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Stroke
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Intracerebral hemorrhage usually starts with a sudden headache that commonly happens during physical activity. The headache can be mild or absent in older patients. Often, the patient loses consciousness in only seconds or minutes. Other common symptoms include delirium, focal or generalized seizures, nausea, and vomiting. The neurologic deficits are usually sudden and very progressive. Large hemorrhages in the brain hemispheres cause hemiparesis. If they occur in the posterior fossa, cerebellar or brainstem deficits occur. These include conjugate eye deviation, ophthalmoplegia, pinpoint pupils, breathing that resembles snoring, and coma. In about 50% of patients, large hemorrhages are fatal in a few days. Those that survive experience a return to consciousness. Neurologic deficits slowly reduce as extravasated blood is resorbed. Since hemorrhage is not as destructive to brain tissue as an infarction, some patients have only a few neurologic deficits. If the hemorrhage is small, there may be focal deficits, but no impairment of consciousness. Headache or nausea may be only very slight. These hemorrhages can mimic an ischemic stroke.
Influenza neurologic complications
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Larry E. Davis, Jennifer R. Plourde
The diagnosis of RS is epidemiologically defined by the Centers for Disease Control and Prevention (CDC) as an acute, non-inflammatory encephalopathy documented by the clinical picture of alterations in the level of consciousness and liver dysfunction [53]. The syndrome developed primarily in children with the peak between the ages of 5 and 14 years [53]. The most commonly used staging system has been based on the system of Lovejoy et al. [54]. Individuals can progress relentlessly from stage I (prodrome) through stage V or stop at any stage and recover. The factors that govern progression of the disease through the stages are unknown. Between 60% and 87% of cases have been associated with an upper respiratory disease (mainly influenza B or A), 20%–30% have been associated with chickenpox, and 5%–15% with diarrhea [52,55]. Vomiting is the cardinal feature of stage I and is abrupt in onset and is repetitive. Fever may be present while jaundice is not and many patients in stage I do not progress further and recover [56]. In stage II, the child is stuporous, may have a non-purposeful response to pain, show sluggish pupillary reactions, and demonstrate conjugate eye deviation to the oculovestibular reflex. In stage III, the patient is comatose and shows decorticate posturing to pain. In stage IV, the posturing is decerebrate, and the oculovestibular reflex may be absent. In stage V, the patient is deeply comatose without spontaneous respirations, muscle tone is flaccid without posturing, and pupillary reflexes are absent. Few patients in stage V survive.
Cerebrovascular Disease
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
The clinical syndromes of lacunar stroke are usually easily recognized. One of the principal features is that patients do not have cortical signs, and in particular do not have cognitive difficulties. The latter indicate occlusion of larger branches of the cerebral arteries. Common examples of cortical signs are confusion, dysphasia, neglect, apraxia, hemianopia and conjugate eye deviation. Absence of these cortical signs with unilateral weakness or sensory loss involving at least two of the face, hand or leg is very suggestive of lacunar infarction, although occasionally small cortical infarcts mimic these features. It can be difficult to distinguish between lacunar infarction in the deep hemisphere structures and a lacune in the pons in the brainstem, which cause identical syndromes. There are many lacunar syndromes but the most common are listed in Box 23.4.
Chronic rhinosinusitis complicated by intracranial suppuration
Published in Acta Oto-Laryngologica Case Reports, 2021
Linnea Chika Kristensen Ejiofor, Christian von Buchwald, Mikkel Christian Alanin
A 63-year-old male with a history of atrial fibrillation, and CRS (through 30 years with daily nasal discharge and intermittent epistaxis), presented with fever (40.3 °C), repeated vomiting, and two episodes of generalized seizures. The patient was unresponsive with a Glasgow Coma Scale (GCS) score of 3 on arrival at the emergency department (ED). However, there was no nuchal rigidity or petechiae. An acute lumbar puncture showed no purulence. The patient developed vertical conjugate eye deviation, anisocoria with normal pupillary light reflex, left-sided Babinski reflex, right-sided indifferent response, but had spontaneous breathing. After 30 min in the ED, the patient had a GCS of 10 but sustained left-sided neurologic deficits.