Controversies in the differential diagnosis of Brown-Sequard syndrome due to cervical spinal disease from stroke: A case series

Stroke is generally considered to be the first preliminary diagnosis in patients presenting with acute hemiparesia in the emergency department. But rarely in unexpected spontaneous neurological pathologies that may lead to hemiparesis. The data from 8 non-traumatic patients who underwent surgical treatment for brown-sequard syndrome (BSS) were reviewed retrospectively. All patients were initially misdiagnosed with strokes. Two of the patients had spinal canal stenosis, two had spinal epidural hematomas, one had an ossified herniated disc and three had soft herniated discs. None of the patients complained of significant pain at the initial presentation. All of the patients had a mild sensory deficit that was initially unrecognized. The pain of the patients began to become evident after hospitalization and, patients transferred to neurosurgery department. Cervical spinal pathologies compressing the corticospinal tract in one-half of the cervical spinal canal may present with only hemiparesis, without neck and radicular pain. If it's too late, permanent neurological damage may become inevitable while it is a correctable pathology. Keywords: Brown-Sequard syndrome, Cervical cord, Herniated disc, Spinal epidural hematoma, Strok

Incidental Finding in a Headache Patient: Intracranial Lipoma

[West J Emerg Med. 2014;15(4):361-362.

Incidental Finding in a Headache Patient: Intracranial Lipoma

[West J Emerg Med. 2014;15(4):361-362.

Pneumomediastinum Associated with Pneumopericardium and Epidural Pneumatosis

Spontaneous pneumomediastinum is a relatively rare benign condition. It may rarely be associated with one or combination of pneumothorax, epidural pneumatosis, pneumopericardium, or subcutaneous emphysema. We present a unique case with four of the radiological findings in a 9-year-old male child who presented to our emergency department with his parents with complaints of unproductive cough, dyspnea, and swelling on chest wall. Bilateral subcutaneous emphysema was palpated on anterior chest wall from sternum to midaxillary regions. His anteroposterior and lateral chest radiogram revealed subcutaneous emphysema and pneumomediastinum. His thorax computed tomography to rule out life-threatening conditions revealed bilateral subcutaneous, mediastinal, pericardial, and epidural emphysema without pneumothorax. He was transferred to pediatric intensive care unit for close monitorization and conservative treatment. He was followed-up by chest radiographs. He was relieved from symptoms and signs around the fifth day and he was discharged at the seventh day. Diagnosis of pneumomediastinum is often made based on physical findings and plain radiographs. It may not be as catastrophic as it is seen. Close cardiopulmonary monitorization is mandatory for complications and accompanying conditions. Most patients with uncomplicated spontaneous pneumomediastinum respond well to oxygen and conservative management without any specific treatment

A Case of Ramsay Hunt Syndrome with Atypical Presentation

SUMMARY: Ramsay Hunt syndrome is a rare complication of herpes zoster which results from the reactivation of the latent varicella-zoster virus in the geniculate ganglion. Although facial nerve is the most common affected nerve in Ramsay Hunt syndrome, other cranial and cervical nerves can also be affected. We present an atypical case of Ramsay Hunt syndrome in a 42-year-old male, with cervical nerve involvement. As spontaneous recovery rate in Ramsay Hunt syndrome is low, early diagnosis and treatment plays a key role in full recovery of paralysis. ÖZET: Ramsay Hunt sendromu, varisella-zoster virüsün latent olarak kaldığı genikulat ganglionda aktifleşmesiyle oluşan herpes zosterin nadir bir komplikasyonudur. Ramsay Hunt sendromunda fasiyal sinir en sık etkilenen sinir olmasına rağmen diğer kraniyal sinirler ve servikal sinirler de tutulabilir. Bu yazıda, 42 yaşındaki erkek hastada servikal tutulumun da eşlik ettiği atipik bir Ramsay Hunt sedromu olgusu sunuldu. Ramsay Hunt sedromunda spontan iyileşme oranları düşük olduğundan bu hastaların tanılarının erken dönemde konması ve tedavilerinin hemen başlanması paralizinin tam olarak iyileşmesinde kilit role sahiptir. Key words: Facial palsy, Ramsay Hunt syndrome, varicella-zoster virus, Anahtar sözcükler: Fasiyal paralizi, Ramsay Hunt sendromu, varisella-zoster virü

