Michael Bauman, Darren Braude, Cameron Crandall
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.005
Published in issue: February 2009
xWe evaluated the efficacy and safety of emergency department technicians' (EDT) use of ultrasound (US) guided peripheral intravenous (PIV) access compared to the traditional approach on a subset of patients with difficult IV access.
Opeolu Adeoye, Christopher Lindsell, Joseph Broderick, Kathy Alwell, Edward Jauch, Charles J. Moomaw, Matthew L. Flaherty, Arthur Pancioli, Brett Kissela, Dawn Kleindorfer
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.004
Published in issue: February 2009
xEmergency medical services (EMS) use by stroke patients varies from 38% to 65%. In an epidemiological study, we determined the proportion of stroke patients who used EMS, hypothesizing that demographics, stroke severity, stroke type, and location at stroke onset would be associated with EMS use.
Michael C. Kontos, Brett D. Roberts, James L. Tatum, Charlotte S. Roberts, Robert L. Jesse, Joseph P. Ornato
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.002
Published in issue: February 2009
xStudies reporting short-term mortality in patients with myocardial infarction (MI) based on the initial electrocardiogram (ECG) are often limited by requiring an ischemic ECG for inclusion. Because few patients with normal or nonspecific findings were included, outcomes in these patients are less clear, especially in the troponin era.
Toshikazu Abe, Yasuharu Tokuda, Sachiko Ohde, Shinichi Ishimatsu, Tomohiko Nakamura, Richard B. Birrer
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.013
Published in issue: February 2009
xThe incidence of asthma exacerbation has been increasing in many countries. Environmental factors may play an important role in this trend. We aimed to investigate the relationship of weather conditions and air pollution to significant exacerbation of asthma.
Michael A. Miller, Marc E. Levsky, William Enslow, Alex Rosin
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.015
Published in issue: February 2009
xPatients with headaches account for approximately 2% of all ED visits, with migraines being the most common defined primary headache syndrome. Our goals were to evaluate the efficacy of intravenous octreotide (OC) for the treatment of migraines, when compared to standard therapy with prochlorperazine.
Mieczyslaw Szyszkowicz
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.010
Published in issue: February 2009
xThis was a study of 157 028 emergency department (ED)-diagnosed visits for chest pain (International Classification of Diseases, Ninth Revision [ICD-9]: 786) in 6 cities in Canada. The generalized linear mixed methods technique was applied to analyze the relations between daily counts of ED visits for chest pain on the levels of ambient air pollutants after adjusting for meteorological variables. The daily counts of visits were analyzed separately for the whole period (January-December), warm (April-September), and cold (October-March).
Ataman Kose, Nurullah Gunay, Cuma Yildirim, Mehmet Tarakcioglu, Ibrahim Sari, Abdullah T. Demiryurek
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.016
Published in issue: February 2009
xAnticholinesterase poisoning is an important health problem in our country, and a complete understanding of its underlying mechanisms is essential for the emergency physician. Thus, we aimed to investigate the cardiac biochemical parameters and mortality in dichlorvos-induced poisoning in rats. Rats were randomly divided into 5 groups as control (corn oil), dichlorvos, atropine, pralidoxime, and atropine+pralidoxime groups. Immunohistochemical analyses of apoptosis and inducible nitric oxide synthase showed no change in cardiac tissue for all of the groups.
Johann Reisinger, Kurt Höllinger, Wolfgang Lang, Christoph Steiner, Thomas Winter, Andreas Winter, Michael Mori, Alexander Lindorfer, Daniel Kiblböck, Peter Siostrzonek
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.020
Published in issue: February 2009
xExisting data indicate that selenium supplementation may be beneficial in critically ill patients and in those with ischemic stroke. The purpose of this retrospective study was to explore the influence of early administration of selenium on neurological outcome after cardiopulmonary resuscitation (CPR).
