Delayed diagnosis of prosopagnosia following a hemorrhagic stroke in an elderly man:A case report

BACKGROUND Acquired prosopagnosia is a rare condition characterized by the loss of familiarity with previously known faces and the inability to recognize new ones.It usually occurs after the onset of brain lesions such as in a stroke.The initial identification of prosopagnosia generally relies on a patient’s self-report,which can be challenging if it lacks an associated chief complaint.There were few cases of prosopagnosia presenting purely as eye symptoms in the previous literature confirmed by functional magnetic resonance imaging(MRI).CASE SUMMARY We present a case of delayed diagnosis of prosopagnosia after a right hemisphere stroke in an elderly man whose chief complaint was persistent and progressive"blurred vision"without facial recognition impairment.Ophthalmic tests revealed a homonymous left upper quadrantanopia,with normal visual acuity.He was found by accident to barely recognize familiar faces.The patient showed severe deficit in face recognition and perception tests,and mild memory loss in neuropsychological assessments.Further functional MRI revealed the visual recognition deficits were face-specific.After behavioral intervention,the patient started to rely on other cues to compensate for poor facial recognition.His prosopagnosia showed no obvious improvement eight months after the stroke,which had negative impact on his social network.CONCLUSION Our case demonstrates that the presentation of prosopagnosia can be atypical,and visual difficulties might be a clinical manifestation solely of prosopagnosia,which emphasizes the importance of routinely considering face recognition impairment among elderly patients with brain lesions.

Relationship between hyperuricemia and contrast-induced nephropathy in patients after emergent percutaneous coronary intervention

Background Few studies have investigated the role of serum uric acid(SUA) on the risk of contrast-induced nephropathy(CIN) in patients with acute coronary syndrome(ACS)after emergent percutaneous coronary intervention(PCI). The present study was conducted to investigate the relationship between hyperuricemia(HUA)and CIN in patients after emergent PCI. Methods A total of 558 consecutive patients with ACS undergoing emergent PCI in Fujian Provincial Hospital were enrolled in this study. Patients were divided into hyperuricemic group(n=136) and normouricemic group(n=422). Hyperuricemia was defined as SUA>420 μmol/L for male,>360 μmol/L for female.CIN was defined as an absolute ≥44.2 μmol/L(0.5 mg/d L)increase inthe serum creatinine(SCr)level within 72 hours after contrast medium exposure. In hospital incidences of CIN and the major adverse cardiac events were compared between the two groups. The relationship between the incidence of CIN and HUA was evaluated by multivariate logistic regression analysis. Results Among the 558 patients, CIN was observed in 34(6.1%) patients, and incidence of CIN was significantly higher in the HUA group than in the normouricemic group [13.2%(18/136) vs. 3.8%(16/422), P<0.001]. SUA concentration was significantly higher in CIN group compared with that in non-CIN group([490.21±76.48 μmol/L)vs.(307.00±65.37 μmol/L), P<0.001].Need for renal replacement therapy(RRT), congestive heart failure(CHF), in hospital mortality after PCI were significantly higher in the HUA group compared with Normouricemic group(all P<0.05). Patients who developed CIN had higher in hospital mortality[44.1%(15/34) vs. 2.9%(15/524), P<0.001].Multivariate analysis indicates that HUA(OR=3.020,95% CI:1.3340-6.805,P<0.001)、Intra-aortic balloon pump(IABP)use(OR=15.724,95%CI:3.913-63.179,P<0.001) and Perioperative hypotension(OR=3.342, 95%CI:1.373-8.138,P<0.01) were predictors of CIN in patients after emergent percutaneous coronary intervention. Conclusion Hyperuricemia is the independent risk predictor of CIN in patients with ACS undergoing emergent PCI.

Relationship between composite hydration volume (Intravenous plus oral) and contrast-induced nephropathy after emergent percutaneous coronary intervention

Background Few studies have investigated the safe limits of total intravenous plus oral hydration to prevent contrast-induced nephropathy(CIN). The present study was conducted to evaluate the effects of different composite hydration rate(intravenous plus oral) on CIN prevention in patients undergoing emergent percutaneous coronary intervention(PCI). Methods This was a retrospective observational study that included 307 eligible patients, who were stratified into quartiles of rate of the composite hydration volumn to body weight and time(HV/W/T). CIN was defined as an absolute ≥0.5 mg/d L or a relative ≥25% increase in the serum creatinine level within 72 hours after the procedure. Results In terms of risks of CIN, there were no statistical differences among individuals in four groups with different composite HV/W/T(27.6%, 19.0%, 23.0%, and 26.9% respectively in quartiles Q1, Q2, Q3, and Q4, P=0.565). Additionally, higher composite hydration ratio seemed not to decrease the risk of in-hospital death, worsening heart failure and stroke(all P>0.05). After adjusting for other risk factors,multivariate analysis showed no statistical difference between Q2, Q3 or Q4, compared with Q1(Q2 vs. Q1: adjusted odds ratio [OR], 0.67, P=0.383; Q3 vs Q1: adjusted OR, 0.77, P=0.550; Q4 vs. Q1: adjusted OR, 0.75, P=0.489). Conclusion Excessive composite hydration may not provide supplemental benefit of CIN prevention and in-hospital outcomes in patients following emergent PCI, and moderate and prophylactic hydration is warranted.