Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

More documents

Recommendations

Info

hemolytic anemia, it is important to have a high-index of suspicion for co-infection of borrelia burgorferi and babesia microti.
Axillary Pseudoaneurysm With Embolization Causing Arterial Occlusion And Brachial Plexopathy Sunter, H., MS III, Lancellotti, G., M.D. Kent Hospital, Warwick, RI Introduction: Most pseudoaneurysms are the result of iatrogenic or penetrating injuries such as trauma resulting in an arterial puncture with subsequent formation of a hematoma. When treatment is delayed, hemorrhage, venous edema, erosion of the skin and neurologic compression due to mass effect are all emergent conditions that risk permanent loss of function or potential life threatening complications. Common presentation of this condition in an extremity includes pallor, decrease or loss of pulses, poikilothermia, paresthesias, pain and potential paralysis. While these findings were all present in our patient, an atypical precipitating event lead to an unforeseen diagnosis. Case: A 62 year old male with a past medical history of hypertension presented to the emergency room with a painful and weak left upper extremity. Patient stated his arm had felt weak with a dull, non-radiating ache since an unwitnessed fall at his home one month ago. Although vitals were within normal limits, on physical exam he had poor capillary refill of the left distal upper extremity coupled with absent radial and ulnar pulses. Also noted on physical was absent sensation distally from the cubital fossa along with biceps strength 3/5, finger flexors 2/5, triceps and finger extensors and intrinsics 0/5. X-ray of the left shoulder revealed inferior and anterior humeral head subluxation, which when coupled with history of traumatic injury raised suspicion of possible fracture. Subsequent non-contrast CT revealed fracture of the superolateral portion of humeral head with adjacent multiple bony fragments as well as a 12.6 X 9.0 cm hematoma. This large hematoma not mentioned on the initial physical assessment, was palpable and the size of a baseball, further explaining subsequent diminished brachial plexus function. CT angiography discovered a large pseudoaneurysm of the left axillary-brachial junction with complete disruption and distal embolization to the brachial trifrication and run off branches. On further work up, arteriography showed thrombosis of the pseudoaneurysm with distal constitution of the brachial artery. Interventional radiology then performed endovascular stent and grafting after which embolectomy and thrombectomy were done. Orthopedics attempted closed reduction of the anterior dislocation but were unsuccessful. Following these interventions, patient regained pulses in ulnar and radial arteries and experienced left upper extremity erythema and warmth. Median nerve function was retained as well as the ability to flex his digits but he was unable to perform digit or elbow extension or intrinsic motion. Despite the development of post perfusion edema without evidence of compartment syndrome and residual symptoms such as paresthesias in the distal extremity, the patient refused rehabilitation treatment but agreed to discharge with home care services. Discussion: While recognition of a pseudoaneurysm typically occurs in the history of a penetrating injury, indicators such as pain, pallor, absent pulses, and paresthesias may hasten diagnosis and decrease the likelihood of emergent vascular or neurologic compromise. Despite the lack of penetrating injury or iatrogenic intervention, when considering these symptoms in any patient, especially one with increased vascular risk factors, it is essential to rule out pseudoaneurysm formation and perform a thorough physical examination as potential mass effect can lead to a surgical emergency.
Page 1 and 2:
Acute Flaccid Paralysis Accompanyin
Page 3 and 4:
Adult Typhilitis Associated With Ly
Page 5 and 6:
Acute Interstitial Nephritis Second
Page 7 and 8:
Atypical Presentation for Complex R
Page 9 and 10:
Ptosis As A Variant Presentation of
Page 11 and 12:
Isolated Gastric Varices as an Etio
Page 13 and 14:
A Case of Idiopathic Pulmonary Arte
Page 15 and 16:
Diagnosis and Management of Meningi
Page 17 and 18:
Surveillance for an Indeterminate H
Page 19 and 20:
contralateral trunk/extremities sho
Page 21 and 22:
An Unexpected Course of Rhabdomyoly
Page 23 and 24:
Severe Autoimmune Hemolytic Anemia
Page 25 and 26: An Uncommon Cause of a Common Sympt
Page 27 and 28: Implications of Epidemiology in Bre
Page 29 and 30: Methicillin-Resistant Staphylococcu
Page 31 and 32: An Unusual Electrocardiogram Presen
Page 33 and 34: Using NSQIP and Zynxhealth to Build
Page 35 and 36: Resident-Run OMM Skills Clinic: Doe
Page 37 and 38: Waves of Health Evaluation of Diabe
Page 39 and 40: A Comparison of Temporal Thermometr
Page 41 and 42: Lactation Assessment Standardized T
Page 43 and 44: Use of Opioids in Management of Chr
Page 45 and 46: Not All Anterior Wall ST Segment El
Page 47 and 48: A Case of Sudden Monocular Blindnes
Page 49 and 50: Can Name Recognition Allow for More
Page 51 and 52: Developing a Treatment Plan for a C
Page 53 and 54: Post-polypectomy Syndrome In A Pati
Page 55 and 56: A Classical Misnomer To Consider: G
Page 57 and 58: A Case of Mycoplasma Pneumoniae Rel
Page 59 and 60: Severe Hirsutism in a Patient with
Page 61 and 62: Case Report: Wernicke-Korsakoff Syn
Page 63 and 64: A New Diagnosis of Adult Onset Stil
Page 65 and 66: Acute Brodifacoum Poisoning: A Case
Page 67 and 68: Inguinal Hernia Containing Endometr
Page 69 and 70: Simultaneous Rupture of the Anterio
Page 71 and 72: Idiopathic Pulmonary Fibrosis: A Ca
Page 73 and 74: Uterine Perforation in a 36 Year Ol
Page 75: Co-infection with Lyme Disease and
Page 79 and 80: Assessing Variability of the Americ
Page 81 and 82: Delirium and the Family Caregiver:
Page 83 and 84: in Haiti. Future research can focus
Page 85 and 86: Lessons to Be Learned: Changing Per
Page 87 and 88: Protective Characteristics of Criti
Page 89 and 90: The Patient Simulator for Training
Page 91 and 92: In Vivo Micron Scale Arthroscopic I
Page 93 and 94: Breast Cancer-Induced Bone Remodeli
show all

Acute Flaccid Paralysis Accompanying West Nile Meningitis Ahmed ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?