1/6. Frontal ataxia in childhood.Frontal ataxia may be the result of a unilateral frontal lesion. In this report three cases are presented with ataxia due to right frontal lesions. One case concerns a boy presenting with an unsteady gait and titubation of the trunk, mimicking developmental disequilibrium and with complex partial seizures. It proved to be caused by a small right-sided cavernoma in the middle frontal gyrus. After surgical intervention the symptoms and the seizures disappeared. Two subsequent cases concern teenage patients presenting with headache after an ENT infection and on physical examination mild dysmetric function of the upper limbs and slight disequilibrium, due to right-sided frontal lobe abscesses. After neurosurgical and antibiotic therapy the symptoms were relieved. The frontal origin of ataxia should be considered in children presenting with a "cerebellar syndrome". Frontal gait disorders consist of a clinical pattern of different gait disorders. The syndrome has been mentioned in the literature under different names. Our patients show signs compatible with the term frontal disequilibrium, a clinical pattern of frontal gait disorder. This assumes walking problems characterized by loss of control of motor planning, leading to imbalance. Remarkably, frontal ataxia may mimic developmental delay as demonstrated in the first case and may be the leading mild symptom in extensive frontal lobe damage as demonstrated by the two other cases. We suppose that frontal ataxia is the result of a disturbance in the cerebellar-frontal circuitries and an impairment of executive and planning functions of the basal ganglia-frontal lobe circuitry.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/6. Disseminated pneumococcal infection with pericarditis and cardiac tamponade: report of one case.A 1-year-5-months-old female who had cough, rhinorrhea and prolonged fever for 19 days was admitted to the intensive care unit due to exertional dyspnea. She was intubated promptly in virtue of hypotension and cyanosis. The physical examination demonstrated diminished breathing sound over the right lung and distant heart sound; echocardiogram showed cardiac tamponade. Further X ray study showed right hydropneumothorax and cardiomegaly. pericardiocentesis and chest thoracostomy were performed, and subsequently all the cultures showed growth of streptococcus pneumoniae. Antibiotics therapy was started promptly after admission. Further investigation indicated osteomyelitis of the right ilium, so that surgical debridement was done. The patient was discharged 54 days later with complete recovery. After following up for 18 months, no restrictive heart disease developed. Purulent pericarditis with cardiac tamponade is an extremely rare complication of pneumococcal infection.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/6. Infected abdominal aortic aneurysm.In the surgical literature, 37 survivors of infected abdominal aortic aneurysmorrhaphy have been reported. The diagnosis is suspected if a patient with fever, leukocytosis, and abdominal pain is noted on physical examination to have a pulsatile abdominal mass. Confirmation is best obtained with computerized tomography and angiography. We used a protocol for surgical diagnosis and management to successfully treat two patients who are added to the list of known survivors of infection of an abdominal aortic aneurysm.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/6. Acute nontraumatic cardiac tamponade.A 33-year-old man presented with acute nontraumatic cardiac tamponade as a result of pneumococcal pericarditis in association with pneumococcal pneumonia. hypotension, tachycardia and pulsus paradoxicus, 50 mm Hg, were present. Echocardiographic findings were compatible with cardiac tamponade. pericardiocentesis was performed. Acute nontraumatic pericardial tamponade in the emergency department presents special problems of diagnosis and management. diagnosis is based on correlation of data from the history, physical examination, electrocardiogram, chest x-ray films, and a high index of suspicion. echocardiography to confirm the diagnosis of tamponade and aid in correct placement of the needle in pericardiocentesis is especially helpful.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/6. purpura in occult pneumococcal bacteremia.An unusual case of occult pneumococcal bacteremia is reported. A 4-month-old female presented with ascending purpura on the lower extremities as the only abnormal physical finding. All initial laboratory studies were normal; however, streptococcus pneumoniae serotype 6 was cultured from her blood within 18 hours and subsequently from the nasopharynx. This is the first reported case in humans of occult pneumococcal bacteremia presenting with the primary clinical finding of purpura. This entity has a well defined animal model in mice.- - - - - - - - - - ranking = 0.048928914202061keywords = physical (Clic here for more details about this article) |
6/6. Pneumococcal pericarditis: a persisting problem in contemporary diagnosis.We reviewed the clinical and laboratory features of six patients with pericarditis caused by streptococcus pneumoniae who were admitted to boston City Hospital. The diagnosis of pneumococcal pericarditis was delayed or missed entirely during life in all patients. The frequent absence of pericardial friction rubs and cardimegaly on chest roentgenograms contributed to the difficulty in recognizing this illness. Electrocardiograms and physical examinations of the heart almost always disclosed abnormalities, but they were not sufficiently specific to suggest pericarditis, and patients were often thought to have had an acute complication of arteriosclerotic heart disease. review of the English literature since 1945 supports the recent experience in our hospital that the diagnosis of pneumococcal pericarditis may be elusive.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |