A&A practice
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Spontaneous intracranial hypotension is an uncommon disorder with symptoms including postural headache that can be debilitating to patients. Diagnosis is mainly clinical, aided by imaging of the brain and spine with or without diagnostic procedures. ⋯ We describe a case of a patient with clinical findings of spontaneous intracranial hypotension but with normal brain imaging. The patient responded to lumbar epidural blood patches and did not require additional tests to confirm the diagnosis.
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Massive pulmonary embolism and its treatment with thrombolysis both carry grave risks. Optimal management hinges on determining the risk-to-benefit ratio of thrombolytic administration. ⋯ Initial laboratory values, however, revealed an elevated international normalized ratio, which precluded lysis, despite a hypercoagulable Thromboelastogram. We believe that viscoelastic testing of coagulation is essential for evaluating coagulation in liver dysfunction, particularly when considering thrombolysis.
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Traditional systems of anesthesia evaluation do not routinely incorporate cognitive screening into preoperative assessments of vital organ systems. Increasing recognition of the importance of preoperative cognitive assessment of the elderly surgical patient has resulted in a "call to action" from experts in this area. ⋯ We describe our preliminary experience with developing a training program and implementing routine cognitive screening in a preoperative evaluation clinic. We outline a process showing our successful clinical implementation of sustainable cognitive stratification and documentation of routine cognitive screening.
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Case Reports
Nutcracker Syndrome-An Unusual Case of Chronic Left Upper Abdominal Pain: A Case Report.
A 38-year-old woman presented with a chief complaint of sharp, achy left upper abdominal pain with radiation to the left flank. This pain started approximately one-and-a-half years before she consulted with a pain specialist. ⋯ The patient was evaluated by an urologist and underwent renal autotransplantation. The patient subsequently had complete relief of her pain.