#susac

[helenabertinell1]

it’s def the artist in me but seeing the oakland a’s players celebrate and be happy despite it all is so comforting …. like those little happy moments when everything’s gone to shit are so important really show the beauty of humanity

[headcanontheshitoutofsoulsborne]

there's a minor spelling error in the most recent melania hc, it says "sucas syndrome" instead of "susac syndrome"

I don't have someone let me correct who cannot even write Malenia right ^^ Ah well, thank you though. I probably won't change it though, my spelling errors are part of the charm on this blog.

[survivingsusac]

Andi Boudoir

Alright guys, come and buckle up because I'm going to start today off going full ADHD style, where I have 85,000,000 topics to cover and not enough focus to do it in a coherent fashion. Sorry, not sorry.

I have two things I have been considering blogging about and so I did something I don't usually do and I asked my ultra selective group of Facebook friends, “Which of these two topics do you guys want to read about?” And, of course, in typical Facebook fashion they said we want to hear it all. Extremely unhelpful right?

Side bar 1: Surviving Susac now is on Instagram: https://www.instagram.com/survivingsusac/

So, this blog entry you guys get Boudoir Part I, next time you get work update, and the next next time you get Boudoir Part II, when I will likely have the final pictures.

Boudoir Part I story starts like this:

I hate my physical body.

I used to be cool with it up until like 2016, but then Susac came into the picture and the body is totally different now than I was used to it being. It is uncooperative. It is not flexible anymore. I can't even freaking jump or run. Don't count on me in an emergency, sorry. Just run away, save yourself; and if I live, I live.

Plus add on top of that a very complex and transactional relationship with my sexual self. I have no trust in my body that it's going to do what I need it to do. I don't trust that it functions in the way it's supposed to function. I mean it tried to unalive itself so that’s a whole *thing*. Then it stopped its regular functions, and they all became irregular functions. Some of them stopped altogether.

If we were to pull apart my mental self, from my emotional self from my physical self the three of us would have a very complicated love triangle. There'd probably be some triangulation, as well as some condescension and a very large dose of irritation.

Back to Boudoir topic

So I’m doom scrolling on Facebook a couple weeks ago, as per my usual habit.

DON’T SCROLL FACEBOOK WHEN YOU’RE SUPPOSED TO BE GOING TO BED.

I came across an open casting call for Andi's boudoir in Roseville. So essentially, you pay about 600 bucks, and you get the full boudoir experience and then that payment goes toward whatever product you choose to purchase from your experience. You just pay the difference toward the total cost of the product you chose, and all the digitals of the photos become property of Andi for use in her publicity and marketing for her company. Cool man, I dig it!

My half asleep self goes, “Hey Aurora, you would totally never come up with this to do for yourself. Maybe Jesus is all up in your Facebook algorithm telling you to give it a shot or something.” My very sciencey, logical brain was thinking that the Boudoir experience could help me get over the fact that I hate my body and maybe learn to accept it a little bit.

Also, it might not hurt to feel a little feminine, right? I mean one of my personal goals for myself is to find a male life partner in the coming years. And I guess ought to realize my femininity as part of opening myself up to finding a partner. *shrugs*

Sidebar 2: Mental note to write a blog later about all the psychological crap I’ve been learning and unlearning to stop attracting and maintaining toxic relationships.

Getting to the point, I complete and submit an application to Andi to ask to participate in the open casting call. I finally expected all the slots to be filled already. But my application is submitted and then in about an hour—because yes I'm still up doom scrolling—I get an e-mail response from Andi telling me that she's really interested in what I say in my application and that she wants to help me with my goals because they're aligned with her visions for her business. I did my happy wiggle hearing that she was going to save space in her schedule for me.

https://www.andiboudoir.com/

I got a call about four days later from her scheduler and she says can you come to the studio in two days? “Heck yeah, let's do it!”

