Presentation
She presented high blood pressure, decreased urine output (with no macroscopic changes), and impaired renal function. [revistanefrologia.com]
A diagnostic and therapeutic approach is presented, based on international guidelines, disease registries and published trials. [ncbi.nlm.nih.gov]
In summary, we present a woman with the clinical and pathological features of Susac’s syndrome. [jnnp.bmj.com]
A diagnostic algorithm for the investigation and management of a patient presenting with thrombotic microangiopathy. Supportive treatment is essential. [cjasn.asnjournals.org]
Entire Body System
- Falling
This type of brain tissue helps you think fast, walk straight, and keeps you from falling. When it becomes diseased, the myelin breaks down. The signals that help you do these things can’t get through. [webmd.com]
This led to a progressive fall in LDH, platelets normalized and creatinine levels fell to 1.35 mg/dl within 1 week ( Table 1 ). Hemoglobin stabilized at 11.0 g/dl. [archbronconeumol.org]
Anemia and thrombocytopenia were primary considered to be consistent with ATG myelotoxicity (fall in hemoglobin 9.3-6.2 g/l; fall in platelet count 254-76 x 10 9/l). [czytelniamedyczna.pl]
differential diagnosis includes complement-mediated aHUS, TTP, and HELLP TTP: 10%–36% of women with TTP present during pregnancy (44) vWf increases in normal pregnancy and consumes ADAMTS13; in women with a genetic predisposition, its activity can fall [cjasn.asnjournals.org]
Extrapyramidal symptoms [ 12, 13, 14 ], gait disturbance [ 15, 16 ], falls [ 13, 16 ] and bladder incontinence [ 16 ] are reputed to be clinical features of brain leukoariosis. [em-consulte.com]
- Gangrene
443.9 converts directly to: 2015/16 ICD-10-CM I73.9 Peripheral vascular disease, unspecified Approximate Synonyms Arterial insufficiency, posterial tibial Claudication due to peripheral vascular disease Claudication in peripheral vascular disease Gangrene [icd9data.com]
Chronic Candidiasis of the fingernails Gangrene in Diabetes Hyperglycemia can allow usually nonpathogenic organisms to establish an infection in traumatized skin, occasionally resulting in gangrene and loss of limb. [telemedicine.org]
[…] and altered consciousness * † Pancreatitis * † Cardiac involvement/myocardial infarction * † Gastrointestinal involvement (including diarrhea, vomiting, abdominal pain) * Cerebral artery thrombosis/stenosis * Extracerebral artery stenosis * Digital gangrene [cjasn.asnjournals.org]
Gastrointestinal
- Vomiting
Vomiting, headache, fever, body aches and flu-like symptoms can also occur. The illness can last from a few days to a few months and patients might feel better, then get worse again. Patients can be treated with antibiotics. [endotoday.com]
Case history A 50 year old right handed woman presented at the end of August 1996 with a 3 day history of intermittent vertical diplopia followed by worsening vertigo, nausea, vomiting, and a low grade headache. Medical history was unremarkable. [jnnp.bmj.com]
[…] not always present) Microangiopathic hemolytic anemia Thrombocytopenia Fever Mental confusion, fluctuating neurological deficits, seizures, coma Abnormal urinalysis (hematuria) with occasional mild renal insufficiency Nonspecific symptoms – nausea, vomiting [arupconsult.com]
- Nausea
Those infected can experience loss of appetite, weight loss, stomach cramps or pain, nausea, gas and fatigue. Vomiting, headache, fever, body aches and flu-like symptoms can also occur. [endotoday.com]
Case history A 50 year old right handed woman presented at the end of August 1996 with a 3 day history of intermittent vertical diplopia followed by worsening vertigo, nausea, vomiting, and a low grade headache. Medical history was unremarkable. [jnnp.bmj.com]
[…] full pentad not always present) Microangiopathic hemolytic anemia Thrombocytopenia Fever Mental confusion, fluctuating neurological deficits, seizures, coma Abnormal urinalysis (hematuria) with occasional mild renal insufficiency Nonspecific symptoms – nausea [arupconsult.com]
Cardiovascular
- Hypertension
The onset of hypertension or poorly controlled blood pressure has been previously described in patients undergoing INFB treatment, with the FDA describing 19 cases of hypertension out of 12,700 patients treated with INFB. [revistanefrologia.com]
Hypertensive microangiopathy, also referred to as chronic hypertensive encephalopathy (not to be confused with acute hypertensive encephalopathy, better known as PRES) results from the sustained effects of elevated systemic blood pressure on the brain [radiopaedia.org]
A total of 45.1% patients in the group had hypertension with WMHs and 28.1% patients had hypertension without WMHs (P=.006). [onlinelibrary.wiley.com]
According to the Framingham study, LVH develops in 15-20% of patients with mild arterial hypertension, and in 50% of patients with severe hypertension. [anatoljcardiol.com]
Skin
- Eruptions
