Introduction: Graves orbitopathy (GO) is an autoimmune disease affecting the orbits and the periorbital tissues with an annual incidence of 16 per 100,000 population in women and 2.9 in men. While GO occurs in the spectrum of hyperthyroidism or Graves disease, 7.9% of these patients have a normal thyroid function and only a few are negative for thyroid antibodies. When left untreated, GO may become debilitating and threaten vision. Case Description: A 64-year-old male presented with gross bilateral proptosis and chemosis, which developed over a period of 10 years. Palpitations, hand tremors, heat intolerance, weight loss, and insomnia were notably absent, and the thyroid gland was normal. The bilateral proptosis was left unattended for 10 years until extreme lagophthalmos and chemosis with corneal and mucosal exposure leading to dryness, foreign body sensation, excruciating eye pain, and blurred vision resulted. Thyroid-stimulating hormone (TSH), T3, and T4, were normal. TSH-receptor antibody (TRAb) and thyroid peroxidase antibody were negative. The computed tomography scan with contrast of the orbits showed bilateral proptosis and extraocular muscle enlargement typical for thyroid eye disease. The patient was diagnosed with TRAb- negative euthyroid GO with a European Group on Graves’ Orbitopathy (EUGOGO) clinical score of 7/7, indicating a severe, active disease. Screening prior to administration of GO immunosuppressive therapy revealed chronic hepatitis B infection. The patient was started with tenofovir for 2 weeks before treatment for GO. The patient was given intravenous methylprednisolone with cumulative dose of 4.5 g for 12 weeks, with daily mycophenolate sodium 0.72 g for 12 weeks. Upon completing the 12-week treatment regimen and undergoing an adjunctive lateral canthotomy and partial tarsorrhaphy, the GO signs and symptoms dramatically resolved, and visual acuity markedly improved. Conclusion This case report presents an unusual condition of a euthyroid, TRAb-negative Graves orbitopathy. It provides insights on the diagnosis and treatment of patients with such atypical presentation. Despite the chronicity and severity of this patient’s GO, excellent results were achieved with appropriate and guideline-directed treatment.
Human ; Male ; Middle Aged: 45-64 Yrs Old ; Graves Ophthalmopathy ; Exophthalmos ; Mycophenolic Acid

BACKGROUND: Uncontrolled hypertension in acute intracerebral hemorrhages (ICH) may cause hematoma expansion within the first 24 hours, and increase patient mortality. We investigated whether there was an association between ICH location and the difficulty in lowering BP in patients with acute hypertensive non- lobar ICH.

METHODS: This is a retrospective cohort study of adults diagnosed with non-lobar ICH admitted at a tertiary hospital over a 2-year period. We documented the time to attain target mean arterial pressure (MAP) of 110-130 mmHg, as well as the use of antihypertensive medications.

RESULTS: Of 357 patients admitted for non-lobar ICH,47 patients fulfilled the study criteria. Basal ganglia hemorrhages were the most common (47%), followed by thalamic (34%), cerebellar (11%), and pontine hemorrhages (8%). While there were no significant differences in baseline MAP among the different sites of hemorrhage, those with thalamic ICH had a significantly longer time-to-target MAP (p=0.02) and required three or more classes of oral antihypertensive medications (p

CONCLUSIONS: Acute thalamic intracerebral hemorrhages may require multiple classes of antihypertensives to lower blood pressure to safer levels.

Human ; Male ; Female ; Middle Aged ; .humans ; Adult ; Antihypertensive Agents ; Blood Pressure ; Tertiary Care Centers ; Retrospective Studies ; Basal Ganglia Hemorrhage ; Cerebral Hemorrhage ; Hypertension ; Hematoma

Antineoplastic Agents ; therapeutic use ; Child, Preschool ; Facial Neoplasms ; drug therapy ; Female ; Follow-Up Studies ; Forearm ; pathology ; Hand ; pathology ; Hemangioma ; drug therapy ; Humans ; Infant ; Male ; Propranolol ; therapeutic use ; Skin Neoplasms ; drug therapy ; Wrist ; pathology