Article

Coexisting subarachnoid haemorrhage and pneumocephalus is really rare?

Correspondence / American Journal of Emergency Medicine 32 (2014) 678682 679

References

  1. Everon SH, Weisenberg M, Haroe E, et al. Proper insertion depth of endotracheal tubes in adults bytopographic landmarks measurements. J Clin Anesth 2007;19:15-9.
  2. Rigini N, Boaz M, Ezri T, et al. Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions. J Clin Anesth 2011;23:367-71.
  3. Hossein-nejad H, Payandemehr P, Bashiri SA, et al. Chest radiography after endotracheal tube placement: is it necessary or not? Am J Emerg Med 2013;31(8):1181-2.

    Coexisting subarachnoid haemorrhage and pneumocephalus is really rare??

    To the Editor,

    We read with great interest the article “Subarachnoid hemorrhage and pneumocephalus due to Epidural anesthesia; a rare case” written by Guzel et al [1]. The authors shared a case of Severe headache and irritability due to provided epidural anesthesia during vaginal delivery and stated in their discussion that there was no report in the literature about association of pneumocephaly and subarachnoid bleeding.

    Subarachnoid hemorrhage is an entity associated with headache, which may present after lumbar puncture [2,3]. Pneumocephaly is a well-described complication of unintentional dural puncture. Both conditions may be encountered especially after trauma and accompany one another. There are, in fact, existing cases related to posttraumatic pneumocephalus and subarachnoid hemorrhage in the literature that have been reported to be seen together [4,5].

    The authors need to clarify several discrepancies in their case report as well. The patient is noted to have been discharged to home on the day 20 after presentation in the abstract, but then state that the patient had stayed in the intensive care unit for 28 days due to pulmonary problems and was then discharged to home in the penultimate sentence of a case-report section.

    Salim Kemal Tuncer, MD Yusuf Emrah Eyi, MD Umit Kaldirim, MD Ibrahim Arziman, MD

    Department of Emergency Medicine Gulhane Military Medical Academy School of Medicine

    Ankara, Turkey E-mail address: [email protected]

    Ali Osman Yildirim, MD Department of Emergency Medicine GATA Haydarpasa Training Hospital

    Istanbul, Turkey

    Emre Zorlu, MD

    Department of neurosurgery GATA Haydarpasa Training Hospital

    Istanbul, Turkey

    http://dx.doi.org/10.1016/j.ajem.2014.02.036

    References

    Guzel M, Salt O, Erenler AK, Baydin A, Demir MT, Yalcin A, Doganay Z. Subarachnoid hemorrhage and pneumocephalus due to epidural anesthesia: a rare case. Am J Emerg Med. Available online 28 January 2014.

  4. Pancu D, Davenport M, Roth K, Heller M. EPs do not accept the strategy of “lumbar puncture first” in subarachnoid hemorrhage. Am J Emerg Med 2004;22(2):115-7.
  5. Mark DG, Pines JM. The detection of nontraumatic subarachnoid hemorrhage: still a diagnostic challenge. Am J Emerg Med 2006;24(7):859-63.
  6. Zhang YX, Liu LX, Qiu XZ. A case report of diffuse pneumocephalus induced by sneezing after brain trauma. Chin J Traumatol 2013;16(4):249-50.
  7. Koizumi H, Miyasaka Y, Tanaka C, Fujii K. A case of open head injury caused by electric saw. No Shinkei Geka 2011;39(6):611-4.

    Acute abdominal pain and dengue fever

    To the Editor,

    Sir, the report on acute abdominal pain and dengue fever is quite interesting [1]. In fact, the atypical presentation of dengue can be seen and this can be sometimes difficult to diagnose [2]. Focusing on abdominal pain, it is not an uncommon presentation. According to a recent report from Brazil [3], Pires et al. noted that “fever, abdominal pain and vomiting” were the three main clinical presentations of dengue fever. Duran et al. reported that abdominal pain was very common in severe dengue case [4]. Hence, the case of dengue presenting with abdominal pain is not an unusual case at all. With expanding endemic area of dengue, dengue should be a differential diagnosis in an emergency case presenting with abdominal pain.

    Viroj Wiwanitkit Surin Rajabhat University Surin Province, Thailand

    E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2014.03.012

    References

    Waseem T, Latif H, Shabbir B. An unusual cause of acute abdominal pain in dengue fever. Am J Emerg Med 2014 pii: S0735-6757(14)00017-5. doi: 10.1016/j. ajem.2014.01.011. [Epub ahead of print].

  8. Wiwanitkit V. Dengue fever: diagnosis and treatment. Expert Rev Anti Infect Ther 2010;8(7):841-5.
  9. Pires RD, Neto L, Sa SL, Pinho SC, Pucci FH, Teofilo CR, et al. Dengue infection in children and adolescents: Clinical profile in a reference hospital in northeast Brazil. Rev Soc Bras Med Trop 2013;46(6):765-8.
  10. Duran A, Ochoa E, Alcocer S, Gomez M, Millano M, Martinez O, et al. Frequency of gastrointestinal signs and symptoms of dengue. Analysis of a cohort of 1484 patients. Invest Clin 2013 Sep;54(3):299-310.

    ED visits and spending by unauthorized immigrants compared with legal immigrants

    and US natives?,??

    To the Editor,

    In light of the ongoing debate about immigration reform, a recent study found that contributions by immigrants to the Medicare Trust Fund outweigh their expenditures [1]. Another 2013 study found that health expenditures are lower for unauthorized immigrants and legal residents than US natives and naturalized citizens [2]. However, evidence for the emergency department (ED) setting is limited, where much of the debate on health service utilization of unauthorized immigrants is concentrated. The most recent study of ED utilization found that noncitizen immigrants used significantly less ED services compared with citizens [3]. However, that study did not have an estimate for unauthorized immigrants. Given the continuing debate about the impact of immigrants on the health system, especially the potential impact of unauthorized immigrants, we compared differences in ED utilization and medical expenditures by nativity and legal status. We used the 2002 to 2011 Medical Expenditure Panel Survey (MEPS)

    to examine ED utilization and expenditures for US natives, naturalized

    ? We have no support in financial or other relationships that might lead to a conflict of interest.

    ? Grant or other financial support: None.

    ?? Conflicts of interest: None.

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