Grade IV Glioma Potentially Disguised As COVID-19 Encephalitis.

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), which became a pandemic in March 2020. Since that time, research has shed light on this disease's pulmonary, cardiac, and hematologic complications. However, we are still unraveling the complex neurologic sequelae of COVID-19. Here we present the case of a 58-year-old female who presented with weakness, gaze preference, and aphasia. She was diagnosed with a stroke which was managed medically. The patient returned two weeks later with memory loss and aphasia. An MRI was consistent with temporal lobe encephalitis, although a lumbar puncture was unremarkable. A polymerase chain reaction (PCR) test for COVID-19 was positive. Treatment was initiated for viral encephalitis with patient improvement. She was discharged a second time, and approximately three months later, she presented again with unrelenting headaches. Further imaging revealed a mass that was determined to be a grade IV glioma. Cases of glioma after viral encephalitis have been studied, but a clear link with COVID-19 has not been established.

Subglottic Stenosis as a Presentation of Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis.

Granulomatosis with polyangiitis (GPA), previously Wegener's granulomatosis, is a necrotizing vasculitic disease process affecting the small- and medium-sized blood vessels. GPA is frequently associated with damage to the respiratory tract and kidneys but often affects other organ systems including the eyes, nasopharynx, and nervous system. Due to the vague nature of presenting symptoms and the progressive nature of GPA, it is essential to keep a broad differential to mitigate the high morbidity and mortality associated with the disease. Here we introduce a case of a GPA presenting as respiratory distress, stridor, and renal injury. We also review common clinical presentations, diagnostic evaluation, and treatment options.

Critical Left Subclavian Artery Stenosis With Retrograde Vertebral Flow: A Case Report and Literature Review.

Subclavian artery stenosis is a rare condition associated with significant morbidity and mortality, making prompt recognition and treatment essential. We present a case of left-sided subclavian artery occlusion with neurological symptoms, including vertigo, unsteady gait, and left upper extremity pain and paresthesia. The patient's symptoms had been progressing over several months. Her risk factors included age, hyperlipidemia, and poorly controlled blood pressure with resultant arteriosclerosis throughout her vasculature. An arteriogram demonstrated critical stenosis of the left subclavian with retrograde flow through the left vertebral artery. Aspirin and clopidogrel were initiated prior to successful balloon angioplasty and stenting. After stent placement, the patient had minimal residual subclavian stenosis and anterograde vertebral artery flow. In this case report, we discuss clinical presentation, typical examination and imaging findings, and treatment options for subclavian stenosis including medical management and revascularization procedures.

The Utility of Abdominal Ultrasound Following Negative Computed Tomography in Diagnosing Acute Pancreatitis.

Aim Acute pancreatitis is a diagnosis established by fulfillment of at least two out of three clinical features, including epigastric pain, elevated lipase, and/or radiographic evidence of acute pancreatitis. Computed tomography of the abdomen and pelvis (CTAP) is the gold standard imaging modality for evaluating acute pancreatitis. Although abdominal ultrasound (AUS) is increasingly utilized given the widespread availability and high sensitivity and specificity for detecting gallstone-related complications, including gallstone pancreatitis, the leading cause of acute pancreatitis in the US. However, recent literature has concluded that performing AUS following a negative CTAP rarely led to changes in management and imparted an increased length of service (LOS) in the ED. Our study investigated whether a similar relationship was observed when managing acute pancreatitis in the inpatient setting. We aimed to quantify how performing AUS influenced inpatient LOS for patients admitted for acute pancreatitis without radiographic evidence of acute pancreatitis on CTAP. We also aimed to quantify how AUS influenced the likelihood of subsequent intervention via endoscopic retrograde cholangiopancreatography (ERCP) or cholecystectomy, including the relative impact of certain demographic or clinical features. Methods A retrospective analysis was performed using a cohort of 6069 patient encounters extracted via the HCA Healthcare enterprise data warehouse (EDW) database. Inclusion criteria were all adult patients with an index admission for acute pancreatitis between January 1 and December 31, 2019, who underwent CTAP during admission. Patients younger than 18 years, with prior cholecystectomy, or without documentation of demographic or clinical data of interest were excluded. The primary outcome was to quantify how performing AUS within 48 hours impacted LOS for patients admitted for acute pancreatitis following negative CTAP. Secondary outcomes examined whether AUS changed management (i.e., per likelihood of subsequent ERCP or cholecystectomy). This included determining the influence of various demographic or clinical characteristics on the likelihood of intervention via ERCP or cholecystectomy. Linear regression was used to determine the effect of performing AUS on the duration of LOS. Logistic regression was used for covariate analysis based on demographic (BMI, sex, race, age) and clinical data (comorbid conditions, abnormal labs, and vital signs). Results Patients with acute pancreatitis who underwent AUS within 48 hours had a reduced LOS of 1.099 days. Patients who underwent AUS were 1.126 times more likely to undergo subsequent ERCP than those who received CTAP alone. Patients who received AUS following CTAP were also 2.711 times more likely to undergo subsequent cholecystectomy. Increasing age and BMI were correlated with an increased likelihood of ERCP and cholecystectomy. Males were less likely to undergo cholecystectomy (OR = 0.753) and ERCP (OR = 0.815) compared to females. Conclusion Performing AUS within 48 hours following negative CTAP in this cohort of patients admitted for acute pancreatitis was associated with a decreased LOS. Furthermore, patients who underwent AUS were more likely to undergo ERCP and even more likely to undergo cholecystectomy. The likelihood of ERCP and cholecystectomy increased proportionally to both age and BMI. Females were more likely than males to undergo subsequent ERCP or cholecystectomy.