Lipid Abnormalities: Eruptive Xanthomas, (Type I Hyperlipidemia), Xanthelasma Fat Hypertrophy secondary to repeated insulin injection. Fat atrophy may also be seen. [telemedicine.org]
Long-term hydroxyurea treatment is also known to induce skin changes, usually termed dermatomyositis-like eruptions. More rarely, cutaneous ulcers have been reported, mainly on the legs, in CML patients ( 30 ). [journals.lww.com]
- Pruritus
The occasional patient will have pruritus, burning, or tenderness. Pain, however, is a frequent companion of ulceration. Some patients report partial or complete anesthesia of the affected sites, suggesting local nerve dysfunction. [telemedicine.org]
- Skin Rash
CASE A 15 year-old girl was admitted to the hospital with a 2-months history of intermittent high fever, migratory polyarthritis involving her wrists, knees, and ankles, evanescent macular skin rash, myalgias, and prostration. [scielo.br]
Psychiatrical
- Fear
Since hydrophilic expanders are translucent, they can be fitted in front of severely microphthalmic eyes with light perception without the fear of blocking out the vision. [nature.com]
Face, Head & Neck
- Epistaxis
Creatinine levels deteriorated, falling to 3.92 mg/dl (0.73 mg/dl on admission), hematocrit fell to 22.6% and thrombocytopenia to 18 000/μl, causing repeated epistaxis. [archbronconeumol.org]
Neurologic
- Stroke
Biomarkers for stroke. J. Stroke. 2013; 15: 27-37 Gutierrez J. Elkind M.S. Virmani R. et al. A pathological perspective on the natural history of cerebral atherosclerosis. Int. J. Stroke. 2015; 10: 1074-1080 Bodle J.D. Feldmann E. Swartz R.H. [atherosclerosis-journal.com]
Stroke-related symptoms were defined as continuous symptoms associated with stroke according to National Institute of Neurological Disorders and Stroke (NINDS) criteria which were neuroradiologically corroborated. [journals.plos.org]
Urogenital
- Hematuria
Inducers of inhibitors – ticlopidine, HIV, autoimmune diseases, HSCT STEC-HUS Enteric infection with a Shiga toxin-secreting strain of E. coli or Shigella dysenteriae Typically follows diarrheal illness Renal impairment (more severe than in TTP), oliguria, hematuria [arupconsult.com]
[…] called verocytotoxin because it damages Vero cells in culture) Main cause of childhood acute renal failure Usually infants and young children, may occur at any age Symptoms : sudden onset of influenza, bleeding (hematemesis or melena), severe oliguria, hematuria [pathologyoutlines.com]
The patient was admitted to Jean Godinot Cancer Center Institute with hemolysis, thrombocytopenia, macroscopic hematuria, renal dysfunction and worsening high blood pressure. [spandidos-publications.com]
[…] pathway-mediated diseases, such as cold agglutinin disease.79 ACH-4471 is the first oral complement inhibitor with promising therapeutic results in in vitro models of diseases with excessive activation of alternate complement pathway such as paroxysmal nocturnal hematuria [nature.com]
Workup
The differential diagnoses are generally broad, while the workup is frequently complex and can be confusing. [mayoclinicproceedings.org]
The lack of early response to plasma exchange prompted extensive laboratory workup. Ultimately, the patient completely recovered with negative fluid balance and control of severe hypertension. [bmcnephrol.biomedcentral.com]
Clinical Workup The clinical measures examined were blood chemistry, cardiovascular assessment, clinical tests and physiological recordings. [journals.plos.org]
Serum
- Dyslipidemia
The pathogenic mechanisms involved in the progress of atherosclerosis in these patients are indeed multifactorial; insulin resistance and adipose tissue dysfunction, dysglycemia and advanced glycation end product formation, dyslipidemia, oxidative stress [jamanetwork.com]
We speculate about the possibility that under dyslipidemias associated with increased exposure of vascular cells to NEFA, like in type 2 diabetes, similar alterations may contribute to associated macrovascular and microvascular complications. [dict.cnki.net]
Maternal serum dyslipidemia occurs early in pregnancy in women with mild but not severe preeclampsia. Am J Obstet Gynecol 2009;201(3):293.e1-293.e4. Ryu S, Huppmann AR, Sambangi N, Takacs P, Kauma SW. [medigraphic.com]
[…] prevalence of 20% to 25%, regardless of disease stage. 2 The most probable reasons for the difference between types 1 and 2 diabetes in this regard are greater disease heterogeneity, association with risk factors (eg, insulin resistance, metabolic control, dyslipidemia [medicographia.com]
In addition, diabetes is frequently associated with other known cardiovascular risk factors, including hypertension, obesity, and dyslipidemia. [ncbi.nlm.nih.gov]
Microbiology
- Candida
The third presentation of Candida infection of the extremities is involvement in the toe nail plates. [telemedicine.org]
Candida glabrata was isolated from the abscess, but there was no hematogenous spread. [archbronconeumol.org]
Treatment
