J Emerg Med
-
Review Case Reports
Diplopia in a patient with carcinomatous meningitis: a case report and review of the literature.
In a patient with a history of malignancy, an isolated neurologic sign or symptom may indicate metastasis to the central nervous system. To exclude this possibility, a lumbar puncture should still be performed after a nondiagnostic cranial computed tomography (CT) scan even in the absence of signs of infection. ⋯ Cranial CT scan was normal but initial cerebrospinal fluid results were suggestive of carcinomatous meningitis, and cytology results later confirmed this diagnosis. A review of diplopia and carcinomatous meningitis is presented, along with a suggested conservative diagnostic algorithm for cancer patients presenting with neurologic signs or symptoms.
-
Review Comparative Study
Computed tomography diagnosis of facet dislocations: the "hamburger bun" and "reverse hamburger bun" signs.
Unilateral or bilateral facet dislocations are difficult to diagnose. Computed tomography (CT) is being used more extensively to screen patients with suspected cervical vertebral injury. ⋯ Normal facet joints are oriented on a CT examination so that they resemble the sides of a hamburger bun. Facet dislocations upset this relationship and reverse the orientation of the "bun" halves to each other.
-
Abnormalities in serum phosphate levels are more prevalent in certain subsets of Emergency Department patients than in the general population. Patients with diabetic ketoacidosis, chronic obstructive pulmonary disease, alcoholism, malignancy, and renal failure are at increased risk. Multiple factors, including nutritional intake, medications, renal or intestinal excretion, and cellular redistribution, are potential etiologies. ⋯ Patients with severe or symptomatic hypophosphatemia should be treated with IV phosphate therapy (0.08-0.16 mg/kg over 6 h) and admitted for monitoring and subsequent serum electrolyte testing. Mild asymptomatic hyperphosphatemia is commonly managed in renal failure by limiting dietary intake and reducing absorption with phosphate-binding salts. Hemodialysis may be required for severe hyperphosphatemia with symptomatic hypocalcemia.