Laxative Abuse Cessation Leading to Severe Edema.

Stimulant laxatives are a common class of laxatives that is abused by patients with eating disorders. We present a case of a 30-year-old female who presented with dyspnea, peripheral edema and weight gain who had been chronically using laxatives. Her symptoms were consistent with rebound edema caused by sodium and free water shifts with abrupt cessation of excessive stimulant laxative use. This case highlights the use of furosemide as the mainstay treatment for rebound edema and weight gain.

All-Cause Mortality and Incidence of Major Adverse Cardiac Events in Sickle Cell Nephropathy: A Comparative Study.

Background Sickle cell disease (SCD) is an autosomal recessive disease resulting in hemolytic anemia and recurrent vaso-occlusive events. Consequently, it can result in a broad range of functional and structural renal and cardiac alterations. Chronic kidney disease (CKD), in SCD, is associated with proteinuria, microalbuminuria, and hemoglobinuria. Cardiac complications in SCD include pulmonary hypertension, left ventricular diastolic heart disease, dysrhythmia, and sudden death. In patients with advancing age, cardio-renal dysfunction can have substantial effects on morbidity and mortality. Our primary aim was to compare the incidence of major adverse cardiac events (MACE) and all-cause mortality in sickle cell nephropathy (SCN). Methods In this retrospective study, we used International Classification of Diseases (ICD)-10 codes to identify admissions in 2019 with a diagnosis of MACE with a prior diagnosis of SCD and/or SCN. Our search of the HCA Healthcare Enterprise Data Warehouse for adult patients >18 years yielded 6,693 patients with SCD, of which 658 patients (9.8%) had SCN. Primary endpoints were incidence of MACE and all-cause mortality. Patients with MACE encompassed those with nonfatal stroke, nonfatal myocardial infarction, and congestive heart failure (CHF) exacerbations. A secondary endpoint was length of stay (LOS). Logistic regression analysis was used for MACE and all-cause mortality. LOS was analyzed using multiple linear regression analysis. Results were considered statistically significant for analyses showing p <0.05. All outcomes were adjusted for demographic variables and comorbidities. Results Logistic regression, after adjustment for comorbidities, demonstrated that SCN patients had significantly higher odds of all-cause mortality (odds ratio [OR] 2.343, p = 0.035, 95% confidence interval [CI] 1.063-5.166) compared to patients without SCN. Compared to those without SCN, those with SCN did not have a higher odds of MACE (OR 1.281, p = 0.265, 95% CI 0.828-1.982). Linear regression for LOS did not reveal a significant association with SCN (p = 0.169, 95% CI 0.157-0.899). Conclusion Based on the analysis of 6,693 patients with SCD, SCN was associated with significantly higher odds of all-cause mortality. SCN was not associated with significantly higher odds of MACE or prolonged LOS.

Ruptured Subcapsular Liver Hematoma: A Rare Complication of HELLP Syndrome.

Subcapsular liver hematoma (SLH) is a rare complication of HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. We report a previously healthy 16-year-old female presenting with pre-eclampsia requiring emergent C-section, who developed immediate postoperative bleeding and abdominal distention. Abdominal computed tomography angiography (CTA) revealed a large encapsulated liver hematoma with active extravasation. The patient was successfully treated with a multidisciplinary approach with medical and surgical management.