J Emerg Med
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Case Reports
Man With Sudden Paralysis: Insidious Spinal Cord Infarction due to a Non-Ruptured Abdominal Aortic Aneurysm.
Acute infarctions of the spinal cord are rare events characterized by sudden paralysis or sensory deficits below the level of injury. Etiologies include spinal cord trauma, vascular injury, arterial dissection, thromboembolic disease, chronic inflammatory conditions, or mass effect on the spinal cord. ⋯ A 63-year-old male presented to the emergency department with sudden-onset bilateral leg numbness and weakness. His physical examination was notable for decreased light touch and temperature sensation and bilateral lower-extremity paresis. Initial magnetic resonance imaging (MRI) of his spine did not show cord injuries. Computed tomography angiography of his chest, abdomen, and pelvis demonstrated a 7.5-cm non-ruptured infrarenal abdominal aortic aneurysm (AAA) extending into bilateral iliac arteries. The patient was diagnosed with clinical spinal cord infarction secondary to a thromboembolic event from his AAA. A repeat MRI 15 h later showed spinal cord infarction from T8 down to the conus. He received an endovascular aortic repair and was ultimately discharged to rehabilitation with slightly improved lower-extremity strength. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Atraumatic cord syndrome is exceedingly rare and is associated with dissection or complication of aortic aneurysm repair. There are very few reported cases of thrombotic events leading to ischemic cord syndrome. When presented with a patient with symptoms consistent with cord syndrome in the absence of trauma or mass effect on the spinal cord, providers should work up for vascular etiology.
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Washington State was one of the first states to legalize recreational marijuana. Increased availability of marijuana may result in more unintentional pediatric exposure, which often presents as altered mental status with unknown cause. ⋯ Reported unintentional pediatric marijuana exposure has increased in the state of Washington since recreational marijuana was legalized. As marijuana becomes more available, clinicians should be aware of the risk of unintentional pediatric marijuana exposure, and this should inform lawmakers regarding regulations around childhood exposure to marijuana.
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Case Reports
An Infected Urachal Cyst in a 4-Year-Old Girl Presenting with Recurrent Abdominal Pain.
Urachal cysts are remnants of urachal ducts and usually present when they get infected or undergo malignant transformation. ⋯ A 4-year-old girl presented to the Emergency Department (ED) with intermittent abdominal pain, fever, dysuria, and umbilical swelling. She was diagnosed with an abscess related to an infected urachal cyst by ultrasound. The patient was treated with antibiotics, and the abscess was drained by Interventional Radiology with ultrasound guidance. She recovered uneventfully and was discharged home. The urachal cyst was excised a month later. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Though urachal cysts are rare, it is important to consider this entity in the differential diagnosis of acute abdomen and recurrent abdominal pain in the ED setting.
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Povidone-iodine (PVP-I) antiseptic solutions have been shown to be effective against methicillin-resistant Staphylococcal aureus, a common cause of superficial skin abscesses. ⋯ There was no difference in clinical cure rates among patients using PVP-I (88.2%) vs. standard care (91.3%) after I&D. There were no major adverse events, but the addition of PVP-I was commonly associated with local skin irritation.
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Atypical hemolytic uremic syndrome (aHUS) is a complement-mediated disease manifesting in thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. It has a higher incidence of extrarenal manifestations, including central nervous system findings like seizure or stroke, pancreatitis, and cardiac manifestations. ⋯ We present a case of an unimmunized 14-month-old girl presenting with generalized seizure and ultimately diagnosed with aHUS. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These atypical neurological symptoms can cause the diagnosis to be commonly missed in the emergency department. The etiology of approximately 60% of patients with aHUS can be attributed to genetic mutations in complement regulators including factor H, membrane cofactor protein, factor I, activator factor B, or C3. Although previously treated with plasma transfusion and immunosuppressants, eculizumab is a newer treatment that has been changing prognosis and management of aHUS, but it should be administered within 48 h of symptom onset for best efficacy.