European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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Review Case Reports
Acute compartment syndrome secondary to diabetic muscle infarction: case report and literature review.
Acute compartment syndrome has a multitude of aetiologies. Unfortunately, the diagnosis is often delayed, resulting in permanent functional loss. Although spontaneous muscle infarction is an uncommon, yet well-recognized complication of diabetes mellitus, subsequent development of compartment syndrome appears to be rare, with only five case reports identified in the literature. ⋯ We report a case of a diabetic gentleman who presented with lower limb pain significantly out of proportion to any obvious injury and had a subsequent diagnosis of acute compartment syndrome. Despite fasciotomies, he had a persistent foot drop. Nontraumatic acute compartment syndrome secondary to diabetic muscle infarction should be considered in any diabetic patient presenting with pain out of proportion to sustained injury.
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As access to computed tomography scanning has become easier, patients with a lower probability of serious pathology are being scanned. We asked how many lumbar punctures need to be performed to detect each subarachnoid haemorrhage in these lower-risk patients. ⋯ In patients who have a low pre-computed tomography probability of subarachnoid haemorrhage and undergo an early computed tomography scan, the risk/benefit ratio of lumbar puncture is unclear. A decision rule (risk stratification system) might improve our ability to help the patient make an informed choice.