THE DIAGNOSIS OF PULMONARY EMBOLISM IN PATIENTS WITH NORMAL D-DIMER LEVELS

Kalkan, Asim/0000-0002-5800-0201;WOS: 000375337700027Introduction: the combination of clinical probability assessment and the D-dimer test has been recommended to avoid unnecessary diagnostic testing in pulmonary thromboembolism (PTE). However, in clinical practice, patients are occasionally diagnosed with PTE despite normal D-dieter levels. in the present study, we reviewed the characteristics of cases in an emergency department (ED) in which a diagnosis of PTE was made despite normal D-dimer test results. Materials and methods: the hospital records of 107 patients who were admitted to the ED of a teaching hospital and diagnosed with PTE between January 2011 and December 2013 were reviewed retrospectively. We acquired data for 11 patients (10.2%) in whom D-dimer measurements obtained by an automated latex turbidimetric quantitative method were below 500 ng/ml (0-450). Results: of the 11 patients, 72.7% (8/11) were female, and mean age was 71. +/- 57.9 (61-84) years. the most common symptom was dyspnea (54.5%, n=6). the mean delay between onset of symptoms and admission to the ED was 10.6 (3-30) days, and follow-ups were performed for patients in other health facilities for various causes of dyspnea. When risk factors were analyzed with the Wells score, 18.2% (2/11) of patients had low probability of PTE, whereas 72.7% (8/11) had intermediate, and 9% (1/11) had high probability. According to the revised Geneva score, 18.2% (2/11) of patients were found to have low probability, and 81.8% (9/11) had intermediate probability. the Pulmonary Embolism Severity Index score classified 18.2% (2/11) of the patients in the low risk group, and the European Society of Cardiology classification classified 81.8% (9/11) in the low risk group. Conclusion: in patients with nonspecific symptoms of PTE, the delay between onset of symptoms and admission to the ED is important. the risk factors of the patients and their pre-test probabilities should be considered along with D-dieter test results

How much should we observe patients with mad honey poisoning?

WOS: 000396830900014The aim of this study was to understand better the pathophysiology of this intoxication by evaluating the effect of mad honey ingestion on Inferior Vena Cava (IVC) diameters and IVC Collapsibility Index (IVC-CI) and develop an objective algorithm for the duration of fluid replacement and observation. the patients with the medical history of mad honey ingestion and admitted to the emergency service due to the signs of mad honey poisoning were analysed. Their data concerning age, gender, admission symptoms and the time of onset of these symptoms, the vital signs during admission, the administered treatment, the post-treatment recovery time and vital signs were all recorded. the inferior vena cava diameter and the IVC collapsibility index were assessed by ultrasonography. of 29 patients included in the study, 79.31% were male, the average age was 52.76 +/- 17.52 years, and the most common cause of admission was dizziness. While 0.9% saline solution was administered to all patients, in 82.75% intravenous atropine was started. Significant differences were determined between the vital signs, the inferior vena cava diameters, and the collapsibility indexes of the pre and post treatment periods. the ingestion of mad honey should be questioned in the medical history in patients who were admitted to the emergency services due to hypotension, bradycardia, and syncope. the assessment of the vital signs and the measurement of the inferior vena cava diameters of the patients should be the parts of the follow-up. the monitoring of the responses to the administered atropine and/or normal saline solutions should be made by the ultrasonographic assessment of the inferior vena cava diameter and the IVC Collapsibility Index (IVC-CI), in addition to monitoring the vital signs

The Use of Cerebral Oximetry in Acute Carbon MonoxideIntoxication

PubMed: 26668162The purpose of this study was to assess the clinical usefulness of near-infrared spectroscopy (cerebral oximetry) in patients presenting to the emergency department (ED) with carbon monoxide (CO) intoxication. Eighteen patients with a diagnosis of CO intoxication who presented to our ED during 2013 were included in this prospective study. All patients were treated and monitored according to the standard recommendations for CO intoxication. In addition, cerebral oxygen saturation (ScO2) was measured using near-infrared spectroscopy, also known as cerebral oximetry. Minimum and maximum ScO2 values from the right and left frontal region were recorded using cerebral oximetry from immediately after presentation to the ED until discharge. Patient blood carboxyhemoglobin (COHb) levels before and after oxygen treatment were compared with the cerebral oximetry measurements. At the time of admission, mean blood (COHb) values were 29.3% ± 6.7%, and ScO2 values were 59.0 ± 4.0 in the right frontal region and 60.9 ± 5.1 in the left. When blood COHb levels had returned to normal following oxygen therapy, ScO2 values were 75.9 ± 6.1 (65.5-90.5) in the right frontal region and 74.9 ± 7.8 (62.0-90.0) in the left. The differences in ScO2 values before and after oxygen therapy were statistically significant (P ? 0.005). Assessment of patients exposed to CO gas using cerebral oximetry can provide information about cerebral oxygen saturation. Blood COHb level measurement is still the best method for diagnosing CO intoxication; however, cerebral oximetry, a non-invasive technique, may be an effective method for assessing cerebral oxygen saturation. © 2015 by The Keio Journal of Medicine