The American journal of emergency medicine
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Case Reports
Early left ventricular free-wall rupture in non-ST-elevation myocardial infarction: never to be neglected.
As the most dramatic and fatal complication, left ventricular free-wall rupture (LVFWR) used to present in approximately 3% of patients with acute myocardial infarction. After the introduction of primary percutaneous coronary intervention, the incidence of LVFWR decreased but remained approximately 1.7%. ⋯ Left ventricular free-wall rupture rarely occurs in patients with non-ST-elevation myocardial infarction, but the risk of it cannot be ignored. This case describes early development LVFWR after non-ST-elevation myocardial infarction to evoke high vigilance of clinicians to this condition.
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Our patient is a 42-year-old woman with muscle paralysis, muscle weakness, and fever. On admission, a neurologic examination showed proximal and distal weakness in the leg. Serum creatine phosphokinase and serum myoglobin level were markedly increased (5600 UI/L and 5197 UI/L, respectively). ⋯ Serologic studies for virus titers showed the antibody immunoglobulin M cytomegalovirus. Muscle weakness and its paralysis, fever, and serum creatine kinase level gradually improved after the administration of methylprednisolone intravenous. Cytomegalovirus infection was thought to have played a central role in this case, leading to an acute but reversible peripheral muscle paralysis.
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Current guideline recommends that immediate coronary angiography (CAG) should be considered in all postcardiac arrest patients in whom acute coronary syndrome is suspected. In the setting of out-of-hospital cardiac arrest (OHCA), obtaining clinical data such as chest discomfort and medical diseases associated with acute coronary syndrome can be difficult. ⋯ In clinical practice, the usefulness of emergency CAG evaluation of OHCA patients without ST-segment elevation myocardial infarction is debatable. We describe 2 OHCA patients who did not exhibit ST-segment elevation after ROSC and received underwent emergency CAG.
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Multiple sclerosis affects many regions of the central nervous system and leads to visual, oculomotor, motor, sensorial, cerebellar, and cognitive disorders. In addition to classic clinical findings, sudden paroxysmal symptoms triggered by motion, hyperventilation, or sensory stimulus may occur. In this article, we present a case of convergence spasm attended by paroxysmal symptoms, a rarely observed situation but one which can have complete recovery through administration of 5-day intravenous (i.v.) methylprednisolone therapy, together with its imaging findings and video records.