I then get a call from Andi and we talk about my comfort levels and personal vision for the shoot. I'm like, “Girl this is my first time ever embracing my femininity in this way. I’m doing this on whim and in an effort to get myself out of my comfort zone and fall back in love with my own body. I'll be your clay you be my sculptor; I will just follow your direction.” Being an artist she of course was so down for that level of artistic freedom and control.

I got to the studio and the whole experience was phenomenal. The three ladies worked so collaboratively as a team that there was absolutely no reason for me to not trust their process. It felt fantastic to get fawned over, to get my hair and makeup done, and play dress up in their wardrobe closet. Andi even got me a mocha, so she was definitely speaking my food love language. The process of taking the pictures was at times a bit awkward because the positions they put me in were strange. However, they ended up creating some really gorgeous photographs.

Of the over 100 photos we took together, I chose my 10 favorite photographs and got an extra of what they called an “After Glow” shot. The 10 photographs will become an album which I chose the binding to coordinate with the lingerie they put me in for the photographs. Any of you guys who know me personally know that I love a theme, so of course the outside wrapping of the album had to match the inside photos of the album! I get a few prints of two other photos and the After Glow shot. They’re totally going up in the apartment!

The whole experience with Andi and her team was so delightful that I want to go back again. The expense is astronomical compared to my income, so I need to find a way to become independently wealthy. That way I can support my new boudoir habit. That, and you know, pay medical bills for myself and my kid and buy food. All the critical things.

Financial independence is in the works, career growth is in the works, finding and maintaining healthy real love is in the works. I just never stop moving you know?

Surviving Susac,

Aurora

[griddlebandits]

Trigger Warning: Suicide

Doctors never did figure out why I had been sleeping so much. They tested for all sorts of things, but came up short. They suspected Susac’s Syndrome, which at the time I thought was fatal, so I’m glad that turned up negative. I’ve had a couple fluorescein angiograms to take pictures of the blood vessels in my eyes, but both times they showed that everything was normal. To this day, I’m still a…

[444names]

Names generated from French, Irish and Italian forenames, excluding the letter "H" and including the letter sequence "Us"

Airguse Alause Alfraympaus Amargius Aoirgus Aolaus Argius Argiusta Argus Aurearlaus Auseo Auseppe Auserre Auseán Auste Austelo Austigín Austino Austo...

