The American journal of emergency medicine
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Panspinal epidural abscess is an extremely rare condition that can potentially lead to major permanent neurological deficits if treatment is delayed or suboptimal. Most patients with spinal epidural abscess have a short segment of vertebrae involved and classically present with fever, low back pain, and focal neurologic deficit. ⋯ Herein, we report the case of a 41-year-old diabetic man who presented at our hospital with the symptoms of headache, quadriplegia with respiratory distress and low back pain. Panspinal epidural abscess and meningitis were diagnosed by carrying out detailed neurologic examinations and neuroimaging studies, which expedited the correct diagnosis and treatment.
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We present an unusual case of tibial nerve compression caused by a true tibial posterior artery aneurysm. A 61-year-old man was admitted to the emergency department due to suspected muscle rupture. He had experienced a sudden, intense right calf pain and swelling that had begun during walking. ⋯ An angiography confirmed the diagnosis. Under spinal anesthesia, we performed aneurysmectomy and decompressed the tibial nerve. The histologic examination was compatible with a true aneurysm of the right posterior tibial artery.
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The purpose was to study the emergency management of patients with suspected meningitis to identify potential areas for improvement. ⋯ Few patients with suspected meningitis received antimicrobial therapy within the first 30 minutes after arrival, but most patients with pneumococcal meningitis and typical symptoms were treated early; patients with bacterial meningitis who received treatment late had complex medical histories or atypical presentations.
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The objective of this study is to determine at what probability of thoracic aortic dissection (TAD) to use a computed tomographic angiography (CTA) or a d-dimer test. ⋯ The TTs for TAD are low and reflect the large mortality benefit from diagnosis and treatment when compared with the small risks of CTA. However, given the low prevalence of TAD (~0.05% among emergency department patients presenting with symptoms previously attributed to TAD), our results suggest that without high-risk features, clinicians should not order a CTA test for TAD. Depending on age, CTA should be considered for those patients with a disease probability greater than 0.3% to 2.1%, whereas d-dimer testing is appropriate in the range of pretest probabilities from 0.01% to 0.6%. Future studies should focus on clinical decision rules that place disease probabilities below, between, and above the calculated TTs.