Folie a Deux or shared psychotic disorder is a rare and poorly understood disorder characterized as transfer of delusional beliefs from one person, the primary patient, to another, the secondary patient, who are closely related. The disorder is mainly seen within a family, most often between spouses or between siblings, although it has been noted in other relationships. Females are more likely than males to both primary and secondary partner. We present a case of a 77-year-old female who was admitted for myasthenia gravis exacerbation with a two-day history of generalized weakness, multiple falls, decreased appetite and blurred vision. However, she also described a detailed and unbelievable story of kidnapping and extortion which, surprisingly, was validated by the patient’s younger sister. Investigation of the story by police and others confirmed it to be false. A diagnosis of shared psychotic disorder was made. The delusions appeared to occur with a rapid onset and resolution. This case highlights the unusual presentation of shared psychotic disorder in two elderly women, well outside the typical age of onset for the disorder as well as its rapid onset and resolution, rather than in the setting of a chronic psychiatric illness such as delusional disorder or schizophrenia.
Folie a Deux或共享精神障碍是一种罕见且知之甚少的障碍，其特征是将妄想信念从一个人(主要患者)转移到另一个人(次要患者)，他们是密切相关的。这种疾病主要发生在一个家庭中，最常发生在配偶之间或兄弟姐妹之间，尽管在其他关系中也有发现。女性比男性更有可能同时拥有第一和第二伴侣。我们报告一位77岁的女性，因重症肌无力加重而入院，她有2天的全身无力、多次跌倒、食欲下降和视力模糊的病史。然而，她还详细描述了一个令人难以置信的绑架和勒索的故事，令人惊讶的是，病人的妹妹证实了这一点。警方和其他人对这个故事的调查证实了它是假的。诊断为共同精神障碍。这些妄想的发作和消退似乎都很迅速。本病例突出了两名老年妇女共同精神障碍的不寻常表现，远远超出了该障碍的典型发病年龄，以及其快速发病和消退，而不是慢性精神疾病，如妄想障碍或精神分裂症。
{"title":"Case Report of Shared Psychotic Disorder or ‘Folie a Deux’ in Two Geriatric Sisters","authors":"K. Patel, A. Schindzielorz, S. Holroyd","doi":"10.21885/WVMJ.2017.19","DOIUrl":"https://doi.org/10.21885/WVMJ.2017.19","url":null,"abstract":"Folie a Deux or shared psychotic disorder is a rare and poorly understood disorder characterized as transfer of delusional beliefs from one person, the primary patient, to another, the secondary patient, who are closely related. The disorder is mainly seen within a family, most often between spouses or between siblings, although it has been noted in other relationships. Females are more likely than males to both primary and secondary partner. We present a case of a 77-year-old female who was admitted for myasthenia gravis exacerbation with a two-day history of generalized weakness, multiple falls, decreased appetite and blurred vision. However, she also described a detailed and unbelievable story of kidnapping and extortion which, surprisingly, was validated by the patient’s younger sister. Investigation of the story by police and others confirmed it to be false. A diagnosis of shared psychotic disorder was made. The delusions appeared to occur with a rapid onset and resolution. This case highlights the unusual presentation of shared psychotic disorder in two elderly women, well outside the typical age of onset for the disorder as well as its rapid onset and resolution, rather than in the setting of a chronic psychiatric illness such as delusional disorder or schizophrenia.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"35 1","pages":"2701"},"PeriodicalIF":0.0,"publicationDate":"2017-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80035155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypersensitivity pneumonitis (HP) is an inflammatory disease caused by repeated inhalation of antigens. HP can mimic a variety of clinical processes from life-threatening anaphylaxis to insidious malignancy, and thus is often misdiagnosed. It is crucial for the clinician to correlate relevant exposure to onset of symptoms, and for the radiologist to provide appropriate differential diagnoses for prompt treatment. Radiological findings, when present, may include ground glass opacities and mosaic attenuation on CT. Clinical improvement upon removal of antigen helps cement diagnosis and facilitate the treatment of antigen avoidance and corticosteroids. We present an interesting case of hypersensitivity pneumonitis, particularly Pigeon Breeder’s lung, in a young man exposed to birds in a research laboratory whose symptoms occurred much sooner than the usual timeframe reported in the literature.
