Wyckoff Heights Medical Center

Neurologic deterioration following cardiac arrest is frequently attributed to global hypoxic-ischemic brain injury. However, focal ischemic stroke may occur concurrently and represents an important diagnostic pitfall in post-resuscitation care. We report the case of a 59-year-old woman with end-stage heart failure with reduced ejection fraction who developed acute neurologic impairment following prolonged pulseless electrical activity arrest. Early non-contrast CT of the head demonstrated a focal left cerebellar infarction without diffuse cerebral edema. MRI of the brain performed four days later showed no acute intracranial abnormality, illustrating radiographic discordance between early CT and delayed MRI in posterior circulation ischemia. These complementary imaging findings informed ongoing neurologic assessment and multidisciplinary discussions. This case underscores the importance of early neuroimaging and maintaining a broad neurologic differential diagnosis in post-cardiac arrest patients.

Tuberculous meningitis (TBM) is the most severe form of central nervous system tuberculosis and carries high morbidity and mortality. We report a 35-year-old man from Ecuador who presented with sepsis-like systemic symptoms and rapidly progressive neurological deficits. Initial imaging revealed cavitary pulmonary lesions and hilar lymphadenopathy, suggestive of pulmonary tuberculosis. Neurological deterioration prompted magnetic resonance imaging (MRI) of the brain and cervical spine, demonstrating communicating hydrocephalus, basilar leptomeningeal enhancement, diffuse cervical cord edema, and multiple rim-enhancing subdural abscesses. Diagnosis was confirmed via bronchoalveolar lavage positive for Mycobacterium tuberculosis after multiple failed sputum induction attempts. This case illustrates a combination of sepsis-like presentation, rapid quadriparesis, and spinal cord abscesses in TBM, highlighting the importance of advanced imaging and alternative microbiologic sampling for timely diagnosis and management.

Myocardial infarction (MI) in individuals younger than 45 years is uncommon but carries significant clinical and psychosocial implications. Its presentation challenges traditional assumptions regarding cardiovascular risk and necessitates tailored approaches to diagnosis and management. We conducted a retrospective analysis of five patients aged <45 years admitted to a local hospital in New York with confirmed MI. Data included comorbidities, imaging, laboratory results, angiographic findings, and treatment modalities. Early-onset MI occurred predominantly in males, most of whom exhibited conventional risk factors. Coronary angiography revealed both single- and multi-vessel disease. Follow-up data were incomplete, with two patients lost to follow-up. These findings highlight the importance of recognizing conventional risk factors in younger populations and emphasize the need for individualized long-term management strategies.

Evaluating altered mental status (AMS) in patients with psychiatric illness presents a major diagnostic challenge, particularly when acute neurologic pathology such as intracerebral hemorrhage (ICH) is present. This report describes a 70-year-old woman with schizophrenia and bipolar disorder on haloperidol, lithium, and clonazepam who presented with confusion, rigidity, and agitation. Workup revealed a supratherapeutic lithium level and a right temporo-occipital intraparenchymal hemorrhage. The differential included lithium toxicity, catatonia, seizure, and hemorrhagic progression.Multidisciplinary evaluation with neurology, psychiatry, and neurosurgery, along with EEG and serial imaging, identified right temporal epileptiform activity and stable hemorrhage. Gradual improvement followed medication adjustments and antiepileptic therapy.This case underscores the diagnostic complexity of AMS in patients with coexisting psychiatric and neurologic disease. Overlapping symptoms can obscure acute intracerebral pathology, emphasizing the need for interdisciplinary collaboration, serial neuroimaging, and prompt EEG when indicated.

A 76-year-old male with a history of gastritis, gastric ulcer perforation, hypertension, and active smoking presented with recurrent chest pain, abdominal pain, and back pain. Workup excluded acute coronary syndrome, pulmonary embolism, aortic dissection, and mesenteric ischemia. CT angiography revealed severe proximal celiac trunk stenosis, an ectatic descending thoracic aorta, bilateral renal cysts, emphysema, and a hepatic hypodensity. Further evaluation demonstrated non-obstructive coronary disease, possibly related to endothelial dysfunction. This case highlights the diagnostic complexity of back pain and chest pain in elderly patients with other comorbidities, emphasizing the importance of distinguishing incidental vascular findings from clinically significant pathology. A multidisciplinary approach involving cardiology, vascular surgery, gastroenterology, pulmonology, and nutrition services was required to optimize care.

Vitamin D supplementation may have beneficial effects on cardiovascular outcomes in patients with chronic kidney disease (CKD), but the underlying data are conflicting. We conducted a meta-analysis to investigate the effect of vitamin D on cardiovascular outcomes in patients with CKD.We searched MEDLINE (via PubMed), the Cochrane Library, Scopus, and ClinicalTrials.gov from inception to 16 March 2024 for all randomized controlled trials (RCTs) assessing vitamin D supplementation in patients with CKD and reporting cardiovascular outcomes. Our primary outcomes were the incidence of adverse cardiovascular events and the change in left ventricular ejection fraction (LVEF) and left ventricular mass index (LVMI). Our secondary outcomes were the change in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Data were pooled using risk ratio (RR) and mean difference as the effect measures.A total of 11 RCTs were included in our review. Vitamin D supplementation reduced the risk of adverse cardiovascular events in patients with CKD (RR 0.39; 95% CI 0.22 to 0.69; I2=0). There was no significant difference in LVEF, LVMI, SBP, and DBP between the vitamin D and control groups.Vitamin D supplementation does not affect adverse cardiovascular events, LVEF, LVMI, SBP, and DBP. Further large-scale RCTs and mechanistic studies are needed to understand the potential benefits of vitamin D supplementation in this patient population.