SAGE open medical case reports
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SAGE Open Med Case Rep · Jan 2018
Case ReportsBlood patch for the treatment of post-dural puncture tinnitus.
Audiometric disturbances are recognised as potential complications after spinal or epidural anaesthesia; however, incidences of tinnitus occur less frequently. We report a case of a patient with severe bilateral tinnitus post-lumbar puncture who was treated with an epidural blood patch. A 40-year-old ASA I lady (a medically fit patient with no known medical problem) presented with ongoing bilateral severe tinnitus for 6 days after a lumbar puncture. ⋯ By her 1-month follow-up, her hearing loss was back to normal. In our experience, an epidural blood patch is an effective treatment for post-dural puncture tinnitus. Its effects are instantaneous and complete resolution is achieved by 24 h.
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SAGE Open Med Case Rep · Jan 2018
Case ReportsTraumatic hemothorax due to chance fracture requiring emergency surgical management: A report of two cases.
Traumatic hemothorax is usually caused by thoracic organ damage. Cases of atypical bleeding sources may be difficult to diagnose. Here we present two surgical cases of vertebral fracture that caused hemothorax. ⋯ Total cross-fracture of the vertebral body solely caused the hemothorax. If bleeding source is unclear in elderly patients, this etiology should be considered. We saved both patients by performing spinal fusion surgery at the appropriate time.
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SAGE Open Med Case Rep · Jan 2018
Case ReportsA delayed presentation of splenic laceration and hemoperitoneum following an elective colonoscopy: A rare complication with uncertain risk factors.
Splenic laceration is a rare yet often underreported complication of colonoscopy that is infrequently discussed with the patient during the consent process. Most cases present within 48 h after the inciting colonoscopy; a delayed presentation is rare. ⋯ Traditionally perceived risk factors such as intra-abdominal adhesions, splenomegaly, anticoagulation use, biopsy, polypectomy, a technically challenging procedure, and anesthesia assistance have not been clearly shown to increase the incidence of splenic injury following a colonoscopy. Since the risk factors of splenic injury remain unclear, the clinical presentation is nonspecific, and the consequences can be serious, the endoscopist should make an effort to inform the patient of this rare complication before the procedure.
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SAGE Open Med Case Rep · Jan 2018
Case ReportsChilaiditi's sign, a cause of pseudo-pneumoperitoneum: A case report.
The differentiation between a pseudo-pneumoperitoneum and true pneumoperitoneum on an initial chest radiograph is challenging but essential to clinical practice. The former is managed conservatively whereas the latter may require surgical intervention. Chilaiditi's sign describes a rare incidental radiological finding of gas filled bowel interpositioned between the right hemi-diaphragm and the liver, which is visible on a plain abdominal or chest radiograph. ⋯ Correct diagnosis of Chilaiditi's sign in an asymptomatic patient can prevent unnecessary procedures. We have reported one incidental chest radiograph with Chilaiditi's sign in a patient presenting and treated for pneumonia. The report aims to illustrate the diagnostic dilemma experienced by clinicians in distinguishing a true versus pseudo-pneumoperitoneum on a chest radiograph.
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SAGE Open Med Case Rep · Jan 2018
Case ReportsSpinal neuraxial anaesthesia for caesarean section in a parturient with type I Arnold Chiari malformation and syringomyelia.
Type 1 Arnold Chiari malformation is associated with prolapse of the cerebellar tonsils into or below the level of the foramen magnum and is usually diagnosed in adults. There are no current guidelines for the management of patients with a residual type I Arnold Chiari malformation, planned for a caesarean section under spinal neuraxial anaesthesia. The paucity in the literature on this topic presents as a management dilemma. ⋯ This case highlights that multidisciplinary management and early anaesthetic consult are of paramount importance in the outcome of the patient, and that spinal neuraxial anaesthesia can be considered as a safe anaesthetic option.