title: Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis.
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.
authors.affiliation: Clinic of Internal Medicine, University Hospital of Basel, Basel, Switzerland.
authors.forename: M
authors.identifier: 0000-0001-7143-6010
authors.initials: M
authors.lastname: Kirsch
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Basel, Basel, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Rimpau
authors.affiliation: Department of Accident and Emergency, University Hospital of Basel, Basel, Switzerland.
authors.forename: C H
authors.initials: CH
authors.lastname: Nickel
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Basel, Basel, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Baier