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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An autopsy case of malignant lymphoma of the central nervous system which showed extracranial disseminations was presented. A 50-year-old man developed mental and physical slowness over one year prior to admission followed by dementia and consciousness disturbance without general physical symptoms. Physical examination on admission showed no lymph node enlargement, hepatomegaly, splenomegaly, or abdominal mass. Neurological examination revealed mild dementia, left positive Babinski and Chaddock reflexes, and bilateral positive frontal lobe signs. CT scan revealed low density areas with contrast enhancement in the white matter of the bilateral parietal lobes adjacent to the trigon of lateral ventricles. Without any therapy, the low density area in the left cerebral hemisphere on CT scan disappeared and the low density area in the right cerebral hemisphere became unenhanced. Any other lesions except brain were found despite of the extensive systemic examinations including scintigrams, echograms, gastrointestinal examinations, body CT scan, aspiration of bone marrow, and lymphography. Primary intracranial malignant lymphoma was suspected and treated with steroid without any response. Subsequent radiation therapy made a transient improvement. But a few months later, the brain lesions gradually worsened, followed by general physical deterioration with diarrhea, pleural fluids, and ascites. Cytologic study of cerebrospinal fluid revealed neoplastic lymphocytes with atypical nuclei containing conspicuous nucleoli and mitosis, which were identified as B cell type malignant lymphoma by analysis using monoclonal antibody. The patient died of cardiac failure about two years after the initial symptom.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[An autopsy case of primary intracranial malignant lymphoma showing extracranial disseminations]. 239 Mar 65

Risk factors of death for a population of 409 patients with well-defined cerebrovascular disease (patients with subarachnoidal hemorrhage excluded) admitted to the Stroke Unit were studied with the aid of the life table technique, log rank test, and multivariate analysis with BMDP's program for regression on the survival curves with Cox's proportional hazard model. The estimated proportion of survivors was 77% after three months, 69% after one year, and 32% after five years. Patients with intracerebral hemorrhage and embolic cerebral infarction had the worst outcome. Impaired consciousness on admission was the most important risk factor of death followed by high age, previous cardiac failure, diabetes mellitus and male sex.
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PMID:Determinants of long-term mortality after stroke. 360 51

A rare case of dural arteriovenous shunt (dAVS) manifested as cerebellar hemorrhage in a neonate is reported. Seven days after birth, a neonate was referred to our hospital because of consciousness disturbance. CT scan revealed cerebellar hemorrhage, subarachnoid hemorrhage, subdural hematoma, and a high density mass lesion at the torcular herophili. Retrograde brachial angiogram failed to show any vascular lesions. He underwent an evacuation of the cerebellar hematoma. Postoperative course was uneventful. However, at the age of four months, he was admitted again because of consciousness disturbance and cardiac failure. CT scan revealed hydrocephalus and an enlarged mass lesion at the torcular herophili. Angiogram disclosed dural AVS. Its feeding arteries were as follows; the bilateral middle meningeal arteries (MMA), the occipital arteries (OA), dural branches of the bilateral posterior inferior cerebellar arteries, arteries consisting of transdural anastomosis from the left posterior cerebral artery. The arterial flow from these feeding arteries was shunting directly to the torcular herophili, the posterior part of the superior sagittal sinus, and the straight sinus. He underwent a venticulo-peritoneal shunting. Then, after treatment for cardiac failure, superselective embolization of the bilateral MMAs and the OAs resulted in diminution of shunting flow. The initial onset of this case was at seven days after his birth. Dural AVS is very rare in the pediatric population, particularly in the neonate. The clinical features, pathogenesis, and the treatment for this rare entity are discussed.
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PMID:[A neonate case of dural arteriovenous shunt presenting with cerebellar hemorrhage]. 766 46