Bargusa Beargius Belforgus Benrigius Berguse Bergustia Bermergius Bliviorgus Brineargus Brugustinn Camuserogán Camustín Caorgius Cargius Ciargus Claurégiuse Clauseppolò Colause Colaustino Comaus Corgius Corgusto Cuisaffaus Céargius Dergiusa Didinaus Donairgiuse Doviellaus Eadargius Eargiusebar Eigius Eigiuse Elaurégius Emaus Eorgius Eorgus Ergiusarnán Ergus Ermaus Euggius Eugus Eugusadama Eugusto Eugustéo Eóirgus Faurégius Feigiusto Ferguseli Filianpause Flausa Frégiuse Gaellaus Gargus Gergusa Giorgusafia Girgius Giusa Giusabre Giusacia Giusaelmón Giusaise Giusal Giusalin Giusane Giusannice Giusaoirène Giuse Giuseadia Giuseal Giuseann Giuseanzo Giusearic Giusearoine Giuseasia Giuseasquel Giusebapti Giusebas Giusela Giusele Giuselles Giusena Giusenne Giusennín Giuseo Giuseonán Giuseppeim Giuseppeo Giuser Giuserea Giusericto Giuserino Giuserio Giuserisa Giuserr Giuseárd Giusta Giustal Giustalle Giustann Giuste Giustel Giustele Giustertúr Giusti Giustia Giustianlo Giustianne Giustiari Giustie Giustienio Giustin Giustine Giustinore Giustinstit Giustis Giusto Giustonán Giustorgus Giustorla Giustra Giustéo Giustín Giustíona Giustíonce Goirgusta Gorgiustigo Gorguse Greziorgus Grégius Gugus Guguseam Guigiustier Gusabbán Gusabeldola Gusabeppe Gusalan Gusamel Gusanice Gusannieu Gusar Gusarnán Gusartrín Guseana Guseandrano Guseard Gusearia Gusearnán Guseas Gusebapo Gusebasán Gusebato Guseleant Gusen Gusenn Gusent Guseo Guseoncene Guseono Guseppe Guseppel Guseppie Guseppo Guser Guserierd Gusern Gusernín Gusero Gusertit Gusevia Guseán Gusta Gustanna Gustanne Gustanto Guste Gustefabio Gustel Gustell Gustelydino Gusterna Gustero Gustie Gustigno Gustin Gustinatria Gustisanie Gusto Gustoisteo Gustora Gustorette Gustrine Gustéad Gustéagán Gustéanda Gustéato Gustéo Gustín Gustíofrine Gustóirea Ianlausto Irgus Jeacorgusa Jergiuste Joclaus Joëllaus Julintorgus Jusalber Jusalla Jusanofán Jusard Jusavirtúr Jusealle Juseard Jusearáir Juseasna Jusebaina Jusebale Jusebas Jusenat Jusenvella Juseo Juseorla Juseppas Juseppe Juseppein Juseppomás Juserianna Jusermaelle Jusetiné Jusette Jusev Juseverienn Juseál Juseán Justa Juste Justemirc Justerinoît Justiamélas Justigit Justin Justinia Justino Justiné Justio Justo Justre Justíonn Kargiusa Kylaustig Lairguste Lamus Laolause Laorgius Lassanaus Lause Lausebarle Lausette Lausetto Lauseán Laustóine Linilegius Lirgustin Lottorgusti Lucargustin Luccamus Lucilegiuse Lugus Luguse Lugusterien Luigius Luirgiuse Luirgus Luirguste Maergus Maoigius Maoiriergus Margiuseppe Margus Marigius Marlorgius Mausall Mausandás Mause Mausenrid Mausette Mausta Maustíne Mergius Miliarigius Milicorguse Mirgus Muellaus Muirgus Muirguseag Musaberna Musait Musalenán Musan Musandán Musaoibébas Museano Museartig Museavo Musebas Musele Museles Muselm Musentie Museo Museoria Museppaoina Museppe Museppie Muser Museric Museriena Muserisabre Musertin Musette Musta Mustancla Mustany Mustanán Muste Mustiand Mustignèse Mustin Mustine Mustinstalo Mustiné Mustio Musto Niertorgus Nuellaustin Oranmaus Orgus Orgustane Orgustieloé Pauseons Pausette Pausta Paustinn Qualausta Rigius Robiamus Roirgiuse Rolaus Rorgiusto Ruggergus Ruggius Rugus Ruguse Ruguseos Rugustan Réampaus Régius Régiuse Régiusto Régorguste Samaus Sambergus Saolegius Sargius Sargiustín Sillaus Susabarna Susacence Susael Susaelo Susaffran Susamonn Susan Susealastín Suseldo Susento Susenzo Suseoire Suseppie Susern Suserraptio Susev Susevidia Susevina Suseán Sustait Sustaín Suste Sustemma Sustertúr Sustia Sustieriam Sustigiette Sustigna Sustin Sustina Susting Sustinn Sustino Sustionn Susto Sustoirey Sustéago Sustín Sustóidia Sylaus Tigiusaore Tingeaspaus Torgius Uggiuse Ugusa Uguse Ugusette Ugustigia Uigius Uistorgusto Valinemmaus Vandranlaus Viorgus Virguse Zanpiergus Éargus Éigiuse Éislaus Évergius

[mariacallous]

The Bosnian state court announced on Wednesday that it has upheld the verdict sentencing former Croatian Defence Council, HVO fighter Nedzad Tinjak to 12 years in prison and his fellow fighters Jure Kordic and Drazen Lovric to three years and one year respectively.

The former members of the HVO, the Bosnian Croat wartime force, were convicted of war crimes against civilians who were illegally detained and mistreated in Mostar in 1993.

