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Case Reports in Emergency Medicine
Volume 2017, Article ID 8512147, 5 pages
https://doi.org/10.1155/2017/8512147
Case Report

Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis

1Clinic of Internal Medicine, University Hospital of Basel, Basel, Switzerland
2Department of Anesthesiology and Intensive Care, University Hospital of Basel, Basel, Switzerland
3Department of Accident and Emergency, University Hospital of Basel, Basel, Switzerland

Correspondence should be addressed to M. Kirsch; hc.sbhu@amhcsrik

Received 25 August 2016; Revised 5 December 2016; Accepted 26 December 2016; Published 1 February 2017

Academic Editor: Ching H. Loh

Copyright © 2017 M. Kirsch et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient’s survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes.