A 56-year-old man with a 2.5-month history of anorexia developed sweating, weakness, and left hemiplegia and hemispatial neglect. Brain magnetic resonance imaging detected no abnormalities, but magnetic resonance angiography revealed narrowing of the right middle cerebral artery (MCA). The focal neurological signs and narrowing of the MCA resolved after detection and correction of hypoglycemia. Endocrinological examinations indicated adrenal insufficiency. Hemiplegia is a rare but important neurological manifestation of hypoglycemia, although the mechanisms involved remain unknown. Combined hypoglycemia and decreased MCA blood flow associated with vasospasm probably induced regionally severe neuroglycopenia with ischemia, which presented as focal neurological symptoms.

A 64-year-old man was brought by ambulance to our hospital complaining of left hypochondrial pain associated with pleurisy. Cytology of the pleural fluid revealed an adenocarcinoma. The massive volume of effusion was treated by tube drainage followed by instillation of talc. Chest computed tomography (CT) after thoracic drainage showed a small nodule in the left upper lobe. Based on these findings, we diagnosed advanced lung adenocarcinoma with pleuritis carcinomatosa. The patient received chemotherapy with Carboplatin, Pemetrexed, and Bevacizumab. However, he experienced acute chest pain and dyspnea on the 15th day after chemotherapy. Chest CT showed a thrombus in the right main pulmonary artery and we diagnosed acute pulmonary thromboembolism associated with Bevacizumab therapy. We conducted thrombolytic therapy using Monteplase and anticoagulant therapy with unfractionated heparin after the diagnosis and he was weaned off mechanical ventilation on the 12th day. Herein, we report this case with a review of the medical literature.

No abstract

A 52-year-old man was admitted to our hospital with the complaints of chronic pain and swelling from the right shoulder to the precordial chest, which had started one month ago. He also exhibited cervical lymphadenopathy. Cervical lymph node biopsy revealed adenocarcinoma. Chest computed tomography (CT) showed a small nodule in the left upper lobe. Fluorodeoxyglucose positron emission tomography (FDG-PET) revealed multiple uptake of FDG in the right pectoralis major muscle, as well as the cervical, axillary, and thoracic lymph nodes. Based on these findings, we diagnosed the patient as having advanced lung adenocarcinoma with metastasis to the right pectoralis major muscle. The patient was treated with bevacizumab combination chemotherapy, which induced tumor regression and improved the symptoms. This is a rare case in which bevacizumab combination chemotherapy proved effective for lung adenocarcinoma metastasis to the skeletal muscles.