{"title":"Pigeon Breeder's Lung: A case report of hypersensitivity pneumonitis","authors":"L. Winkler, Z. Patel, Racine Gue","doi":"10.21885/WVMJ.2017.20","DOIUrl":"https://doi.org/10.21885/WVMJ.2017.20","url":null,"abstract":"Hypersensitivity pneumonitis (HP) is an inflammatory disease caused by repeated inhalation of antigens. HP can mimic a variety of clinical processes from life-threatening anaphylaxis to insidious malignancy, and thus is often misdiagnosed. It is crucial for the clinician to correlate relevant exposure to onset of symptoms, and for the radiologist to provide appropriate differential diagnoses for prompt treatment. Radiological findings, when present, may include ground glass opacities and mosaic attenuation on CT. Clinical improvement upon removal of antigen helps cement diagnosis and facilitate the treatment of antigen avoidance and corticosteroids. We present an interesting case of hypersensitivity pneumonitis, particularly Pigeon Breeder’s lung, in a young man exposed to birds in a research laboratory whose symptoms occurred much sooner than the usual timeframe reported in the literature.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"55 51 1","pages":"2702"},"PeriodicalIF":0.0,"publicationDate":"2017-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80728972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prosthetic joint infections are a significant cause of morbidity and mortality, which affect only a small number of joint replacements annually. Antibiotic impregnated beads are increasingly used to combat these infections. This delivery system is believed to be safe, however, we present a case of a patient who developed severe hypercalcemia several days after implantation of calcium sulfate beads during a revision of an infected total knee athroplasty. A 70-year-old male was admitted to our institution due to infected prosthetic total knee arthroplasty. All of the patient’s pre-operative labs were within normal limits. He was taken for irrigation, debridement and poly exchange of the infected knee by orthopedics. During the procedure, 10 mL of 10 ml of calcium sulfate beads impregnated with Vancomycin and 10 mL of calcium sulfate beads impregnated with Tobramycin was implanted in the knee. Approximately 48-72 hours post-operatively, the patient became more lethargic, confused and had a poor appetite. He was found to be severely hypercalcemic at 14.0 mg/dL An extensive workup for hypercalcemia was unremarkable and the only logical explanation was tbe implanted beads. He was started on aggressive intravenous hydration with IVF and Lasix for volume control with resolution of his symptoms and hypercalcemia. He had no further occurrence of hypercalcemia during follow up period. Hypercalemia is a medical emergency seldomly encountered by internists, but requires acute interventions. This case demonstrates a possible new cause of hypercalcemia in surgical patients, antimicrobial impregnated calcium sulfate beads. Nonetheless, clinicians should be aware of this etiology of hypercalcemia, given the increased utilization of these types of treatments.
{"title":"Severe Hypercalcemia Following the Implantation of Antibiotic Impregnated Calcium Sulfate Beads for Prosthetic Joint infection","authors":"M. Forte, R. Pellegrino","doi":"10.21885/wvmj.2017.18","DOIUrl":"https://doi.org/10.21885/wvmj.2017.18","url":null,"abstract":"Prosthetic joint infections are a significant cause of morbidity and mortality, which affect only a small number of joint replacements annually. Antibiotic impregnated beads are increasingly used to combat these infections. This delivery system is believed to be safe, however, we present a case of a patient who developed severe hypercalcemia several days after implantation of calcium sulfate beads during a revision of an infected total knee athroplasty. \u0000\u0000A 70-year-old male was admitted to our institution due to infected prosthetic total knee arthroplasty. All of the patient’s pre-operative labs were within normal limits. He was taken for irrigation, debridement and poly exchange of the infected knee by orthopedics. During the procedure, 10 mL of 10 ml of calcium sulfate beads impregnated with Vancomycin and 10 mL of calcium sulfate beads impregnated with Tobramycin was implanted in the knee. Approximately 48-72 hours post-operatively, the patient became more lethargic, confused and had a poor appetite. He was found to be severely hypercalcemic at 14.0 mg/dL An extensive workup for hypercalcemia was unremarkable and the only logical explanation was tbe implanted beads. He was started on aggressive intravenous hydration with IVF and Lasix for volume control with resolution of his symptoms and hypercalcemia. He had no further occurrence of hypercalcemia during follow up period. \u0000\u0000Hypercalemia is a medical emergency seldomly encountered by internists, but requires acute interventions. This case demonstrates a possible new cause of hypercalcemia in surgical patients, antimicrobial impregnated calcium sulfate beads. Nonetheless, clinicians should be aware of this etiology of hypercalcemia, given the increased utilization of these types of treatments.