Hypoxemic measles pneumonitis in an immunocompetent adult

peer reviewedMeasles is a highly contagious viral disease and one of the biggest causes of morbidity and mortality in the world. Transmission occurs from person to person through direct contact or by aerosolization of pharyngeal secretions. It can be responsible for severe respiratory and neurological complications. The diagnosis is clinical, confirmed by serology, PCR or culture of the measles virus. Treatment is symptomatic and prevention is based on a well conducted vaccination. In severe cases, the use of vitamin A is recommended by the World Health Organization, at least in chidren. Antivirals (ribavirin) have not been shown to be effective in clinical practice. We present a severe respiratory form of measles, affecting a young immunocompetent adult

encéphalite post-rougeoleuse chez un patient non-vacciné

peer reviewedMeasles is one of the most contagious diseases with, in 1/1000 case, an acute disseminated encephalomyelitis (ADEM) as complication for non-vaccinated population

Dissection de l’aorte thoracique compliquée d’un syndrome coro narien aigu: un piège diagnostique évitable

peer reviewedLa dissection aortique entreprenant les coronaires constitue un défi diagnostique car le tableau clinique peut être confondu avec un syndrome coronarien aigu en raison des anomalies électrocardiographiques souvent observées. Lorsque c’est le cas, le traitement chirurgical est retardé et un traitement anticoagulant, antiagrégant, voire fibrinolytique peut être erronément entrepris. Le score de détection de la dissection aortique permet d’identifier les patients à risque de dissection aortique. Nous rapportons le cas d’un patient de 60 ans décédé d’une dissection aortique avec tamponnade cardiaque. Le diagnostic initialement retenu étant celui d’un syndrome coronarien aigu, le patient avait été traité par héparine et acide acétylsalicylique. Ce cas illustre le piège diagnostique entre le syndrome coronarien «isolé» et celui associé à une dissection aortique. Nous en profitons pour refaire une revue des recommandations 2020 de l’European Society of Cardiology pour la prise en charge des NSTEMI

Rare Case of Ischaemic Stroke Following Cervical Transforaminal Injection

We report a case of brainstem infarction following a C5–C6 cervical transforaminal injection, a rare and serious neurological complication of this procedure. Cervical transforaminal steroid injection is a common therapy for patients with persistent cervical radiculopathy not relieved by conservative treatment, and is effective in 65–70% of cases. Unfortunately, this procedure may lead to serious complications such as neurological damage. These complications are rare but potentially fatal, as reported in our case. Complications could be due to three mechanisms: the technique itself, the cervical vascular anatomy and the properties of the product (corticoids). The neurological complications can be diagnosed through brain MRI. This case report focuses on the importance of a risk/benefit evaluation when performing this medical procedure

Fatal serotonin syndrome induced by Ecstasy consumption

peer reviewe

Abrupt Severe Chest Pain and Vomiting: Remember to Think of a Ruptured Oesophagus (Boerhaave Syndrome)

Boerhaave syndrome or spontaneous rupture of the oesophagus is a severe condition commonly misdiagnosed or unrecognized. Prognosis is poor even if the diagnosis is made promptly. We describe a case of Boerhaave syndrome diagnosed after the development of pneumomediastinum and cardiac arrest. Unfortunately, the patient died 48 hours after admission to the Intensive Care Unit. This entity requires a multidisciplinary management approach which may include conservative, surgical or endoscopic procedures

Severe Hydrocephalus due to Obstructive Basilar Dolichoectasia of the Third Ventricle.

peer reviewed[en] Vertebro-basilar dolichoectasia (VBD) is a rare pathology of unknown aetiology. Its clinical presentation is wide and prognosis is generally poor with a high mortality rate. Cerebral magnetic resonance imaging is the gold standard for diagnosis. We report an unusual case of intracranial dolichoectasia. VBD was revealed during investigation of a patient with altered mental status. CT brain imaging demonstrated severe obstructive hydrocephalus secondary to compression of the third ventricle. Management is always challenging and depends on the location and the mode of presentation. Our patient died despite surgical management with placement of an external ventricular shunt. LEARNING POINTS: Vertebro-basilar dolichoectasia is a little known cause of altered mental status in elderly patients.An atypical presentation of vertebro-basilar dolichoectasia can mimic extensive cerebrovascular haemorrhage.The prognosis is poor despite prompt diagnosis and the surgical treatment of choice

Un cas inhabituel de cyanose centrale

editorial reviewedLa consommation de poppers à titre récréatif est en augmentation pour ses effets euphorisants du fait de la facilité d’accès et du faible prix de celui-ci. La distinction des toxidromes en médecine d’urgence est cruciale afin de fournir un traitement précoce et adapté. Une méthémoglobinémie sévère peut engager le pronostic vital. Il s’agit donc d’une urgence diagnostique et thérapeutique. Le diagnostic de méthémoglobinémie secondaire à une intoxication au poppers nécessite une connaissance du tableau clinique et du traitement spécifique

A Rare Case of Adult Acute Disseminated Encephalomyelitis Associated with Primary Epstein-Barr Virus Infection

We report a rare case of acute disseminated encephalomyelitis (ADEM) secondary to a primary Epstein-Barr (EBV) infection, in a 22-year-old male. Symptomatic infectious mononucleosis and ADEM are both quite uncommon conditions in this age group

Haemothorax in a Pregnant Woman Secondary to Rupture of a Pulmonary Arteriovenous Malformation.

peer reviewed[en] Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between the arteries and veins of the pulmonary vasculature leading to a right-to-left shunt. We report the case of a pregnant patient who presented with chest pain revealing a haemothorax secondary to the rupture of an arteriovenous malformation. The diagnosis was made during arteriography after simultaneous performance of an urgent caesarean section and thoracic drainage. LEARNING POINTS: The rupture of a pulmonary arteriovenous malformation in a pregnant patient is a serious and potentially life-threatening event, especially if it is not diagnosed quickly.It is crucial to use whatever imaging test is available whether ionizing or non-ionizing, as no thoracic imaging has been shown to adversely affect the fetus beyond embryogenesis.It is important for emergency doctors to consider this life-threatening condition in the differential diagnosis of atypical chest pain in pregnant women