Manganese Neurotoxicity as a Stroke Mimic: A Case Report.

Manganese (Mn)-induced cerebral toxicity is a rare neurological condition that can present as a stroke mimic in high-risk populations. We present a case of a 40-year-old male with no known comorbidities who was brought to the emergency department with complaints of nonprogressive slurred speech and left facial weakness for eight days. Further history revealed that he had been working as a welder in a steel factory for the past seven years without using proper personal protective equipment (PPE). On physical examination, an upper motor neuron (UMN) type weakness on the left side of his face and spastic dysarthria could be appreciated. Following a brain computed tomography (CT) scan that showed ill-defined hypodensities in the basal ganglia without any signs of a hemorrhage, he was admitted to the stroke unit for conservative management and further investigations. A magnetic resonance imaging (MRI) scan of the brain done later showed features of manganese deposition and absorption in the globus pallidus and corticospinal tracts, indicating a diagnosis of manganese-induced cerebral toxicity. His serum manganese levels obtained during admission were normal. He was managed conservatively with intravenous rehydration and was discharged after symptomatic improvement. He was counseled and educated regarding the importance of wearing protective equipment while at work to reduce further exposure to the metal. During his follow-up visit, his symptoms had considerably improved with proper adherence to workplace safety measures.

Adnexal Torsion Associated With Recurrent Ovarian Hyperstimulation Syndrome: A Case Report.

Adnexal torsion due to hyperstimulation is one of the well-recognized serious complications of assisted reproductive techniques like in vitro fertilization (IVF). We report a case of a 35-year-old primigravida who presented to the emergency department with complaints of acute severe left iliac fossa pain and nausea. Further history revealed that the patient had previously undergone one cycle of ovulation induction and was diagnosed with ovarian hyperstimulation syndrome (OHSS). After prompt management, she reportedly underwent a cycle of IVF successfully. Her gestational age was five weeks and one day on presentation. A transabdominal ultrasound revealed bilateral enlarged ovaries with adequate blood supply and a single intrauterine gestational sac with a yolk sac. The patient was admitted as a case of recurrent OHSS for conservative management. Despite the initial improvement of symptoms with parenteral analgesia, an emergency laparoscopic surgery was done later due to worsening symptoms. Intraoperative findings were consistent with the suspected diagnosis of adnexal torsion which was managed accordingly. Postoperatively, the patient recovered without complications and was discharged two days later with a plan for outpatient follow-up.