Typical Presentation Research Articles

A challenging case of granulomatosis with polyangiitis with cardiac involvement: a rare case report

Granulomatosis with polyangiitis (GPA), a systemic antineutrophil cytoplasmic antibody (ANCA) associated vasculitis, is characterized by inflammation of the small arteries, arterioles, and capillaries classically manifesting with glomerulonephritis and necrotizing granulomatous lesions of the upper and lower respiratory tract. With an incidence of approximately 12 cases per one million individuals per year it is an uncommon diagnosis that typically presents as frequent pulmonary and sinus infections; however, if left without definitive treatment progresses to more severe manifestations specifically hemoptysis and hematuria. This case report highlights a 15-year-old woman who had both classic and non-classic findings making the diagnosis challenging. Specifically, her age of presentation, improvement with anti-microbials, and coronary dilation were not classic. Additionally, her lab work was negative for the cytoplasmic subset antineutrophil cytoplasmic autoantibody (c-ANCA), but positive for serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) which further delayed the ultimate diagnosis as this is typically c-ANCA positive. Other systemic vasculitides, such as mucocutaneous lymph node disease, are associated with cardiac pathology necessitating further medical management and follow-up to prevent increased morbidity and mortality. Knowing this, we conclude that further evaluation for cardiac pathology would be prudent as part of the initial workup of patients with a diagnosis of GPA. Included is a brief review of available literature on GPA to emphasize the typical presentation, lab findings, and importance of early diagnosis.

Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis.

Routine hip magnetic resonance imaging (MRI) before arthroscopy for patients with femoroacetabular impingement syndrome (FAIS) offers questionable clinical benefit, delays surgery, and wastes resources. To assess the clinical utility of preoperative hip MRI for patients aged ≤40 years who were undergoing primary hip arthroscopy and who had a history, physical examination findings, and radiographs concordant with FAIS. Cohort study; Level of evidence, 3. Included were 1391 patients (mean age, 25.8 years; 63% female; mean body mass index, 25.6) who underwent hip arthroscopy between August 2015 and December 2021 by 1 of 4 fellowship-trained hip surgeons from 4 referral centers. Inclusion criteria were FAIS, primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication, reattempt of nonoperative management, and concomitant periacetabular osteotomy. Patients were stratified into those who were evaluated with preoperative MRI versus those without MRI. Those without MRI received an MRI before surgery without deviation from the established surgical plan. All preoperative MRI scans were compared with the office evaluation and intraoperative findings to assess agreement. Time from office to arthroscopy and/or MRI was recorded. MRI costs were calculated. Of the study patients, 322 were not evaluated with MRI and 1069 were. MRI did not alter surgical or interoperative plans. Both groups had MRI findings demonstrating anterosuperior labral tears treated intraoperatively (99.8% repair, 0.2% debridement, and 0% reconstruction). Compared with patients who were evaluated with MRI and waited 63.0 ± 34.6 days, patients who were not evaluated with MRI underwent surgery 6.5 ± 18.7 days after preoperative MRI. MRI delayed surgery by 24.0 ± 5.3 days and cost a mean $2262 per patient. Preoperative MRI did not alter indications for primary hip arthroscopy in patients aged ≤40 years with a history, physical examination findings, and radiographs concordant with FAIS. Rather, MRI delayed surgery and wasted resources. Routine hip MRI acquisition for the younger population with primary FAIS with a typical presentation should be challenged.

