A patient who had a spot on her brain for over a decade before it was diagnosed as a rare tumor. Another patient who had intractable nausea and vomiting that disappeared after taking an unexpected medicine. A third patient who had depression that went away after being treated for an underlying steroid deficiency. Dr. Shinjini Kundu recounts fascinating patient encounters in these case reports.
Medical Mysteries
Publications
Resolution of suicidal ideation with corticosteroids in a patient with concurrent Addison's disease and depression
Neuropsychiatric disturbances in Addison’s disease are often reported, but rarely recognized in clinical practice. Neuropsychiatric manifestations may often be the initial or sole presenting symptom in many cases of Addison’s disease. We report a case of concurrent severe depression and Addison’s disease in which depressive symptoms resolved after a single administration of high-dose corticosteroids.
Angioglioma misdiagnosed as encephalomalacia on magnetic resonance imaging for over a decade
We report a case of intractable seizures secondary to an angioglioma that was misdiagnosed as post-traumatic encephalomalacia for over a decade, with a discussion of the radiological findings and a review of the literature.
Rapid improvement in post-infectious gastroparesis symptoms with mirtazapine
We report the case of a 34-year-old woman with severe post-infectious gastroparesis who was transferred from an outside medical facility for a second opinion regarding management. This patient had no prior history of gastrointestinal symptoms. However, in the aftermath of a viral illness, she developed two months of intractable nausea, vomiting, and oral intake intolerance that resulted in numerous hospitalizations for dehydration and electrolyte disturbances. A solid-phase gastric emptying scan had confirmed delayed emptying, confirming gastroparesis. Unfortunately, conventional pro-kinetic agents and numerous anti-emetic drugs provided little or no relief of the patient’s symptoms. At our institution, the patient experienced a cessation of vomiting, reported a significant reduction in nausea, and tolerated oral intake shortly after taking mirtazapine. Based on mirtazapine’s primary action as a serotonin (5-HT) 1a receptor agonist, we infer that this receptor system mediated the clinical improvement through a combination of peripheral and central neural mechanisms. This report highlights the potential utility of 5-HT1a agonists in the management of nausea and vomiting. We conclude that mirtazapine may be effective in treating symptoms associated with non-diabetic gastroparesis that are refractory to conventional therapies.