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  1. Article: Management of medical complications associated with a presumed tetanus infection in a northwest bornean orangutan (pongo pygmaeus pygmaeus)

    Thurber, Mary Irene / Doss, Grayson / Kory, Pierre / Tarula, Erick / Sladky, Kurt

    Journal of zoo and wildlife medicine. 2021 Jan. 12, v. 51, no. 4

    2021  

    Abstract: An 18-yr-old female orangutan (Pongo pygmaeus pygmaeus) developed opisthotonus after sustaining conspecific bite wounds 3 wk earlier. The orangutan developed progressive tetraparesis and dysphagia, despite normal mentation, suggestive of tetanus. A ... ...

    Abstract An 18-yr-old female orangutan (Pongo pygmaeus pygmaeus) developed opisthotonus after sustaining conspecific bite wounds 3 wk earlier. The orangutan developed progressive tetraparesis and dysphagia, despite normal mentation, suggestive of tetanus. A tetanus vaccine had been administered at 2 yr of age, but none since. Brain magnetic resonance imaging, computed tomography, cerebral spinal fluid tap, and bloodwork were unremarkable. Viral, Baylisascaris, and tetanus toxin testing were negative. A femoral central venous catheter (CVC) was placed to provide medications, fluids, and parenteral nutrition. The orangutan received human tetanus immunoglobulin, tetanus toxoid, penicillin, methocarbamol, and analgesia. After 1 wk, the catheterized limb became edematous; a deep vein thrombosis (DVT) was diagnosed ultrasonographically. A cephalic CVC was placed, the limb casted, intravenous therapy reinitiated, and enoxaparin started. The orangutan became mobile days later, and progressively improved. Despite no compliance with enoxaparin, the DVT resolved without residual signs. This is the first reported case of presumptive tetanus and DVT in a great ape.
    Keywords Baylisascaris ; Pongo pygmaeus ; analgesia ; brain ; central venous catheters ; compliance ; conspecificity ; dysphagia ; enoxaparin ; females ; humans ; immunoglobulins ; intravenous injection ; magnetism ; medicine ; parenteral feeding ; penicillins ; tetanus ; thrombosis ; toxins ; vaccines ; wildlife ; zoos
    Language English
    Dates of publication 2021-0112
    Size p. 1072-1076.
    Publishing place American Association of Zoo Veterinarians
    Document type Article
    Note NAL-AP-2-clean
    ZDB-ID 2174930-9
    ISSN 1937-2825 ; 1042-7260
    ISSN (online) 1937-2825
    ISSN 1042-7260
    DOI 10.1638/2020-0120
    Database NAL-Catalogue (AGRICOLA)

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  2. Article: MANAGEMENT OF MEDICAL COMPLICATIONS ASSOCIATED WITH A PRESUMED TETANUS INFECTION IN A NORTHWEST BORNEAN ORANGUTAN (

    Thurber, Mary Irene / Doss, Grayson / Kory, Pierre / Tarula, Erick / Sladky, Kurt

    Journal of zoo and wildlife medicine : official publication of the American Association of Zoo Veterinarians

    2021  Volume 51, Issue 4, Page(s) 1072–1076

    Abstract: An 18-yr-old female orangutan ( ...

    Abstract An 18-yr-old female orangutan (
    MeSH term(s) Animals ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Anticoagulants/therapeutic use ; Ape Diseases/pathology ; Ape Diseases/therapy ; Bites and Stings ; Enoxaparin/therapeutic use ; Female ; Pongo pygmaeus ; Tetanus/complications ; Tetanus/therapy ; Tetanus/veterinary ; Venous Thrombosis/etiology ; Venous Thrombosis/therapy ; Venous Thrombosis/veterinary
    Chemical Substances Anti-Bacterial Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Anticoagulants ; Enoxaparin
    Language English
    Publishing date 2021-01-22
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2174930-9
    ISSN 1937-2825 ; 1042-7260
    ISSN (online) 1937-2825
    ISSN 1042-7260
    DOI 10.1638/2020-0120
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Febrile Infection-Related Epilepsy Syndrome Treated Successfully With Anakinra in a 21-Year-Old Woman.

    Westbrook, Cecilia / Subramaniam, Thanujaa / Seagren, Ryan M / Tarula, Erick / Co, Dominic / Furstenberg-Knauff, Meghan / Wallace, Adam / Hsu, David / Payne, Eric

    WMJ : official publication of the State Medical Society of Wisconsin

    2019  Volume 118, Issue 3, Page(s) 135–139

    Abstract: Introduction: Febrile infection-related epilepsy syndrome (FIRES) is a syndrome of new-onset status epilepticus preceded by fever and highly refractory to treatment, thus resulting in high mortality and severe neurologic morbidity in surviving patients. ...

    Abstract Introduction: Febrile infection-related epilepsy syndrome (FIRES) is a syndrome of new-onset status epilepticus preceded by fever and highly refractory to treatment, thus resulting in high mortality and severe neurologic morbidity in surviving patients. Anakinra is an IL-1 receptor antagonist that has previously demonstrated efficacy in treating children with FIRES.
    Case presentation: A 21-year-old previously healthy woman presented with new-onset superrefractory status epilepticus following a febrile illness. This was subsequently diagnosed as FIRES after an extensive evaluation failed to identify an alternative etiology. The patient's seizures were refractory to numerous antiepileptic drugs and immunomodulatory therapy. She was maintained under pharmacologic sedation for 31 days.
    Management and outcome: Anakinra was initiated on day 32 of her hospital stay, with swift and complete remission of her status epilepticus. Seizures ceased within 24 hours. The patient remains in remission with minimal side effects from the medication and no known long-term morbidity.
    Discussion: Here we report what we believe is the second case of super-refractory status epilepticus due to FIRES responding to anakinra, and the first such case in an adult patient. Anakinra was well tolerated with few side effects. Our results are further evidence for the autoinflammatory nature of FIRES and support the use of anakinra early in the treatment to prevent long-term sequelae.
    MeSH term(s) Epileptic Syndromes/drug therapy ; Female ; Humans ; Interleukin 1 Receptor Antagonist Protein/therapeutic use ; Seizures, Febrile/drug therapy ; Young Adult
    Chemical Substances Interleukin 1 Receptor Antagonist Protein
    Language English
    Publishing date 2019-06-08
    Publishing country United States
    Document type Case Reports
    ZDB-ID 441051-8
    ISSN 2379-3961 ; 0043-6542 ; 1098-1861
    ISSN (online) 2379-3961
    ISSN 0043-6542 ; 1098-1861
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Progressive mental status changes and seizures with fluid attenuated inversion recovery (FLAIR) hyperintensity on brain MRI.

