STUDENT ABSTRACTS
Each year medical students from the five medical schools and residents from the eight Internal Medicine training programs in Louisiana are invited to submit abstracts for the Annual American College of Physicians (ACP) Resident and Student Meeting of the Louisiana Chapter. The content of these abstracts includes clinical case vignettes or research activities. The abstracts have all identifying features removed (i.e., names, institutional affiliations, etc.) before being sent to resident council judges. This year a total of 117 abstracts were submitted for the meeting. We are excited to be able to publish the three resident and the sole student winning presentations at this year’s competition selected by a panel of judges. All abstracts were presented at the Associates Meeting held virtually due to the COVID-19 pandemic on January 22, 2022. We would like to thank the Journal of the Louisiana State Medical Society and appreciate its efforts to publicize the hard work of these trainees Shane Sanne, DO, FACP Co-Chair, Louisiana Associates Liaison Committee Miranda Mitchell, MD Co-Chair, Louisiana Associates Liaison Committee Shahzeem Bhayani, MD Co-chair, Louisiana Student Liaison Committee Catherine Hebert, MD, FACP Co-Chair, Louisiana Student Liaison Committee Angela Johnson, MD, FACP Governor, Louisiana Chapter ACP
RESIDENT ABSTRACT WINNERS BILATERAL THALAMIC GLIOBLASTOMA MULTIFORME PRESENTING WITH APHASIA G Unis MD, E Philon DO Department of Medicine, Ochsner Medical Center, New Orleans, LA
INTRODUCTION: Bilateral thalamic lesions on brain Magnetic Resonance Imaging (MRI) represent a unique and unusual radiographic pattern. While unique, the differential for bilateral thalamic lesions is broad and can include cerebrovascular disease, toxin or metabolic syndromes, posterior reversible encephalopathy syndrome, viral infections, and neo- and paraneoplastic processes. CASE: A 55-year-old male with hypertension and type 2 diabetes presented with an acute aphasia of 5 hours in duration and general malaise prior to admission but denied other significant symptoms. Physical examination at the time of admission was negative for neurological abnormalities including cranial nerve testing, as well as being fully alert and oriented with appropriate mentation. He was afebrile, slightly hypertensive with a blood pressure of 149/96, and without oxygen requirements. Laboratory studies were within normal limits on admission however, computed tomography of the head demonstrated Department of Medicine, Tulane Health Sciences Center, New Orleans, LA INTRODUCTION: Hyperammonemia is often the result of liver pathology. When hyperammonemia is not the result of liver disease, an occult disorder of metabolism must be on the differential for unexplained hyperammonemia, such as a urea cycle disorder. CASE: A 57-year-old man with recovered systolic heart failure, atrial fibrillation, hypertension, and cervical neck fracture status post recent cervical spine corpectomy and fusion presented with worsening dysphagia and neck discomfort and was found to have a cervical fluid collection. He had no known underlying liver disease and denied significant alcohol history. He received a dexamethasone taper and a lumbar drain. He was later admitted to the intensive care unit (ICU) for unstable atrial fibrillation with
subtle diminished density within the left thalamus. MRI imaging of the brain demonstrated bilateral thalamic enlargement with diffuse T2/FLAIR signal hyperintensity. Lumbar puncture was obtained and routine cerebral spinal fluid (CSF) studies in addition to viral, bacterial cultures, and autoimmune studies were ordered. The patient was found to be positive for West Nile Virus (WNV) but with a negative WNV polymerase chain reaction (PCR) and toxoplasmosis IgG positive results. The patient was treated empirically for toxoplasmosis but failed to improve. Repeat MRI was obtained and demonstrated new enhancement which prompted a brain biopsy of the temporal lobe. Pathology showed WHO Grade IV glioblastoma multiforme and the patient was referred to oncology.
DISCUSSION: This rare and unusual disease, while previously described in the literature highlights the broad differential for bilateral thalamic lesions found on brain MRI and represents a unique learning case. SEVERE NONCIRRHOTIC HYPERAMMONEMIA: WHAT UREA-LLY SHOULD CONSIDER S Wu, C Basilio MD, MPH
rapid ventricular rates. In the ICU, the patient became more somnolent and was unable to follow commands. Encephalopathy workup revealed elevated BUN with normal creatinine, ammonia of 772, and mildly elevated transaminases. Liver workup was normal. Workup for inborn errors of metabolism showed mildly decreased citrulline. Urine and plasma amino acids were otherwise normal. His hyperammonemia resolved and his mentation improved with lactulose three times daily and rifaximin twice daily. Urea cycle disorder gene panel and further genetic workup is ongoing. Patient will follow up with genetics after discharge.
DISCUSSION: Patients with elevations of ammonia present with encephalopathy, which may progress quickly to cerebral
10 J LA MED SOC | VOL 174 | SUMMER 2022
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