Parkinsonism caused by adverse drug reactions: a case series

<p>Abstract</p> <p>Introduction</p> <p>Parkinsonism puts a high direct cost burden on both patient and caregiver. Several reports of drug-induced parkinsonism have been published, but to the best of our knowledge, there has not been any report of quinine or halothane inducing parkinsonism.</p> <p>Case presentation</p> <p>We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29-year-old black Nigerian woman and to halothane in a 36-year-old black Hausa (Nigerian) man who received it as general anaesthesia for appendicectomy in our teaching hospital.</p> <p>Conclusion</p> <p>These are two unusual cases of parkinsonism caused by adverse drug reactions to high-dose quinine and to halothane as general anaesthesia. We consider that these two cases are important in bringing this potential side-effect to the attention of both pharmacologists and primary care physicians as these are two of the most commonly used medications in our clinics. We conclude that parkinsonism should be included among the adverse drug reactions to high-dose quinine and halothane general anaesthetic.</p

Acute Embolic Stroke as the Sole Presentation of Infective Endocarditis in Mitral Valve Prolapse

Case : A 43 yo. male was hospitalized with acute drowsiness and left-sided hemiparesis. Stroke was confirmed by head CT scan. Diagnosis of definite infective endocarditis (IE) was made by 1 major criterion (vegetation at mitral valve on echocardiography) and 3 minor criteria (mitral valve prolapse, persistent fever, and stroke). However, blood cultures were negative presumably due to early antibiotics administration. He was treated with parenteral antibiotics for 10 days, and continued with outpatient parenteral antibiotic therapy (OPAT). A clinical improvement was observed. Conclusion: Acute stroke can be an early manifestation of IE without any cardiac symptoms.Kasus :Laki-laki 43 tahun masuk rumahsakit dengan penurunan kesadaran dan hemiparesis sinistra. CT scan kepala sesuai gambaran stroke nonhemoragik. Diagnosis endokarditis infektif berdasarkan kriteria Duke yaitu 1 kriteria mayor (vegetasi katup mitral pada ekokardiografi) dan 3 kriteria minor (prolapsus katup mitral sebagai faktor predisposisi, demam menetap, dan stroke). Hasil kultur darah negatif dapat disebabkan pemberian antibiotik dini. Pasien diterapi dengan antibiotik parenteral selama 10 hari di rumahsakit dilanjutkan pada rawat jalan. Kondisi klinis pasien membaik. Simpulan: Stroke akut dapat merupakan manifestasi awal endokarditis infektif, meskipun tanpa keluhan jantung