    Tarula, Erick / Ramkissoon, Shakti / Pittock, Sean / Sheen, Volney L

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

    2012  Volume 19, Issue 6, Page(s) 873, 924

    MeSH term(s) Adult ; Brain/pathology ; Brain Diseases/complications ; Brain Diseases/diagnosis ; CD3 Complex/metabolism ; Cerebrospinal Fluid ; Disease Progression ; Encephalitis ; Glial Fibrillary Acidic Protein/metabolism ; Hashimoto Disease/complications ; Hashimoto Disease/diagnosis ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Receptors, N-Methyl-D-Aspartate/immunology ; Seizures/etiology
    Chemical Substances CD3 Complex ; Glial Fibrillary Acidic Protein ; Receptors, N-Methyl-D-Aspartate
    Language English
    Publishing date 2012-07-04
    Publishing country Scotland
    Document type Case Reports ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1193674-5
    ISSN 1532-2653 ; 0967-5868
    ISSN (online) 1532-2653
    ISSN 0967-5868
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Nonparetic arm force does not overinhibit the paretic arm in chronic poststroke hemiparesis.

    Dimyan, Michael A / Perez, Monica A / Auh, Sungyoung / Tarula, Erick / Wilson, Matthew / Cohen, Leonardo G

    Archives of physical medicine and rehabilitation

    2014  Volume 95, Issue 5, Page(s) 849–856

    Abstract: Objective: To determine whether nonparetic arm force overinhibits the paretic arm in patients with chronic unilateral poststroke hemiparesis.: Design: Case-control neurophysiological and behavioral study of patients with chronic stroke.: Setting: ... ...

    Abstract Objective: To determine whether nonparetic arm force overinhibits the paretic arm in patients with chronic unilateral poststroke hemiparesis.
    Design: Case-control neurophysiological and behavioral study of patients with chronic stroke.
    Setting: Research institution.
    Participants: Eighty-six referred patients were screened to enroll 9 participants (N=9) with a >6 month history of 1 unilateral ischemic infarct that resulted in arm hemiparesis with residual ability to produce 1Nm of wrist flexion torque and without contraindication to transcranial magnetic stimulation. Eight age- and handedness-matched healthy volunteers without neurologic diagnosis were studied for comparison.
    Interventions: Not applicable.
    Main outcome measure: Change in interhemispheric inhibition targeting the ipsilesional primary motor cortex (M1) during nonparetic arm force. We hypothesized that interhemispheric inhibition would increase more in healthy controls than in patients with hemiparesis.
    Results: Healthy age-matched controls had significantly greater increases in inhibition from their active to resting M1 than patients with stroke from their active contralesional to resting ipsilesional M1 in the same scenario (20%±7% vs -1%±4%, F1,12=6.61, P=.025). Patients with greater increases in contralesional to ipsilesional inhibition were better performers on the 9-hole peg test of paretic arm function.
    Conclusions: Our findings reveal that producing force with the nonparetic arm does not necessarily overinhibit the paretic arm. Though our study is limited in generalizability by the small sample size, we found that greater active contralesional to resting ipsilesional M1 inhibition was related with better recovery in this subset of patients with chronic poststroke.
    MeSH term(s) Aged ; Aged, 80 and over ; Arm/physiopathology ; Chronic Disease ; Exercise Therapy/methods ; Female ; Follow-Up Studies ; Hand Strength/physiology ; Humans ; Male ; Middle Aged ; Motor Cortex/physiopathology ; Motor Skills/physiology ; Paresis/etiology ; Paresis/physiopathology ; Paresis/rehabilitation ; Recovery of Function ; Retrospective Studies ; Stroke/complications ; Stroke/physiopathology ; Stroke Rehabilitation ; Task Performance and Analysis ; Treatment Outcome
    Language English
    Publishing date 2014-01-16
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, N.I.H., Intramural
    ZDB-ID 80057-0
    ISSN 1532-821X ; 0003-9993
    ISSN (online) 1532-821X
    ISSN 0003-9993
    DOI 10.1016/j.apmr.2013.12.023
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Postictal bradyarrhythmia following an isolated seizure in a patient with left hemisphere stroke.

    Krishnan, Vaishnav / Tarula, Erick / Anderson, Matthew P / Hanafy, Khalid A / Herman, Susan T

    Seizure

    2013  Volume 22, Issue 10, Page(s) 908–910

    MeSH term(s) Aged ; Bradycardia/etiology ; Female ; Humans ; Seizures/complications ; Stroke/complications
    Language English
    Publishing date 2013-07-10
    Publishing country England
    Document type Case Reports ; Letter
    ZDB-ID 1137610-7
    ISSN 1532-2688 ; 1059-1311
    ISSN (online) 1532-2688
    ISSN 1059-1311
    DOI 10.1016/j.seizure.2013.06.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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