Case Reports 2020
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Item The effects of spaced transcranial Direct Current Stimulation combined with conventional dysphagia therapy in Parkinson’s disease(IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund, 2020-06-04) Dashtelei, Ali Akbar; Nitsche, Michael A.; Bakhtiyari, Jalal; Habibi, Seyed Amirhassan; Sepandi, Mojtaba; Khatoonabadi, Ahmad RezaParkinson's disease (PD) is a neurodegenerative disease of the central nervous system that is characterized by a set of motor and non-motor symptoms. Impaired swallowing or dysphagia is one relatively common motor symptom in patients with PD. We investigated whether neuroplasticity induction by spaced transcranial Direct Current Stimulation (tDCS) combined with conventional swallowing therapy leads to long-lasting effects on swallowing ability in patients with PD. We present a case of a 61-year-old male PD patient with dysphagia. Conventional Swallowing Therapy (CDT) combined with tDCS (bilateral anodal, 1 mA, 20 min, 10 online sessions, twice daily with a 20 min interval in between for five days over two weeks) was applied over the pharyngeal motor cortex. Our findings suggest that anodal tDCS combined with CDT is feasible, safe, and well-tolerated, and leads to a clinically relevant improvement of swallowing functions.Item Undifferentiated pleomorphic sarcoma in the anterior mediastinum with a rapidly progressive course(IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund, 2020-08-17) Sato, Masamichi; Inoue, Sumito; Arao, Tsuyoshi; Igarashi, Akira; Yamauchi, Keiko; Sato, Kento; Nakano, Hiroshi; Watanabe, MasafumiA 77-year-old woman with heart failure was admitted to our hospital. Computed tomography (CT) of the chest revealed an anterior mediastinal tumor. CT-guided biopsy revealed a malignant nonepithelial tumor of unknown origin. She was not treated with chemotherapy or radiotherapy because of her poor clinical condition. She died 33 days after admission. Following autopsy, we confirmed that the mediastinal tumor had infiltrated the large blood vessels. After final histological examination, undifferentiated pleomorphic sarcoma was diagnosed. Primary mediastinal sarcomas are very rare; clinicians should be aware of their possibility because some cases may progress rapidly as evidenced in this case.Item Severe rhabdomyolysis in homozygote carnitine palmitoyltransferase II deficiency(IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund, 2020-09-11) Schnedl, Wolfgang J.; Schenk, Michael; Enko, Dietmar; Mangge, HaraldCarnitine palmitoyltransferase II (CPT II) deficiency represents an inherited defect in mitochondrial long-chain fatty acid oxidation. Rhabdomyolysis with necrosis of muscle is caused by the destruction of skeletal muscle and leads to systemic, multiorgan complications due to the release of intracellular muscle components. Severe rhabdomyolysis may be triggered by combination of a genetic predisposition, including CPT II deficiency, with additionally acting causes. Generally, patients with CPT II deficiency are rarely clinical recognized and reported. We describe a patient presenting severe rhabdomyolysis due to urosepsis, who, in genetic testing, demonstrated the homozygous CPT II deficiency (c.338C>T, p.Ser113Leu) mutation. The diagnosis of CPT II deficiency helped this patient to put the symptoms into context, and this reduced myopathy and the risk of recurring rhabdomyolysis. We report on this patient to increase awareness of diagnostic and medical management in CPT II deficiency.Item Mental disorder or conscious disturbance in epidermal growth factor receptor-tyrosine kinase inhibitor treatment of advanced lung adenocarcinoma(IfADo - Leibniz Research Centre for Working Environment and Human Factors, Dortmund, 2020-02-28) Zhu, Jing; Zhou, Rui; Xiao, HengEpidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are currently recommended by international guidelines as first-line treatment in patients with advanced EGFR-mutant non-small-cell lung cancer. With the availability of drugs, more and more patients choose EGFR-TKI treatment. However, pharmaceutical drugs used in clinical practice have side effects, such as diarrhea, paronychia, and hepatotoxicity. Mental or conscious disturbance has never been reported before. In our clinical center, we found that several patients with advanced lung adenocarcinoma developed a mental disorder or conscious disturbance after EGFR-TKI treatment. This situation has not previously been reported. We conducted a retrospective study of patients with advanced lung adenocarcinoma treated with EGFR-TKI who showed a mental disorder or conscious disturbance. We reported five cases of lung adenocarcinoma who developed a mental disorder or conscious disturbance after treatment with EGFR-TKI. The main clinical symptoms of these patients were sluggishness, memory deterioration, cognitive disorder, and even hallucination. Brain magnetic resonance imaging showed increased ischemic foci and lacunar infarction, worse encephalatrophy, and demyelination after EGFR-TKI therapy. These psychiatric symptoms did not improve but worsened after taking antipsychotic drugs, suggesting that they were irreversible. The neuropsychiatric symptoms in EGFR-TKI treatment must be considered, and the underlying reason warrants further study.