Abstract Hypertensive brainstem encephalopathy is an unusual form of hypertensive encephalopathy, resulting from failure of autoregulation of the cerebral blood flow causing vasogenic edema of ...brainstem, is a medical emergency. Hypertensive brainstem encephalopathy may share similar clinical manifestations with other etiologies involving the brainstem such as central pontine myelinolysis or acute pontine infarcts. However, misdiagnosis by the emergency physicians results in an inappropriate treatment and may lead to permanent neurologic deficits or even death. We present a diagnostic pitfall of hypertensive brainstem encephalopathy in an 84-year-old woman with a 2-day history of altered consciousness and an initial misdiagnosis as central pontine myelinolysis. This case report aims to raise red flags suggesting that when hyponatremia with coconmitant hypodense brainstem abnormailties detected by cranial computed tomography but with poor responses to reversal of electrolyte imbalances are encountered in acute delirium individuals, the rare possibility of hypertensive brainstem encephalopathy should be considered in the differential diagnosis to avoid inappropriate treatment. Magnetic resonance imaging sequences may be critical in the timely diagnosis and management of these patients sharing similar clinical features.
On the next day after presentation, the patient gradually became stuporous and rapidly comatose following a generalized tonic-clonic seizure. Because potential airway compromise and oxygen ...desaturation, emergency endotracheal intubation with continuous mechanical ventilation was performed. ...in cases involving with progressive neurological dysfunction resembling infectious meningoencephalitis but with poor responses to empiric antimicrobial agents, LMC should be considered in the differential diagnosis even if the patients have no known malignancy.
Background We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients. Methods From the Taiwan Stroke Registry data, we identified 46,770 ...ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013. Results Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of <120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval CI = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of <120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Conclusions Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or <120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.