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"43 1","pages":"2698"},"PeriodicalIF":0.0,"publicationDate":"2017-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73876261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nutritional status is an important, but often overlooked, component of care for patients being seen in any number of subspecialty clinics. The neurologic ramifications of nutritional deficiencies tend to present in the later stages of prolonged malnutrition. A 34 year-old woman with a history of alcoholism presented to the emergency department with two weeks of worsening gait imbalance, diffuse paresthesia, allodynia, and weakness of all extremities. The physical examination yielded diffuse loss of sensation to all sensory modalities in a length-dependent manner and complete lack of deep tendon reflexes in all extremities. There was also mild 4/5 weakness of proximal musculature of upper and lower extremities. Nerve conduction studies showed a diffuse sensorimotor axonal neuropathy that was worse in the lower extremities compared to the upper extremities. Laboratory evaluation yielded significant deficiencies that included calcium, pyridoxine, vitamin E, folate, borderline low thiamine, and elevated homocysteine levels. This was a unique case of severe malnutrition manifesting as an acute diffuse axonal neuropathy. Lower socioeconomic status with concurrent alcohol use can lead to a bevy of neurologic conditions as seen in our patient.
{"title":"A Case of Significant Malnutrition Presenting as Acute Sensorimotor Axonal Neuropathy","authors":"Vincent Arnone, S. Sultan","doi":"10.21885/WVMJ.2017.17","DOIUrl":"https://doi.org/10.21885/WVMJ.2017.17","url":null,"abstract":"Nutritional status is an important, but often overlooked, component of care for patients being seen in any number of subspecialty clinics. The neurologic ramifications of nutritional deficiencies tend to present in the later stages of prolonged malnutrition. A 34 year-old woman with a history of alcoholism presented to the emergency department with two weeks of worsening gait imbalance, diffuse paresthesia, allodynia, and weakness of all extremities. The physical examination yielded diffuse loss of sensation to all sensory modalities in a length-dependent manner and complete lack of deep tendon reflexes in all extremities. There was also mild 4/5 weakness of proximal musculature of upper and lower extremities. Nerve conduction studies showed a diffuse sensorimotor axonal neuropathy that was worse in the lower extremities compared to the upper extremities. Laboratory evaluation yielded significant deficiencies that included calcium, pyridoxine, vitamin E, folate, borderline low thiamine, and elevated homocysteine levels. This was a unique case of severe malnutrition manifesting as an acute diffuse axonal neuropathy. Lower socioeconomic status with concurrent alcohol use can lead to a bevy of neurologic conditions as seen in our patient.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"32 1","pages":"2697"},"PeriodicalIF":0.0,"publicationDate":"2017-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88436975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lung cancer remains the leading cause of cancer related death in America. The national prevalence of lung cancer is 59.1 per 100,000; however, the state of West Virginia has a higher reported prevalence of 79.1 per 100,000. Small cell lung carcinoma (SCLC) accounts for 10-15% of total lung carcinomas. The syndrome of inappropriate antidiuretic hormone (SIADH) is a well-documented paraneoplastic syndrome associated with SCLC. We present a case of a 60-year-old female with greater than a 90 pack-year smoking history who presented with symptomatic hyponatremia. Throughout her multiple hospital admissions, she received numerous chest x rays, all of which initially revealed no lung pathology. This ultimately delayed her cancer diagnosis until a more thorough workup of her SIADH etiology was performed.
