The American journal of emergency medicine
-
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.
-
Case Reports
Diagnosis of metacarpal fracture with equivocal x-ray by point-of-care ultrasound: a case report.
Metacarpal fractures represent a very common injury among patients presenting to the emergency department. Diagnosis is of utmost importance given the high morbidity associated with lack of full hand function. We report a case of a 37-year-old man who sustained extremity trauma after a mechanical fall. ⋯ X-ray of the hand was equivocal for a metacarpal fracture; however, point-of-care ultrasound revealed disruption of the bony cortex confirming the diagnosis. The patient was splinted and referred for follow-up with a hand specialist. Point-of-care ultrasound may be useful for the diagnosis of hand fractures, which may reduce health care costs and radiation exposure in the future.
-
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.
-
Case Reports
Delayed massive hemothorax complicating simple rib fracture associated with diaphragmatic injury.
Traumatic hemothorax is potentially life threatening. Rib fractures are the commonest injury after chest trauma, which accounts for 10% of patients after trauma. ⋯ We present a case of this uncommon situation with delayed massive hemothorax caused by simple fracture of the lower ribs. Admission should be considered for close observation when presenting with fracture of the lower ribs because of the possibility of diaphragmatic injury or intra-abdominal injury, even if a simple rib fracture is found initially.