The American journal of emergency medicine
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Case Reports
Unilateral neck pain: a case of Eagle syndrome with associated nontraumatic styloid fracture.
We present a case of Eagle syndrome in a 77-year-old woman with associated aneurysm and nontraumatic styloid process fracture, without history of tonsillectomy, who presented to the emergency department. The first set of symptoms associated with the elongation of the temporal styloid process and/or the calcification of the stylomandibular or stylohyoid ligaments was described by Eagle in 1937. Classically, unilateral pain in the oropharynx radiating to the neck and face that is exacerbated by head turning and neck rotation is characteristic of Eagle syndrome. ⋯ Eagle syndrome is a rare but important differential that the emergency physician must consider in a patient with unilateral neck pain and positional neurological symptoms with head turning and in posttonsillectomy patients. Patients with medical history of Eagle syndrome presenting with neck pain and especially neurological symptomsmust be thoroughly evaluated for carotid and jugular venous injury. Specifically, the decision to obtain computed tomography and computed tomographic angiography to evaluate for carotid artery injury is important for patient management and disposition.
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Jolt accentuation or exacerbation of a baseline headache with horizontal rotation of the neck is a physical finding believed to assess for meningeal irritation. We conducted a prospective observational study of neurologically intact emergency department (ED) patients undergoing lumbar puncture in 2 inner city academic EDs to validate the sensitivity and specificity of jolt accentuation and to assess the sensitivity and specificity of Kernig sign, Brudzinski sign, and nuchal rigidity, in predicting cerebrospinal fluid (CSF) pleocytosis in individuals being assessed for meningitis. Adult patients 18 years and older undergoing lumbar puncture between 2006 and 2009 were approached for consent. ⋯ The specificity of jolt accentuation was 82%, Kernig sign was 97%, Brudzinski sign was 98%, and nuchal rigidity was 80%. Jolt accentuation in our cohort was poorly predictive of pleocytosis and insensitive. The presence of Kernig sign, Brudzinski sign, or nuchal rigidity has moderate positive but no negative predictive value for pleocytosis.
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A 28-year-old man presented to the emergency department (ED) 20 minutes after injecting 20 mL of an insecticide containing 0.05% β-cyfluthrin. Upon presentation, he had no complaints; and vital signs demonstrated a sinus tachycardia of 150 beats per minute, blood pressure of 140/65 mm Hg, no fever, and a normal respiratory rate. Further physical examination was notable only for the lack of tremor and the presence of a left antecubital recent injection site. ⋯ He remained asymptomatic and was transferred to the Psychiatric Assessment Unit after approximately 6 hours of observation. We present the first published case of cyfluthrin parenteral human injection. Although this patient experienced a benign clinical course, vigilance for pyrethroid toxic effects such as seizures, severe tremors, diaphoresis, and choreoathetosis is paramount.