1/9. Early diagnostic magnetic resonance imaging in acute disseminated encephalomyelitis.We report two cases and review the literature concerning the importance of early magnetic resonance imaging (MRI) of the brain as a guide for the early diagnosis and treatment of acute disseminated encephalomyelitis (ADEM). A nonspecific term, ADEM refers to an acute disease that is postinfectious, parainfectious, postvaccinal, or of an unknown precipitating factor. Often when there is clinical suspicion of ADEM, MRI is not done before significant morbidity and mortality occur, despite the existence of adequate treatments. Primary care physicians should be aware of the importance of early MRI in ADEM.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. giant cell arteritis. Episodes of syncope add complexity to an unusual presentation.GCA presents in various forms, creating a diagnostic conundrum for the treating physician. Evaluation requires extensive medical examination, testing, and imaging to rule out other conditions. Compared with the process of diagnosing GCA, treating it is relatively straightforward. Most patients show significant improvement with corticosteroid therapy. Our patient presented with syncope, which also has numerous causes. Detailed testing confirmed a positional trigger for her syncope in the absence of hemodynamic disturbances. She responded promptly to corticosteroid therapy. We speculate that flow-limiting stenosis in the vertebrobasilar system may have caused her symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Chronic subdural hematoma presenting as headache and cognitive impairment after minor head trauma.Although relatively uncommon, a chronic subdural hematoma carries a high incidence of morbidity and potential mortality. An aging population combined with an increased usage of anti-platelet and anticoagulation drugs enhances the likelihood that physicians will encounter this condition in routine practice. A heightened index of suspicion, coupled with a thorough clinical and diagnostic examination, is necessary to uncover this sometimes indolent problem. This case study highlights the presentation of an unusual case and discusses the diagnosis, evaluation and treatment of chronic subdural hematomas.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. stroke or encephalitis?Viral encephalitis is associated with significant morbidity and mortality, particularly when appropriate management is omitted as a result of delayed diagnosis. A case of herpes simplex virus type 1 (HSV-1) encephalitis is presented, demonstrating that the presentation of confusion, speech difficulties and fever with non-specific early brain CT appearances can easily be misdiagnosed as pneumonia with stroke. This case highlights the need for increased awareness of HSV-1 encephalitis among emergency physicians and radiologists, given that the early spectrum of clinical and CT findings can mimic the more common diagnoses of sepsis and stroke.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. cat-scratch disease: an unusual cause of combative behavior.Acute encephalitis is an unusual manifestation of cat-scratch disease. The authors present the case of a 27-year-old man who exhibited the acute onset of encephalitis manifested by violent behavior and confusion. The diagnosis of drug abuse was presumed initially, but a careful examination revealed the true cause to be cat-scratch disease. Emergency physicians are frequently faced with the challenging task of evaluating confused and combative patients. This case demonstrates the importance of a complete physical examination and a thorough laboratory evaluation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. plasma concentrations of complement-activation complexes correlate with disease activity in patients diagnosed with isolated central nervous system vasculitis.Isolated central nervous system (CNS) vasculitis is rare medium- sized vessel disease limited to intracerebral vessels. The two most common symptoms of this inflammatory disorder observed at entry to a hospital are headaches and mild memory deficits. Further progression of this disease may result in focal neurologic alterations and seizures. Currently, the most common laboratory abnormality noted is an elevated erythrocyte sedimentation rate. The complement (C) system is known to play a role in many inflammatory processes; it may also be involved in CNS vasculitis. In this longitudinal study of patients with CNS vasculitis, we detected C activation by highly sensitive and specific assays that are capable of identifying breakdown products formed after C activation: C3a des arg, C4a des arg, C5a des arg, C1rC1s-C1-inhibitor complex, and terminal C complex (C5b-9). We present two cases of documented CNS vasculitis in which serial measurements of these C-activation products correlate with disease activity. Our results indicate that a temporal association exists between C activation and the clinical presentation of CNS vasculitis. We conclude that physicians should monitor C-activation by-products in plasma when they attempt to follow the clinical course of CNS vasculitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Acute renal failure and neurotoxicity following oral acyclovir.OBJECTIVE: To report a case of acute renal failure and neurotoxicity following administration of oral acyclovir. DATA SOURCES: Medical record of the patient, case reports identified by medline. DATA EXTRACTION: Data were abstracted from relevant published data by Johnson and reviewed by the remaining authors. CASE SUMMARY: A 69-year-old woman was diagnosed with herpes zoster and oral acyclovir was prescribed by her local physician. After approximately two days the patient was taken to the emergency department of a local hospital with signs of acute confusion and acute renal failure. Medications included oxycodone/acetaminophen, alprazolam, prazepam, and digoxin. Pertinent laboratory abnormalities included serum digoxin 4.1 mumol/L, white blood cell count 17.6 x 10(9)/L, blood urea nitrogen (BUN) 24 mmol/L of urea, and serum creatinine 305 mumol/L (patient baseline is 11 mmol/L of urea and 91.5 serum creatinine mumol/L, respectively). Because of increasing lethargy and a focal seizure, she was transferred to our institution. Despite an extensive workup, no organic cause of her altered mental status and acute renal failure was identified. Four days after discontinuation of the acyclovir, without specific intervention, the patient's mental status improved and her BUN and serum creatinine concentrations had decreased to 21 mmol/L of urea and 190.6 mumol/L, respectively. On day 5, the patient was alert and oriented to name, place, year, and month. On day 9, her renal function and mental status had returned to baseline and she was discharged. CONCLUSIONS: Acute renal failure and neurotoxicity are usually associated with intravenous acyclovir. The temporal relationship between the initiation of oral acyclovir therapy and the onset of adverse events, supported by published data of a few similar cases, strongly implicate oral acyclovir as the cause of this patient's acute renal failure and neurotoxicity. This case suggests that elderly patients with mild increased serum creatinine concentrations may be at increased risk and should be monitored closely for signs and symptoms of acute renal failure and neurotoxicity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. Reversible neurological deficits in a chronic alcohol abuser: a case report of Wernicke's encephalopathy.The abuse of alcohol presents daily challenges for the emergency medicine physician. Wernicke's encephalopathy represents one of the metabolic complications associated with alcoholism. A classic presentation of Wernicke's encephalopathy is reported. The patient presented to the emergency department with the chief complaint of confusion, difficulty ambulating, and visual disturbances. Following administration of intravenous thiamine, the patient's symptoms spontaneously resolved. The pathophysiology, clinical presentation and therapy of this classic disorder are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. psoas abscess with sepsis mimicking traumatic hemorrhagic shock after a fall.Abscess of the psoas muscle is infrequently encountered. An infectious emergency of this type usually presents in a nonspecific manner and thus poses a significant diagnostic challenge to the emergency physician. Diagnosis and specific treatment are often delayed, which can lead to increased mortality. This case report presents a patient with altered mental status and hypotension after a fall, who was initially managed as a trauma victim. Emergency department evaluation initially focused on a traumatic etiology of the above abnormalities. Subsequent assessment determined that the patient's condition was due to an underlying psoas abscess with sepsis. Appropriate anatomy, clinical presentation, and management are discussed in hopes of increasing physician awareness of this uncommon infectious condition.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |