J Emerg Med
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Paliperidone is an atypical antipsychotic that is approved to treat schizophrenia in patients 12 years of age and older. There are minimal data on the clinical effects of exposure in the < 12-year-old age group. ⋯ We report the case of a 7-year-old girl who was accidentally dosed with paliperidone for 3 days. Her clinical course was notable for a dystonic reaction and profound sinus tachycardia, with a heart rate peaking at 201 beats/min. The tachycardia persisted for over 64 h after her last dose. The mechanism of tachycardia has not been elucidated and is likely multifactorial, with alpha blockade and anticholinergic effects probably contributing. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians should be aware that paliperidone ingestion in children may result in delayed, profound tachycardia and may require more prolonged observation times or admission to the hospital.
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Case Reports
Acute Spinal Cord Infarction Presenting With Chest Pain and Neurogenic Shock: A Case Report.
Spinal cord infarction (SCI) is rare, accounting for approximately 1% of strokes. ⋯ We present the case of a 63-year-old male who presented to the emergency department (ED) with chest pain and acute-onset generalized weakness and was ultimately diagnosed with SCI secondary to suspected occlusion of the artery of Adamkiewicz. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: SCI may present diagnostic challenges, with its predilection for mimicking other major emergency conditions, such as acute aortic dissection, aortic aneurysm rupture, spinal cord compressive myelopathy, or transverse myelitis. Its consequences are often significantly disabling initially, though patients may experience subsequent clinical improvement. It is important to include SCI in the differential for patients with chest or back pain coupled with neurologic symptoms.
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Editorial Comment
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