Eating and Lifestyle Habits in Underweight Patients with Insulin Resistance

Background: In recent years, there has been a significant increase in the prevalence of insulin resistance (IR) which has become a global health problem. Obesity is the typical clinical presentation of IR. The connection between underweight and IR is less known. Objective: The study aimed to investigate the characteristics of eating habits in underweight and obese patients with IR. After the obtained results, propose suitable dietary instructions specific to 2 subject groups. The task was to determine the difference in the nutritional status of underweight and obese patients with proven IR. The questionnaire was designed to collect data on diet and eating habits. Methods: The research included 60 subjects of both sexes between the ages of 20 and 60. Inclusion criteria for entering the study were: proven obesity (BMI ≥ 30), underweight (BMI≤18,5) and confirmed IR by assessment of the homeostatic model for insulin resistance (HOMA IR-2). BMI, waist-to-hip ratio (WHR), and visceral fat area (VFA) were calculated using the bioelectrical impedance. Data on dietary habits was collected using a questionnaire that included general patient data, physical activity, lifestyle and eating habits. Descriptive statistical methods were used to process and analyse the obtained data. Results: The average BMI in obese subjects was 34.32 kg/m2, and in underweight subjects, 17.26 kg/m2. There are statistically significant differences between BMI, WHR and VFA. The mean value of HOMA-IR in the obese patients was 2.87 and in the underweight, 2.45. Underweight subjects have a statistically significant (p<0.05) tendency to lose weight, consume milk and milk products, prefer lean meat, and drink more alcohol. Obese subjects are significantly (p<0.05) less physically active, more prone to insomnia, tend to gain weight, enjoy food, consume fewer fruits and vegetables and more carbohydrate food, do not follow clinical nutritional guidelines, and mostly eat in a social setting. Both groups rarely practiced mindful eating. Consumption of highly processed food and sweets is common in both groups. Conclusion: There are statistically significant differences in the dietary and lifestyle habits of underweight and obese patients diagnosed with IR. It is necessary to educate healthcare workers and the general population about the importance of nutrition for preventing IR, regardless of body weight.

Multiple sclerosing hemangiomas mimicking hepatocellular carcinoma: A case report.

Hepatocellular carcinoma is a prevalent malignant tumor affecting the liver, and surgical resection and liver transplantation are the primary treatment options for early-stage HCC patients. However, the presence of benign hepatic tumors with similar imaging characteristics to HCC poses challenges in diagnosing and treating the disease, often resulting in misdiagnosis and inappropriate treatment. This case report presents a 52-year-old female patient who exhibited space-occupying liver lesions on abdominal CT and MRI scans. Based on pathological sections from other hospitals, liver malignancy was highly suspected, and hepatocellular tumor was diagnosed preoperatively. But the tumor markers of the patient were all within the normal range. After evaluating the overall condition of the patient, we finally chose the diagnosis and treatment of dissection and partial hepatectomy. Surprisingly, the final diagnosis of postoperative pathology was sclerosing hemangioma. The patient recovered well and was discharged 2weeks later. Hepatic sclerosing hemangioma is an extremely rare disease that can be easily mistaken for malignant liver tumors due to absence of typical imaging presentations. The diagnosis also needs to be differentiated from other benign tumors, such as liver adenoma and liver abscess, according to the medical history, symptoms, and auxiliary examinations. Therefore, special attention should be given to the diagnosis and treatment of sclerosing hemangioma.

Publicly funded exome sequencing for outpatients with neurodevelopmental disorders demonstrates a high rate of unexpected findings impacting medical management

PurposeExome sequencing (ES) is a powerful tool that facilitates the diagnosis of patients with rare Mendelian syndromes. In 2018 the Israeli Ministry of Health initiated a national pilot program that funds ES for outpatients with global developmental delay (GDD). Here, we describe the 3-year impact of this program on patient care in a single tertiary hospital. MethodsFrom 2018 to 2020, trio ES was performed on 170 participants fulfilling Israeli Ministry of Health criteria: (1) moderate to severe GDD and (2) mild GDD with epilepsy or a major congenital anomaly. We retrospectively analyzed this cohort. ResultsA diagnosis was achieved in 74 individuals (43%). There were 82 clinically significant variants, the majority being novel. Consanguinity was reported in 22% and was not associated with a higher diagnostic rate. The presence of autism spectrum was associated with a lower diagnostic rate of 8/33 (24%). Autosomal dominant inheritance was identified in 14% of participants, and the parental phenotype ranged between fully affected and asymptomatic. Among the diagnosed participants, 16% had an unexpected diagnosis that did not fit the typical clinical presentation. In 9%, the diagnosis changed short-term active clinical management, in 19%, the surveillance recommendations, and in 23%, the family-focused outcomes. ConclusionThe introduction of a national program that funds ES for GDD has transformed patient care, leading to a significant effect on medical management and treatment. The high rate of an unexpected inheritance mode and variable phenotypes emphasizes the diagnostic complexity of neurodevelopmental disorders and the strength of a non-targeted approach.

