victims presenting with loss of consciousness and lateralizing signs using brain CT scan. Public enlightenment is needed to enhance early presentation following snakebite
Rendu-Osler-Weber Syndrome: A Rare Case Report and Literature Review
No full textRendu-Osler disease is a rare inherited vascular disorder. Through this article, the authors recall the digestive manifestations of this condition, which when associated with other clinical signs, are sufficiently characteristic to allow the gastroenterologist to suggest the diagnosis
Scimitar Syndrome or Halasz Syndrome
No full textScimitar syndrome or Felson's vein-lobar syndrome is a very rare condition characterized by a combination of cardiopulmonary abnormalities including abnormal right pulmonary venous return, most often located in the inferior vena cava.
We here report an original observation of a nine-month-old female infant who presented with acute dyspnea in an endemic period. Symptomatic treatment for bronchiolitis was initiated, without success, with persistent respiratory distress. The diagnosis was suspected on chest X-ray and confirmed on CT scan which showed a single large right pulmonary vein draining into the right atrium associated with dextrocardia and pulmonary sequestration
Vascular Consideration with COVID-19 Vaccination: Clinical Case Report
No full textAdverse cardiovascular side effects of the COVID -19 vaccine include myocarditis/pericarditis, vaccine induced thrombotic Thrombocytopenia (VITT) and thrombosis, which often related to low platelet levels and VITT in the setting. A 60-year-old female presented to our Emergency Department (ED) after cardiopulmonary resuscitation due to Asystole at home. The patient underwent a chest computed tomography (CT) scan that revealed bilateral pleural effusion without pulmonary embolism. The cardiovascular complications have been reported with both COVID-19 and its vaccination. The COVID-19 vaccines have adverse side effects, which are rare but also sometimes fulminant too
The Commonness of Rarity
No full textMalaria is the most frequent tropical disease in developing nations. Among the four types of malaria, P. falciparum malaria is the most severe, as it affects multiple systems. Acute Respiratory Distress Syndromes (ARDS) is the most severe respiratory complication commonly associated with P. falciparum but very rarely with P. vivax. Here, we present an interesting case report pertaining to young patient (Male/25 years/no co-morbidities) presented with severe breathlessness, diagnosed as ARDS post P. vivax malaria complicated by secondary bacterial infection achieving complete recovery with the combined holistic approach of early mechanical ventilation support, prone positioning, antibiotic titration, physiotherapy and good nutrition. This case reinstates the importance of early recognition of ARDS, clinical suspicion for secondary infection and implication of prone position ventilation and other recruitment manoeuvres (RM)
A Case Report on PRES and HELLP Syndrome in 08 Months Amoneherric Women
No full textPosterior Reversible Encephalopathy Syndrome (PRES), in 1996 was originally described by Hinchey. It is also so-called as reversible posterior leukoencephalopathy syndrome, an illness in which a person present’s with acutely altered mentation, visual impairment, drowsiness or sometimes stupor, seizures (focal or general tonic-clonic), and sudden or constant, non-localized headaches, and nausea and vomiting. If recognized promptly and treated, the clinical syndrome generally resolves within a week, and the variations seen in magnetic resonance imaging (MRI) resolve over days to weeks. The syndrome of hemolysis, elevated liver enzymes, and low platelets, is referred to as HELLP syndrome, has historically been classified as a complication or progression of severe preeclampsia. An ischemic-reperfusion injury initiates the liver damage in HELLP syndrome. The clinical presentation may vary from patient to patient with HELLP syndrome, and may present with colicky mid-epigastric and/or right upper quadrant pain associated with fatigue, nausea and vomiting. An appropriate physical examination must be conducted if any of the above complications are suspected
Right Atrial Mass, Concomitant Right Atrium and Liver Hemangioma
No full textIntroduction: Tumors of the heart comprise 0.2% of all human tumors, Right atrial masses are rare whiten cardiac tumors,We herein present a concomitant heart and liver tumor.