{"title":"Symptomatic Hyponatremia as the Initial Presentation of Small Cell Lung Carcinoma: A Case Report of Delayed Diagnosis","authors":"Ciara A. Brown, Dolat Singh","doi":"10.21885/WVMJ.2017.16","DOIUrl":"https://doi.org/10.21885/WVMJ.2017.16","url":null,"abstract":"Lung cancer remains the leading cause of cancer related death in America. The national prevalence of lung cancer is 59.1 per 100,000; however, the state of West Virginia has a higher reported prevalence of 79.1 per 100,000. Small cell lung carcinoma (SCLC) accounts for 10-15% of total lung carcinomas. The syndrome of inappropriate antidiuretic hormone (SIADH) is a well-documented paraneoplastic syndrome associated with SCLC. We present a case of a 60-year-old female with greater than a 90 pack-year smoking history who presented with symptomatic hyponatremia. Throughout her multiple hospital admissions, she received numerous chest x rays, all of which initially revealed no lung pathology. This ultimately delayed her cancer diagnosis until a more thorough workup of her SIADH etiology was performed.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"21 1","pages":"2692"},"PeriodicalIF":0.0,"publicationDate":"2017-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85924686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam Adam Schindzielorz, MD, D. Scott Murphy, MD, Suzanne Holroyd, MD
Musical hallucinations have been likened to the auditory equivalent of Charles Bonnet Syndrome, which involves complex visual hallucinations, most often in the context of visual impairment. Musical hallucination frequently take the form of hymns, carols, and show-tunes and are strongly associated with hearing loss, with some studies suggesting a prevalence of 2.5–3.6% in the hearing impaired. Musical hallucinations are typically treated with anticonvulsant and anticholinesterase medications, with some studies having evaluated the efficacy of sedative hypnotics, antipsychotics and antidepressants in various psychiatric and medical subpopulations suggesting a heterogeneous spectrum of causes for this disorder. We present two cases of musical hallucinations in both a 70-year-old African American female with past psychiatric history of major depressive disorder who developed hymnal auditory hallucinations during an acute medical and psychiatric admission and an 86-year-old Caucasian female, who complained of hearing gospel music with eventual onset of visual hallucinations after a fall at age 80. Our patients were successfully treated in both the inpatient and outpatient settings with atypical antipsychotics. The presented cases add to the paucity of literature regarding utilization of atypical antipsychotics for treatment of musical hallucinations and demonstrate efficacy to this effect. This study lends further validity to the use of psychopharmacologic agents for novel purposes that have yet to be fully explored.
{"title":"Musical Hallucinations Treated with Atypical Antipsychotics in a Geriatric Population – A Case Series","authors":"Adam Adam Schindzielorz, MD, D. Scott Murphy, MD, Suzanne Holroyd, MD","doi":"10.21885/WVMJ.2017.15","DOIUrl":"https://doi.org/10.21885/WVMJ.2017.15","url":null,"abstract":"Musical hallucinations have been likened to the auditory equivalent of Charles Bonnet Syndrome, which involves complex visual hallucinations, most often in the context of visual impairment. Musical hallucination frequently take the form of hymns, carols, and show-tunes and are strongly associated with hearing loss, with some studies suggesting a prevalence of 2.5–3.6% in the hearing impaired. Musical hallucinations are typically treated with anticonvulsant and anticholinesterase medications, with some studies having evaluated the efficacy of sedative hypnotics, antipsychotics and antidepressants in various psychiatric and medical subpopulations suggesting a heterogeneous spectrum of causes for this disorder.\u0000\u0000We present two cases of musical hallucinations in both a 70-year-old African American female with past psychiatric history of major depressive disorder who developed hymnal auditory hallucinations during an acute medical and psychiatric admission and an 86-year-old Caucasian female, who complained of hearing gospel music with eventual onset of visual hallucinations after a fall at age 80. Our patients were successfully treated in both the inpatient and outpatient settings with atypical antipsychotics. \u0000\u0000The presented cases add to the paucity of literature regarding utilization of atypical antipsychotics for treatment of musical hallucinations and demonstrate efficacy to this effect. This study lends further validity to the use of psychopharmacologic agents for novel purposes that have yet to be fully explored.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"10 6 1","pages":"2690"},"PeriodicalIF":0.0,"publicationDate":"2017-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74776625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cryoglobulins are proteins that form ‘cloudy’ precipitates at temperatures <37°C. In type I cryoglobulinemia, the causative protein is a monoclonal immunoglobulin due to an underlying plasma cell dyscrasia. Cryoglobulinemia can present with hyperviscosity syndrome, characterized by headache, fatigue, and blurred vision. In episodes of severe cryoglobulinemia, premature precipitation of proteins can lead to falsely negative diagnostic tests and complications with treatment. The following case exemplifies the complications of diagnosis and treatment of cryoglobulinemia with hyperviscosity syndrome.
