RESUMO
Objective: To investigate the misdiagnosis of area postrema syndrome (APS) manifesting as intractable nausea, vomiting and hiccups in neuromyelitis optic spectrum disease (NMOSD) and reduce the risk of misdiagnosis. Methods: We retrospectively analyzed data from NMOSD patients attending the Department of Neurology at the First Medical Center of PLA General Hospital between January 2019 and July 2021. SPSS25.0 was then used to analyze the manifestations, misdiagnosis, and mistreatment of APS. Results: A total of 207 patients with NMOSD were included, including 21 males and 186 females. The mean age of onset was 39±15 years (range: 5-72 years). The proportion of patients who were positive for serum aquaporin 4 antibody was 82.6% (171/207). In total, 35.7% (74/207) of the NMOSD patients experienced APS during the disease course; of these patients, 70.3% (52/74) had APS as the first symptom and 29.7% (22/74) had APS as a secondary symptom. The misdiagnosis rates for these conditions were 90.4% (47/52) and 50.0% (11/22), respectively. As the first symptom, 19.2% (10/52) of patients during APS presented only with intractable nausea, vomiting and hiccups; 80.8% (42/52) of patients experienced other neurological symptoms. The Departments of Gastroenterology and General Medicine were the departments that most frequently made the first diagnosis of APS, accounting for 54.1% and 17.6% of patients, respectively. The most common misdiagnoses related to diseases of the digestive system and the median duration of misdiagnosis was 37 days. Conclusions: APS is a common symptom of NMOSD and is associated with a high rate of misdiagnosis. Other concomitant symptoms often occur with APS. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing physical examinations are essential if we are to reduce and avoid misdiagnosis.
Assuntos
Soluço , Neuromielite Óptica , Masculino , Feminino , Humanos , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Neuromielite Óptica/complicações , Neuromielite Óptica/diagnóstico , Área Postrema , Estudos Retrospectivos , Soluço/etiologia , Soluço/complicações , Vômito/diagnóstico , Vômito/etiologia , Náusea/diagnóstico , Náusea/etiologia , Inflamação , Síndrome , Autoanticorpos , Erros de Diagnóstico , Aquaporina 4RESUMO
A 73-year-old Japanese man with diabetic complications presented with involuntary lip movements and long-lasting hiccups after developing zoster rash. Magnetic resonance imaging revealed lesions involving the medial temporal lobe and C1 level of the spinal cord. Varicella-zoster virus (VZV) encephalomyelitis was diagnosed. We considered attributing the orofacial dyskinesia, a very rare symptom of VZV central nervous system (CNS) complications, to the temporal lobe lesion. Although the culprit lesion for the hiccups was unclear, further examinations may have clarified this issue. As immunocompromised patients with herpes zoster may develop CNS complications with a wide variety of symptoms, special care is needed.
Assuntos
Discinesias , Encefalite por Varicela Zoster , Encefalomielite , Herpes Zoster , Soluço , Masculino , Humanos , Idoso , Herpesvirus Humano 3 , Soluço/complicações , Herpes Zoster/complicações , Encefalomielite/diagnóstico , Encefalomielite/diagnóstico por imagemRESUMO
Objective: To investigate the misdiagnosis of area postrema syndrome (APS) manifesting as intractable nausea, vomiting and hiccups in neuromyelitis optic spectrum disease (NMOSD) and reduce the risk of misdiagnosis. Methods: We retrospectively analyzed data from NMOSD patients attending the Department of Neurology at the First Medical Center of PLA General Hospital between January 2019 and July 2021. SPSS25.0 was then used to analyze the manifestations, misdiagnosis, and mistreatment of APS. Results: A total of 207 patients with NMOSD were included, including 21 males and 186 females. The mean age of onset was 39±15 years (range: 5-72 years). The proportion of patients who were positive for serum aquaporin 4 antibody was 82.6% (171/207). In total, 35.7% (74/207) of the NMOSD patients experienced APS during the disease course; of these patients, 70.3% (52/74) had APS as the first symptom and 29.7% (22/74) had APS as a secondary symptom. The misdiagnosis rates for these conditions were 90.4% (47/52) and 50.0% (11/22), respectively. As the first symptom, 19.2% (10/52) of patients during APS presented only with intractable nausea, vomiting and hiccups; 80.8% (42/52) of patients experienced other neurological symptoms. The Departments of Gastroenterology and General Medicine were the departments that most frequently made the first diagnosis of APS, accounting for 54.1% and 17.6% of patients, respectively. The most common misdiagnoses related to diseases of the digestive system and the median duration of misdiagnosis was 37 days. Conclusions: APS is a common symptom of NMOSD and is associated with a high rate of misdiagnosis. Other concomitant symptoms often occur with APS. Gaining an increased awareness of this disease/syndrome, obtaining a detailed patient history, and performing physical examinations are essential if we are to reduce and avoid misdiagnosis.
