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Neurology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Routine blood investigations are essential and include a full blood count, urea and electrolytes and C-reactive protein. Cerebrospinal fluid analysis is key in determining a diagnosis. Cerebrospinal fluid findings include the presence of mononuclear cells with a normal or elevated protein and reduction in glucose. Cerebrospinal fluid should be sent for a polymerase chain reaction test for enteroviruses and herpes virus. Prior to a lumbar puncture, patients should, of course, undergo a CT or MRI head.
Examine the cranial nerves
Published in Hani TS Benamer, Neurology for MRCP PACES, 2019
According to the likely cause: NCS/EMG.Brain MRI.Cerebrospinal fluid analysis.
Melanoma-associated emergencies
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Vidya Kharkar, M. R. L. Sujata
Ophthalmologic examinations should be reserved for patients who have Melanoma with unknown primary (MUP) with visceral metastases, primarily of the liver. Funduscopic examination of MAR is usually normal at onset, with retinal arterial attenuation seen later. Cerebrospinal fluid analysis is generally normal. Otorhinolaryngologic examination is done to look for metastases to the head and neck region. Proctoscopy and gynecologic examinations are done if inguinal lymph node metastases are present.
Bilateral Panuveitis Associated with Morvan Syndrome: A Case Report and Review of the Literature
Published in Ocular Immunology and Inflammation, 2023
Michael T. Kryshtalskyj, Robert G. Devenyi, Mili Roy
Morvan syndrome is exceedingly rare. It predominantly affects males, with a male-to-female ratio of 19 to 1.3 Diagnosis of MoS incorporates clinical features and the presence of antibodies against proteins associated with voltage-gated potassium channels (VGKC). Patients with MoS display elevated levels of Caspr2 antibodies, LGI-1 antibodies, or both. Generally, titres of Caspr2 antibodies are higher than LGI-1 antibodies.5,6 MoS can occur with myasthenia gravis in up to 31% of cases and acetylcholine receptor antibodies may be demonstrated.2,3,5 Brain magnetic resonance imaging (MRI) is typically normal.5,7 Cerebrospinal fluid analysis may demonstrate lymphocytosis, protein, oligoclonal bands and Caspr2 antibodies.5,8 Electromyography may be helpful in confirming peripheral nerve hyperexcitability.5,7
De Novo Vogt-Koyanagi-Harada Disease following Covid-19 Vaccine: A Case Report and Literature Overview
Published in Ocular Immunology and Inflammation, 2022
Jean-Baptiste Brunet de Courssou, Mylène Tisseyre, Jérôme Hadjadj, Laurent Chouchana, Florent Broca, Benjamin Terrier, Pierre Duraffour, Soledad Henriquez
Cerebrospinal fluid analysis revealed an aseptic meningitis. In details, proteins levels were of 0.28 g/L, white blood cells count 110/µL – of which 99% lymphocytes – and red blood cells 1/µL with a normal glycorrhachia. There was no integumentary change nor cochleo-vestibular impairment. Other physical examination, standard blood analysis and brain MRI were normal – namely ruling out demyelination. Of note, C-reactive protein was elevated at 14 mg/L. There was no evidence for syphilis infection, Behçet’s disease nor sarcoidosis. Antinuclear antibodies were not searched. The audiogram was in favor of an age-related sensorineural hearing loss. A diagnosis of incomplete VKH disease was made, as there was no integumentary findings.2 Choroidal thickening, due to local inflammation, associated with choroidal folds are highly suggestive of this disease.3
Systemic Lupus Erythematosus and Third Nerve Palsy: Unusual Presentation and Review of the Literature
Published in Neuro-Ophthalmology, 2022
Divya Natarajan, Mohan Kannam, M Vishnu Vardhan Reddy, Virender Sachdeva
A diagnosis of right eye incomplete third cranial nerve palsy was made. Magnetic resonance imaging (MRI) of the brain and orbits with contrast was normal (Figure 3). Cerebrospinal fluid analysis (CSF) was also normal. Laboratory investigations showed pancytopaenia, raised erythrocyte sedimentation rate (ESR), normal CRP, and negative rheumatoid factor (Table 1). In view of haematological abnormalities in a young female with a PUO, an autoimmune aetiology was considered. She was referred to an immunologist who performed an autoimmune work-up. Her anti-nuclear antibody (ANA) was positive and extractable nuclear antigen (ENA, using enzyme linked immunosorbent assay, ELISA) revealed multiple autoantibody positivity suggestive of SLE. Her anti-double stranded deoxyribonucleic acid (anti-dsDNA) antibody titre was elevated. Detailed results are presented in Table 1.