Tolosa-Hunt Syndrome in a Kenyan Patient: Case Report and Review of the Literature
Paul Bundi Karau,
Winnie Mueni Saumu
Issue:
Volume 4, Issue 3, September 2023
Pages:
32-34
Received:
4 April 2023
Accepted:
11 July 2023
Published:
20 July 2023
Abstract: Tolosa-Hunt syndrome is a rare cause of painful ophthalmoplegia accompanied by ipsilateral ocular motor palsies, oculosympathetic paralysis and peri-orbital pain around the distribution of the ophthalmic division of the trigeminal nerve. Though the cause is unknown, idiopathic inflammation has been implicated. The pathology can be localized in the cavernous sinus, superior orbital fissure or the apex of the orbital cavity. Localization of the pathology requires a combination of careful history, physical examination and imaging, preferably MRI. We present a 40 year old Kenyan female patient with Tolosa-Hunt syndrome. She presented with left-sided periorbital headache and ptosis. Further examination revealed left-sided trochlear and abducens palsy, and partial left-sided oculomotor palsy. She had allodynia and hyperesthesia on the distribution of the left ophthalmic division of the trigeminal nerve. After an initial normal head CT scan, a magnetic resonance imaging revealed a soft-tissue hyperintensity extending from the left cavernous sinus, superior orbital fissure and apex of the orbit. She responded positively to steroid therapy, with cessation of headaches, correction of ptosis and ophthalmoplegia and an improved quality of life. There was minimal improvement in vision, with persisting pallor of the disc. This case shines the spotlight on a relatively rare disorder; whose diagnosis requires careful history, examination and interpretation of MRI findings.
Abstract: Tolosa-Hunt syndrome is a rare cause of painful ophthalmoplegia accompanied by ipsilateral ocular motor palsies, oculosympathetic paralysis and peri-orbital pain around the distribution of the ophthalmic division of the trigeminal nerve. Though the cause is unknown, idiopathic inflammation has been implicated. The pathology can be localized in the ...
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Characteristics and Determinants of COVID-19-Associated AKI Among Patients of COVID-19 in Rivers State, Nigeria
Ochuko Otokunefor,
Collins Amadi,
Kelachi Thankgod Wala,
Emmanuel Mustapha Owamagbe,
Bright Chike Amadi,
Adekemi Layo Kiyesi,
Chidozie Johnbosco Okafor,
Ini John Ntuenibok
Issue:
Volume 4, Issue 3, September 2023
Pages:
35-43
Received:
8 July 2023
Accepted:
24 July 2023
Published:
5 August 2023
Abstract: Background: Severe acute respiratory coronavirus-2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) is reportedly associated with acute renal injuries (AKI). However, this has been characterized majorly among Caucasians who have pre-existing confounding comorbidities that may also induce AKI, and hence, limit the conclusions of these previous studies. Consequently, the current study evaluated AKI incidence and associated factors among Nigerian COVID-19 patients of Negroid race who are without any pre-existing comorbid conditions. Methods: This was a retrospectively-designed observational study conducted among COVID-19 patients who presented at a COVID-19-designated treatment facility in Port Harcourt, Nigeria. Demographic, medical, and laboratory data obtained upon presentation were acquired and analyzed by AKI status using descriptive and inferential statistics. Results: Upon presentation, AKI occurred among 46.4% (n=181) of the entire studied population (n=390) which were majorly of stage 1, etiologically pre-renal, community-acquired, and of transient clinical course. Most of the AKI occurred among males, those with severe COVID-19 variants, and those who are unvaccinated against the disease. Those with COVID-19-associated AKI also had higher levels of peak plasma creatinine, plasma C-reactive protein, serum D-dimer, plasma osmolality, proteinuria, and hematuria but lower levels of within 24-hour urine volume, urine specific gravity, and urine osmolality compared to the non-AKI sub-group upon presentation. However, AKI patients with concurrent severe COVID-19 had a higher preponderance of stage 3, intra-renal and persistent AKI compared to patients with non-severe COVID-19 disease. In multivariate models, severe COVID-19 variant (OR: 6.017; CI: 5.880–6.422; p<0.001), the need for ICU transfer/treatment (OR: 3.210; CI: 3.119–3.341; p<0.001), serum D-dimer levels (OR: 3.967; CI: 3.688-4.297; p<0.001), and proteinuria (OR: 2.008; CI: 1.971–2.174; p=0.002) were independent risk factors for AKI among the studied population. Conclusion: AKI is common among COVID-19 patients independent of pre-existing comorbidities. The various COVID-19-associated AKI risk factors identified in the current study are valuable parameters that may guide clinical management among COVID-19 patients.
Abstract: Background: Severe acute respiratory coronavirus-2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) is reportedly associated with acute renal injuries (AKI). However, this has been characterized majorly among Caucasians who have pre-existing confounding comorbidities that may also induce AKI, and hence, limit the conclusions of these previo...
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