Samuel A. McLean, Ned L. Kirsch, Cheribeth U. Tan-Schriner, Ananda Sen, Shirley Frederiksen, Richard E. Harris, William Maixner, Ronald F. Maio
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.054
Published in issue: February 2009
xPostconcussion (PC) syndrome etiology remains poorly understood. We sought to examine predictors of persistent PC symptoms after minor injury.
Michael S. Radeos, Rita K. Cydulka, Brian H. Rowe, R. Graham Barr, Sunday Clark, Carlos A. Camargo Jr
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.011
Published in issue: February 2009
xTo determine whether the self-reported diagnosis of adults who present to the emergency department (ED) with an acute exacerbation of either asthma or chronic obstructive pulmonary disease (COPD) is validated by medical record review.
Li Yekuo, Wang Shasha, Huo Feng
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.060
Published in issue: February 2009
xThe aim of this study is to investigate the use of multipolar radiofrequency (RF) ablation with internally cooled electrodes to control hemorrhage percutaneously from blunt liver trauma.
Lena Marie Beillon, Björn-Ove Suserud, Ingvar Karlberg, Johan Herlitz
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.012
Published in issue: February 2009
xThe aim of this study was to analyze possible differences in the use of ambulance service between densely and sparsely populated areas.
Fuping Guo, Tengda Xu, Houli Wang
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.027
Published in issue: February 2009
xTo report the clinical characteristics of myxedematous respiratory failure in the elderly and to facilitate early recognition of hypothyroidism in critically ill old patients.
Sony Jacob, Justin C. Sebastian, Prasad K. Cherian, Aril Abraham, Sinoj K. John
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.056
Published in issue: February 2009
xClinical diagnosis of chronic or slowly progressing pericardial effusion with impending tamponade remains a challenge, particularly when classical physical signs are subtle or absent. A high index of suspicion should be entertained in such cases in the appropriate setting even when the clinical signs and symptoms are missing. We present two cases where the pericardial effusion was missed in the emergency department due to subtle clinical features or mistaken for a more familiar ”look-a-like” presentation.
Sarah Barker, Hemant Solomon, James D. Bergin, J. Stephen Huff, William J. Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.016
Published in issue: February 2009
xTakotsubo cardiomyopathy, or left ventricular apical ballooning syndrome, is a newly described disorder in which patients develop anginal symptoms, often times with acute congestive heart failure, during periods of stress. The electrocardiogram demonstrates ST-segment and/or T-wave abnormalities similar to those findings seen in acute coronary events; on occasion, serum markers can be abnormal. As an extreme, acute pulmonary edema with or without cardiogenic shock can also be encountered. At cardiac catheterization, these patients are found to have abnormal left ventricular function yet normal coronary arteries.
Richard F. Edlich, William B. Long III, K. Dean Gubler, George T. Rodeheaver, John G. Thacker, Lise Borel, Margot E. Chase, Catherine L. Cross, Allyson L. Fisher, Kant Y. Lin, Mary J. Cox, Robert B. Zura
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.009
Published in issue: February 2009
xDuring the last 25 years, scientific experimental and clinical studies have documented the dangers of cornstarch powder on examination and surgical gloves because the cornstarch promotes wound infection, causes serious peritoneal adhesions and granulomatous peritonitis, and is a well-documented vector of the latex allergy epidemic in the world. Realizing the dangers of cornstarch on examination and surgical gloves, Germany's regulations of personal protective equipment banned the use of surgical glove powder cornstarch in 1997.
Koracevic Pante Goran
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.041
Published in issue: February 2009
xAcute aortic dissection (AoD) is a catastrophic disease and a real emergency. Its prognosis depends critically on the early diagnosis, putting the physician on a challenge [1]. However, despite recent advances in diagnostic tools, for example, spiral computed tomography, AoD has been frequently overlooked. It is partially because AoD incidence has been much lower in comparison with acute coronary syndrome [2].