{"title":"A Curious Case of Multiple Myeloma Hidden in a Cloud of Severe Cryoglobulinemia","authors":"N. Fei, A. Kanate","doi":"10.21885/wvmj.2017.14","DOIUrl":"https://doi.org/10.21885/wvmj.2017.14","url":null,"abstract":"Cryoglobulins are proteins that form ‘cloudy’ precipitates at temperatures <37°C. In type I cryoglobulinemia, the causative protein is a monoclonal immunoglobulin due to an underlying plasma cell dyscrasia. Cryoglobulinemia can present with hyperviscosity syndrome, characterized by headache, fatigue, and blurred vision. In episodes of severe cryoglobulinemia, premature precipitation of proteins can lead to falsely negative diagnostic tests and complications with treatment. The following case exemplifies the complications of diagnosis and treatment of cryoglobulinemia with hyperviscosity syndrome.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"1 1","pages":"2687"},"PeriodicalIF":0.0,"publicationDate":"2017-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84035742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Facog David C. Jude, P. Nieuwenhuizen, Bs Benjamin D. Jude, Facog Brenda Mitchell
West Virginia leads the nation in death rates due to opioid abuse. Providing naloxone to people who use drugs, their friends, and families has been shown to decrease the number of deaths from overdose. In 2016, West Virginia passed legislation allowing access to naloxone (Narcan®) without a prescription. We report on the knowledge and availability of naloxone in a cohort of pregnant women in a medication assisted treatment program. Twenty-six consecutive opioid addicted gravidas enrolling in a medication assisted treatment program were queried regarding their knowledge about and access to naloxone. They were also asked if they lived with or were frequently around people who use drugs without a prescription. Of the twenty-six respondents, twenty-four (92.3%) either lived in a home or had regular contact with someone who used drugs obtained illegally. Twenty-three (88.5%) had knowledge of naloxone. Only two (7.7%) reported knowing how to access naloxone. In our small sample size, people at the highest risk of needing naloxone to prevent overdose in themselves or close contacts did not know how to obtain naloxone.
{"title":"Women In An Opioid Addiction Treatment Program Do Not Know How To Obtain Naloxone","authors":"Facog David C. Jude, P. Nieuwenhuizen, Bs Benjamin D. Jude, Facog Brenda Mitchell","doi":"10.21885/WVMJ.2017.13","DOIUrl":"https://doi.org/10.21885/WVMJ.2017.13","url":null,"abstract":"West Virginia leads the nation in death rates due to opioid abuse. Providing naloxone to people who use drugs, their friends, and families has been shown to decrease the number of deaths from overdose. In 2016, West Virginia passed legislation allowing access to naloxone (Narcan®) without a prescription. We report on the knowledge and availability of naloxone in a cohort of pregnant women in a medication assisted treatment program. Twenty-six consecutive opioid addicted gravidas enrolling in a medication assisted treatment program were queried regarding their knowledge about and access to naloxone. They were also asked if they lived with or were frequently around people who use drugs without a prescription. Of the twenty-six respondents, twenty-four (92.3%) either lived in a home or had regular contact with someone who used drugs obtained illegally. Twenty-three (88.5%) had knowledge of naloxone. Only two (7.7%) reported knowing how to access naloxone. In our small sample size, people at the highest risk of needing naloxone to prevent overdose in themselves or close contacts did not know how to obtain naloxone.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"15 1","pages":"1880"},"PeriodicalIF":0.0,"publicationDate":"2017-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86299824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cognitive impairment is a critically important clinical occurrence, but because symptoms may be subtle, it can be overlooked. Conversation about identifying cognitive impairment in the acute care setting often becomes sidetracked by efforts to choose the best screening tool or protocol, with little attention paid to the very first step – recognition that impairment is present. We review how this important problem may not always be detected, documented, and dealt with, and suggest a simple approach to ensuring that affected patients are not missed. This project entails utilizing an old concept in an innovative way. Working with the well-known principle of Universal Precautions, i.e., assuming that any and all body fluids may be contaminated, we refashion the idea into “Universal Observations”, a way of recognizing that any and all acutely ill persons may have cognitive impairment. Additionally, we demonstrate application of the phrase “If you see something, say something” to the hospital environment.
