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Query: UMLS:C0012833 (dizziness)
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George Gershwin, renowned composer and pianist, well known for his popular works, died on the 11th July 1937 due to a brain tumor. His neurological symptoms first appeared on that same year, in February, with a simple olfactory partial seizure, characterized by an unpleasant smell of burnt rubber (uncinated seizure). He later had a quick clinical descend, with severe headache that occurred in bouts, dizziness, coordination compromise and olfactory seizures, eventually lapsing into a coma on the 9th July 1937. It was then that a gliomatosus cyst was diagnosed, which on microscopic examination proved to be a "glioblastoma multiforme". Despite the surgical intervention, Gershwin died soon after the procedure without recovering his consciousness. We make a brief review of Gershwin's neurologic disease, with emphasis on the initial symptoms, namely the uncinated seizures.
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PMID:The uncinated crisis of George Gershwin. 1213 61

Addison's disease due to adrenal lymphoma usually manifests as bilateral adrenal enlargement. We report a patient with Addsion's disease in whom the initial overt primary adrenal insufficiency was accompanied by an only slightly enlarged right adrenal gland. The 80-year-old man presented with nausea, anorexia, weight loss, and hyperpigmentation of the skin and buccal mucosa. Addison's disease was diagnosed based on this clinical presentation and laboratory findings of low cortisol and high adrenocorticotropin levels. Computerized tomography (CT) of the adrenal glands revealed a small right adrenal tumor. His family refused to allow percutaneous or surgical biopsy to determine the nature of the tumor. His general condition improved after steroid supplementation. However, about 1 year later, dizziness, fever, night sweats, and edema of the lower legs developed, and adrenal CT scanning revealed that the left adrenal gland had enlarged and now exceeded the size of the right one. Left adrenalectomy was performed and pathology showed a diffuse large B-cell lymphoma. Staging work-up using whole-body CT scanning suggested a stage IIIb lymphoma. Chemotherapy was given, but the disease still progressed and the patient died 4 months after diagnosis. Primary adrenal lymphoma should be considered in the differential diagnosis of Addison's disease, even if only slight enlargement of the adrenal glands is found initially.
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PMID:Adrenal lymphoma and Addison's disease: report of a case. 1263 19

A 57-year-old man consulted an herbalist for epigastric discomfort. Four hours after he drank a decoction made from 14 herbs, he developed nausea, epigastric pain, and dizziness. He also had two loose bowel movements. On arrival at the hospital 4 hours later, his blood pressure was 77/46 mm Hg, and his pulse was 60 beats/min. He was given intravenous fluids. In the next 3 hours, his blood pressure gradually returned to his usual level of 100/65 mm Hg. His other gastrointestinal symptoms gradually subsided during the next 24 hours. His white cell count was 17.8 x 109/L but was normal on recheck. Complete cell counts, renal function and liver function tests, and electrocardiogram were otherwise normal. He was discharged home on day 2. Seven of the 14 herbs taken by this patient are known to have vasodilatory or blood pressure-lowering effects, and 3 of these herbs are used to manage hypertension. In traditional Chinese medicine, practitioners often use a combination of herbs in an attempt to improve the efficacy but reduce the adverse effects of treatment. The risk of adverse herbal interactions will also be higher.
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PMID:Adverse herbal interactions causing hypotension. 1276 56

Severe acute respiratory syndrome is a new disease that is highly contagious and is spreading in the local community and worldwide. This report is of a hospital medical officer with severe acute respiratory syndrome. He presented with sudden onset of fever, chills, myalgia, headache, and dizziness in early March 2003. He developed progressive respiratory symptoms and bilateral pulmonary infiltrates during the second week of his illness. Blood tests showed lymphopenia, mild thrombocytopenia, and prolonged activated partial thromboplastin time with normal d-dimer level. His chest condition gradually responded to ribavirin and corticosteroids, and serial chest X-ray showed resolving pulmonary infiltrates. The importance of early diagnosis lies in the potential for early treatment, leading to better response.
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PMID:Severe acute respiratory syndrome in a doctor working at the Prince of Wales Hospital. 1277 57

