The American journal of emergency medicine
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Charles Bonnet syndrome describes visual field or acuity loss with complex hallucinations. This typically occurs in the elderly with preexisting visual impairment. We describe a patient who presented to the emergency department with acute hemianopsia and intermittent complex hallucinations. ⋯ Results of computed tomography and magnetic resonance imaging of the head with contrast were negative. Standard 30-minute electroencephalography revealed near-continuous epileptiform discharges in the left occipital lobe. To our knowledge, this is the first case report of new-onset seizure presenting as Charles Bonnet syndrome.
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Amiodarone is a widely used antiarrythmic drug for various atrial and ventricular arrhythmias. It has the potential to cause prolongation of the QT interval, which, in turn, can increases the incidence of torsade de pointes. ⋯ Other causes of QT prolongation as electrolyte abnormalities or administration of other drugs that prolong the QT interval were excluded. Awareness of this phenomenon and method of calculation of QT interval in this scenario is of utmost importance.
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Although trauma-induced simple pubic ramus fracture is common in the emergency department (ED), it can result in life-threatening hemorrhagic shock. We describe a 58-year-old woman with closed minimally displaced simple pubic ramus fracture. ⋯ She was successfully treated with transarterial embolization and discharged uneventfully 10 days later. Literature review showed involvement of the superior pubic ramus in all reported cases probably because of hemorrhage from “corona mortis” with delay in shock presentation mostly within 6 hours, suggesting at least an equivalent observation period for these patients, particularly those at high risk for hemorrhage.
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Case Reports
Acute confusion in headache with neurologic deficits and cerebrospinal fluid lymphocytosis syndrome.
Abrupt headaches with focal neurologic deficits usually indicate medical emergencies that require advanced investigations and prompt treatment. The distinct syndrome of “headache with neurologic deficits and cerebrospinal fluid lymphocytosis” (HaNDL) is infrequent and considered a benign, self-limited disorder. ⋯ The diagnosis was made carefully by exclusion of other likely entities. It is important for clinical physicians to differentiate HaNDL from other potentially fatal.
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Case Reports
Neurogenic stunned myocardium as a manifestation of encephalitis involving cerebellar tonsils.
Neurogenic stunned myocardium is defined as a myocardial injury or dysfunction after neurological insults. It is most commonly reported in patients with subarachnoid hemorrhage, and the presenting symptoms may mimic an acute myocardial infarction or myocarditis. In severe cases, cardiogenic shock and acute pulmonary edema may occur and lead to a devastating event. ⋯ We herein report the case of a 25-year-old woman who presented to our hospital with the symptoms of acute pulmonary edema, shock, and consciousness disturbance. The diagnosis of encephalitis of cerebellar tonsils complicated with acute hydrocephalus and neurogenic stunned myocardium was made. Detailed neurologic examinations, neuroimaging studies, and characteristic echocardiographic changes expedite the correct diagnosis and treatment.