Lightning injury can cause severe damage to many systems and often results in a high mortality. We report a case of sustained lightning injury in which a 54-year-old woman presented with heart failure, pulmonary edema and consciousness disturbance. The patient was found unconscious, lying face down on the ground of a trash dump on the day of a thunderstorm. No deformities were seen in the extremities, but scattered third degree burns (less than 1%) were found on her neck where her necklace had been. Ventilator and inotropic agents with an adequate fluid supply were used. A Swan-Ganz catheter was inserted for monitoring. The patient was discharged two weeks later with an uneventful clinical course, except for mild neurologic sequelae (amnesia, disorientation).
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PMID:Lightning injury: report of a case. 790 54

A 23-year-old male patient with plasma cell leukemia showed characteristic clinical features: accelerating heart failure and consciousness disturbance accompanied with an increase of plasma cells in peripheral blood. Evaluation of cardiac function revealed a hyperdynamic cardiac state with low somatic vascular resistance, indicating high-output cardiac failure. However no disorders causing high-output cardiac failure were found. Consciousness disturbance and hyperammonemia with serum amino acid abnormality of unknown origin were also demonstrated. After intensive combined chemotherapy (MVD + VAD), high-output cardiac failure and hyperammonemia improved with disappearance of plasma cells, suggesting that these symptoms were closely related with progression of plasma cell leukemia.
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PMID:[Primary plasma cell leukemia complicated with high-output cardiac failure and hyperammonemia]. 793 62

A case of aneurysm arising from the posterior communicating artery itself clipped by contralateral frontotemporal craniotomy (pterional approach) is presented. A 65-year-old female developed sudden severe headache and chest pain in January of 1993. Neurological examination on admission revealed consciousness disturbance such as stupor and nuchal stiffness. CT-scan showed marked subarachnoid hemorrhage. She also suffered from acute myocardial ischemia and cardiac failure. Cerebral angiograms after recovery from cardiac dysfunction demonstrated three saccular aneurysms arising from the dilated right posterior communicating artery itself, the junction of the left internal carotid artery and the posterior communicating artery, and the bifurcation of the left middle cerebral artery. The left IC-PC junction aneurysm was thought to be ruptured because of its size and contour, so left frontotemporal craniotomy was undertaken. By the left pterional approach, successful clipping of all three aneurysms involving the one arising from the contralateral posterior communicating artery was achieved. The aneurysm at the posterior communicating artery itself was found to arise from the non-branching site and to project inferiorly, thus the successful clipping through the prechiasmal cistern could be performed without compromising any small perforating arteries.
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PMID:[Clipping of aneurysm arising from the posterior communicating artery itself by contralateral craniotomy: a case report]. 801 76

We experienced a plasma cell leukemia (PCL) patient complicated with high output cardiac failure (HOCF), proved as his elevated cardiac index and pulmonary artery wedge pressure and decreased systemic vascular resistance index in a hemodynamic study. We found no possible causes of HOCF. Interestingly, HOCF was improved as PCL responded to intensive chemotherapy. On the other hand, he showed consciousness disturbance, and had frequent attacks of generalized seizure. His electroencephalogram showed slow waves, and a spike and wave complex. Hyperammonemia and abnormal amino acid distribution were also found. This abnormal serum amino acid distribution, especially elevated glycine level, was different from that seen in chronic liver failure, and he had no hepatic disease. After intensive chemotherapy, the serum ammonia level and glycine level decreased. In this patient, PCL seemed to be responsible for HOCF, hyperammonemia, and abnormal amino acid distribution. We experienced two more cases of multiple myeloma (MM) with HOCF, hyperammonemia, abnormal serum amino acid distribution, and consciousness disturbance of unknown origin. Those two cases showed slow waves in the electroencephalogram. Improvement was seen in their HOCF, hyperammonemia, and abnormal amino acid levels after chemotherapy. The possibility of MM as a cause of HOCF is discussed.
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PMID:Multiple myeloma associated with serum amino acid disturbance and high output cardiac failure. 942 22

Mycobacterium kansasii infection has been reported to be about 20 percent of non-tuberculous mycobacteriosis, and its disseminated type is uncommon and the prognosis is reported to be generally poor. We experienced one case of disseminated Mycobacterium kansasii infection. A 81 year-old man who had been short-bowel syndrome due to the operation for superior mesenteric artery occlusion since 1998 was admitted on April 24th, 2001 to our hospital because of slowly progressive consciousness disturbance and anorexia. He had shown progressive productive cough and respiratory failure and laboratory findings were C-reactive protein elevation and pancytopenia. Human immunodeficiency virus (HIV) antibody was negative. Chest X-ray and computed tomography showed diffuse miliary nodules and infiltrative shadow. Sputum examination was positive for mycobacteria. The cultured isolate was identified as Mycobacterium kansasii. Bone marrow aspirations revealed inflammatory granuloma with necrosis. He was diagnosed as disseminated Mycobacterium kansasii infection and heart failure, and was treated by anti-tuberculosis drugs and diuretics. Treatment was very effective and Chest X-ray findings and respiratory failure had been completely improved. In this case we speculated that the malnutrition due to short-bowel syndrome could be one of the most suspected reasons of Mycobacterium kansasii dissemination. Disseminated Mycobacterium kansasii infection has been rarely reported comparing with the other mycobacterial infections in Japan. However, due to the increasing numbers of immunocompromised hosts with aging, HIV infection, cancer, and steroid therapy, this type of infection will become more common and its earlier diagnosis and adequate treatment will be important to improve the prognosis.
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PMID:[A rare case of disseminated Mycobacterium kansasii infection]. 1599 1

A 52-year-old woman was admitted to the hospital because of appetite loss, unsteadiness, psychogenic symptoms, ataxia, and consciousness disturbance as a result of the ingestion of a diet restricted to only carbohydrates for a long term. Laboratory examination indicated the presence of pancytopenia with macrocytic anemia; further, decreased vitamin B1 and B12 levels were detected in her serum. Magnetic resonance imaging fluid attenuated inversion recovery (FLAIR), revealed high-signal intensity in the bilateral corpus striatum, third ventricle circumference, and cerebellar cortex. Thereafter, she received drip infusion that did not include vitamin B1 or B12 and subsequently suffered a cardiac arrest due to the aggravation of cardiac insufficiency; consequently, she was transferred to our hospital. Upon admission the patient was diagnosed to have obvious cardiomegaly with pleural effusion; further, a negative T-wave was obtained on the electrocardiogram. A diagnosis of beriberi heart disease was made because of thiamine deficiency. She was treated by thiamine administration, following which the cardiac symptoms improved immediately. Various neurological symptoms caused by encephalopathy, peripheral neuropathy and subacute combined spinal cord degeneration improved by treatment with thiamine and cyanocobalamine administration; however, some of these symptoms still remained. General awareness of the fact that neurological symptoms can be caused by vitamin deficiency is essential.
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PMID:[Case of Wernicke's encephalopathy and subacute combined degeneration of the spinal cord due to vitamin deficiency showing changes in the bilateral corpus striatum and cardiac arrest due to beriberi heart disease]. 1980 6

A 45-year-old woman complaining of consciousness disturbance demonstrated multiple brain infarctions. Echocardiogram showed vegetation on the posterior mitral leaflet. Infectious endocarditis was initially suspected and we started empirical antibiotics. However, mitral vegetation grew rapidly and caused severe mitral regurgitation. Acute heart failure was so poorly controlled by conservative treatment that we concluded cardiac surgery was indicated. Mitral valve replacement was safely performed, and there was no sign of heart failure or recurrent thromboembolism during the postoperative course. Thereafter, multiple hepatic masses and a solid lesion in the pancreatic head were detected by computed tomography. The patient finally died of multiple organ failure that presumably resulted from malignancy in the terminal stage. The clinical course of this case can be explained by the pathology of nonbacterial thrombotic endocarditis (NBTE). The standard treatment for NBTE consists of systemic anticoagulation as well as controlling the underlying malignancy. However, we could not diagnose this case as NBTE before surgery. Although mitral valve replacement was finally effective to control acute heart failure in this case, NBTE should be exactly diagnosed as quickly as possible and the treatment policy should be deliberated.
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PMID:Effective surgical treatment for controlling the acute heart failure induced by acutely progressed mitral regurgitation with nonbacterial thrombotic endocarditis. 3054 5


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