The American journal of emergency medicine
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Guillain-Barre Syndrome (GBS) is a life-threatening condition in which patients may present to the Emergency Department in respiratory distress leading to death. The early identification and treatment of such a condition is paramount in preventing mortality. While there are many infections associated with GBS, the association with Lyme disease is uncommon. ⋯ In this case we report a 31-year-old male who was diagnosed with Lyme disease and GBS with relevant clinical presentation including progressive numbness and weakness in bilateral hands and feet for the past 1week along with areflexia. Initiation of medical therapy with intravenous immunoglobulin and parenteral ceftriaxone resulted in resolution of his symptoms. The treatment of both diseases early can help prevent further central nervous complications leading to high morbidity and mortality.
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Horton's disease is a systemic inflammatory vasculitis, usually found in persons over 50years old. It affects medium and large-sized arteries stemming from the external carotid, especially the superficial temporal arteries. It can affect extracranial large vessels but only rarely the aorta. Diagnosis of aortitis is difficult and its incidence is probably underestimated. ⋯ In the present case, this patient had Horton's disease, based on 3 criteria of The American College of Rheumatology (age, temporal artery abnormalities and inflammatory syndrome) associated with aortitis. However, aortitis is a rare complication of Horton disease and is a major cause of mortality inasmuch as it can be complicated by aneurysm and dissection. It is unusual to diagnose Horton's disease from aortitis symptoms without complications. The aorta represents the most severe localization of Horton's disease. It should not be ignored in etiological hypotheses regarding febrile abdominal pain in the elderly. Corticosteroids should be started rapidly at high doses and temporal artery biopsy should be planned.
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Idiopathic Intracranial Hypertension (IIH) is a syndrome seen predominantly in obese women of reproductive age group, characterized by signs and symptoms of increased intracranial pressure due to an unknown cause. Some individuals have a more malignant form of disease called fulminant idiopathic intracranial hypertension with rapid worsening of symptoms over days. ⋯ She was managed with prompt surgical intervention. In patients with fulminant idiopathic intracranial hypertension, surgery such as cerebrospinal fluid shunting or optic nerve sheath fenestration should not be delayed to prevent vision loss.
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Observational Study
Long-term survival of out-of-hospital cardiac arrest patients with malignancy.
The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy. ⋯ Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy.
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Sedative-hypnotic medications (e.g., Benzodiazepines [BZDs] and non-benzodiazepine receptor agonists [nBZRAs]) are associated with adverse events, especially in the elderly, that may require emergency department (ED) treatment. This study assessed outcomes from ED visits attributed to BZDs and/or nBZRAs, and variations in these associations by age group. ⋯ Findings highlight the need for clinical and regulatory initiatives to reduce BZD use, especially in combination with nBZRAs, and to promote treatment with safer alternatives to these medications.