Inverted circadian variation of arterial pressure in a geriatric patient: an indicator of autonomic dysfunction

Abstract Background Orthostatic hypotension (OH) in geriatric patients frequently involves a component of autonomic failure (AF). The combination of OH with nocturnal hypertension (NHT) is indicative of AF, which is described as pure (PAF), when neurologic symptoms are absent, or as multisystem atrophy (MSA), when combined with motor disturbance (Parkinsonism or Parkinson disease). Case presentation An 87-year-old man presented with long-lasting OH. He frequently fell, causing several fractures, and he developed heart failure. Blood pressure (BP) registration revealed a reversal of the day-night rhythm with NHT. An 18-FDG PET brain CT scan showed cerebellar hypometabolism, indicating MSA. Conclusions This case demonstrates the use of continuous BP registration in geriatric patients with OH for diagnosing NHT. It illustrates the usefulness of 18-FDG PET brain CT scan to specify the nature of the AF. The case also illustrates the difficulty of managing the combination of OH and NHT.

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

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2021.102220 ◽

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

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

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2017.071 ◽

2017 ◽

Vol 5 (3) ◽

pp. 319-323 ◽

Cited By ~ 2

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. Patientâ€™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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