Frictional Lichenoid Dermatitis

A previously healthy 4-year-old boy presented with a rash on his elbows and knees that over 3 weeks became pruritic and expanded to the posterior cervical region and hands. It appeared during the summer, while frequently wearing a thermal suit. The patient had no systemic symptoms and none of his cohabitants had a rash. Skin examination revealed flesh-colored to mildly erythematous flat-topped papules on the extensor surfaces of the elbows and knees, posterior cervical region and the dorsum of the hands (Figure 1). The findings were compatible with the diagnosis of frictional lichenoid dermatitis, no further studies were performed and the patient was treated with topical hydrocortisone during 2 weeks, with improvement. Frictional lichenoid dermatitis is probably underdiagnosed and it is a benign and self-limited disease with typical clinical presentation, so it is important to recognize it as not to prescribe unnecessary workup and medication.

PS-R03-9: PERIODIC PARALYSIS AS A PRESENTATION OF PRIMARY HYPERALDOSTERONISM: A CASE REPORT

Objective: the typical clinical presentations of patients with primary aldosteronism (PA) include generalized weakness, fatigue, high blood pressure and potassium deficiency. However, onset of PA with periodic paralysis is rare. Design and method: herein, we present the case of a 40-year-old, Caucasian women (BMI 25,6 kg/m2) with severe resistance arterial hypertension (BP 200–190/110–120 mmHg while taking antihypertensive drugs: valsartan 320 mg/day, bisoprolol 5 mg, hydrochlorthiasid 12,5 mg, amlodipin 10 mg/day, spironolacton 25 mg/day) and muscle weakness. Over the last 2 years prior to presentation, she had multiple such episodes of generalized weakness and losing the ability to stand up, move limbs, wich typically lasted for few minutes to hours/days and resolved spontaneously. Her blood pressure was uncontroled despite taking antihypertensive drugs. She was hospitalized several times because of these conditions, but there is no data on potassium levels during that period. Due to misdiagnosis, she was operated on twice (discectomy C5-C6, C6-C7 and resection of the right internal carotid artery due to pathological tortuosity), but her condition did not improve. Results: At the presentation U waves were registered in the electrocardiography the laboratory examination revealed low plasma potassium level (3,05 mmol/l). Serum TSH, cortisol level were normal. Pasma aldosteron level was 38,6ng/dl (n. 4–31). CT abdomen: adenoma of left adrenal gland. Surgical adrenalectomy was performed. Pathological diagnosis was a bening cortical adenoma. Outcomes: Patient's serum potassium level became normalized after surgical removal of adrenal adenoma. Patient's blood pressue is controlled (130/80 mmHg) by taking a fixed combination perindopril 10 mg/indapamid 2,5 mg/amlodipin 10 mg daily and there is no muscle weakness. Conclusions: Patients with periodic acute muscles weakness and arterial hypertension should monitor electrolyte levels, especially potassium, and evaluate for primary hyperaldosteronism to avoid delayed diagnosis and treatment.

The athlete's shoulder : overview of the typical clinical presentations

Shoulder injuries are common in athlete population. They can be due to trauma or overuse. Traumatic lesions are roughly the same in the non-athlete population. On the other hand, overuse lesions are specific to the sport, depending on the movements performed by the athlete. The majority of the early literature studied baseball pitchers. Pathophysiological theories have been applied to other overhead sport. In this article, we discuss briefly the main specificities and conditions of the painful athlete's shoulder.

Unusual presentation of an invasive mucinous adenocarcinoma (aka-BAC) as cavitating pneumonia: a case report

Mucinous adenocarcinoma, previously termed Broncho-alveolar carcinoma aka “BAC”, has a typical radiographic presentation that includes a solitary lesion, consolidation and diffuse pattern. A 50-year-old female presented with a productive cough, episodic haemoptysis and significant weight loss, with the initial radiographic finding showing an atypical form of cavitating pneumonia mimicking tuberculosis. Chest CT showed a cavitating lesion of the right lower lobe. There was no clinical or radiographic resolution after treatment with antibiotics. An open lung biopsy was performed and was consistent with invasive mucinous adenocarcinoma. Unfortunately, before the introduction of appropriate therapy, respiratory failure led to her demise. To avoid misdiagnosis, clinicians in areas with high TB incidences should be aware of the atypical presentation of mucinous adenocarcinoma as it can mimic infectious processes, as in our case. Early diagnosis avoids delays in initiating proper treatment and resultant poor outcomes.