Patients Personation and Mangment: Our patient was a 49-year-old man with dyspnea at rest of 2 months’ duration. transthoracic echocardiography revealed normal right ventricular size with mild-to-moderate right ventricular systolic dysfunction , mild right atrial enlargement with a homogenous, oval-shaped mass (4 × 2.71 cm) featuring a translucent rim,Pulmonary computed tomography (CT) angiography yielded no filling defects and findings in favor of pulmonary emboli or tumoral lesions.Abdominopelvic sonography showed fatty liver (grade I) and a heterogeneous, hyperechoic ill-defined mass (128 × 98 mm) in the right lobe of the liver. Abdominopelvic intravenous contrast CT illustrated an infiltrative tumoral lesion in the liver lobe with heterogeneous, nodular enhancement at an early phase. Abdominal magnetic resonance imaging demonstrated a large, lobulated mass lesion, 15 × 12× 10 cm in size, in the right lower lobe of the liver with heterogeneous high-signal intensity in T2, as well as peripheral nodular enhancement after contrast injection, followed by centripetal progression of the enhancement, in favor of a cavernous hemangioma.The patient underwent open-heart surgery in our center and right atrial mass extracted. The pathology examination reported a benign vascular lesion, compatible with a hemangioma with venous and capillary features.
Conclusion: concomitant right atrium and liver hemangioma as a primary benign tumor is rare and despite its late onset personation it must be considered in patients with both heart and liver mass
Ramsay Hunt Syndrome with Cranial Polyneuropathy and Aseptic Meningoencephalitis: A Case Report
No full textIntroduction: Ramsay Hunt Syndrome is characterized by paroxysmal ear pain, vesicular rash around the auricle and ear canal with ipsilateral peripheral fascial nerve palsy. It is due to reactivation of Varicella Zoster Virus (VZV) in the fascial nerve ganglion. It is considered to be the second most common cause of peripheral fascial nerve palsy. Involvement of other cranial nerves is uncommon. Rarely, dissemination of infection can lead to meningoencephalitis.
Case Presentation: A 14-year-old immunocompetent boy presented with fever associated with vertigo, fascial asymmetry and difficulty in swallowing. He also complained of a rash on his left ear associated with ear pain, one week prior to this presentation. He had a few crusted lesions on his left ear pinna and ear canal on examination. Cranial nerve examination revealed a left sided lower motor neuron type fascial and palatal palsy. Cerebrospinal fluid (CSF) analysis was suggestive of viral meningoencephalitis. He was treated for Ramsay Hunt Syndrome with cranial polyneuropathy and meningoencephalitis with Acyclovir and steroids. He had a uncomplicated recovery.
Conclusion: This case highlights the importance of clinicians diagnosing Ramsay Hunt Syndrome amongst patients presenting with multiple cranial nerve palsies and meningoencephalitis. It is a reminder that careful history and meticulous examination can lead to prompt recognition of a reversible cause of cranial polyneuropathy
Role of Patient Education, Motor Imagery and Crossover Therapy in an Acute Post-traumatic Multi-system Involvement Condition- A Case Report
No full textAims: With the increased number of road traffic accidents, especially involving younger males, it becomes important to discuss the acute stage rehabilitation of such cases where it has to be planned keeping in mind the associated complications, yet achieving successful outcomes.
Presentation of Case: The case report describes trauma and consequent fracture to the right humerus and scapula, multiple ribs, and right lung leading to haemothorax. The patient also had an injury to various upper limb nerves leading to a lack of muscle activation. It talks about the thorough physical therapy assessment after initial medical management, followed by holistic physical therapy rehabilitation involving patient education, motor imagery, cross-over therapy, guided relaxation, etc during the acute stage of healing.
Discussion: In acute multi-traumatic and post-surgical rehabilitation, there is difficulty in obtaining cooperation from the patient given the pain. Patient education forms the mainstay to obtain the cooperation of the patient. Motor Imagery and Cross Over therapy are particularly useful for ensuring the voluntary activation of brain areas without actually doing the movement, thereby working on the paths of neuroplasticity.
Conclusion: The above rehabilitation methods achieved recovery by assisting the process of neuroplasticity and nerve growth, in contrast to traditional acute rehabilitation plans