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A Case of Klebsiella pneumoniae Meningitis Associated with Brain Abscess and Endophthalmitis
윤성상,Baeseoup Song,Sung Sang Yoon,우호걸 대한신경초음파학회 2022 대한신경초음파학회지 (JNN) Vol.14 No.2
Meningitis, brain abscess, and endophthalmitis are rare manifestations of K. pneumoniae infection. We present a case of Klebsiella meningitis associated with a brain abscess and endophthalmitis. A 58-year-old man with alcoholic liver cirrhosis and hepatocellular carcinoma presented with fever, pain in the right eyeball, and vision loss. Endophthalmitis and urinary tract infections were identified through ophthalmologic examination and urine analysis, respectively, and empirical antibiotic therapy was administered. Approximately seven days after treatment, the patient presented with persistent headaches. In the cerebrospinal fluid study, the white blood cell count was 210/mm3, the protein level was 540 mg/dL, and the glucose level was 28.6 mg/ dL. Magnetic resonance imaging of the brain revealed diffuse brain abscesses in both hemispheres. Klebsiella pneumoniae was isolated from the blood and urine cultures. After intravenous injection of antibiotics (vancomycin and ceftriaxone) for 2 months, the headache resolved and the results of the cerebrospinal fluid study were normal.
급성 뇌경색 환자의 증상 발현 후 응급실 도착까지의 시간이 치료 결과에 미치는 영향
권영대,윤성상,장혜정,Kwon, Young-Dae,Yoon, Sung-Sang,Chang, Hye-Jung 대한예방의학회 2007 예방의학회지 Vol.40 No.2
Objectives : Recent educational efforts have concentrated on patient's early hospital arrival after symptom onset. The purpose of this study was to evaluate the time interval between symptom onset and hospital arrival and to investigate its relation with clinical outcomes for patients with acute ischemic stroke. Methods : A prospective registry of patients with signs or symptoms of acute ischemic stroke, admitted to the OO Medical Center through emergency room, was established from September 2003 to December 2004. The interval between symptom onset and hospital arrival was recorded for each eligible patient and analyzed together with clinical characteristics, medication type, severity of neurologic deficits, and functional outcomes. Results : Based on the data of 256 patients, the median interval between symptom onset and hospital arrival was 13 hours, and 22% of patients were admitted to the hospital within 3 hours after symptom onset. Patients of not-mild initial severity and functional status showed significant differences between arrival hours of 0-3 and later than 3 in terms of their functional outcomes on discharge. Logistic regression models also showed that arrival within 3 hours was a significant factor influencing functional outcome (OR=5.6; 95% CI=2.1, 15.0), in addition to patient's initial severity, old age, cardioembolism subtype, and referral to another hospital. Conclusions : The time interval between symptom onset and hospital arrival significantly influenced treatment outcome for patients with acute ischemic stroke, even after controlling for other significant clinical characteristics. The findings provided initiatives for early hospital arrival of patients and improvement of emergency medical system.
이도경 ( Do Kyung Lee ),허성혁 ( Sung Hyuk Heo ),박기정 ( Key Chung Park ),안태범 ( Tae Beom Ahn ),윤성상 ( Sung Sang Yoon ),정경천 ( Kyung Cheon Chung ),장대일 ( Dae Il Chang ) 경희대학교 경희의료원 2010 慶熙醫學 Vol.26 No.1
Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication occurring in ovarian induction therapy. We report a case of ischemic stroke with OHSS. Previously healthy 33-year-old woman underwented In vitro fertilization-Embryo transfer (IVF-ET) 6 days ago. She admitted for dyspnea and abdominal distension. Chest X-ray arid simple abdomen showed massive pleural effusion and ascites. Left hemiparesis and sensory extinction were developed suddenly 2days after admission. She was administrated with recombinant tissue-plasminogen activator (rt-PA) intravenously witin 3hours of symptom onset. Hemiparesis was improved remarkably after rt-PA infusion. Magnetic resonance imaging showed acute ischemic infarction on the right basal ganglia, corona radiata, temporal lobe and parietal lobe, and left frontal lobe, and parietal lobe. Laboratory studies showed Hemoconcentration (hematocrit: 50.4%), elevated D-dimer and fibrinogen (5.03 μg/mL and 406 mg/dL respectively) and decreased protein S activity (51%). 20 days after admission, she discharged without neurologic sequelae. Screening test for hypercoagulable state should be considered before ovulation induction therapy to prevent cerebrovascular complication with OHSS.