{"title":"A Pilot Program to Improve Recognition of Cogntive Impairment in Acute Care","authors":"S. Neitch, Carolyn Canini, R. Edwards, Jane Marks","doi":"10.21885/wvmj.2017.12","DOIUrl":"https://doi.org/10.21885/wvmj.2017.12","url":null,"abstract":"Cognitive impairment is a critically important clinical occurrence, but because symptoms may be subtle, it can be overlooked. Conversation about identifying cognitive impairment in the acute care setting often becomes sidetracked by efforts to choose the best screening tool or protocol, with little attention paid to the very first step – recognition that impairment is present. We review how this important problem may not always be detected, documented, and dealt with, and suggest a simple approach to ensuring that affected patients are not missed. \u0000\u0000This project entails utilizing an old concept in an innovative way. Working with the well-known principle of Universal Precautions, i.e., assuming that any and all body fluids may be contaminated, we refashion the idea into “Universal Observations”, a way of recognizing that any and all acutely ill persons may have cognitive impairment. Additionally, we demonstrate application of the phrase “If you see something, say something” to the hospital environment.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"20 1 1","pages":"1865"},"PeriodicalIF":0.0,"publicationDate":"2017-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78291735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kinjan P Patel, P. Farjo, Ahmed Almustafa, J. Mills
Introduction: A complex atheroma of the aortic arch puts a patient at risk for an embolic stroke. We present a patient with no cardiac history who came with acute stroke-like symptoms from a large, complex aortic atheroma. Case presentation: A 60-yearold woman with known thoracic aortic aneurysm presented with acute right-sided weakness. An MRI of the brain showed a left middle cerebral artery (MCA) embolic stroke. A CT angiogram (CTA) showed the known, stable thoracic aneurysm and concern for type A aortic dissection. Later gated CT scan revealed a focal filling defect in the proximal aortic arch, compatible with a floating thrombus. A transesophageal echocardiogram (TEE) then demonstrated a 18mm by 14mm, highly mobile atheroma in this area. Specialty team concluded that the stroke was due to the atheroma and suggested anticoagulation and statin therapy. Discussion: A large and mobile aortic atheromas are recognized as a potential cause of embolic events in the elderly population. These patients will benefit from an anticoagulation and statin therapy to reduce the risk of stroke recurrence. Conclusion: A complex aortic atheroma is likely an independent risk factor for embolic stroke and may be an indication for prophylactic anticoagulation and statin therapy.
{"title":"Large highly mobile complex ascending aortic atheroma causing left middle cerebral artery stroke in patient without any history of cardiac disease.","authors":"Kinjan P Patel, P. Farjo, Ahmed Almustafa, J. Mills","doi":"10.21885/WVMJ.2017.10","DOIUrl":"https://doi.org/10.21885/WVMJ.2017.10","url":null,"abstract":"Introduction: A complex atheroma of the aortic arch puts a patient at risk for an embolic stroke. We present a patient with no cardiac history who came with acute stroke-like symptoms from a large, complex aortic atheroma. Case presentation: A 60-yearold woman with known thoracic aortic aneurysm presented with acute right-sided weakness. An MRI of the brain showed a left middle cerebral artery (MCA) embolic stroke. A CT angiogram (CTA) showed the known, stable thoracic aneurysm and concern for type A aortic dissection. Later gated CT scan revealed a focal filling defect in the proximal aortic arch, compatible with a floating thrombus. A transesophageal echocardiogram (TEE) then demonstrated a 18mm by 14mm, highly mobile atheroma in this area. Specialty team concluded that the stroke was due to the atheroma and suggested anticoagulation and statin therapy. Discussion: A large and mobile aortic atheromas are recognized as a potential cause of embolic events in the elderly population. These patients will benefit from an anticoagulation and statin therapy to reduce the risk of stroke recurrence. Conclusion: A complex aortic atheroma is likely an independent risk factor for embolic stroke and may be an indication for prophylactic anticoagulation and statin therapy.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75312016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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