Interferon treatment was discontinued and treatment with renin angiotensin system inhibitors was initiated. [revistanefrologia.com]
The review suggested that there may be an association between interferon beta treatment and thrombotic microangiopathy and between interferon beta treatment and nephrotic syndrome. [gov.uk]
Patients can only switch treatment arms once. [clinicaltrials.gov]
Téllez-Hinojosa et al.2 elegantly analyzes classic TM etiopathogenesis, diagnosis and treatment in this issue of Medicina Universitaria. [elsevier.es]
Treatment with ixazomib and lenalidomide was discontinued. Despite these measures, the thrombocytopenia persisted and the renal failure worsened, the patient requiring dialysis after 72 hours. [journals.lww.com]
Prognosis
Research in Respiratory Intensive Care Onco-Hematology) European Respiratory Journal 2016 47: 688-690; DOI: 10.1183/13993003.01276-2015 Abstract Better pathophysiological understanding of PTTM could result in specific targeted therapies and improve prognosis [erj.ersjournals.com]
Microphthalmos with cyst had the worst prognosis, coloboma with microcornea and microphthalmos a poor prognosis, coloboma with only microcornea had an intermediate prognosis, and simple coloboma had the best prognosis. [aao.org]
In post kidney transplantation TMA have a better prognosis, and if limited to the allograft, resolution is reported around to 80%. [kidneypathology.com]
Frequency of microangiopathic hemolytic anemia in patients with systemic lupus erythematosus exacerbation: Distinction from thrombotic thrombocytopenic purpura, prognosis, and outcome. Arthritis Rheum. 2005 Dec;53(6):982-5. (10.) [aprendeenlinea.udea.edu.co]
Etiology
Multiple etiological factors include VASCULAR ENDOTHELIAL CELL damage due to SHIGA TOXIN; FACTOR H deficiency; and aberrant VON WILLEBRAND FACTOR formation. Se även Thrombosis Svenska synonymer Inga svenska synonymer finns. [mesh.kib.ki.se]
There are different pathologies of various etiologies, hereditary or acquired, which causes said microangiopathy. [elsevier.es]
Multiple etiological factors include vascular endothelial cell damage due to shiga toxin; factor h deficiency; and aberrant von willebrand factor formation. [icd10data.com]
[…] absent 1 = “caps” or pencil-thin lining 2 = smooth “halo” 3 = irregular periventricular signal extending into the deep white matter deep white matter (DWM) 0 = absent 1 = punctate foci 2 = beginning confluence 3 = large confluent areas Importantly the etiology [radiopaedia.org]
Epidemiology
George at the Departments of Internal Medicine and Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, P.O. Box 26901, Oklahoma City, OK 73126-0901, or at [email protected] . [nejm.org]
SHOWING 1-10 OF 106 REFERENCES Diabetes Mellitus and Its Complications: Molecular Mechanisms, Epidemiology, and Clinical Medicine, The Annals of the New York Academy of Science Volume 1084 (1st edition) Glucose, Advanced Glycation Extraesophageal reflux [semanticscholar.org]
The descriptive epidemiology of anophthalmia and microphthalmia. Int J Epidemiol. 1996;25:1009–1016. ↑ 8.0 8.1 Forrester MB, Merz RD. Descriptive epidemiology of anophthalmia and microphthalmia, Hawaii, 1986–2001. [eyewiki.aao.org]
Pathophysiology
OBJECTIVES: The progression and pathophysiology of neuropathy in impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) is poorly understood, especially in relation to autophagy. [ncbi.nlm.nih.gov]
The pathophysiology of LVH includes hypertrophy of cardiomyocytes, interstitial and perivascular fibrosis, coronary microangiopathy and macroangiopathy. [anatoljcardiol.com]
Vincent for the GrrrOH: Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (Group for Research in Respiratory Intensive Care Onco-Hematology) European Respiratory Journal 2016 47: 688-690; DOI: 10.1183/13993003.01276-2015 Abstract Better pathophysiological [erj.ersjournals.com]
The current classification of various syndromes of TMA is heterogeneous and often does not take the underlying pathophysiology into consideration. [academic.oup.com]
There is possible parallel and/or overlap in the pathophysiology of TMA and PRES. [ajnr.org]
Prevention
REFERENCE BOOK Screening for Colorectal Cancer | CTFPHC REFERENCE BOOK Screening for Cognitive Impairment | CTFPHC REFERENCE BOOK Screening for Depression | CTFPHC REFERENCE BOOK Screening for Developmental Delay | CTFPHC Review Canadian Task Force on Preventive [qxmd.com]
To prevent death and serious organ damage TTP requires immediate treatment with plasma exchange (PLEX) – see Figure 5 for a diagram. [unckidneycenter.org]
We also highlight how new insights into pathogenic mechanisms of vascular damage in diabetes may indicate new targets for prevention and treatment. Copyright © 2017 Elsevier Inc. All rights reserved. [ncbi.nlm.nih.gov]
The offending agent suspected of causing the TMA should be promptly discontinued to prevent further progression of injury. If the offending agent needs to be redosed, caution should be taken to re-introduce the drug at a lower dose. [ajkdblog.org]