BMJ Case Reports最新文献

A man in his 50s, normally fit and well, had an ischaemic thalamic stroke confirmed on MRI, manifesting with left-sided weakness, numbness and ataxia. Admission BP was 254/150 mm Hg. All tests for secondary hypertension were normal. After 72 hours as an inpatient, starting antihypertensives reduced the systolic BP to 170 mm Hg; however, after discharge, his BP rose again and remained persistently high despite up-titration of antihypertensives to five medications. After further questioning, the patient revealed an average daily consumption of eight cans of energy drink, each containing 160 mg caffeine, a habit which had not been specifically asked about during admission. On cessation of this consumption, his BP normalised and antihypertensives were successfully withdrawn. This article explores what we can learn from this case about whether energy drink consumption could be a risk factor for stroke and cardiovascular disease, and therefore the importance of targeted questioning in clinical practice, and greater public awareness.

Primary bladder perivascular epithelioid cell tumours (PEComas) are rare tumours that typically present in the third or fourth decade of life. Radiological and histopathological findings play a crucial role in establishing the diagnosis, and treatment is primarily based on surgical excision. We present the case of a primary bladder PEComa in an early adolescent male presenting with macroscopic haematuria and a hypervascular bladder mass. These peculiar symptoms should prompt consideration of the rare diagnosis of PEComa, even in paediatric patients.

A woman in her 30s with a history of simple trachelectomy and permanent cervical cerclage for stage IA1 cervical cancer presented with a missed miscarriage at 9 weeks gestation following IVF pregnancy. After a review of the literature and a failed medical management of miscarriage, a multidisciplinary decision was made to continue a prolonged expectant management protocol. The patient's primary priority was the preservation of her fertility potential to facilitate future IVF following miscarriage resolution. Surgical approach to miscarriage management was considered with a high risk of complications including perforation, removal of cerclage and hysterectomy; therefore, this option was to be avoided unless absolutely necessary. Over a 7-month period with regular ultrasound follow-up we demonstrated gradual resolution with clearance of all products of conception 7 months from initial diagnosis. She remained clinically well throughout this process. This case highlights the challenges of managing early pregnancy failure in patients with a history of trachelectomy and supports the role of prolonged conservative management and individualised care plans.

Acute necrotising encephalopathy (ANE) of childhood is a rare, rapidly progressive and often fatal form of encephalopathy characterised by distinctive clinical and neuroradiological features. It typically presents with a sudden and progressive alteration of consciousness, along with the characteristic finding of multifocal, symmetric lesions involving the thalami, brainstem, cerebellum and cerebral white matter. Although its exact pathogenesis remains unclear, it is thought to result from a cytokine storm triggered by viral infections, leading to blood-brain barrier disruption and brain injury. There is currently limited evidence on optimal treatment and no established consensus to standardise management. This case series presents three paediatric cases of influenza A-associated ANE, all of whom initially exhibited mild neurological symptoms but rapidly deteriorated to coma and death. These cases highlight the urgent need for further research and the development of standardised treatment guidelines for this severe and under-recognised condition.

Subacute bacterial endocarditis is often associated with non-specific symptoms and multi-system embolic phenomena that can make diagnosis difficult. We present a case of Aggregatibacter actinomycetocomitans (Aa) prosthetic valve endocarditis, initially causing a transient ischaemic attack, inflammatory arthropathy, then intracerebral haemorrhage, the latter leading to diagnosis. Aa should be suspected in prosthetic valve recipients with sequential onset of inflammatory arthropathy and cerebrovascular disease.

Most common pathologies resulting in shoulder pain are usually a consequence of degenerative, traumatic or metabolic aetiologies involving various structures around the shoulder. Benign tumours leading to pain and functional disturbance in the shoulder are rare. We report a case of a man in his 20s who presented with shoulder pain that remained unresolved for 1.5 years. Clinical examination revealed no signs of instability related to labral or rotator cuff injury. A plain radiograph of the shoulder revealed sclerosis in the coracoid process. A CT scan of the shoulder showed a nidus at the base of the coracoid, confirming the diagnosis of osteoid osteoma. He was managed by arthroscopic excision of the lesion. Postoperatively, he was able to return to all his activities within 3 months. At 1 year follow-up, no recurrence was observed.

Due to the implementation of stricter regulations in many countries, carisoprodol toxicity is an increasingly uncommon presentation to the emergency department. However, it remains a potential drug of abuse due to its low price, availability and ability to modulate GABA-A. Others have reported presentations that challenge the GABAergic mechanism of carisoprodol. Here, we present a case of serotonin syndrome with carisoprodol holding a pivotal role. This case highlights the potential serotonergic activity of carisoprodol which contradicts the agent's supposed GABAergic mechanism of action.

This report describes the case of a woman in her 40s who developed debilitating knee pain and instability 1 year after undergoing an anterior cruciate ligament reconstruction. MRI revealed a complex pathology, including marked widening of both the femoral and tibial bone tunnels, significant perigraft cyst formation, a complete posterior root tear of the medial meniscus with extrusion and a partial tear of the lateral meniscal root. This indicated a functional failure of the primary reconstruction, leading to secondary intra-articular damage. A staged surgical approach was planned with an open excision of the proximal tibial tunnel cyst with meticulous curettage of the tunnel walls, combined with an arthroscopic all-inside repair of the medial meniscus. Substantial bone loss was addressed with autologous iliac crest bone graft. The patient experienced an uneventful recovery with significant symptomatic improvement, evidence-based approach to managing complex postoperative anterior cruciate ligament reconstruction complications.

Vesicovaginal fistula (VVF) is one of the most common iatrogenic complications of pelvic surgery. Giant VVFs reported in the literature that were successfully repaired were done transabdominally or using a combination of different approaches. This study presents a giant VVF that was successfully repaired transvaginally. This is a case of a female who came in for continuous vaginal leakage which presented 3 weeks after a total hysterectomy. Physical examination revealed a 6.0×3.0 cm vaginal defect. The patient underwent Latzko repair of vesicovaginal fistula with peritoneal flap interposition. The patient had a successful repair and remained continent for 13 months on follow-up. Fistula size alone may not necessarily be a single determinant in the route of fistula repair. With surgical experience and other complex factors ruled out, successful vaginal repair of giant vesicovaginal fistulas proves to be possible.

This study describes a case of an umbilical cord haemangioma diagnosed during a first-trimester ultrasound examination in the 13th week of gestation. The anomaly initially presented as a double cystic lesion located in the mid-portion of the umbilical cord. Subsequent ultrasound scans revealed a hyperechoic solid structure within the cystic lesion near the umbilical vessels, and an umbilical cord haemangioma was suspected. Given the possible fetal complications related to the growth of the lesion, serial ultrasound examinations with detailed Doppler flow studies of the lesion were performed. The pregnancy progressed without complications, and the patient underwent elective caesarean delivery at term. The histopathological examination of the cord confirmed a benign capillary haemangioma with pseudocystic degeneration of Wharton's jelly. Postnatally, a small cutaneous haemangioma was noted on the scalp of the newborn.