A 57 year old Japanese male with chest oppression due to exercise is presented. This symptom was likely due to effort angina pectoris. Master's double two-step test revealed ischemic ST segment depression on the electrocardiogram, thus, a Tl201 myocardial stress imaging test using a bicycle ergometer was undertaken. Immediately following the exercise test, the patient experienced dizziness and palsy in his left upper and lower limbs. Cerebral angiography demonstrated 70% stenosis at the right internal carotid artery, but no abnormal findings were demonstrated on a cranial x-ray CT scan and magnetic resonance imaging. His palsy in the left limbs completely recovered within 3 weeks. Thus this event was diagnosed as a reversible ischemic neurological deficit (RIND). Major but non-cardiogenic complications during exercise testing are very rare, and RIND has not been reported thus far to the best of our knowledge.
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PMID:Reversible ischemic neurological deficit (RIND) due to exercise testing for the diagnosis of angina pectoris. 1290 39

A 63-year-old man presented with subclavian steal syndrome associated with left internal mammary artery (IMA) bypass graft to a coronary artery. He was admitted with a history of oppressive sensation in the chest, dizziness, and light headedness on exertion for 2 weeks in March 2002. He had undergone myocardial revascularization consisting of a left IMA-to-left anterior descending coronary artery graft in April 1988. His blood pressure was 140/70 mmHg in the right arm and 80/64 mmHg in the left arm. Aortic arch arteriography revealed complete occlusion of the left subclavian artery proximal to the left IMA takeoff and subclavian steal with anterograde flow of the left IMA. Percutaneous angioplasty and stent placement with protection of the left IMA bypass graft using a balloon catheter was successfully performed without complication by cerebral or myocardial ischemia. Complete recanalization of the occluded left subclavian artery and anterograde flow of the left vertebral artery were achieved. His symptoms disappeared and blood pressure in the left arm recovered. This variant of coronary subclavian steal might require protection of the left IMA during angioplasty and stent placement.
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PMID:Percutaneous transluminal angioplasty and stent placement for subclavian steal syndrome with concomitant anterograde flow in the left internal mammary artery graft for coronary artery bypass--case report. 1462 Feb

A 44-year-old male presented with dizziness, blurring of vision, unproductive cough, dyspnoea, heaviness of head, fever and hepatosplenomegaly along with reticulonodular infiltration in chest x-ray. His serum showed monoclonal IgM gammopathy. Peripheral blood smear, bone marrow examination and serum protein electrophoresis suggested it was a case of Waldenstrom's macroglobulinaemia. Chest x-ray and CT scan of thorax were suggestive of pulmonary involvement in the form of interstitial lung disease.
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PMID:Hyperviscosity syndrome with pulmonary involvement. 1516 94

Patients with chronic renal failure, because of concomitant conventional cardiovascular and uremia-associated risk factors, are at risk of developing diffuse and accelerated atherosclerosis involving both the coronary and peripheral territories. We report an end-stage renal failure patient with a history of coronary artery bypass surgery who developed both angina and dizziness during hemodialysis via a left forearm arteriovenous fistula. Magnetic resonance imaging diagnosed the presence of significant subclavian artery stenosis. The patient then underwent successful percutaneous stenting of the left subclavian artery. His angina and dizziness symptoms resolved subsequently.
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PMID:Concomitant coronary and subclavian steal caused by ipsilateral subclavian artery stenosis and arteriovenous fistula in a hemodialysis patient. 1517 Jul 20