“The Bosnian state court issued a second-instance verdict rejecting as unfounded an appeal from the Bosnian state prosecution and appeals from the defence lawyers for the defendants Jura Kordic, Drazan Lovric and Nedzad Tinjak, confirming the first-instance verdict from February 24, 2023,” the court said in a statement.

Tinjak was found guilty of having participated in the unlawful arrests of Bosniak civilians who were then detained at the Vojno detention camp in Mostar, as well as treating them inhumanely.

He was also convicted of raping two women.

Kordic was found guilty of participating in unlawful arrests and treating detainees at the Vojno detention camp inhumanely. Lovric was convicted of unlawful arrests.

Six other wartime HVO fighters were acquitted under the first-instance verdict – Dario Susac, Nuhan Sikalo, Dario Mihalj, Stanko Skobic, Tomislav Ancic and Slavko Golemac.

They were cleared of the unlawful detention, torture, inhumane treatment and rape of civilians who were held in inhumane conditions at the Vojno detention camp from 1993 to 1994.

The trial began almost six years ago, in May 2018. Two defendants, Nedzad Coric and Marinko Sunjic, died during the proceedings.

The second-instance verdict cannot be appealed.

[baseballjerseynumbers]

Adam Frazier takes 12. Last worn by Rougned Odor in 2022.

Cole Irvin takes 19. Last worn by Chris Davis in 2020.

DL Hall switches from 49 to 24. Last worn by DJ Stewart in 2022.

James McCann takes 27. Last worn by Andrew Susac in 2018.

Kyle Bradish switches from 56 to 39. Last worn by Chris Ellis in 2022.

Kyle Gibson instead takes 48. Last worn by Jorge López in 2022.

Spenser Watkins switches from 80 to 52. Last worn by Alex Wells in 2022.

Mychal Givens takes 60. Last worn by Louis Head in 2022.

[europahoynews]

El aumento de las temperaturas impulsa el cultivo del olivo en Bosnia

El aumento de las temperaturas impulsa el cultivo del olivo en Bosnia

Las temperaturas más altas del calentamiento global están haciendo posible el cultivo del olivo más al norte. La tierra del enólogo y olivicultor Jure Susac en Bosnia solía estar cubierta de escarcha o incluso de nieve al final del otoño, pero los años de temperaturas en aumento ahora significan un clima templado hasta bien entrado el año. Hacía 28 grados centígrados (82 Fahrenheit) mientras su…

[desordrecreatiu]

FRANCISCO DE GOYA - Síndrome de Susac

A l’entrada del blog que exposarem avui, tractarem sobre el Síndrome de Susac, una malaltia molt inusual que va patir el pintor Francisco de Goya a partir dels 46 anys. Aquest trastorn no se li va diagnosticar en el moment que el va patir, sinó que fins que fa relativament poc, la doctora estatunidenca Rona Hertzano per al Historical Clinicopathological Conference (conferencia on diagnostiquen trastorns a artistes de segles passats) li va diagnosticar. Fins a aquest últim diagnòstic, s'especulava amb una possible sífilis o còlics, per la excessiva exposició al plom, que portava la quantitat de pintura blanca que utilitzava, que li va portar a la sordesa per a tota la seva vida.

Francisco de Goya va néixer al 1746 a un poble de Zaragoza que es diu Fuendetodo, fill de família artesana, però que no va voler continuar amb l’ofici familiar com ho ha demostrat al llarg de la historia. Des de ven petit va començar amb la pintura, tenia 5 anys quan feia les primeres obres i als 14 anys va deixar els estudis per dedicar-se al que li agradava de debò, la pintura. Tan aviat com va poder se'n va marxar cap a Madrid per continuar formant-se, allí va conèixer a Francisco Bayeu, el seu mentor, que li va aconseguir els primers treballs fins aconseguir tenir un nom a la pintura. Amb el seu estil rococó, tocant el neoclassicisme, fins al preromanticisme, va aconseguir pintar per a la casa reial. On la majoria de les seves obres van ser retrats, cossos nus i la història de la guerra.

En l'àmbit personal, Francisco de Goya es va casar amb Josefa Bayeu, germana del seu gran amic Francisco Beyaur. Durant aquest matrimoni va tenir 8 fills, dels quals només un va aconseguir sobreviure al part. I la seva tragèdia no va terminar aquí, quan es va traslladar a una casa anomenada “La Quinta del Sordo” a les afores de Madrid, es va morir la seva dona. Això i juntament amb una sordesa i marejos que anava arrossegant (primers símptomes del Síndrome de Susac) va anar convertint en Goya una persona més antipàtica i grotesca.  

I ja finalment, als 46 anys va significar un abans i un després a la seva vida, tant professional com personal, on va patir el Síndrome de Susac. Aquest síndrome esta causat per al sistema immune que ataca els revestiments de petits gots sanguinis. Això, provoca inflamació al cervell que pot causar dolors de cap i al·lucinacions, mentre que el dany al subministri de sang als ulls i a les oïdes comporta problemes visual i auditius. L’origen del Síndrome de Susac està en un problema vascular, que son petits infarts que apareixen en diverses arteries de l’encèfal, de la retin i en l’oïda interna. Fins que, en algun moment, la persona en qüestió entra en coma (fet que li va succeir a Goya als 46 anys).

Després de 2 anys va aconseguir recuperar-se, però li van quedar seqüeles com la sordesa per a tota la seva vida. Poc a poc va anar acostumant-se però definien els seus problemes de salut com: “Un mal que li fa el seu cap, que es on té tot el seu mal. El soroll al seu cap i la sordesa no han cedit, però esta molt millor de la vista i ja no te la torbació que tenia, que li feia perdre l’equilibri. Ja pot pujar i baixar escaleres molt bé i per fi pot fer coses que abans no podia”

Degut a la seva sordesa, va tenir que deixar la Real Acadèmia de San Francisco, i va començar una de les seves etapes més representatives i productives, anomenada com la Sèrie Negra. Va deixar el seu període artístic on les seves obres eren més realistes, lluminoses i detallades. Ja que després de la seva malaltia va transformar el seu art en un univers més pessimista, foscor, deformat i grotesc.  

Aquesta foscor que habitava en ell a causa de la sordesa, va convertir en Goya un artista amb un estil avantguardista, que sense donar-se compte va assentar les bases de la pintura contemporània.  

A dia d’avui Fracisco de Goya hauria sigut tractat amb fàrmacs de modulació immune per al síndrome de Susac. Hauria quedat igualment sord, però mitjançant estímuls elèctrics hagués recuperat la capacitat per atendre la parla.  

No obstant, si hagués sigut tractat, possiblement no hauríem disposat d’aquelles obres d’art que actualment són historia de l’art espanyol.

Escrit per - Biel Fernández

[grucomdoo]

Izvršena popravka sistema klime na Bomag kompaktoru www.grucom.rs 0659930900 #klima #servisklime #airconditioning #airconditioner #bomag #compactor #valjak #dynapac #deloviklime #kompresorklime #susacklime #susac #crevoklime #freon #freon134a #delovizabagere #delovizavaljak #delovizagrajevinskemasine #opremazagradjevinskemasine #opremazabagere #beograd #srbija #grucomdoo (у месту Pančevo) https://www.instagram.com/p/CfzK7eksS39/?igshid=NGJjMDIxMWI=

[chookophilosopher]

@denopoly @thejimmydoreshow #thejimmydoreshow #westdesmoines #thefunnybone #chookolingo #susac #usa #standupcomedy #politicalhumor (at Des Moines Funny Bone) https://www.instagram.com/p/CdZzBzUugMy/?igshid=NGJjMDIxMWI=

[bbarchivolto]