Assuntos
Masculino , Feminino , Humanos , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Neuromielite Óptica/diagnóstico , Área Postrema , Estudos Retrospectivos , Soluço/complicações , Vômito/etiologia , Náusea/etiologia , Inflamação , Síndrome , Autoanticorpos , Erros de Diagnóstico , Aquaporina 4RESUMO
BACKGROUND: Visceral pain (VP) following laparoscopic sleeve gastrectomy remains a substantial problem. VP is associated with autonomic symptoms, especially nausea and vomiting, and is unresponsive to traditional pain management algorithms aimed at alleviating somatic (incisional) pain. The present study was performed to evaluate the safety and effectiveness of laparoscopic paragastric autonomic neural blockade (PG-ANB) in managing the symptoms associated with VP following sleeve gastrectomy. STUDY DESIGN: This prospective, double-blinded, randomized clinical trial involved patients undergoing laparoscopic sleeve gastrectomy at two high-volume institutions. The patients were randomized to laparoscopic transversus abdominis plane block with or without PG-ANB. The primary outcome was patient-reported pain scores assessed at 1, 8, and 24 h postoperatively. The secondary outcome measures were analgesic requirements, nausea, vomiting, hiccups, and hemodynamic changes immediately after PG-ANB and postoperatively. RESULTS: In total, 145 patients (block group, n = 72; control group, n = 73) were included in the study. The heart rate and mean arterial pressure significantly decreased 10 min after PG-ANB. The visual analog scale score for pain was significantly lower in the PG-ANB than in the control group at 1 h postoperatively (p < 0.001) and 8 h postoperatively (p < 0.001). Vomiting, nausea, sialorrhea, and hiccups were significantly less prevalent in the PG-ANB group. Patients in the PG-ANB group received fewer cumulative doses of analgesics at 1 h postoperatively (p = 0.003) and 8 h postoperatively (p < 0.001). No differences between the groups were detected at 24 h (p = 0.298). No complications related to PG-ANB occurred. CONCLUSION: PG-ANB safely and effectively reduces early VP, associated autonomic symptoms, and analgesic requirements after laparoscopic sleeve gastrectomy.
Assuntos
Soluço , Laparoscopia , Obesidade Mórbida , Dor Visceral , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Músculos Abdominais , Dor Visceral/complicações , Dor Visceral/cirurgia , Estudos Prospectivos , Soluço/complicações , Soluço/cirurgia , Obesidade Mórbida/cirurgia , Método Duplo-Cego , Gastrectomia/efeitos adversos , Laparoscopia/efeitos adversos , Analgésicos , Vômito/etiologia , Náusea/etiologia , Analgésicos Opioides , Anestésicos LocaisRESUMO
BACKGROUND: Anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis, an autoimmune disorder, is characterized by faciobrachial dystonic seizures, epilepsy, memory deficits and altered mental status while hiccup is not commonly found in patients. CASE PRESENTATION: A 62-year-old male was presented with slurred speech, abnormal gait, faciobrachial dystonic seizures and impaired cognition. Besides, the hiccup was one of the initial symptoms. His brain magnetic resonance images (MRI) revealed multiple lesions with left caudate nucleus, putamen, insula and left hippocampus involvement. Because a diagnosis of antibody-related limbic encephalitis was suspected, studies including an autoimmune profile were done by cell-based assays. After anti-LGI1 antibodies were detected in both cerebrospinal fluid and serology, pulse methylprednisolone and intravenous immunoglobulin were started and hence hiccups disappeared along with other symptoms. CONCLUSIONS: Clinicians should be aware that persistent hiccups might be one of the initial manifestations of LGI1 subtype of voltage-gated potassium channel complex antibody associated autoimmune encephalitis.