Severe COVID-19 infection in a pediatric case of Chron's disease on immunosuppressive therapy

Background: Globally, the prevalence of Crohn's disease (CD), an inflammatory bowel disease (IBD), has been rising. The occurrence has been more prevalent over the past few decades, particularly among young children in Middle Eastern nations. This case report aims to increase awareness of the typical CD presentation in children and add the possibility of IBD to the list of diagnoses for suspected cases. Case Presentation: Our patient was identified as having CD based on the clinical, laboratory, imaging, and enteroscopy with biopsy. After that, he began treating the patient with 2 g of mesalazine taken orally once daily, and added 50 mg of azathioprine, the patient's symptoms and laboratory results improved. After taking immunosuppressive drugs for 6 months, he got a coronavirus disease 2019 infection that worsened the patient's condition. Conclusion: By raising awareness of early CD diagnosis and beginning therapy based on histopathological reports and the results of colonoscopy and enteroscopy, complications can be avoided and thus improve patients' quality of life.

Gastrulation and Split Cord Malformation.

Split cord malformation (SCM) is a rare form of closed spinal dysraphism, in which two hemi-cords are present, instead of a single spinal cord. SCM is categorised into type 1 and type 2. Type 1 SCM is defined by the presence of a bony or osseocartilaginous spur between the hemi-cords, whereas type 2 SCM has no bony spur, and the two hemi-cords are contained within a single dura. In this chapter, we present the putative mechanisms by which SCM arises, including gastrulation defects and Pang's unified theory. The typical and rare clinical presentations and variations are described. Finally, we outline the step-by-step surgical approach to both SCM 1 and 2 and the overall prognosis of both conditions.

Post-traumatic stress disorder and associated factors among adults exposed to stress in Ethiopia: A meta-analysis and systematic review.

Post-traumatic stress disorder is a complex psychiatric disorder that develops after exposure to traumatic events, such as violent physical assaults, accidents, rape, natural disasters, and conflicts, stranger than usual human experiences. The typical presentation of intrusive thoughts, the persistence of the trauma, the avoidance of pertinent stimuli, emotional numbness, and physiological hyperarousal are the characteristics of this anxiety symptom. Despite the presence of a study conducted on this problem, the pooled effect, particularly in Ethiopia, is not known; therefore, this study assessed the allover burden of post-traumatic stress disorder. The available study was extracted and conducted on post-traumatic stress disorder and its associated factors in Ethiopia by three independent authors. The data were analyzed by using STATA version 11 after extraction was done on a Microsoft Excel spreadsheet. The random-effect model was used to estimate the pooled effect size of post-traumatic stress disorder and its effect in the previous studies with 95% confidence intervals. Funnel plots analysis and Egger regression tests were conducted to detect the presence of publication bias. A subgroup analysis and a sensitivity analysis were done. Thirteen (13) studies were included with a total of 5874 study participants in this meta-analysis and systematic reviews. The pooled prevalence of post-traumatic stress disorder in Ethiopia was 39.28% with a 95% confidence interval (26.54, 52.01). Poor social support (adjusted odds ratio = 2.86; 95% confidence interval (1.81, 4.53)), being female (adjusted odds ratio = 1.89; 95% confidence interval (1.53, 2.34)), presence of previous mental illness (adjusted odds ratio = 4.72; 95% confidence interval (2.62, 8.36)), and witness (adjusted odds ratio = 2.01; 95% confidence interval (1.30, 3.11)) were associated with post-traumatic stress disorder. The burden of post-traumatic stress disorder in this meta-analysis and systematic review is high; therefore, immediate intervention is needed for those specific traumatized individuals.

Sclerodermiform alterations in the hands of an adolescent

Objective Illustrate an typical presentation of a rare dermatosis. Methods Pityriasis rubra pilaris (PRP) is a rare inflammatory papulo-squamous dermatosis. Genetic factors, changes in vitamin A metabolism and infections have been proposed as triggering mechanism of the disease, but its etiology and pathogenesis are still unknown. It has been described in association with HIV, drugs, autoimmune disease and visceral neoplasms. It affects all races and genders equally, with a peak distribution in the first and fifth decades of life. Most case occur sporadically, but familial cases have been reported. Results Adolescent, 18 years old, with report of generalizes pruritic skin lesions since the age of 3 months, treatd only with antihistamines. He denied comorbidities, allergies or family history of skin diseases. On examination, follicular hyperkeratosis alternating with islands of healthy skin on the anterior and posterior trunk, ichthyosiform desquamation on the lower limbs, palmoplantar keratoderma and sclerodermiform alterations on the hands and feet were noted. A biposy of the lesion on the back was performed, which showed psoriasiform dermatitis with orhokeratosis and parakeratosis alternating horizontally. Considering the clinical-pathological correlation, the diagnosis was juvenile atypical PRP subtype. Conclusion The juvenile atypical subtype of PRP is the least frequent (5% of cases) and accounts for most familial cases. It appears in the first years of life and has a chronic course. It is characterized by follicular hyperkeratosis, erythema, ichthyosiform desquamation on the lower limbs, gross palmoplantar keratoderma and sclerodermiform alterations of the hands and feet.

