1/17. ehlers-danlos syndrome type IV and multiple aortic aneurysms--a case report.Beside atherosclerosis, aortic aneurysms can be part of the clinical spectrum of many systemic diseases, including infectious, inflammatory, genetic and, less often, congenital disorders. A 48-year-old white man presented with multiple large aneurysms of the aorta and its main branches. Medical history was unremarkable except for the presence of a softened abdominal mass since he was 28 years old. On the physical examination, an arterial murmur was heard over the left carotid artery and a palpable mass was noted in the whole right side of the abdomen. No skin or joint abnormalities were noted. aortography, computed tomography, and magnetic resonance angiography showed multiple large aneurysms of the descending thoracic and abdominal aorta. Aneurysms of the innominate, left subclavian, and carotid arteries were also seen. This case resembles those previously reported, in which multiple aortic aneurysms were associated with abnormalities of the type III procollagen gene (COL3A1). Although the classic stigmas of the ehlers-danlos syndrome type IV were lacking, this genetic disease may be the cause of the multiple aneurysms in this patient.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/17. The art of perimetry.There is no single method of perimetric examination which is applicable to all types of visual field defects. Perimetry is a subjective psychophysical sensory examination. It is not an exact science unless one includes the objective measurement of visual evoked response in the optic cortex. Until such a method becomes clinically available it will be necessary for the perimetrist to determine which techniques to use in a given case and to apply these techniques with sympathetic understanding. This is the art of perimetry.- - - - - - - - - - ranking = 0.10574732891851keywords = physical (Clic here for more details about this article) |
3/17. Horner's syndrome resulting from agenesis of the internal carotid artery: report of a third case.INTRODUCTION: Only two previous reports of agenesis of the internal carotid artery with a coexistent Horner's syndrome are to be found in the medical literature. CASE REPORT: We report a case of a male child seen initially for what was presumed to be a traumatic superficial temporal artery aneurysm. MRA incidentally revealed ipsilateral agenesis of the internal carotid artery. This child's physical exam included ipsilateral Horner's syndrome. CONCLUSION: This case report illustrates that agenesis of the internal carotid artery does indeed cause Horner's syndrome in some cases. The clinician who diagnoses a patient with Horner's syndrome should remember that agenesis of the internal carotid artery may be the cause as this entity can be associated in itself with other pathologies of the central nervous system.- - - - - - - - - - ranking = 0.10574732891851keywords = physical (Clic here for more details about this article) |
4/17. Bilateral external carotid artery aneurysms.A 60-year-old female was found on a physical examination to have bilateral palpable pulsatile neck masses. She denied local pain, cranial nerve compressive symptoms, or symptoms of cerebral ischemia. Duplex ultrasonography demonstrated bilateral 1.5 x 2.2 cm external carotid artery aneurysms. Isolated bilateral external carotid artery aneurysms were confirmed by computed tomography and angiography. The patient has been treated conservatively, and at 4-year follow-up, she remains asymptomatic, and the carotid artery aneurysms are unchanged in size.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/17. Acquired and congenital internal carotid artery anomalies in two cases: an important threat for the otolaryngologist.Diseases of the extracranial portion of the internal carotid artery (ICA) are rarely seen in the otolaryngology practice. We report two different pathologies of the ICA, which presented with otolaryngological symptoms. The first case was a 70-year-old woman with symptoms of chronic pharyngitis. On physical examination, a pulsatile mass at the right posterolateral oropharynx was identified. Magnetic resonance imaging revealed a tortuous ICA. No treatment was offered. The second case was a 75-year-old woman with a two-month history of upper neck mass. She did not have any additional complaints and her physical examination was normal except for the mass. Doppler ultrasonography showed a high fluid flow within the mass. Digital angiography demonstrated an ICA aneurysm. Because the patient refused any surgery, antiplatelet treatment was started.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
6/17. Dissections of the cervicocerebral arteries.We present four cases of cerebral ischemia secondary to dissections of cervicocerebal arteries. The majority of patients presented with transient ischemic attacks and strokes, although one patient presented with headache and focal seizure. In addition to history and physical examination, the diagnostic evaluation of these patients included computed tomography scan, carotid duplex studies, angiogram, and, in some cases, magnetic resonance imaging studies. Initially, the patients were anticoagulated with heparin and then with warfarin for a period of six to eight weeks. The emergency physician must consider such dissections in younger patients with sudden neurologic deficits and no or few risk factors for cerebrovascular disease. In our experience, these are not rare syndromes; with proper workup, prompt diagnosis, and therapy, the prognosis is usually excellent.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/17. Recurrent attacks of amaurosis fugax treated with calcium channel blocker.Vasospasm may be one of the causes of amaurosis fugax. A patient is reported who daily experienced multiple brief episodes of amaurosis fugax. The absence of physical, laboratory, or radiographic evidence for thromboembolism, hemodynamic compromise, or vasculitis, suggested that the amaurosis might be caused by vasospasm. This hypothesis was supported by cessation of the attacks of amaurosis when the patient was treated with a calcium channel blocker.- - - - - - - - - - ranking = 0.10574732891851keywords = physical (Clic here for more details about this article) |
8/17. radiation-associated atheromatous disease of the cervical carotid artery: report of seven cases and review of the literature.The natural history of postirradiation extracranial cerebrovascular disease is uncertain. Previous reported cases spanning 20 years of carotid surgery are difficult to evaluate, because patients may sometimes have unspecified symptoms, physical examinations, postoperative results, and follow-up. Also, the evolution of carotid surgery over the past two decades makes it impossible to compare earlier operative technique with the state-of-the-art technique of today. Our series of 7 patients underwent 9 carotid endarterectomies with an average follow-up period of 46 months. The number of patients is small, and although technically this is a more difficult operation, we feel the results are favorable and may be comparable with endarteerctomy procedures in nonirradiated patients. These patients should be approached as if radiation changes are not a major factor when they are considered for reconstructive arterial surgery.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/17. May focal epileptic seizures be considered a marker of TIAs?Late-onset focal epileptic seizures occurred in 8 patients with ischemic cerebro-vascular disease (ICVD) and were associated with TIAs in 6 of them. History, physical, laboratory, ancillary examinations and follow-up revealed no other disease which might be responsible for the seizures. Moreover, time of onset and appropriate signs of ICVD suggested that transient cerebral ischemia was the most likely cause of seizures.- - - - - - - - - - ranking = 0.10574732891851keywords = physical (Clic here for more details about this article) |
10/17. Traumatic carotid-cavernous fistula with contralateral proptosis.A case of traumatic carotid-cavernous fistula with an isolated contralateral proptosis is described and illustrated followed by a discussion on the likely cause of the patient's paradoxical physical signs.- - - - - - - - - - ranking = 0.10574732891851keywords = physical (Clic here for more details about this article) |
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