CASE PRESENTATION: We present a case of a 13-year-old girl who initially presented with headaches, followed by episodic complex-partial seizures; which was controlled via medication. She also had right sided hemiparesis. Computed tomography (CT) showed evidence of left parieto-temporal infarct with cerebral atrophy. Complementary magnetic resonance imaging (MRI) did not reveal additional information. Workup for young stroke was negative. Upon further evaluation by Neuroradiology, features suggesting Dyke-Davidoff-Masson syndrome were confirmed. Patient has been under Neurology follow up since.
CONCLUSIONS: Due to its rarity, Dyke-Davidoff-Masson syndrome may easily be missed by the majority of treating clinicians. Knowledge of its features on imaging enables timely and accurate diagnosis - allowing appropriate management.
CASE PRESENTATION: We report a patient who developed overt lupus nephritis after consuming a course of herbal supplement. Her renal status did not improve upon cessation of the offending drug, and she required immunosuppressive therapy. After one cycle of IV cyclophosphamide, we managed to get the patient into remission - she is now on tapering doses of steroids.
CONCLUSION: We wish to highlight the possibility of consumption of herbal medication and the emergence of drug-induced lupus nephritis. A thorough anamnesis and high index of suspicion of drug-induced lupus nephritis is warranted when a patient on supplements presents with urinary abnormalities.
Methods: Retrospective cross-sectional study conducted in Hospital Serdang, Malaysia. We included end-stage renal disease (ESRD) patients who opted for PD and examined catheter-related infections (peritonitis, exit site infection, and tunnel tract infection) and organisms causing these infections.
Results: We included 126 patients in this study; 75 patients received the coiled PD catheter (59.5%) and 51 patients received the straight PD catheter (40.5%). The majority of patients were young, under the age of 65 years old (77.3% and 72.5%) in the coiled and straight PD catheter group, respectively, and the main cause of ESRD was diabetes mellitus in both groups (78.7% vs. 92.2%). The demographic and anthropometric data were similar between both groups. Peritonitis rate (0.29 episodes/patient-years vs. 0.31 episodes/patient-years, P value = 0.909), exit site infection rate (0.31 episodes/patient-year vs. 0.37 episodes/patient-year, P value = 0.730), and tunnel tract infection rate (0.02 episodes/patient-year, P value = 0.430) were similar in the coiled versus straight PD catheter groups. The predominant organism causing peritonitis was the gram-negative organism; Escherichia coli and Klebsiella pneumoniae. In exit site and tunnel tract infections, there is a predominance of gram-negative organisms; Pseudomonas aeruginosa and K. pneumoniae.
Conclusions: There was no difference in infectious outcomes between the two different types of catheters. Type of organism in both groups was gram-negative.
METHODS: We retrospectively analyzed one-year data from our stroke registry that began with the establishment of our hyperacute stroke service at Universiti Putra Malaysia Teaching Hospital from April 2020 until May 2021.
RESULTS: Setting up acute stroke services during the pandemic with constrained manpower and implementation of COVID-19 SOPs, was challenging. There was a significant dip of stroke admission from April to June 2020 due to the Movement Control Order (MCO) implemented by the government to curb the spread of COVID-19. However, the numbers of stroke admission steadily rose approaching 2021, after the implementation of recovery MCO. We managed to treat 75 patients with hyperacute stroke interventions i.e. intravenous thrombolysis (IVT), mechanical thrombectomy (MT) or both. Despite implementing COVID-19 SOPs and using magnetic resonance imaging (MRI) as our first line acute stroke imaging modality, clinical outcomes in our cohort were encouraging; almost 40% of patients who underwent hyperacute stroke treatment had early neurological recovery (ENR), and only 33% of patients had early neurological stability (ENS). In addition, we were able to maintain our door-to-imaging (DTI) and door-to-needle (DTN) time in line with international recommendations.
CONCLUSIONS: Our data reflects that COVID-19 SOPs did not deter successful delivery of hyperacute stroke services in our center. However, bigger and multi center studies are required to support our findings.
CASE PRESENTATION: We report a rare case of a young female, with underlying Evans syndrome, who was initially thought to have non-hemorrhagic stroke, eventually diagnosed having isolated non-traumatic, non-aneurysmal convexal subarachnoid haemorrhage.
CONCLUSIONS: Spontaneous non-traumatic, non-aneurysmal convexal subarachnoid hemorrhage is a rare entity - of which there are multiple possible etiologies.