Melanie K. Turock, David J. Watts, Hannah Mude, John Prestosh, Jill Stoltzfus
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.043
Published in issue: February 2009
xIn our community hospital, located approximately 60 miles from a large urban center, we noticed an apparent increase in the number of narcotic overdoses in June 2006. Reports of fentanyl-laced heroin had appeared in the lay press weeks earlier in the cities of Detroit, Philadelphia, and Camden [1]. These incidents peeked the week of April 14, 2006, and it is estimated that Delaware, Pennsylvania, and the south Jersey tristate area has had 170 deaths and 300 nonfatal overdoses between April and August of 2006 [2].
Hande Koksal
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.013
Published in issue: February 2009
xI read the article by Gunduz et al [1] with great interest. A case-controlled study to determine whether ischemia-modified albumin (IMA) could be used for the diagnosis of acute mesenteric ischemia was described in this study. In this article, IMA levels in patients and control group were 0.264 ± 0.057 and 0.163 ± 0.025 absorbance units (ABSU), respectively. When plasma IMA levels were compared, there was statistically significant increases (P = .003).
Gunduz Abdulkadir, Turedi Suleyman
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.014
Published in issue: February 2009
xWe are delighted with the interest shown in our articles on Ischemia modified albumin (IMA) and ischemic diseases and welcome all constructive criticism [1-3]. Our publications are not perfect of course, and we are always trying to reach ever higher standards. We are setting out below my thoughts regarding 2 issues troubling the writer and hope to eliminate those particular question marks.
Chiaki Takahashi, Hiroshi Okudera, Tetsuya Sakamoto, Tohru Aruga, Tomio Ohta
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.015
Published in issue: February 2009
xVarious coma scales have been developed and used for evaluation of consciousness level in patients. Especially in the settings where patients in the acute phase are treated (such as the ED), a rapid and accurate grasp of consciousness level is very important. The Glasgow Coma Scale (GCS) [1-3] is internationally accepted when discussing patient level of consciousness with other professionals. However, the GCS has the disadvantages of complexity and overestimate [4-6]. For the purpose of overcoming these disadvantages, Ohta tried to design an easier and accurate coma scale in 2003, termed Emergency Coma Scale (ECS) (Table 1) [7-10].
Graeme McNeill, Darragh Halpenny, Aisling Snow, A. Geoghegan, William C. Torreggiani
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.012
Published in issue: February 2009
xWe read with interest the article in American Journal of Emergency Medicine by Lin C and Po H entitled “Extrapontine myelinolysis after correction of hyponatraemia presenting as generalised tonic seizures” [1]. In their article, the authors describe the development of myelinolysis after correction of hyponatremia and the etiology and treatment of central and extrapontine myelinolysis.
Roberto Manfredini, Fabio Manfredini, Benedetta Boari, Raffaella Salmi, Massimo Gallerani
DOI: http://dx.doi.org/10.1016/j.ajem.2008.10.024
Published in issue: February 2009
xAvailable evidence suggests that the occurrence of cardiovascular events, for example, myocardial infarction, cardiac arrest, and sudden death, exhibits a peak on Monday compared to other days of the week [1-4], and this Monday excess risk in cardiovascular mortality has been estimated with an odds ratio of 1.19 [5]. An earlier single-center study confirmed such Monday preference also for onset of ischemic stroke [6]. This retrospectively study, conducted by using the database of the region Emilia-Romagna (RER) of Italy, was aimed to investigate whether the most common risk factors, such as arterial hypertension, diabetes mellitus, and dyslipidemia, could influence the temporal weekly pattern of onset of ischemic stroke or not.
Oliver J. Wagner, Stephan A. Vorburger, Aristomenis K. Exadaktylos, Heinz Zimmermann
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.008
Published in issue: February 2009
xWe agree with the author's opinion that patients older than 40 years (men) or 50 years (women) or patients with positive personal or familial history for malignancies should undergo digital rectal examination (DRE) as standard in the clinical workup. Digital rectal examination may remain a useful screening tool for suspected abnormal anorectal and urologic findings or gynecologic disorders [1].
Weekitt Kittisupamongkol
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.010
Published in issue: February 2009
xI read with interest the article by Sedlak and colleagues [1]. Digital rectal examination would change decision making in patients with lower right abdominal pain. If physicians palpate rectal mass especially in high risk group for malignancy [2], colorectal cancer presenting with abdominal pain must be included among differentials. The appropriate incision in such case is midline rather than at McBurney point.
Georges Mion, Sébastien Larréché
DOI: http://dx.doi.org/10.1016/j.ajem.2008.12.015
Published in issue: February 2009
xWe read with a great interest the article of Açikalin et al [1] who report the efficacy of low-dose antivenom therapy in 45 consecutive Viperidae bites in Turkey.
Shu-Tien Huang, Yu-Jang Su, Ding-Kuo Chien, Erik Jaushwo Li, Wen-Han Chang
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.026
Published in issue: February 2009
xWe describe a case of Solanum erianthum poisoning that happened to a 75-year-old man. He ate the S erianthum that he gathered from the countryside, believing that it would be helpful in improving the numbness of his distal limbs. S erianthum is a solanaceous plant that contains a variable concentration of solanum alkaloids, causing gastrointestinal irritation, and tropane alkaloids that have anticholinergic properties producing typical and sometimes severe atropine-like symptoms.
Youichi Yanagawa
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.027
Published in issue: February 2009
xAn 8-year-old boy was struck by a truck, and the impact carried him 10 m away from the scene. On arrival at the hospital, his chest and left thigh roentgenograms revealed fractures of the left clavicle, scapular, and left femur shaft. His chest computed tomography scan demonstrated right dominant bilateral multiple ill-defined and hazy ground-glass density areas 70 minutes after the accident. He was treated with conservative therapy with 2 L/min of oxygen. On the fourth hospital day, the chest computed tomography scan revealed the disappearance of most of the pulmonary lesions.
April C. Hurdle, Ryan D. Moss
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.028
Published in issue: February 2009
xWe report the case of a patient with schizophrenia who presented to the emergency department (ED) with a mental status change. He was initially treated for nonconvulsive seizures until a valproic acid (VPA) serum concentration test was performed and indicated acute intoxication. To report a case of acute intoxication with VPA that was unrecognized and treated as nonconvulsive seizure. A 28-year old man presented to the ED after being assaulted. A computed tomography scan of his head showed no intracranial injury.
Turandot Saul, Jocelyn M Sonson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.029
Published in issue: February 2009
xThis is a case ireport of a 22 year old female who presented to the emergency department with abdominal pain following ovulation induction for the purpose of transvaginal harvesting of the ovum. This article depicts the ultrasound findings in Ovarian Hyperstimulation Syndrome, a common complication of ovulation induction.
Wei-Liang Chen, Yuh-Feng Lin, Wei-Chi Tsai, Yu-Tzu Tsao
DOI: http://dx.doi.org/10.1016/j.ajem.2008.05.030
Published in issue: February 2009
xImmune reconstitution inflammatory syndrome is recognized as a paradoxical worsening of preexisting or smoldering opportunistic infections in patients with human immunodeficiency virus on highly active antiretroviral therapy because of the recuperating of immune system. We report a 42-year-old man on antiretroviral therapy with silent mycobacterium tuberculosis pyomyositis presenting with characteristic clinical and imaging features of immune reconstitution inflammatory syndrome. Because tuberculosis pyomyositis is less recognized and may be easily overlooked in terms of protean manifestations in extrapulmonary tuberculosis spreading, such mycobacterial infection can bring about substantial morbidity and even mortality during the immune recovery phase.