This is the first known case report of electrocardiographic (ECG) changes suggestive of coronary vasospasm following a centipede envenomation. A 60-year-old man presented to the emergency department (ED) 1 hour after being stung by a 12-cm centipede. He complained of right great toe pain that did not radiate to his leg. The patient had no known ischemic heart disease. He did not describe any exertional symptoms but admitted experiencing weakness. During the ED course, concurrent with obtaining peripheral intravenous access, the patient experienced diaphoresis, dizziness, hypotension, and bradycardia. His ECG showed new ST-T wave changes, which suggested an acute ischemic process. The patient's blood pressure was 89/60 mm Hg, his pulse rate was 47 beats/min, and his respiration rate was 28 breaths/min. In the following hours, ECG findings returned to baseline. His blood pressure improved gradually with fluid resuscitation after approximately 5 hours. Cardiac markers returned to normal in the 13th hour after the event, and the patient underwent exercise stress testing, which was negative. The patient was discharged with cardiology follow-up. Adult patients with centipede envenomation should be closely monitored in anticipation of possible myocardial ischemia due to vasospasm, hypotension, and myocardial toxic effects of the venom. A child receiving the same amount of venom would be potentially at greater risk.
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PMID:Acute coronary ischemia following centipede envenomation: case report and review of the literature. 1522 64

PRESENTING FEATURES: A 53-year-old man who had human immunodeficiency virus (HIV) presented to the Johns Hopkins Hospital with a 3-month history of increasing dysphagia, cough, dyspnea, chest pain, and an episode of syncope. His past medical history was notable for oral and presumptive esophageal candidiasis that was treated with fluconazole 6 months prior to presentation. Three months prior to presentation, he discontinued his medications, and his symptoms of dysphagia recurred. During that time he developed intermittent fevers and chills, progressively worsening dyspnea on exertion, and a cough productive of white sputum. He also reported a 40-lb weight loss over the past 3 months. On the day prior to presentation, he had chest pain and shortness of breath followed by weakness, dizziness, and a brief syncopal episode. He denied orthopnea, paroxysmal nocturnal dyspnea, lower extremity edema, jaundice, hemoptysis, hematemesis, melena, hematochezia, or diarrhea. There was no history of alcohol use, and he stopped smoking tobacco approximately 1 month previously. He smoked cocaine but denied injection drug use. The patient had never been on antiretroviral therapy and had never had his CD4 count or viral load measured. On physical examination, the patient was a thin, cachectic man who appeared older than his stated age. His vital signs were notable for blood pressure of 102/69 mm Hg, resting tachycardia of 102 beats per minute, resting oxygen saturation of 92% on room air, normal resting respiratory rate, and a temperature of 38.1 degrees C. His oropharynx was clear, with no signs of thrush or mucosal ulcers. His pulmonary examination was notable for diminished breath sounds in the lower lung fields bilaterally. Cardiac, abdominal, and neurologic examinations were normal. His skin was intact, with no visible petechiae, rashes, nodules, or ulcers. Laboratory studies showed a total white blood cell count of 3.2 x 10(3)/microL, with a total lymphocyte count of 330/microL, hematocrit of 30.2%, a serum sodium level of 129 mEq/L, and a serum lactate dehydrogenase level of 219 IU/L. The patient had an absolute CD4 count of 8 cells/mm3 and a HIV viral load of 86,457 copies/mL. His arterial blood gas on room air had a pH of 7.51, a PCO2 of 33 mm Hg, and a PO2 of 55 mm Hg. Electrocardiogram and serial serum cardiac enzymes were normal. A chest radiograph showed bilateral upper lobe patchy infiltrates with left upper lobe consolidation. Computed tomographic (CT) scan of the chest with contrast showed bilateral ground glass infiltrates with focal consolidation (Figure 1) and no evidence of pulmonary embolism. Induced sputum was negative for Pneumocystis carinii, fungi, or acid-fast bacilli. A bronchoalveolar lavage was performed. What is the diagnosis?
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PMID:Cases from the Osler Medical Service at Johns Hopkins University. Diagnosis: P. carinii pneumonia and primary pulmonary sporotrichosis. 1533 85


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