Case report: MRI findings of acute uremic encephalopathy in a 1-year-old boy

We present a 1-year-old boy who presented to the emergency department with a 7-day history of diarrhoea and vomiting. The initial renal function profile demonstrated a urea of 55 mmol l−1 (normal range between 5 and 20 mmol l−1), creatinine 695 micromol/L (normal range between 62–106 micromol/L) and potassium 9.1 mmol l−1 (normal range between 3.5–5.0 mmol l−1), with a profound metabolic acidosis. Upon examination, there were no significant findings, specifically no neurological abnormality. He was prescribed back-to-back Salbutamol nebulisers, to increase the shift of extracellular potassium into the intracellular space, followed by i.v. calcium gluconate, with some improvement in potassium levels. A further 5 mmol of sodium bicarbonate was given, as well as a stat dose of 1 mg/kg furosemide, and per rectal calcium resonium. He was then commenced on an infusion with 10% dextrose with insulin. He was subsequently found to be in urinary retention and a catheter was inserted, which drained 1700 ml. A subsequent renal function profile, 24 hours after admission, demonstrated improvement with urea 39 mmol l−1, creatinine 300 micromol/L and potassium 3.0 mEq/L.

MRI Brain Documentation

In many clinical cases, a patient may come to the hospital with a neurological abnormality. This patient happen to have a normal brain MRI study that is recorded on the Picture Archiving and Communicating system (PACs) of that hospital. The previous normal study will help in identifying any pathology take place in the future easily. What if all the patients did have a previous studies for the brain as some kind of documentation? It will help a lot. The aim of this paper is to propose a new idea that required for all the citizens in a country to have a normal brain MRI study recorded on their medical file and this MRI study updated every five years by undertaking an MRI scan. The usefulness of this idea can be imply in different ways. For example; when a patient affected by any type of neurological issue, we have a morphological documentation for the brain prior to that neurological event took a place. As well, this is will provide a database for researchers to find pre and post neurological event documentation. Furthermore, it will help in detecting and documenting senile atrophic changes over the time. Sometime patients will have a “silent stroke” which has no symptoms which can be detected by the brain MRI scan.

One More Twist ~ Knowledge How and Ability

According to Bengson et al.’s (2009) Salchow case, Irina is a novice skater who (1) has a mistaken belief about what amounts to a Salchow, but also (2) has a neurological abnormality which, unknowingly to her, affects both her movement and her sense of it. As a result of this twist, she (3) always ends up succeeding in jumping the Salchow whenever she tries. This story was presented as a counterexample to a variant of anti-intellectualism, and as Bengson and colleagues expected, the vast majority of participants in their survey judged both that Irina is able to do the Salchow and that she does not know how to do it. But the three conditions above leave some ambiguity about the story. That is whether Irina is aware of her own ability, or whether she is aware of what she is doing when she performs it, and therefore the fact that she can reliably perform the Salchow. However, as we report here, disambiguating this point will radically change the responses of people, which rather poses a serious challenge to intellectualism.

Functional Neurological Symptom Disorder: A Diagnostic Algorithm

Functional neurological symptom disorder (FNSD) is a neuropsychiatric disorder characterized by the presence of neurological symptoms in the absence of any neurological abnormality that can be linked to a known pathology. Few studies have taken interest in this subject probably because of the heterogeneity of results. It is most often a diagnosis of exclusion which often means that patients undergo many tests and find themselves erring for a diagnosis with very little satisfaction of the outcomes. A reliable imagery pattern would therefore provide some relief and confirmation for both patients and clinicians. It could also facilitate acceptation of the diagnosis and reduce the societal cost associated with FNSD for the patient. The aim of this present study was to describe a clinicoradiological correspondence algorithm of FNSD using the PET scan and SPECT scan (PoSPs) and grant the clinician with a reliable tool to facilitate the diagnosis of FNSD. A systematic review according to the 2009 PRISMA criteria statement was used to guide the review. Our study included 3 of our own consenting patients who met the Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria as well as 25 other patients from 7 different studies. Our results showed a hypoactivation with poor clinicoradiological correspondence and poor stability in time. This hypoactivation was mostly in the frontal lobe, which could explain some behavioral alterations. These findings oppose the ones found in organic pathologies and therefore should orient towards FNSD. In the light of these findings, we recommend the clinicians to perform two PoSPs, searching for clinicoradiological lack of correspondence and time stability using our algorithm.

Acute Calcification of Intervertebral Disc and Posterior Longitudinal Ligament in a 7-Year-Old Girl: A Case Report

A 7-year-old girl presented with a 2-day history of acute neck pain without any preceding injury. The pain was around the left posterior paraspinal muscle and was aggravated by neck movement. There was no neurological abnormality; white cell count and inflammatory markers were slightly elevated. Radiology of the cervical spine showed calcification of C3/4 and C4/5 discs as well as the posterior longitudinal ligament over C3/4. She was treated conservatively with a neck collar and Panadol syrup. No non-steroidal anti-inflammatory drug was prescribed. Two months later, calcification of the posterior longitudinal ligament had resolved and calcification at C3/4 and C4/5 discs and the C4 lower endplate had decreased. After one year, she was pain-free with no tenderness over her neck and had full range of neck motion and complete resolution of the calcification.

Suspected neospora-associated myocarditis in a dog

Neosporosis was diagnosed in an American Staffordshire Terrier with collapse and arrhythmia episodes by serological and cardiovascular examination. Clinical signs, diagnosis and treatment ofNeospora caninumare described. The dog did not develop any neurological abnormality, which is the most common manifestation. Furthermore, the dog was also serologically positive for antibodies toToxoplasma gondiiand negative forBartonella henselaeandBorrelia burgdorferi. Serological diagnosis was achieved by indirect immunofluorescence. The arrhythmia, cardiac markers, biochemistry, complete blood count and clinical signs gradually improved following therapy with clindamycin and antiarrhythmic therapy. After 3 months of therapyToxoplasma gondiititres persisted low butNeospora caninumtitres changed to negative values. According to the veterinary literature and to the authors’ knowledge this was one of the few cases successfully treated for this condition. These observations demonstrated that neosporosis should be considered in the differential diagnosis of myocarditis in dogs and can be successfully treated by supportive therapy and clindamycin.

Femoral nerve entrapment in a dog with diffuse idiopathic skeletal hyperostosis

SummaryObjective: To report femoral neuropathy caused by nerve entrapment associated with diffuse idiopathic skeletal hyperostosis (DISH).Study Design: Case report.Animal: Seven-year-old female spayed Boxer dog.Results: Entrapment of the right femoral nerve due to DISH caused a femoral nerve deficit and atrophy of muscle groups associated with the affected nerve. A combination of computed tomography and magnetic resonance imaging was performed to provide a diagnosis. Amputation of the right transverse process of the sixth lumbar vertebra at the level of nerve entrapment relieved the neurological abnormality.Conclusions: Nerve entrapment leading to neurapraxia may occur concurrently with DISH and surgery in this case was successful in restoring function.Clinical relevance: Peripheral neuropathy from nerve entrapment should be considered in patients with DISH. Surgical amputation of impinging osseous structures may be indicated for relief of femoral neuropathy.