Trombosis venosa profunda de repetición en miembros superiores

Deep vein thrombosis in the upper limbs is a rare disease. It can be idiopathic or secondary to neoplasms, devices (catheters, pacemakers), or thrombophilia. We describe an unusual case of recurrent deep vein thrombosis in the upper limbs and its association with sternoclavicular hyperostosis. Our studies confirmed a mediastinal mass with negative histopathological results for neoplasia but positive for fibrosis. After starting anticoagulation, the clinical condition was resolved, and we ruled out oncological, infectious, and thrombophilic diseases. Therefore, we assumed focal fibrous mediastinitis as the cause of recurrent thrombosis and clavicular hyperostosis syndrome.La trombosis venosa profunda en miembros superiores es una entidad poco frecuente, pudiendo ser idiopática o bien secundaria a neoplasias, dispositivos (catéteres, marcapasos) o trombofilia. Se describe el caso de una trombosis venosa profunda recidivante en miembros superiores y su asociación con una hiperostosis esternoclavicular. Durante su estudio se constató la presencia de una masa mediastínica con resultados histopatológicos sugestivos de fibrosis. El cuadro clínico se resolvió tras el inicio de la anticoagulación, descartando asimismo la asociación del evento trombótico con causas oncológicas, infecciosas o diátesis trombofílicas. Se asume finalmente el diagnóstico de mediastinítis fibrosa focal como causa de la trombosis recidivante y el síndrome de hiperostosis clavicular

De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review

BACKGROUND: Non-convulsive status epilepticus (NCSE) often goes unnoticed and is not easily detected in patients with a decreased level of consciousness, especially in older patients. In this sense, lack of data in this population is available. AIMS: The aim of the present study was to examine daily clinical practice and evaluate factors that may influence the prognosis of NCSE in non-epileptic medical inpatients. METHODS: We conducted a retrospective analysis including patients admitted by any cause in an Internal Medicine ward. All patients with compatible symptoms, exclusion of other causes, clinical suspicion or diagnosis of NCSE, and compatible EEG were included. Patients with a previous diagnosis of epilepsy were excluded. We also conducted a literature review by searching the PubMed/Medline database with the terms: Nonconvulsive Status OR Non-Convulsive Status. RESULTS: We included 54 patients, mortality rate reached 37% and the main factors linked to it were hypernatremia (OR = 16.2; 95% CI, 1.6-165.6; P = 0.019) and atrial fibrillation (OR = 6.7; 95% CI, 1.7-26; P = 0.006). There were no differences regarding mortality when comparing different diagnosis approach or treatment regimens. Our literature review showed that the main etiology of NCSE were neurovascular causes (17.8%), followed by antibiotic treatment (17.2%) and metabolic causes (17%). Global mortality in the literature review, excluding our series, reached 20%. DISCUSSION: We present the largest series of NCSE cases in medical patients, which showed that this entity is probably misdiagnosed in older patients and is linked to a high mortality. CONCLUSION: The presence of atrial fibrillation and hypernatremia in patients diagnosed with NCSE should advise physicians of a high mortality risk

De-novo non-convulsive status epilepticus in adult medical inpatients without known epilepsy: Analysis of mortality related factors and literature review

Background Non-convulsive status epilepticus (NCSE) often goes unnoticed and is not easily detected in patients with a decreased level of consciousness, especially in older patients. In this sense, lack of data in this population is available. Aims The aim of the present study was to examine daily clinical practice and evaluate factors that may influence the prognosis of NCSE in non-epileptic medical inpatients. Methods We conducted a retrospective analysis including patients admitted by any cause in an Internal Medicine ward. All patients with compatible symptoms, exclusion of other causes, clinical suspicion or diagnosis of NCSE, and compatible EEG were included. Patients with a previous diagnosis of epilepsy were excluded. We also conducted a literature review by searching the PubMed/Medline database with the terms: Nonconvulsive Status OR Non-Convulsive Status. Results We included 54 patients, mortality rate reached 37% and the main factors linked to it were hypernatremia (OR = 16.2; 95% CI, 1.6–165.6; P = 0.019) and atrial fibrillation (OR = 6.7; 95% CI, 1.7–26; P = 0.006). There were no differences regarding mortality when comparing different diagnosis approach or treatment regimens. Our literature review showed that the main etiology of NCSE were neurovascular causes (17.8%), followed by antibiotic treatment (17.2%) and metabolic causes (17%). Global mortality in the literature review, excluding our series, reached 20%. Discussion We present the largest series of NCSE cases in medical patients, which showed that this entity is probably misdiagnosed in older patients and is linked to a high mortality. Conclusion The presence of atrial fibrillation and hypernatremia in patients diagnosed with NCSE should advise physicians of a high mortality risk. </jats:sec

PRISMA recommendations checklist.

(DOCX)</p

Database.

Database including all cases with complete data. (XLS)</p

Variables linked to mortality.

Variables linked to mortality.</p

Baseline characteristics and comparison regarding gender.

Baseline characteristics and comparison regarding gender.</p

Cases included in the literature review by main etiology.

NP: not performed, NR: not reported, D: day, W: week, Min: minutes, LEV: levetiracetam, LCM: lacosamide, PHT: Phenytoin, MPHT: mephenytoin, VPA: Valproic acid, BZD: benzodiazepines, PB: phenobarbital, DXM: dexamethasone, DZP: diazepam, THP: thiopental, PPF: propofol, PPH: phospho-phenytoin, MDZ: midazolam, LMG: lamotrigine, RPD: risperidone, HPD: Haloperidol, MTP: methylprednisolone, PDN: prednisone, CyC: cyclophosphamide, IVIG: immunoglobulins, RTX: rituximab, CLZ: clonazepam, CLP: chlorpromazine, QCN: quinacrine, PLPH: plasmapheresis, ZND: zonisamide, FBT: felbamate, PTB: pentobarbital, GBP: gabapentin, DPH: diphenylhydantoin, STE: steroids, NLX: naloxone, (ISN + RIF + PYR + ETB): isoniazid, rifampicin, pyrazinamide and ethambutol, SIRPID: stimulus-induced rhythmic, periodic, or ictal discharges, PRES: posterior reversible encephalopathy syndrome, UTI: urinary tract infection, ACS: acute coronary syndrome. *Global data from Canas N. et al: 6 patients admitted in ICU, 9 patients died. **Global data from Labar D. et al: 3 patients died and 2 presented a complete recovery. (PDF)</p