A Case Study on Jelly Belly

Pseudomyxoma peritonei (PMP) is a rare malignant growth characterised by the progressive accumulation of mucus-secreting (mucinous) tumour cells within the abdomen and pelvis. The common manifestations in patients are abdominal distension and appendicitis-like symptoms. Computed tomography scan with contrast of the chest, abdomen and pelvis is currently the imaging modality of choice for the diagnosis of PMP. As per the current guideline, the curative treatment for PMP is complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy. The purpose of this article is to highlight the rarity of the disease and the typical presenting symptoms, the trends in diagnosis and treatment, the role of nurses and the challenges faced in taking care of patients with rare malignancies receiving treatment.

Tuberculose ocular num Profissional de Saúde

ABSTRACT Introduction Tuberculosis is considered an Occupational Disease in Health Care Professionals and can have pulmonary manifestations or, more rarely, extrapulmonary manifestations, such as Ocular Tuberculosis, which can manifest in different ways. According to the Direção Geral de Saúde, Health Institutions should adopt early detection measures and considers that cases of active Tuberculosis in Health Care Professionals should be considered as an Occupational Disease. Case Report Technical Assistant, 57 years old, in the Physical Medicine and Hospital Rehabilitation service, with a history of recurrent episcleritis in the left eye for one year. She is observed by Ophthalmology and Internal Medicine. No other major complaints or background. She had a positive Mantoux test and a positive Interferon Gamma Release Assay test in a patient already medicated with oral and local corticosteroids, without improvement. It was assumed that it would be Ocular Tuberculosis, despite not being a typical presentation of the disease, but given the recurrence and treatment failure, it was decided to start treatment for Tuberculosis as active disease, with total remission of complaints. Given the occupational exposure, this case was reported as a suspicion of Occupational Illness and she was removed from her workplace until treatment was completed. Discussion Tuberculosis is one of the most important Occupational Diseases in Health Professionals. As an extrapulmonary manifestation, ocular tuberculosis is rare, but it can have strong implications for the patient’s health. Contrary to what has been observed with other occupational infectious diseases, the incidence of Tuberculosis has been increasing, so it is recommended to screen the risk groups. If there is suspicion, the Occupational Physician must remove the worker from the workplace, notify and report the suspicion of occupational disease. Early diagnosis can be difficult, due to the diversity of presentation, and constitutes a considerable clinical challenge, being often a presumptive diagnosis and the basic principles of treatment for extrapulmonary tuberculosis are common to pulmonary tuberculosis. Conclusion Ocular Tuberculosis as a disease presentation is rare and in Health Care Professionals it is an Occupational Disease given the risk of exposure. Occupational Disease participation by Occupational Medicine took into account the workplace and the risks, showing us the importance of correctly analyzing the place and working conditions, as well as the screening, prevention and infection control measures. Keywords: Ocular Tuberculosis; Occupational disease; Biological risk; Healthcare professional, Occupacional Health, Occupational Medicine.

S urgical Management of Ranula- F loor of M outh by M arsupialization: A C ase Series.

Abstract Introduction: The extravasation of saliva from the sublingual gland on the floor of the mouth results in a ranula. The most typical presentation is swelling under the tongue. The mylohyoid muscle may allow it to herniate, Causing a plunging ranula. Ranula can be treated in many ways, including ranula excision alone, excision of the sublingual gland with or without ranula, aspiration of cystic fluid, sclerotherapy, marsupialization, incision and drainage. Material and methods: This case study includes six patients with ranula who underwent surgical treatment by marsupialization. The indications, age and sex distribution, Marsupialization methods, pathology reports, recurrence rates, and complications were seen. Results: Out of 6 patients in our case series, no one patient has shown to be any recurrence or complications of marsupialization. Conclusions: Management of Ranula by Marsupialization is a good option, but if it recurs after marsupialization, Excision of the lesion and the affected gland is the best course of action.

