Non-traumatic subarachnoid hemorrhage due to ruptured middle cerebral artery aneurysm in a young lady: a challenge in diagnosis

We present a case of a young lady who had subarachnoid hemorrhage and was initially misdiagnosed as acute sinusitis. High index of suspicion and ability to analyze her risk factors and associated electrocardiographic, biochemical and radiological findings eventually led to the right diagnosis and treatment. A high index of suspicion remains the cornerstone of diagnosis

Rare presentation of systemic lupus erythematosus with idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) is an extremely rare condition and rare in systemic lupus erythematosus (SLE). Herein we report a case of young lady presenting with increased intra-cranial pressure (ICP), normal neurological examination and imaging. She was diagnosed with IIH and responded well to steroid and cyclophosphamide. Meticulous clinical and laboratory assessment must be carried out in suspicious case to avoid misdiagnosis

A case of dengue hemorrhagic fever with myocarditis and complete heart block

We report a case of serologically confirmed dengue hemorrhagic fever in a 20 year-old Vietnamese male, complicated by myocarditis and asymptomatic, complete AV block

Validation of an Asian cerebrovascular risk prediction model in multiethnic country population

Objective: The importance of using risk prediction instruments to control cerebrovascular risk factors has been emphasized in most of the latest evidenced-based stroke prevention guidelines. The value of inclusion of stroke in cardiovascular risk prediction instruments are increasingly recognized as part of the outcome cluster. However, the lacking of validation of these cerebrovascular risk models in a multiethnic population limits its use in primary stroke prevention, particular in a multiethnic country. This study aimed to evaluate the validity of the Chinese Adults 10-Year Risk of Fatal and Non-fatal Ischemic Cardiovascular Diseases Risk Score. Design and method: Patients aged 35–59 were randomly selected and included in this 10-year retrospective cohort study. Patient medical records such as baseline demographic characteristics, comorbidities and cerebrovascular risk parameters were documented. The 10-Year risk scores according to Chinese Adults 10-Year Risk of Fatal and Non-fatal Ischemic Cardiovascular Diseases Risk Score were computed. Results: A total of 622 patients were studied. The actual number of stroke that occurred in the 10 years was 20 (20/662 = 3.0%) whereas the predicted was 21 (3.2%). The actual event in the low-risk group (20%); the actual event and the predicted event were 0 (0%) and 2 (29.7%) respectively. The Chinese 10-Year risk score has a poor discrimination index in this studied population as the area under the curve (AUC) is 0.43, with p value of 0.310. There was good calibration with Hosmer-Lemeshow test X2 = 4.48, P = 0.48. Conclusions: The risk score appears to underestimate stroke risk in low-risk group whereas it appears overestimate in the intermediate and high risk group. The results suggest that this risk model is unlikely to provide an appropriate stroke risk estimation. Future validation study with a larger population sample size is therefore advised

Unusual site of disseminated Staphylococcus infection: erosive chest wall abscess

Erosive chest wall abscess as a complication following disseminated Staphylococcus aureus infection is rare. Here, we reported a case of disseminated Staphylococcus aureus infection with an erosive chest wall abscess. A 15 year-old gentleman, presented with 2 days of left knee swelling and high grade fever for 1 week’s duration. On admission, he was in sepsis with multiorgan dysfunction. Further investigations revealed that he had left calf abscess, tricuspid valve infective endocarditis, bilateral pulmonary septic emboli with loculated pleural effusion, bilateral pyelonephritis with left renal abscess, and chest wall abscess. The striking feature was the presence of the abscess which extended through the sternum into the mediastinum with manubriosternal dislocation, involvement of bilateral sternoclavicular joints and left clavicle cortical erosion. Both cultures from blood and pus (left calf abscess) grew Methicillin Sensitive Staphyloccus Aureus (MSSA)

A case of severe Plasmodium knowlesi in a splenectomized patient

Plasmodium knowlesi, a zoonotic malaria, is now considered the fifth species of Plasmodium causing malaria in humans. With its 24-hour erythrocytic stage of development, it has raised concern regarding its high potential in replicating and leading to severe illness. Spleen is an important site for removal of parasitized red blood cells and generating immunity. We reported a case of knowlesi malaria in a non-immune, splenectomized patient. We observed the delay in parasite clearance, high parasitic counts, and severe illness at presentation. A thorough search through literature revealed several case reports on falciparum and vivax malaria in splenectomized patients. However, literature available for knowlesi malaria in splenectomized patient is limited. Further studies need to be carried out to clarify the role of spleen in host defense against human malaria especially P. knowlesi

Managing post stroke hyperglycaemia

Post stroke hyperglycaemia (PSH) is prevalent in acute ischaemic stroke (AIS) patients and it has been associated with a dismal outcome of death and disability. Insulin has been proven to attenuate glucose effectively in stroke patients, thus many trials over the years had studied the efficacy of intensive treatment aiming at normalization of blood sugar level in order to improve the bleak outcomes of PSH. However, tight glycaemic control failed to be translated into clinical benefits and the outcomes are no different from the conventional approach, despite the costly healthcare expenditure invested. On the contrary, it brings more significant harm than the intended benefit, as 1 in every 9 treated patients had symptomatic hypoglycaemia. Thus, the benefits of tight glucose control, if any, are overshadowed by this potential risk of hypoglycaemia causing permanent neurological injury. Therefore, international practice guidelines recommend for less aggressive treatment to maintain blood glucose level within an appropriate range in AIS patients. However, there are limited details for stroke-specific glycaemic management and this made management of PSH particularly difficult. This review is to discuss and provide suggestions concerning glycaemic control in acute ischaemic stroke; the direction of its future prospective clinical trials and the treatment strategy required based on recent literature

Coexistence of neurofibromatosis type-1 and primary pulmonary sarcoma: a case report and review of the literature

Neurofibromatosis type-1 (NF1) is a genetic disorder characterized by café-au-lait spots, neurofibroma and other associated features. The risk of malignancy is approximately 2.5 to 4-fold higher as compared to general population. However, primary pulmonary sarcoma is rarely reported in patients with NF1. Here, we describe a case of NF1 complicated with primary pulmonary sarcoma

Acute necrotising pancreatitis and acalculous cholecystitis: a rare presentation of leptospirosis

Leptospirosis typically presents with fever and thrombocytopenia, with or without jaundice. Acute necrotising pancreatitis and acalculous cholecystitis are rare presentations of this spirochetal infection. Here is the case of necrotising pancreatitis and acalculous cholecystitis associated with leptospirosis in an elderly patient. Leptospirosis was diagnosed by serological tests and abdominal CT imaging. The patient was successfully treated medically with intravenous antibiotics (imipenem and ceftriaxone) and proper hydration

A complicated case of rhabdomyolysis in dengue fever: finding balance between aggressive hydration and preventing plasma leakage in critical phase

We present a case of a 43-year-old gentleman presented with dengue shock syndrome following 5 days of fever associated with 2 days of diarrhea. Rhabdomyolysis was diagnosed on the 7th day of illness. He was treated with aggressive hydration and sodium bicarbonate and made an uneventful recovery. The mainstay of treatment is aggresive hydration, with rigorous monitoring of fluid balance. Our case demonstrates the importance of detecting rhabdomyolysis early, as it can worsens the outcome of dengue fever