scholarly journals Os odontoideum: a rare cause of syncope

2019 ◽  
Vol 12 (11) ◽  
pp. e230945
Author(s):  
Christopher Shane Buntting ◽  
Ashraf Dower ◽  
Haider Seghol ◽  
Saeed Kohan
Keyword(s):  
Emergency Department ◽  
Ct Scan ◽  
Dynamic Instability ◽  
Vasovagal Syncope ◽  
Arterial Disease ◽  
Arterial System ◽  
Os Odontoideum ◽  
Lateral Mass ◽  
Negative Results ◽  
Neurological Pathology

Syncopal events are a concerning presentation and timely evaluation is warranted. Common aetiologies include cardiac and neurological pathology such as arrhythmias, vertebrobasilar arterial disease and vasovagal syncope. We describe the case of a 65-year-old man who presented to our emergency department with symptoms of vertigo and syncope. He was investigated extensively for both cardiac and neurological causes of his symptoms which returned negative results. An outpatient CT scan demonstrated the presence of Os odontoideum and dynamic instability of the atlantoaxial junction, with presumed dynamic obstruction of the vertebral arterial system. This was successfully managed with a posterior atlantoaxial lateral mass fusion with resolution of syncopal symptoms.

COVID-19: how nuclear medicine can provide a differential diagnosis in very dubious case

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Maria Silvia De Feo ◽  
Viviana Frantellizzi ◽  
Giuseppe De Vincentis
Keyword(s):  
Infectious Disease ◽  
Differential Diagnosis ◽  
Ct Scan ◽  
Imaging Technique ◽  
False Negative ◽  
Clinical Signs ◽  
Negative Results ◽  
Infectious Disease Department ◽  
False Negative Results ◽  
99Mtc Hmpao

Background: We present the case of a 55-year-old woman, admitted to the Infectious Disease Department of Policlinico Umberto I, Rome, in mid-March 2020, with suspicion of COVID-19 infection. Objective: The rRT-PCR was negative and the following CT scan, performed to exclude false-negative results and help diagnosis, was inconclusive. Methods: It was decided to submit the patient to 99mTc-HMPAO-labelled leukocyte scan. Results: This exam led to the diagnosis of infective endocarditis. Conclusion: In the present pandemic scenario, 99mTc-HMPAO-labelled leukocyte scan represents a reliable imaging technique for differential diagnosis with COVID-19 in patients with confusing clinical signs, possible false-negative rRT-PCR results and inconclusive CT scan.

scholarly journals Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease

2021 ◽  
Vol 07 (03) ◽  
pp. e132-e137
Author(s):  
Mohammed Alagha ◽  
Thomas M. Aherne ◽  
Ahmed Hassanin ◽  
Adeel S. Zafar ◽  
Doireann P. Joyce ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Sensitivity And Specificity ◽  
False Negative ◽  
Arterial Disease ◽  
Initial Assessment ◽  
Reference Standard ◽  
Lower Extremity Arterial Disease ◽  
Negative Results ◽  
Positive Results ◽  
Arterial Imaging

Abstract Introduction Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark. Methods In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard. Results Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively. Conclusion ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.

scholarly journals The utility of brain CT scan modality in the management of dizziness at the emergency department: A retrospective single-center study

2021 ◽  
pp. 102220
Author(s):  
Khaled Z. Alawneh ◽  
Liqaa A. Raffee ◽  
Ahmad A. Oqlat ◽  
Ammar A. Oglat ◽  
Majdi Al Qawasmeh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ct Scan ◽  
Single Center ◽  
Brain Ct ◽  
Single Center Study ◽  
Brain Ct Scan ◽  
Center Study

Negative Results Associated With Medication in the Emergency Department of a Hospital

2008 ◽  
Vol 32 (3) ◽  
pp. 157-162
Author(s):  
V. García ◽  
I. Marquina ◽  
A. Olabarri ◽  
G. Miranda ◽  
G. Rubiera ◽  
...  
Keyword(s):  
Emergency Department ◽  
Negative Results

scholarly journals The effective use of hyperbaric oxygen therapy (HBOT) in the management of air embolism – rare and potentially fatal acute complication of hemodialysis