Etiology, evaluation, and management of facial nerve trauma

A typical presenting concern in general practitioners' offices, emergency rooms, otolaryngology, and neurology departments are facial nerve paralysis. Penetrating injury to the facial nerve, especially iatrogenic damage, is one of the most frequent traumatic reasons of facial paralysis. The facial paralysis that results from blunt trauma that crushes the nerve frequently appears as an incomplete or delayed paralysis. The affected part of the nerve will determine how the injury manifests clinically. For adequate patient counseling with respect to prognosis and management, accurate diagnosis of facial nerve palsy must be achieved. The most often employed standardized instrument for determining the level of facial weakness is the House-Brackmann 6-grade instrument for facial nerve activity. The greatest success chances for reanimation occur in cases of a recent, sudden nerve transection i.e., less than 72 hours, where the nerve is quickly identified and repaired using direct coaptation or interposition grafts. The primary strategy of care is surveillance in situations with facial nerve paralysis where it is known that the nerve is physically intact such as blunt force trauma with incomplete or delayed complete paralysis. Neurological, muscular, static, and facial plastic treatments are some examples of facial reanimation approaches.

Normal lipase acute pancreatitis: A case report and brief review of literature

Acute pancreatitis is a common presentation in Emergency Department. Elevated amylase and lipase level are one of the three important criteria to diagnose acute pancreatitis. Out of amylase and lipase, the latter is considered more specific for acute pancreatitis. We report a case of acute pancreatitis with a normal lipase level. On review of published literature on acute pancreatitis with normal lipase levels, 23 such case reports were retrieved. A brief review of all these cases including the case presented here had unknown etiology in 50% of cases followed by alcohol and gall stone. Pain abdomen was the commonest presentation followed by vomiting. The normal discharge could be done in 71% of cases and 17% of patients were non-survivors. Hence, normal lipase cannot rule out acute pancreatitis on its own. A typical presentation of acute pancreatitis needs radiological work up like an Ultrasound abdomen or CT scan with IV contrast (if not contraindicated) before refuting its possibility.

Magnetic resonance imaging negative myelopathy in Leber’s hereditary optic neuropathy: a case report

BackgroundLeber’s hereditary optic neuropathy (LHON) is a common form of mitochondrial disease. The typical clinical presentation of LHON is subacute, painless loss of vision resulting from bilateral optic nerve atrophy. Moreover, extra-ocular manifestations such as cardiac conduction abnormalities and neurological manifestations such as multiple sclerosis (MS) like disease or parkinsonism are encountered in some patients. Abnormal findings in spinal cord MR imaging or in the cerebrospinal fluid (CSF) have been observed in previous cases of LHON-associated myelopathy.Case presentationWe report a male patient with LHON who developed symptoms of myelopathy including gait unsteadiness, enhanced deep tendon reflexes and sensory loss of the lower extremities. Imaging of the brain and spinal cord, CSF analysis, as well as neurography and electromyography did not disclose any abnormalities. The somatosensory evoked potential (SEP) findings were suggestive of dorsal column dysfunction.ConclusionsThe patient case demonstrates that myelopathy associated with LHON can present without abnormal findings in central nervous system MR imaging or in the CSF, and without evidence suggestive of multiple sclerosis or MS-like disease. The dorsal column seems to be particularly vulnerable to myelopathy changes in LHON. Evoked potential investigations may assist in confirming the diagnosis, when clinical features are in line with myelopathy but findings in CSF analysis and central nervous system imaging are normal.

Arterijska hipertenzija i bubrežna bolest - neočekivana komplikacija

Arterial hypertension and chronic kidney disease are mutually interconnected. Uncontrolled arterial hypertension along with diabetes is one of the two most common causes of end-stage chronic kidney disease. On the other hand, chronic kidney disease, as well as renal artery stenosis, results in the development of arterial hypertension. Hypertensive crisis with target-organ damage, also known as a hypertensive emergency, is a serious arterial hypertension complication which is however becoming less frequent. It requires urgent parenteral antihypertensive treatment adjusted to the values of arterial hypertension and accompanying clinical signs. Damage can manifest on numerous organ systems primarily eyes, brain, cardiovascular system, and the kidneys. This is a case report of a patient who presented with hypertensive crisis and kidney damage and was eventually diagnosed with abdominal aortic dissection expanding into the renal arteries, but without typical clinical presentation of stabbing pain. MSCT aortography, despite the risk of progression of renal damage due to the effect of contrast agent, allowed us to set definitive diagnosis and clarify the aetiology of kidney damage and resistant arterial hypertension.