Assuntos
Encefalite , Glioma , Soluço , Encefalite Límbica , Autoanticorpos , Encefalite/complicações , Encefalite/diagnóstico , Glioma/complicações , Soluço/complicações , Humanos , Peptídeos e Proteínas de Sinalização Intracelular , Leucina , Encefalite Límbica/diagnóstico , Encefalite Límbica/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Convulsões/etiologiaRESUMO
Tuberculosis (TB) and lung cancer are the leading causes of mortality and morbidity in the world. The burden of TB is significantly high in developing countries causing serious public health concern, and the incidence of lung cancer is also increasing all around the world with high mortality. Pulmonary TB coexisting with lung cancer can mask the underlying disorder producing diagnostic dilemma resulting in a delay in diagnosis leading to decreased survival of the patients. Here, we report a rare case of a 66-year-old male diagnosed with microbiologically confirmed TB along with coexisting small cell neuroendocrine carcinoma of the lung presenting with syndrome of inappropriate antidiuretic hormone.
Assuntos
Carcinoma Neuroendócrino , Soluço , Neoplasias Pulmonares , Tuberculose Pulmonar , Idoso , Carcinoma Neuroendócrino/complicações , Carcinoma Neuroendócrino/diagnóstico , Soluço/complicações , Humanos , Pulmão , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico , Masculino , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , VasopressinasRESUMO
BACKGROUND: To our knowledge, previous studies have not investigated hiccups in patients with cancer with detailed patient-level data with the goal of capturing a broad spectrum of hiccup symptomatology. METHODS: This multi-site, single institution study examined consecutive medical records to better understand hiccups in patients with cancer. RESULTS: A total of 320 patients are the focus of this report. The median age of patients when hiccups were first reported in the medical record was 63 years (range: 21, 97 years) with 284 (89%) men and 36 (11%) women. The most common diagnose was gastrointestinal cancer. Hiccups most frequently occurred daily, as seen in 194 patients (62%), and the most common duration was less than 1 week, as seen in 146 patients (47%). However, nine patients had had daily hiccups for greater than 6 weeks, and 5 had symptoms for years. Cited etiology was non-chemotherapy medications in 36 (11%) and cancer chemotherapy in 19 (6%). Complications occurred in approximately a third and included insomnia in 51 patients (16%); hospitalization or emergency department visit in 34 (11%); and musculoskeletal pain in 23 (7%). Baclofen was the single most prescribed agent for hiccup palliation, but 100 patients received more than one medication. Medical procedures, which included acupuncture, paracentesis, or phrenic nerve block, were performed in 5 patients. In 234 patients (73%), the medical record documented hiccup cessation. CONCLUSIONS: Hiccups appear to be highly problematic in a small subset of patients with cancer with no well-defined palliative approaches.
