1/6. An unresponsive infant in the emergency room.The physician must be aware of the computed tomography appearance of an acute-hyperacute subdural hematoma in child abuse and not mistake it for chronic subdural hematoma with "spontaneous" rebleeding. As always, the imaging findings must be correlated with the clinical findings. Clinical and imaging findings of injury out of proportion to the history, and injuries of different ages are the key indicators to the possibility of child abuse, particularly when encountered in a young infant.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Treatable complications of cancer patients referred to an in-patient hospice.This paper illustrates the importance of accurate diagnoses and treatments of complications in terminally ill cancer patients. The paper reports on five hospice in-patients who completely recovered from life-threatening complications; three of them had been incorrectly labeled as "imminently dying" by the referring physicians. The paper concludes that it would be beneficial for patients to receive examinations and a trial of medical treatment in their continuing treatment settings.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. A brief neurobehavioral exam useful for early detection of postoperative complications in neurosurgical patients.This article describes data from 11 patients evaluated before and after neurosurgical intervention for treatment of brain tumor, subdural hematoma and hydrocephalus. The Neurobehavioral Cognitive Status Examination (NCSE) was administered pre- and postoperatively. Improvement was documented by the NCSE in 6 of the 11 patients. In the remaining five patients, there was evidence of deterioration in cognitive functioning. After clinical and diagnostic re-evaluation by the physician, four patients had repeat operations. Follow-up evaluation after the second operation was useful in determining treatable and non-treatable causes of progressive cognitive deterioration. In these patients use of the NCSE may have expedited effective diagnostic evaluation and subsequently improved patient care. Such instruments have clinical utility since they are easily administered, pragmatic, and objectify subtle changes in cognitive functioning which may be early signs of increased intracranial pressure or complications of surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Bloody cerebrospinal fluid: traumatic tap or child abuse?A central nervous system dysfunction of nontraumatic etiology was initially suspected in three cases of shaken baby syndrome. blood contaminating the cerebrospinal fluid was attributed to a traumatic lumbar puncture. Failure to detect retinal hemorrhages contributed to the misdiagnosis. Emergency physicians must consider the diagnosis of shaken baby syndrome in a critically ill infant with bloody cerebrospinal fluid. ophthalmoscopy should be done routinely in these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Minor head injury.The evaluation and treatment of minor head injuries are reviewed, with particular emphasis on those problems of head injury commonly seen by family physicians. Clinical history, physical examination, and radiologic studies that are of value in diagnosing minor head injuries are highlighted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. headache, thrombolytic therapy, and chronic subdural hemorrhage--a case report.Subdural hematomas are well known but infrequent complications of thrombolytic therapy. Although these are usually associated with head trauma, the authors describe a case of a patient who received a particularly aggressive thrombolytic regimen and presented six months later with complaints of nothing more than a headache resistant to medical therapy, without associated neurologic manifestations, which was finally diagnosed as a chronic subdural hematoma by computerized tomography. In the era of thrombolysis, physicians should maintain a heightened index of suspicion for subdural hematoma in patients complaining of headache.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |