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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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.
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Eperisone hydrochloride is a centrally acting muscle relaxant prescribed for muscle stiffness that acts by depressing the activities of α and γ efferent neurons in the spinal cord and supraspinal structures. Although a case of eperisone-induced severe QT prolongation had been reported, the relationship between serum eperisone concentration and QT interval remains obscure. ⋯ Serum eperisone concentration correlates with QTc interval in patients who overdose on eperisone.