Buon giorno from Susa! The capital of the "Sun" A very happy and sunny day today. A good occasion to visit Susa valley. Have a good Susa valley then! 😉😎 Join Archivolto B&B in the historical centre of Susa and make your base camp ! We are at 30 minuts from everywhere in Susa valley Getting old guys!  Please Book now! :-) Whatsapp me +393496705887 ______________________________ Make sure to Visit Susa Valley before you die😜 ------------------------------------------------- Have a nice day 🇮🇹🤗  #archivoltogallery #susacity #dronestagram #piedmont #sunnyday #summer #discovereurope #dronefly #village  #piemonte #alps #susavalley #valledisusa  #visitvaldisusa #summerweather #ig_piemonte #ig_susa #yallerspiemonte  #myvalsusa #свысотыптичьегополета #ig_world #visititaly #naturelover #crpiemonte #shotz_of_piemonte #italian_trips #volgopiemonte  #visitpiemonte #igerspiemonte #mountainlovers #piemonte_super_pics (presso Susa, Italy) https://www.instagram.com/p/BnBHou9nG9N/?utm_source=ig_tumblr_share&igshid=15oofps9rw9zd

[survivingsusac]

What do you know about hyperchloremia?

It’s latin for high chloride in the blood.

Jumping right in today because I'm too tired for my typical rambles. Unusual, I know. And borderline concerning.

I got a complete blood panel workup done this week. It's a typical lab ordered for people who are on intravenous or subcutaneous immunoglobulins. I was on intravenous and now I do my own subcutaneous. A complete blood panel is used to make sure that the somewhat heavy medication isn't taking a negative toll on your body's organs, focusing on the kidney and liver function. As those are the organs that filter things out of the circulatory system.

Pretty much everything was in normal levels which is great. I like being “healthy."

That was ironic humor for those of you who may have missed it. Aurora is not “healthy,” but she finds it ironically funny that her levels are in the ”healthy” range.

Interestingly, there was one metric that was on the tippy top high end of the normal range. My chloride levels.

What is chloride?

Chloride is a mineral electrolyte in your blood which helps maintain the acid base balance in your blood. Chloride is measured on a spectrum called the pH scale, which ranges from zero to 14. 7, being smack dab in the middle, is true neutral. Healthy pH of blood is normally slightly basic with a pH range of about 7.35 to 7.45. Usually, the body maintains the pH of blood close to 7.40. Blood tests, like my full blood panel work up, measure the acid base balance by measuring the pH and levels of carbon dioxide-a gas which makes your blood more acidic-and bicarbonate-a base, present in antacids like Alka seltzer-in the blood.

Electrolytes help control nerve and muscle function.

*This information immediately connected little dots in my brain between spasticity and chloride*

The amount of chloride in your blood is often measured with other electrolytes to monitor kidney disease heart failure liver disease and high blood pressure.

What part of your body makes chloride?

High cortisol levels play a part in chloride increases. Cortisol, often called the stress hormone, is produced by the adrenal glands. The adrenal glands sit like tiny little berets on the top of each kidney.

Higher chloride levels in brain region weakens synaptic transmission in the cortex. High chloride = slow brain neuron firing, like you’re sleeping.

What does a high chloride level really mean? Explain it like I’m five, please.

High chloride can indicate that you are dehydrated, that you have kidney disease, that you have metabolic acidosis or respiratory alkalosis. Metabolic acidosis is when your blood is too acidic (low on the pH scale). Respiratory alkalosis is when you breathe excessively or hyperventilate so you have too much carbon dioxide in your blood so it’s more basic (high on the pH scale).

The most common culprit for elevated chloride is dehydration. And your girl Aurora is chronically dehydrated. So while I have my theories of why my adrenal glands began over-producing cortisol, I also recognize that I have a serious problem with keeping myself hydrated.

Side bar:

If you can’t connect the dots to how I would have experienced an increase in cortisol-the stress hormone-would play a role in a physiological response in my body, all I can say is have you read the blog? Not trying to be rude. But here’s the bullet point Spark Notes style version:

Fight or flight response active for entirety of marriage

Adrenal glands on, increase in cortisol and apparently chloride

Habitual issue with hydration (not helping the chloride processing situation)

That’s it. That’s my Spark Notes version.