Assuntos
Soluço , Neoplasias , Distúrbios do Início e da Manutenção do Sono , Baclofeno/uso terapêutico , Feminino , Soluço/complicações , Soluço/etiologia , Humanos , Masculino , Neoplasias/tratamento farmacológico , Neoplasias/terapia , Cuidados Paliativos , Distúrbios do Início e da Manutenção do Sono/complicaçõesRESUMO
La analgesia epidural mediante inyección de corticoides es un procedimiento frecuente en las unidades de dolor. A pesar de ser una técnica con bajo índice de complicaciones, se ha descrito la aparición de hipo persistente tras la intervención. Se presenta como caso clínico el primer episodio publicado en España y sexto en el mundo de hipo persistente por betametasona administrada mediante inyección epidural, acompañado de una recapitulación sobre la definición de esta entidad y su etiología, fisiopatología, manejo e incidencia en pacientes a tratamiento con corticoides orales y epidurales. Debido a la duración, impacto en la calidad de vida y necesidad de tratamiento sintomático, se considera el caso más grave publicado hasta la fecha.(AU)
Epidural analgesia by corticosteroid injection is a common procedure in pain units. Despite being a technique with a low rate of complications, the appearance of persistent hiccups after the intervention has been described. We present as a clinical case the first episode published in Spain and the sixth in the world of persistent hiccups due to betamethasone administered by epidural injection, accompanied by a summary of the definition of this entity and its aetiology, pathophysiology, management and incidence in patients treated with oral and epidural corticosteroids. Due to its duration, impact on quality of life and need for symptomatic treatment, it is considered the most severe case published to date.(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Soluço/complicações , Bupivacaína/administração & dosagem , Injeções Epidurais , Betametasona/administração & dosagem , Pacientes Internados , Exame Físico , Manejo da Dor , Dor/tratamento farmacológicoAssuntos
Tratamento Farmacológico da COVID-19 , Clorpromazina/uso terapêutico , Deficiência do Fator V/tratamento farmacológico , Hemorragia/tratamento farmacológico , Soluço/tratamento farmacológico , Metoclopramida/uso terapêutico , COVID-19/complicações , COVID-19/fisiopatologia , COVID-19/virologia , Deficiência do Fator V/complicações , Deficiência do Fator V/fisiopatologia , Deficiência do Fator V/virologia , Testes Hematológicos , Hemorragia/complicações , Hemorragia/fisiopatologia , Hemorragia/virologia , Soluço/complicações , Soluço/fisiopatologia , Soluço/virologia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/crescimento & desenvolvimento , SARS-CoV-2/patogenicidade , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Continuous hiccups during surgery not only affect the surgical procedure, they can also cause adverse effects for the patient. Apart from active investigation of the cause of the hiccups, their timely termination is also necessary. CASE PRESENTATION: We reported a case of a 70-year-old woman with continuous intraoperative hiccups that appeared during vaginal hysterectomy under low continuous epidural anesthesia. After the ineffectiveness CO2 repeated inhalation and intravenous administration of chlorpromazine and methoxychlorpromide, we performed unilateral phrenic nerve block under ultrasound guidance. Hiccups were terminated without any related complications. CONCLUSIONS: During intraoperative continuous hiccups, ultrasound guided phrenic nerve block may be a suitable treatment option when physical methods and drug therapy are not effective. However, given the absence of a vital risk related to hiccups, this block should imply the complete absence of any respiratory contraindication and a prolonged postoperative respiratory monitoring.
Assuntos
Bloqueio Nervoso Autônomo/métodos , Soluço/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Nervo Frênico/diagnóstico por imagem , Ultrassonografia de Intervenção/métodos , Idoso , Feminino , Soluço/complicações , Soluço/terapia , HumanosRESUMO
We herein report the case of a 76-year old man with aquaporin-4-Immunoglobulin-G (AQP4-IgG)-positive neuromyelitis optica spectrum disorder (NMOSD), in whom transient interstitial pulmonary lesions developed at the early stage of the disease. Chest X-ray showed multiple infiltrative shadows in both upper lung fields, and computed tomography revealed abnormal shadows distributed randomly in the lungs. Surgical lung biopsy showed features of unclassifiable interstitial pneumonia, characterized by various types of air-space organization, which resulted in obscure lung structure. This is the first report to describe the pathological findings of interstitial pneumonia, which may represent a rare extra-central nervous system complication of NMOSD.
