Parainfluenza virus infection associated with posterior reversible encephalopathy syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Posterior reversible encephalopathy syndrome is a clinical and radiological entity. The most accepted theory of posterior reversible encephalopathy syndrome is a loss of autoregulation in cerebral blood flow with a subsequent increase in vascular permeability and leakage of blood plasma and erythrocytes, producing vasogenic edema. In infection-associated posterior reversible encephalopathy syndrome, a clinical pattern consistent with systemic inflammatory response syndrome develops. Parainfluenza virus has not been reported in the medical literature to be associated with posterior reversible encephalopathy syndrome.</p> <p>Case presentation</p> <p>We report herein the case of a 54-year-old Caucasian woman with posterior reversible encephalopathy syndrome associated with parainfluenza virus infection who presented with generalized headache, blurring of vision, new-onset seizure and flu-like symptoms.</p> <p>Conclusion</p> <p>Infection-associated posterior reversible encephalopathy syndrome as well as hypertension-associated posterior reversible encephalopathy syndrome favor the contribution of endothelial dysfunction to the pathophysiology of this clinicoradiological syndrome. In view of the reversible nature of this clinical entity, it is important that all physicians are well aware of posterior reversible encephalopathy syndrome in patients presenting with headache and seizure activity. A detailed clinical assessment leading to the recognition of precipitant factors in posterior reversible encephalopathy syndrome is paramount.</p

Risk factor model to predict a missed clinic appointment in an urban, academic, and underserved setting

In the chronic care model, a missed appointment decreases continuity, adversely affects practice efficiency, and can harm quality of care. The aim of this study was to identify predictors of amissed appointment and develop a model to predict an individual\u27s likelihood of missing anappointment. The research team performed a retrospective study in an urban, academic,underserved outpatient internal medicine clinic from January 2008 to June 2011. A missedappointment was defined as either a no-show or cancellation within 24 hours of the appointmenttime. Both patient and visit variables were considered. The patient population was randomly divided into derivation and validation sets (70/30). A logistic model from the derivation set was applied in the validation set. During the period of study, 11,546 patients generated 163,554 encounters; 45% of appointments in the derivation sample were missed. In the logistic model, percent previouslymissed appointments, wait time from booking to appointment, season, day of the week, provider type, and patient age, sex, and language proficiency were all associated with a missedappointment. The strongest predictors were percentage of previously missed appointments and wait time. Older age and non-English proficiency both decreased the likelihood of missing anappointment. In the validation set, the model had a c-statistic of 0.71, and showed no gross lack of fit (P=0.63), indicating acceptable calibration. A simple risk factor model can assist in predicting the likelihood that an individual patient will miss an appointment

A rare case of Raynaud’s vasculitis secondary to Hepatitis B vaccination: The induced auto-immune attack syndrome

Raynaud’s syndrome is a cutaneous vasculitis associated with a variety of underlying conditions such as connective tissue disorders, occupational exposures, drugs and very rarely vaccines. We report a case of Hepatitis B vaccination-induced Raynaud’s vasculitis in a previously healthy 46-year-old male. The sequence of events along with acute onset of symptoms with confirmation of small vessel vasculitis by CT angiogram and exclusion of other recognized etiologies was consistent with vaccine-induced vasculitis. Although extremely rare, physicians must be made aware of instances of vaccination-induced vasculitis (small and medium vessel) in a patient presenting with vasculitic symptoms

Parainfluenza virus infection associated with posterior reversible encephalopathy syndrome: A case report

INTRODUCTION: Posterior reversible encephalopathy syndrome is a clinical and radiological entity. The most accepted theory of posterior reversible encephalopathy syndrome is a loss of autoregulation in cerebral blood flow with a subsequent increase in vascular permeability and leakage of blood plasma and erythrocytes, producing vasogenic edema. In infection-associated posterior reversible encephalopathy syndrome, a clinical pattern consistent with systemic inflammatory response syndrome develops. Parainfluenza virus has not been reported in the medical literature to be associated with posterior reversible encephalopathy syndrome. CASE PRESENTATION: We report herein the case of a 54-year-old Caucasian woman with posterior reversible encephalopathy syndrome associated with parainfluenza virus infection who presented with generalized headache, blurring of vision, new-onset seizure and flu-like symptoms. CONCLUSION: Infection-associated posterior reversible encephalopathy syndrome as well as hypertension-associated posterior reversible encephalopathy syndrome favor the contribution of endothelial dysfunction to the pathophysiology of this clinicoradiological syndrome. In view of the reversible nature of this clinical entity, it is important that all physicians are well aware of posterior reversible encephalopathy syndrome in patients presenting with headache and seizure activity. A detailed clinical assessment leading to the recognition of precipitant factors in posterior reversible encephalopathy syndrome is paramount