Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Ghazal Becker, OMS-IV 1 ; Benjamin Alwood, MD 2 1 VCOM-Louisiana; 2 Department of Neurology, University of Florida College of Medicine, Jacksonville, Florida 68 ANOSOGNOSIA IN THE SETTING OF ACUTE STROKE

Gowrish Vaka, OMS-III; Abir Islam, OMS-III; Roopin Singh, OMS-III; Wasifuddin Syed, OMS-III; Kareem Abdelhamid, OMS-III; Trevor Perry, OMS-III 1 Willis-Knighton Bossier City; 2 Family Medicine 69 COMORBIDITIES ASSOCIATED WITH AGENT ORANGE EXOPOSURE

Context/Impact: This case report entails the clinical importance of recognizing anosognosia as a sign of acute stroke. Report of Case: A 65-year-old African American male with a past medical history of diabetes, hypertension, alcohol use disorder, tobacco use, gout, and peripheral artery disease presented to the emergency department (ED) with an 8-day history of left great toe pain. While being in the ED, the patient was found to have mild right facial droop, speech changes and decreased strength in the right arm. A CT head revealed a subacute infarct in the left MCA territory. Last known well was unknown for our patient. Hence, he did not receive acute stroke treatment with thrombolytics. His NIH stroke scale was 4 at initial presentation. He was admitted under neurology service and was worked up for further evaluation of his stroke. Magnetic resonance imaging (MRI) scan of the brain showed recent left MCA vascular territory infarct. Transthoracic echocardiogram for our patient showed enlarged left atrium and later on telemetry, he was found to have atrial fibrillation rhythm, making the cause of his stroke likely cardioembolic. Hence, he was placed on apixaban 5 mg two times a day. Additionally,

the patient’s risk factors for stroke including uncontrolled diabetes with prior A1c range of 12-13% and history of uncontrolled hypertension with systolic blood pressure ranging from 140 180 millimeters of mercury were addressed. He was also found to have syphilis with nonreactive rapid plasma reagin (RPR) but reactive treponema pallidum antibody. Infectious disease was consulted, lumbar puncture was completed and ruled out neurosyphilis. In addition to full stroke and infectious disease work up, the patient’s chief complaint of left great toe pain was addressed with allopurinol 100 mg daily and colchicine 0.6 mg daily. Throughout the hospital stay, the patient continued to not recognize his motor deficits. Anosognosia is an uncommon symptom of acute stroke that is difficult to recognize. Our patient’s risk factors for stroke were evaluated, physical and occupational therapy were completed while in the hospital for better recognition and improvement of his neurological deficits. He was discharged after 16 days of hospitalization and was advised to follow up outpatient with a neurologist, primary care provider, and was encouraged to continue physical therapy outpatient to help improve his strength and awareness of his dysfunction.

Comments/Conclusion: The exact cause of anosognosia is unclear. According to the Cleveland Clinic, anosognosia is most commonly seen with dementia, stroke, bipolar disorder, and schizophrenia (2022). The prevalence of anosognosia in stroke patients with motor impairment have been reported to be 33-58% (Formica et al., 2022). Anosognosia has been described as reversible in the first 3 months after stroke (Formica et al., 2022). Anosognosia is diagnosed at bedside by assessing patients’ knowledge of their symptoms (Acharya and Sánchez-Manso, 2020). While there are no specific treatments for anosognosia, vestibular stimulation can improve this condition temporarily by influencing awareness of the neglected side and cognitive therapy can help patients better understand their deficits (Acharya and Sánchez-Manso, 2020). Further research is needed for better understanding and treatment of anosognosia in the setting of acute stroke.

Background: Herbicidal warfare is a devasting military tactic that has been used many times in history. The United States employed the usage of Rainbow Herbicides in the Vietnam War, one of these compounds was Agent Orange, a herbicide composed of equal parts of 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T). Additionally, Agent Orange was contaminated by trace amounts (2-3 ppm) of the dioxin 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Dioxins are chemical byproducts that have been associated with toxicity, immunosuppression, endocrine, neural, and reproductive issues. They are classified as carcinogens by the WHO. More than 300 dioxins have been identified, the most toxic of which is TCDD. This Case Report looks at a 73-year-old who had developed Prostate Cancer, Coronary Artery Disease, and Type II Diabetes Mellitus related to his exposure to Agent Orange. Prostate hyperplasia and cancer is something that all men eventually develop, however, most men die from natural causes before succumbing to prostate cancer. Exposure to dioxin has been linked with early onset prostate cancer, which the patient developed, resulting in a prostatectomy at the age of

49. There has been research that associates exposure to dioxins to reduced levels of insulin, which when combined with other factors such as BMI and diet can lead to the development of T2DM. Dioxin and similar compounds have been found to activate the aryl hydrocarbon receptor which leads to atherosclerosis, which ultimately can result in CAD. While Agent Orange and other herbicides are no longer used today, the effects of the chemicals are still profound. The chemicals can still found in the soil of Southeast Asia, leading to developmental issues for the natives. The effects of herbicides can also be extrapolated when considering farmers and other chemicals workers in the United States. While consulting patients on proper diet and exercise, physicians should also be aware the effects that chemical exposure can have on metabolic syndromes and properly inform patients on precautions to protect themselves and reduce potential health consequences.

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2025 Research Recognition Day