American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Aug 1991
Case ReportsDelayed presentation of a carotid-cavernous sinus fistula in a patient with traumatic brain injury.
Carotid-cavernous sinus fistulas are rare complications of traumatic brain injury, facial trauma and postorthognathic surgery. A high level of clinical suspicion is necessary, particularly for patients who are unable to communicate, to establish the diagnosis. A case of delayed presentation of a carotid-cavernous sinus fistula after traumatic brain injury is presented. This case illustrates that early recognition of this disorder is crucial to prevent significant morbidity.
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Am J Phys Med Rehabil · Jun 1991
Comparative StudyMalpractice in physical medicine and rehabilitation. A review and analysis of existing data.
Malpractice issues are a concern for physiatrists, but little information specific to the field is readily available. Medical, legal and economic literature provide profiles of physicians involved in malpractice claims and the types of clinical situations in which suits are brought in general but no specifics on physiatry before 1973. Nine malpractice studies were examined to characterize malpractice claims in the field. ⋯ Cases involving femoral fracture comprised 14% of paid claims accounting for 34% of the total losses. Conditions of the vertebral column accounted for 35% of monetary losses and medication error accounted for 14% of monetary losses. The claim incidence was very low as one study of 71,130 claims identified none against physiatrists, with no more than 110 claims in any single study.
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Am J Phys Med Rehabil · Dec 1990
Case ReportsMotor-evoked potentials reflect spinal cord function in post-traumatic syringomyelia.
The purpose of this study was to examine electrophysiologic abnormalities, including motor-evoked potentials, in a patient with post-traumatic syringomyelia before and after syringopleural shunting. A patient with C5 quadriplegia presented with pain, ascending sensory loss, and new weakness in the left upper extremity two yr after spinal cord injury. MRI revealed a syrinx extending from C2 to T12. ⋯ Fifteen days after syringopleural shunting at the T7 level, CMCTs had dropped to 6.9 ms on the left and 4.6 ms on the right; the left median F-wave reappeared with a normal latency. Repeat MRI revealed the syrinx to be smaller in diameter. These results suggest that CMCTs measured from magnetic stimulation of the motor cortex may be useful in the diagnosis of post-traumatic syringomyelia, as well as for following such patients postoperatively.