Aurora is verbose by nature, but she can break things down into the short and sweet. But you’ll need the contextual knowledge for what is contained in those bullets points for it to mean much to you intrinsically.

So, just…read the blog.

Surviving Susac,

Aurora

[consultatiiladomiciliu-ro]

Triplă amenintare: trei simptome comune se adaugă la o singură afectiune rară

Citeste articolul pe https://consultatiiladomiciliu.ro/tripla-amenintare-trei-simptome-comune-se-adauga-la-singura-afectiune-rara/

Triplă amenintare: trei simptome comune se adaugă la o singură afectiune rară

Când o femeie în vârstă de 39 de ani, sănătoasă, cu vedere încețoșată, pierderea auzului și migrenă, a prezentat serviciul de urgență (DE) de la Spitalul St. Michael din Toronto, Canada, Dr Sanskriti Sasikumar, MD, știa că este necesară o abordare multidisciplinară acest caz neobișnuit.

Pacienta i-a spus lui Sasikumar, unul dintre primii clinicieni care a văzut-o, că a venit la spital la sfatul medicului ei de familie. În ultimele 3 săptămâni, a spus ea, nu se simțise ca ea însăși.

Se confruntă cu dureri de cap, amorțeală la degete și în jurul gurii, vedere încețoșată la ambii ochi și pierderea auzului. Soțul ei a raportat că a dezvoltat recent apatie, ceea ce a ridicat un steag roșu pentru Sasikumar.

Când pacienții experimentează o schimbare bruscă a personalității, „este neobișnuit și începem să ne gândim la encefalopatie”, spune Sasikumar pentru Medscape Medical News.

Cazul a fost publicat online pe 24 noiembrie în Neurologie .

Pete “Vată de bumbac”

Pentru a investiga, clinicienii au efectuat un istoric detaliat, au testat funcția cognitivă a pacientului, au efectuat o audiogramă și un examen de fund de ochi detaliat și au efectuat un RMN al creierului și măduvei spinării superioare.

Deși pacienta a negat să se confrunte cu deficite cognitive, ea a obținut 20 din 30 la evaluarea cognitivă din Montreal, indicând o afectare ușoară.

Audiograma a arătat pierderea auzului cu frecvență scăzută, iar examenul ocular a evidențiat două pete de “vată” în ochiul stâng și una în ochiul drept, identificate ca ocluzii ale arterei retiniene ramificate.

Rezultatele RMN, spune Sasikumar, au fost “foarte anormale, ceea ce ne-a surprins, având în vedere cât de funcțională [cognitiv] era atunci când am văzut-o prima dată”. Imagistica a dezvăluit multiple leziuni „bine circumscrise” în talamus, corpul calos și trunchiul cerebral. „A fost un lucru foarte dramatic de văzut”, adaugă Sasikumar.

Aceste leziuni, împreună cu celelalte simptome ale pacientului, au condus echipa să ia în considerare un diagnostic al sindromului Susac, o boală autoimună rară, cu trei caracteristici definitorii – encefalopatia, ocluzia ramurilor retiniene și pierderea auzului.

Sindromul Susac se prezintă frecvent ca o durere de cap care progresează către afectarea funcției cerebrale, în funcție de localizarea leziunilor. Provoacă inflamația vaselor de sânge mai mici, care la rândul lor blochează fluxul de sânge către urechi și ochi, provocând pierderea auzului și tulburări vizuale.

Diagnosticele diferențiale luate în considerare de echipă au inclus demielinizarea, cum ar fi apariția sclerozei multiple (SM) și a altor tulburări inflamatorii, limfom și infarctele multiple din vasculită.

