Case Report : Uncommon presentation of pernicious anemia, hypothyroidism, and pericardial effusion

Introduction: Pernicious anemia is not commonly investigated as an etiology for Vitamin B12 deficiency. However, it is associated with other autoimmune disorders and may be linked with H. pylori infections as well as an increased risk of gastric cancers. Case Presentation: The patient was a 42 year old male patient who presented with hemoglobin of 4.5, MCV of 133.3, and pancytopenia. His symptoms at admission were dyspnea and peripheral neuropathy. His past medical history was significant for hypothyroidism and plaque psoriasis. The patient was found to have low serum vitamin B 12 with positive parietal cell antibodies. Echocardiogram revealed a stable pericardial effusion. He was administered one unit of packed red blood cells, parenteral cobalamin, and oral levothyroxine. He clinically improved with conservative management.Conclusion: This case highlights the constellation of signs, symptoms, laboratory findings, and imaging that can be seen with pernicious anemia, and it also discusses management. It is important for the patient to undergo proper workup of the autoimmune conditions associated with pernicious anemia when appropriate

Seizure prophylaxis in the neuroscience intensive care unit

Abstract Background Seizures are a considerable complication in critically ill patients. Their incidence is significantly high in neurosciences intensive care unit patients. Seizure prophylaxis with anti-epileptic drugs is a common practice in neurosciences intensive care unit. However, its utility in patients without clinical seizure, with an underlying neurological injury, is somewhat controversial. Body In this article, we have reviewed the evidence for seizure prophylaxis in commonly encountered neurological conditions in neurosciences intensive care unit and discussed the possible prognostic role of continuous electroencephalography monitoring in detecting early seizures in critically ill patients. Conclusion Based on the current evidence and guidelines, we have proposed a presumptive protocol for seizure prophylaxis in neurosciences intensive care unit. Patients with severe traumatic brain injury and possible subarachnoid hemorrhage seem to benefit with a short course of anti-epileptic drug. In patients with other neurological illnesses, the use of continuous electroencephalography would make sense rather than indiscriminately administering anti-epileptic drug

The Benefit of Neuromuscular Blockade in Patients with Postanoxic Myoclonus Otherwise Obscuring Continuous Electroencephalography (CEEG)

Introduction. Myoclonus status epilepticus is independently associated with poor outcome in coma patients after cardiac arrest. Determining if myoclonus is of cortical origin on continuous electroencephalography (CEEG) can be difficult secondary to the muscle artifact obscuring the underlying CEEG. The use of a neuromuscular blocker can be useful in these cases. Methods. Retrospective review of CEEG in patients with postanoxic myoclonus who received cisatracurium while being monitored. Results. Twelve patients (mean age: 53.3 years; 58.3% male) met inclusion criteria of clinical postanoxic myoclonus. The initial CEEG patterns immediately prior to neuromuscular blockade showed myoclonic artifact with continuous slowing (50%), burst suppression with myoclonic artifact (41.7%), and continuous myogenic artifact obscuring CEEG (8.3%). After intravenous administration of cisatracurium (0.1 mg–2 mg), reduction in artifact improved quality of CEEG recordings in 9/12 (75%), revealing previously unrecognized patterns: continuous EEG seizures (33.3%), lateralizing slowing (16.7%), burst suppression (16.7%), generalized periodic discharges (8.3%), and, in the patient who had an initially uninterpretable CEEG from myogenic artifact, continuous slowing. Conclusion. Short-acting neuromuscular blockade is useful in determining background cerebral activity on CEEG otherwise partially or completely obscured by muscle artifact in patients with postanoxic myoclonus. Fully understanding background cerebral activity is important in prognostication and treatment, particularly when there are underlying EEG seizures