2021 ◽  
Author(s):  
Grzegorz Kade ◽  
Sebastian Spaleniak ◽  
Artur Maliborski ◽  
Jacek Siewiera ◽  
Stefan Antosiewicz ◽  
...  
Keyword(s):  
Ct Scan ◽  
Hyperbaric Oxygen ◽  
Vascular Access ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Rare Complication ◽  
Air Embolism ◽  
Arterial System ◽  
Sensor Failure ◽  
Acute Complication

Introduction: Air embolism is a rare and potentially fatal acute complication. Its causes are mainly iatrogenic. It requires rapid diagnostics and treatment, including hyperbaric oxygen therapy (HBOT). Aim: The main aim was to present the potential causes of air embolism during hemodialysis (HD) and show the importance of quick clinical diagnosis and therapy – on the base of clinical case. Case study: 65-years old male patient with diabetic nephropathy was treated with HD. The permanent dialysis catheters were used as vascular access due to the difficulties with formation of arteriovenous fistula. The massive air embolism occurred during one of the dialysis sessions. The clinical suspicion was confirmed by CT scan which showed the presence of gas bubbles in abdominal arteries. The cause of air embolism was sensor failure. The presence of patent foramen ovale (PFO) with reversed leakage caused the air ingress into arterial system. Patient was qualified for the immediate hyperbaric therapy. The quick improvement in the condition of the patient took place. Results and discussion: The massive air embolism may occur in HD patients, particularly in those who are dialyzed with use of catheters as vascular access. This rare complication should be considered in the case of sudden worsening of patient condition during HD procedure. The use of CT scan to confirm the air embolism suspicion and availability of HBOT are necessary for successful management of this complication. Conclusions: HBOT is a safe and effective method of air embolism treatment in HD patients.

scholarly journals Delay in presentation of acute ischemic stroke in Lahore General Hospital, Lahore

2016 ◽  
Vol 11 (3) ◽  
Author(s):  
Rafiq A Basharat ◽  
Kamran Rashid Mirza ◽  
Muhammad Yousuf Qamar
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Ct Scan ◽  
Acute Ischemic Stroke ◽  
General Hospital ◽  
Clinical History ◽  
Clinical Findings ◽  
Study Data ◽  
Time Interval ◽  
Time Required

Objectives: To find out the time interval from onset of the symptoms to admission in the hospital of patients suffering from acute ischemic stroke, in order to assess the feasibility of thrombolytic therapy in Lahore General Hospital. Design: Hospital-based, prospective and observational study Setting: Lahore General Hospital Lahore. Duration: Six months from January - June 2004. Patients: Seventy two patients with acute ischemic stroke diagnosed on basis of clinical findings and CT scan. Methods: Patients o f a cute ischemic stroke including cerebral infarct, T IA, venous infarct and lacunar infarct were diagnosed on basis of clinical history, examination and CT scan and enrolled in the study. Data was collected on a Performa. Time taken by patients to reach hospital after onset of symptoms, distance of patients` residences from hospital, education level of patients and time required to do a CT scan after arrival of patient in hospital were studied. Results: 54.2% were male and mean age of patients was 60 years. 58 patients had cerebral infarction, TIA`s and venous infarction were 8 and 6 respectively. Delay in presentation was divided in three groups. Within three hours (hrs) 15 (21%) patients arrived. 54 and 18 patients arrived in 3-- 24 hrs group and >24 firs group. Mean distance was roughly 44 km. Mean distance for 0-3hrs, 3-24hrs and >24hrs group was 14, 35, and 85 Km respectively. Average time required to do CT scan was nine hours after arrival of patient in emergency department. Sixty-five percent of patients coming were illiterate. Conclusion: Majority of the patients with ischemic stroke present late to. emergency department. Many factors including distance from hospital, illiteracy, non-availability of ambulance services responsible for it. Evaluation-of patients and provision of urgent CT scan is required. in hospitals.

scholarly journals Feasibility and Efficacy of a Decision Aid for Emergency Department Patients with Suspected Ureterolithiasis: Protocol for an Adaptive Randomized Controlled Trial

