The American journal of emergency medicine
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Alexia without agraphia (pure alexia) was the first of the disconnection syndromes to be described by Dejerine who reported a patient of alexia without agraphia secondary to an embolic occipital lobe infarct. We herein report a 55-year-old man who presented with alexia without agraphia with magnetic resonance imaging suggestive of left posterior cerebral artery infarct involving left occipital lobe and splenium of corpus callosum. ⋯ Ophthalmologists should also be aware of this disconnection syndrome as many patients initially take their advice due to predominant visual complaints. Early diagnosis and treatment of this condition help in ensuring the patient and attendants about nonprogressive nature of the disease and may prevent further episodes of stroke.
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Case Reports
Valsalva retinopathy and branch retinal artery occlusion after cardiopulmonary cerebral resuscitation.
We report a 53-year-old woman who had acute visual loss 10 days after cardiopulmonary cerebral resuscitation performance. Immediately after she had performed cardiopulmonary cerebral resuscitation, she developed floater symptoms in her left eye, which persisted for 2 hours, and she was diagnosed as having Valsalva retinopathy. Ten days later, she had an acute painless visual loss in the same eye (visual acuity 20/1000). ⋯ Four months later, her visual acuity had increased to 20/40; however, the inferior altitudinal visual field defect remained. To rule out cardiac associations of branch retinal artery occlusion, transesophageal echocardiography was performed and a patent foramen ovale on her atrial septum was detected. This case indicates a possible risk that emergency medical personnel could have medical problems while performing strenuous tasks to help other people.
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A patient scheduled for a laparoscopic cholecystectomy had an anaphylactic shock during induction of anesthesia. After the injection of vecuronium, an unusual fall of arterial pressure occurred, with bradycardia, enlargement of the QRS complex, then a circulatory arrest. Chest compressions were initiated, while intravenous epinephrine 1 mg was administered. ⋯ Experimental studies have shown that blocking the β-adrenergic effects of epinephrine attenuates postresuscitation myocardial dysfunction or helps the return of spontaneous circulation after VF. Norepinephrine, a potent α-adrenergic drug nearly devoid of β-adrenergic properties, could be an interesting alternative to epinephrine. It can improve organ perfusion during cardiopulmonary resuscitation and could be more efficient than epinephrine in case of VF.
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Essential thrombocytosis (ET) falls under the umbrella of myeloproliferative disorders, which also includes chronic myelogenous leukemia, polycythemia vera, and myelofibrosis with myeloid metaplasia. Essential thrombocytosis results from a clonal proliferation of megakaryocites within the bone marrow, leading to an absolute elevation of platelets that can cause both hemorrhagic and thrombotic complications.
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Thrombotic thrombocytopenic purpura (TTP) is a challenging diagnosis to make in the emergency department. We present a case of TTP initially presenting with refractory hypoglycemia in a woman with thromboangiitis obliterans (Buerger's disease). To our knowledge, this is the first description of the association of hypoglycemia and thromboangiitis obliterans with TTP. We briefly review key aspects of the acute diagnosis and management of hypoglycemia and TTP pertinent to the emergency physician.