A & A case reports
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Case Reports
Severe Postpartum Headache and Hypertension Caused by Reversible Cerebral Vasoconstriction Syndrome: A Case Report.
Reversible cerebrovascular vasoconstriction syndrome is an uncommon condition that presents as severe headache and hypertension. Recent literature suggests a 1% incidence in postpartum headache cases. It can cause subarachnoid hemorrhages, cerebral ischemia, and seizures. ⋯ When treatment for eclampsia failed to resolve her symptoms, magnetic resonance angiography was performed. It demonstrated the pathognomic signs of reversible cerebrovascular vasoconstriction syndrome. Her symptoms resolved with nimodipine.
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Cardiopulmonary resuscitation has a low success rate both in and out of the hospital setting. Return of spontaneous circulation, however, is considerably higher for intraoperative cardiac arrests. Chest compressions remain of utmost importance. ⋯ However, this depth is often not achieved. We describe a case in which the adequacy of chest compressions, based on hemodynamic monitoring, was achieved with 2 persons simultaneously providing a compressive force. This hemodynamic-directed care resulted in return of spontaneous circulation on 2 separate occasions.
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Case Reports
Epidural Injections Contraindicated for Lumbar Radiculopathy in May-Thurner Syndrome: A Case Report.
A 59-year-old patient presented to the chronic pain clinic with a 6-week history of worsening lumbar back pain, bilateral thigh pain, and unilateral radiculopathy. Magnetic resonance imaging revealed mild discogenic and facetogenic disease, but significant epidural venous plexus engorgement compressing the thecal sac. ⋯ A discussion with the radiologist confirmed worsening of the patient's May-Thurner Syndrome was the likely cause of the patient's symptoms. The patient was referred back to the surgeon to relieve the venous obstruction because routine injection therapy would be ineffective.
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Case Reports
Genicular Radiofrequency Ablation for Treatment of Post Total Knee Arthroplasty Posterior Thigh Pain: A Case Report.
We present a case of a 68-year-old woman with 6 months of chronic unilateral posterior thigh pain after a total knee arthroplasty. The patient's pain was refractory to various treatments. After appropriate diagnostic tests, a genicular nerve block and subsequent radiofrequency ablation were performed. These procedures provided substantial pain relief of her thigh pain at 3 months follow-up.
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Review Case Reports
Perioperative Management for Abdominal Surgery in Bilateral Diaphragmatic Paralysis: A Case Report and Literature Review.
The optimal approach to postoperative analgesia in patients with bilateral diaphragmatic paralysis undergoing abdominal surgery remains unclear. We report a 69-year-old woman with bilateral diaphragmatic paralysis who underwent a laparoscopic hernia repair and an open laparotomy for reversal of a Hartmann procedure under general anesthesia. ⋯ The patient's trachea was successfully extubated at the end of both surgical procedures. Epidural analgesia was associated with better pain control and shorter intensive care unit stay.