Presenter of 2 Presentations
WATCH OUT FOR YOUR NECK – A CLINICAL CASE
Abstract
Abstract Body
Background
Carotid artery dissection is a cause of stroke, particularly in young adults, but may occur at any age. There seems to be a slightly higher incidence in males vs females. Common causes of arterial dissection include trauma or spontaneous events, with underlying predispositions in some cases. Most dissections occur spontaneously or after minor or trivial injury. Dissection most often results in ischemic stroke or transient ischemic attack, usually associated with local symptoms such as neck pain or headache, Horner syndrome, cranial and cervical neuropathies, and pulsatile tinnitus.
Methods
A 55-year-old male was admitted to an appointment in a health care center. The patient presented with temporal right headache for 6 days, blurred vision and photophobia in the right eye, dysarthria and tongue movement limitation to the right side. He denied cervical trauma, although he reported a chiropractic session 2 weeks before for cervical radiculopathy. He was referred to the emergency department and admitted to Neurology ward on suspicion of carotid artery dissection.
Results
The patient underwent Computed Tomography Angiography that showed carotid artery stenosis of 55%, probably due to a carotid dissection. These findings were then confirmed by MRI, which excluded ischemic stroke. He was discharged on antiplatelet therapy and was referred to speech therapy. To the present date, there was an overall improvement without symptoms recurrence.
Conclusions
The clinical diagnosis of carotid artery dissection can be challenging. It’s important for primary care physicians to be aware of this condition, since they are often the first sought by patients.
A RARE LUNG OFFENDING AGENT – A CLINICAL CASE
Abstract
Abstract Body
Background
Statins are widely used to prevent cardiovascular morbidity and mortality in patients with known risk factors. It appears that statins have profound multisystem effects that extend well beyond lipid metabolism. Certain adverse effects are well-known. Statin-induced interstitial lung disease (ILD), nevertheless, is a lesser known complication. Diagnosing ILDs at a point that clinical course can be changed by withdrawing the contributing agent is thus important.
Methods
A 57-year-old female presented to the primary care with fatigue for low intensity activity (mMRC 2), chest tightness and cough with sputum for 2 years. She denied weight loss or any other associated symptoms. Pulmonary Function Tests and echocardiogram were normal. A chest CT was requested and it showed ground-glass opacification. The patient was then referred to a Pneumology consultation where she underwent a lung biopsy.
Results
The lung biopsy identified a chronic interstitial pneumonitis probably due to a drug. According to the patient’s prescriptions simvastatin was assumed as the probable cause. The patient discontinued the statin and started inhaled fluticasone furoate/vilanterol. At 1-year follow-up she had improved, although she still had complaints of fatigue for medium intensity activity (mMRC 1).
Conclusions
Many conditions can cause ILD and identifying them can be challenging. Despite being a rare complication, as the number of patients taking statins rises, awareness of this potentially severe complication is increasing, especially for primary care physicians, so they can know when to refer to a specialist.