BMJ case reports
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Case Reports
Blunt traumatic internal carotid artery dissection with delayed stroke in a young skydiver.
We describe a case of a 33-year-old skydiver who presented to the emergency department after a traumatic landing following a parachuting episode. He initially presented with right knee pain secondary to a tibial plateau fracture. ⋯ An urgent work-up showed right middle cerebral artery thrombosis with right internal carotid thrombosis and dissection. We have discussed some possible mechanism of injury in skydiving that may have predisposed to the occurrence of cervical dissection in our patient.
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Review Case Reports
High dose of prokinetics for refractory hiccups after chemotherapy or the return to a simple drug.
Hiccups in patients with cancer might be difficult to treat, impacting negatively on the quality of life. Many therapies are available, but they are usually started empirically, and often they are unsuccessful. We report a case of a man with metastatic colon cancer who after the first cycle of chemotherapy developed persistent hiccups refractory to neuroleptics and low dose of metoclopramide. ⋯ This case shows how searching for potential causes helps start the right treatment immediately, and therefore it is relevant for the prompt relief from this bothersome symptom. So far, no cases reporting high doses of prokinetics to treat persistent hiccups after chemotherapy have been published. This option should be taken into account when developing hiccups and gastro-oesophageal reflux after chemotherapy, especially if low doses of prokinetics have already been tried.
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Review Case Reports
Aneurysmal bone cyst of thoracic spine: case report and brief review of literature.
A 16-year-old girl was admitted with insidious onset, gradually progressive spastic sensori-motor paraparesis, with a sensory level at D10 dermatome without bowel or bladder involvement for the last 2 months following trivial trauma on the lower back. MRI of the spine showed a low-to-intermediate signal intensity, heterogeneous mass with multiple fluid levels. A diagnosis of aneurysmal bone cyst was made. ⋯ Histopathology of the mass showed cyst cavity filled with haemorrhage surrounded by bony trabeculae confirming the diagnosis. Following excision the patient had excellent recovery. We report this case owing to its rarity and to emphasise the importance of surgery if there is cord compression.
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We report a case of serious lung injury from beanbag bullet. A 46-year-old gentleman, shot with beanbag bullets was brought to the emergency department. Upon arrival he was in obvious respiratory distress and complained of severe pain in the right chest. ⋯ The bullet and skin fragments overlying the lung and along the bullet track were extracted. The pleural cavity was washed with normal saline and haemostasis was confirmed. The patient had an uneventful postoperative recovery.