SIMPTOME Rare, subrAportate

Orphanet, un site web care descrie bolile rare și medicamentele orfane, estimează că, începând din 2020, au fost raportate peste 500 de cazuri de sindrom Susac la nivel mondial. Organizatia Nationala pentru tulburari rare, spune că este probabil că această condiție este subraportată în parte, deoarece acesta poate fi diagnosticat greșit ca SM atipice.

“Este unul dintre acele sindroame rare despre care suntem învățați întotdeauna, dar nu este ceva pe care mulți oameni îl văd în cariera lor. Am fost uimiți de cât de înaltă funcționează ea, având în vedere RMN”, spune Sasikumar.

Sasikumar notează că, odată ce au descoperit inflamația măduvei spinării, care nu este tipică sindromului, a fost imperativ ca ei să excludă alte diagnostice.

Echipa a efectuat o puncție lombară și sânge de rutină ca parte a unei serii largi de investigații. A fost efectuată o scanare CT pentru screeningul cancerului.

“Am avut colegii noștri în oftalmologie, boli infecțioase și reumatologie în acest caz, având în vedere implicarea multiorgană”, spune Sasikumar.

Clinicienii au exclus alte condiții și au reușit să numere acest lucru printre puținele cazuri raportate de sindrom Susac cu inflamație a măduvei spinării cervicale, spune ea.

Odată ce au avut un diagnostic ferm, pacientul a fost tratat cu un curs de 5 zile de corticosteroizi intravenoși împreună cu imunoglobulină intravenoasă (IVIG) pentru a împacheta un pumn terapeutic mai mare, spune Sasikumar.

În câteva zile de tratament, frecvența și severitatea cefaleei s-au îmbunătățit. La externare, cunoașterea pacientului s-a îmbunătățit și în următoarele luni, distorsiunea vizuală a devenit rară, dar pierderea auzului a persistat.

„zburAM FARA ALTIMETRU”

După terapia IV, regimul pacientului a fost tranziționat la prednison timp de 1 lună. Planul era reducerea lentă a dozei în următoarele luni. A fost de asemenea inițiat tratamentul cu micofenolat de mofetil titrat la 1 g de două ori pe zi și a primit tratament de întreținere IVIG la fiecare 5 până la 6 săptămâni.

Echipei i-a fost dificil să decidă asupra medicamentelor specifice bolii, deoarece nu există un consens în literatura de specialitate cu privire la ce să utilizeze. „Zburam in orb”, spune Sasikumar. Pe baza expertizei unei echipe multidisciplinare a făcut toată diferența în ceea ce privește deciziile de tratament, adaugă ea.

“Am reușit să o preluăm devreme. De multe ori, când oamenii prezintă această afecțiune, sunt deja foarte confuzi și au o mulțime de probleme de comportament și simptome focale, cum ar fi slăbiciune sau amorțeală sau descoperiri mai evidente”, spune ea.

Pacienta a fost externată din spital la 3 săptămâni după prezentarea sa inițială la ED și continuă să se îmbunătățească, spune Sasikumar.

Neurologie. Publicat online 24 noiembrie 2020. Text integral

[twins2994]

Pittsburgh Pirates @ Minnesota Twins 2.29.20

Pittsburgh Pirates Lineup Minnesota Twins Lineup

1.) Kevin Newman SS     1.) Ehire Adrianza 2B

2.) Ke’Bryan Hayes 3B    2.) Josh Donaldson 3B

3.) JT Riddle 2B              3.) Nelson Cruz DH

4.) Jose Osuna 1B          4.) Eddie Rosario LF

5.) Socrates Brito RF      5.) Alex Avila C

6.) Andrew Susac C        6.) Jake Cave RF

7.) Kevin Kramer DH      7.) Royce Lewis SS

8.) Jake Elmore LF         8.) Zander Wiel 1B

9.) Jason Martin CF        9.) Gilberto Celestino CF

SP Derek Holland LHP  SP Jose Berrios RHP

(0-0) 10.80 ERA            (0-0) 0.00 ERA

(2020 MLB Spring Training Stats)

-Chris Kreibich-