2021 ◽  
Author(s):  
Elizabeth M Schoenfeld ◽  
Kye E Poronsky ◽  
Lauren M Westafer ◽  
Paul Visintainer ◽  
Brianna M DiFronzo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Ct Scan ◽  
Radiation Exposure ◽  
Kidney Stone ◽  
Decision Aid ◽  
Controlled Trial ◽  
Signs And Symptoms ◽  
Patient Knowledge ◽  
Randomized Controlled

Abstract Background: Approximately 2 million patients present to Emergency Departments in the US annually with signs and symptoms of ureterolithiasis (or renal colic, the pain from an obstructing kidney stone). Both ultrasound and CT scan can be used for diagnosis, but the vast majority of patients receive a CT scan. Diagnostic pathways utilizing ultrasound have been shown to decrease radiation exposure to patients but are potentially less accurate. Because of these and other trade-offs, this decision has been proposed as appropriate for Shared Decision-Making (SDM), where clinicians and patients discuss clinical options and their consequences and arrive at a decision together. We developed a decision aid to facilitate SDM in this scenario. The objective of this study is to determine the effects of this decision aid, as compared to usual care, on patient knowledge, radiation exposure, engagement, safety, and healthcare utilization. Methods: This is the protocol for an adaptive randomized controlled trial to determine the effects of the intervention – a decision aid (“Kidney Stone Choice”) – on patient-centered outcomes, compared with usual care. Patients age 18-55 presenting to the Emergency Department with signs and symptoms consistent with acute uncomplicated ureterolithiasis will be consecutively enrolled and randomized. Participants will be blinded to group allocation. We will collect outcomes related to patient knowledge, radiation exposure, trust in physician, safety, and downstream healthcare utilization. Discussion: We hypothesize that this study will demonstrate that “Kidney Stone Choice,” the decision aid created for this scenario, improves patient knowledge and decreases exposure to ionizing radiation. The adaptive design of this study will allow us to identify issues with fidelity and feasibility and subsequently evaluate the intervention for efficacy. Trial registration: ClinicalTrials.gov - NCT04234035https://clinicaltrials.gov/ct2/show/NCT04234035Registered January 21, 2020 – Retrospectively Registered

scholarly journals The Relationship between Risk Factors of Head Trauma with CT Scan Findings in Children with Minor Head Trauma Admitted to Hospital

2017 ◽  
Vol 5 (3) ◽  
pp. 319-323 ◽  
Author(s):  
Babak Masoumi ◽  
Farhad Heydari ◽  
Hamidreza Hatamabadi ◽  
Reza Azizkhani ◽  
Zahra Yoosefian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Ct Scan ◽  
Head Trauma ◽  
Predictive Value ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Normal Brain ◽  
Brain Ct ◽  
Brain Ct Scan

BACKGROUND: In emergency medicine for determining the intracranial injury (ICI) in children with head trauma, usually brain CT scan is performed. Since brain CT scan, especially in children, has some disadvantages, it is better to find a procedure which could help to choose only the children with real head trauma injury for brain CT scan.AIMS: The aim of this study is to find such procedure. This study was descriptive, analytic and non-interventional.METHODS: We reviewed the archived files of children with head trauma injuries referred to the emergency department of Imam Hossein Hospital within two years. Patient’s CT scan findings and head trauma risk factors were evaluated in this study.RESULTS: Out of 368 patients, 326 patients had normal brain CT scan. 28 of them showed symptoms of ICI consisting intraventricular haemorrhage (IVH), contusion, subarachnoid haemorrhage (SAH), subdural haemorrhage (SDH), epidural hematoma (EDH), and pneumocephalus. Twenty-seven patients showed skull FX, which 14 of them had an Isolated fracture, and 13 of them also showed symptoms of ICI. Since patients with isolated FX usually discharge quickly from Emergency Department; their data did not include in results of the study. The patients have been divided into two groups: 1- ICI, 2- without ICI. RR (relative risk), CI (Confidence interval) and sensitivity, positive predictive value (PPV), negative predictive value (NPV) and association of these risk factors with ICI were assessed with the Chi-2 test. In the end to determine the indications of CT scan, the presence of one of these five risk factors is important including abnormal mental status, clinical symptoms of skull FX, history of vomiting, craniofacial soft tissue injury (including subgaleal hematomas or laceration) and headache.CONCLUSIONS: For all other patients without these risk factors, observation and Follow Up can be used which has more advantages and less cost.

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