The American journal of emergency medicine
-
Thus far, only a few spine fracture cases related to severe nocturnal hypoglycemia in type 1 diabetes patients have been reported. Due to the relatively young age of these subjects, osteoporosis was not taken into consideration and bone mineral density was not assessed. We report three type 1 diabetes cases in young patients with durations of 2, 4, and 19 years. ⋯ For the first time, it was demonstrated that low bone mineral density in young type 1 diabetes patients may contribute to an increased compression fracture risk of the dorsal spine during severe nocturnal hypoglycemia courses. The possibility of osteoporosis in young patients with short diabetes durations suggests it might be advisable to perform bone mineral density testing during diabetes diagnoses. Spinal pain occurrences in young patients after severe nocturnal hypoglycemia should be investigated using procedures for the diagnosis of vertebral compression fracture, even if there is no evident trauma.
-
Case Reports
Cholinergic symptoms with low serum cholinesterase from therapeutic cholinesterase inhibitor toxicity.
Although cholinesterase inhibitors have been frequently used in the treatment of Alzheimer disease, its effects on serum cholinesterase concentrations have been rarely described. We described significant depression of serum cholinesterase levels due to cholinesterase inhibitor toxicity from redundant use of donepezil and rivastigmine in a 78-year-old man. Recovery of serum cholinesterase level was noted upon drug discontinuation and cholinergic symptom resolution. Serum cholinesterase level can be used as a biomarker for central cholinesterase inhibitor toxicity.
-
Venous thromboembolism (VTE) is serious medical condition, which might be caused by psychotropic medications. Previously, antipsychotic-induced VTE due to olanzapine, risperidone, clozapine, and amisulpiride was reported. In this report, we present 2 cases of paliperidone-induced VTE.
-
Spontaneous spinal epidural hematoma accounts for most cases of spinal epidural hematoma, but very few cases of recurrent spontaneous spinal epidural hematoma have been published to date. We herein report a case of a 20-year-old man who presented with 10-day history of pain in the interscapular region, followed by paraparesis and sensory loss below umbilicus along with urinary retention. The patient gave history of 2 similar episodes in the last 3 months, with complete spontaneous recovery. ⋯ On reviewing previous 2 magnetic resonance images of dorsal spine, it was apparent that the patient had recurrent hematoma at the same site. Thus, a provisional diagnosis of recurrent spontaneous spinal hematoma at the level of upper dorsal spine was kept and was managed accordingly. Patient with recurrent spontaneous spinal epidural hematoma should be educated about the nature of the disease and advised to consult a neurosurgeon as early as possible in case of a relapse, so that they can undergo surgical management preferably within 8 hours and not later than 36 hours.