Assuntos
Aquaporina 4/sangue , Soluço/complicações , Imunoglobulina G/sangue , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/etiologia , Neuromielite Óptica/sangue , Neuromielite Óptica/complicações , Idoso , Autoanticorpos/sangue , Humanos , MasculinoRESUMO
No disponible
Assuntos
Humanos , Masculino , Criança , Soluço/etiologia , Caixa Torácica/diagnóstico por imagem , Caixa Torácica/lesões , Soluço/tratamento farmacológico , Soluço/complicações , Baclofeno/uso terapêutico , Clorpromazina/uso terapêutico , Corticosteroides/uso terapêutico , Administração IntravenosaAssuntos
Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico , Soluço/complicações , Soluço/diagnóstico , Equilíbrio Postural , Transtornos de Sensação/complicações , Transtornos de Sensação/diagnóstico , Disfunção Cognitiva/diagnóstico por imagem , Diagnóstico Diferencial , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/diagnóstico por imagem , Soluço/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Sensação/diagnóstico por imagemRESUMO
Persistent singultus, hiccupping that lasts for longer than 48 hours, can have a tremendous impact on a patient's quality of life. Although involved neurologic structures have been identified, the function of hiccups remains unclear-they have been controversially interpreted as a primitive reflex preventing extent swallowing of amniotic fluid in utero, an archaic gill ventilation pattern, or a fetus' preparation for independent breathing. Persistent singultus often presents as a symptom for various diseases, most commonly illnesses of the central nervous system or gastrointestinal tract; they can also be evoked by a variety of pharmacological agents. It is often impossible to define a singular cause. A wide range of treatment attempts, pharmacological and nonpharmacological, have been concerted to this date; however, chlorpromazine remains the only Food and Drug Administration-approved drug in this context. Large-scale studies on efficacy and tolerance of other therapeutic strategies are lacking. Gabapentin, baclofen, and metoclopramide have been reported to accomplish promising results in reports on the therapy of persistent singultus; they may also be effective when given in combination with other drugs, eg, proton pump inhibitors, or as conjoined therapy. As another approach of note, acupuncture treatment was able to abolish hiccups in a number of studies. When managing hiccup patients within the clinical routine, it is of importance to conduct a comprehensive and effective diagnostic workup; a well-functioning interdisciplinary team is needed to address possible causes for the symptom. Persistent singultus is a medical problem not to be underestimated; more research on options for effective treatment would be greatly needed.
Assuntos
Anestesiologia/métodos , Soluço/complicações , Soluço/diagnóstico , Aminas/uso terapêutico , Baclofeno/uso terapêutico , Doença Crônica , Ácidos Cicloexanocarboxílicos/uso terapêutico , Gabapentina , Soluço/tratamento farmacológico , Humanos , Relaxantes Musculares Centrais/uso terapêutico , Ácido gama-Aminobutírico/uso terapêuticoRESUMO
Bronchogenic cysts are congenital lesions developing during early embryogenesis. The intradiaphragmatic location is extremely rare. We present a giant bronchogenic cyst arising from the left crus of diaphragm. Based on our literature review results, intradiaphragmatic bronchogenic cysts have the following characteristics: 1) they are more common in female patients; 2) the patients are usually asymptomatic, or present with symptoms of chest pain, abdominal pain, and hiccups; 3) the cysts located in the left diaphragm are more than those in the right diaphragm, most of which are located in the area of the left diaphragm crus.
Assuntos
Dor Abdominal/complicações , Cisto Broncogênico/patologia , Dor no Peito/complicações , Diafragma/patologia , Soluço/complicações , Adulto , Cisto Broncogênico/etiologia , Cisto Broncogênico/cirurgia , Diafragma/cirurgia , Humanos , Masculino , Adulto JovemAssuntos
Forame Oval Patente/complicações , Hemodinâmica , Soluço/fisiopatologia , Função do Átrio Esquerdo , Pressão Atrial , Cateterismo Cardíaco , Ecocardiografia , Eletrocardiografia , Forame Oval Patente/diagnóstico por imagem , Forame Oval Patente/fisiopatologia , Forame Oval Patente/terapia , Soluço/complicações , Humanos , Ataque Isquêmico Transitório/etiologia , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Soluço/etiologia , Soluço , Clorpromazina/uso terapêutico , Metoclopramida/uso terapêutico , Haloperidol/uso terapêutico , Anticoagulantes/uso terapêutico , Soluço/complicações , Soluço/tratamento farmacológico , Soluço/fisiopatologia , Tomografia Computadorizada de Emissão/instrumentação , Tomografia Computadorizada de Emissão/métodos , Embolia Pulmonar/complicações , Distúrbios do Sono por Sonolência Excessiva/induzido quimicamente , Distúrbios do Sono por Sonolência Excessiva/complicações , Tomografia por Emissão de Pósitrons , Adenocarcinoma/complicaçõesRESUMO
No disponible