Enbiya Aksakal, Taner Ulus, Ednan Bayram, Hakan Duman
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.024
Published in issue: February 2009
xDiabetic ketoacidosis (DKA) is an important medical emergency and may cause electrocardiogram (ECG) changes mimicking myocardial infarction. In the literature, hyperkalemia-associated ST-segment elevations have been defined in DKA; it has been demonstrated that these changes resolve completely after the treatment of hyperkalemia. We aimed to present a case with DKA in whom ST-segment elevation in inferior derivations was observed, but serum potassium level (4.4 mEq/L) was normal. The patient was admitted to the emergency department with complaints of nausea, bloody vomiting, and epigastric pain.
Chun-Cheng Chiu, Hsiu-Fen Yeh, Te-Fa Chiu
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.025
Published in issue: February 2009
xHemothorax is defined as collection of blood in the pleural cavity. Massive hemothorax may result in severe respiratory distress. We present an extremely rare cause of non-traumatic hemothorax in a 3 1/2-year-old girl by Bochdalek diaphragmatic hernia (BDH), and that was initially misdiagnosed as pneumonia with massive pleural effusion. Hemothorax masks the clinical and X-ray findings of BDH that makes the diagnosis even more difficult. Delayed or incorrect diagnosis of BDH complicated with respiratory distress leads to the wrong decision-making and the subsequent management, which may result in significant morbidity and mortality.
Cenker Eken, Dilek Durmaz, Bulent Erol
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.026
Published in issue: February 2009
xRenal colic is one of the painful conditions in emergency medicine practice. Opiates and nonsteroidal anti-inflammatory drugs are the cornerstone of pain management in renal colic. However, alternative procedures should be considered in patients refractory to conventional therapies. We present a case of renal colic successfully treated by trigger point injection that was refractory to 150 μg fentanyl and 5 mg morphine.
Ying-Jen Chen, Wei-Liang Chen, Wei-Chi Tsai, Yu-Tzu Tsao
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.027
Published in issue: February 2009
xCentral retinal artery occlusion is one of the most challenging practices and is not an infrequent presentation at the emergency department. We describe a 46-year-old man presenting with abrupt onset of amaurosis fugax secondary to sentinel central retinal artery occlusion followed by acute idiopathic renal infarction. This patient highlights that the preceding visual events could portend a devastating thromboembolic insult in the clinical setting. Early recognition with prompt treatment may preserve organ function, avoid unnecessary management, and prevent debilitating complication.
Rahi Kapur, Michael D. Smith
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.028
Published in issue: February 2009
xCaffeine overdoses produce multiple symptoms, most of which are commonly associated with a marked increase in adrenergic tone. These can include hypertension, tachycardia, dysrhythmias, and central nervous and skeletal muscle stimulation. This case illustrates a massive caffeine ingestion with resultant cardiovascular collapse. The patient was stabilized with a combination of lidocaine and phenylephrine in the emergency department and underwent hemodialysis in the intensive care unit, with rapid extubation and return to baseline functioning.
Florence Dumas, Gerald Kierzek, Sophie Coignard, Anne Bouvet, Jean-Louis Pourriat
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.029
Published in issue: February 2009
xThe incidence of invasive streptococcal pyogenic infections has been on a worldwide increase. The most frequent clinical manifestations start with cutaneous septicemias. We report an unusual case of Streptococcus pyogenes–based septicemia, secondary to appendicitis with rapidly evolving peritonitis.
Graham Roche-Nagle, Bary B. Rubin
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.030
Published in issue: February 2009
xThe clinical presentation of acute onset of nausea, vomiting, and flank pain in combination with acute elevation of blood pressure should raise high suspicion of renal infarction. However, because of its nonspecific presentation, diagnosis may be delayed. We report the case of a 63-year-old man who presented with a 2-day history of right flank pain that was treated initially as a renal stone. He had a background history of atrial fibrillation. Further investigations confirmed this as a case of renal infarction.
Michael Ciccarelli, Donald Jeanmonod, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.032
Published in issue: February 2009
xGiant cell temporal arteritis (GCA) is a systemic vasculitis that affects individuals older than 50. Erythrocyte sedimentation rate (ESR) has typically been used in the ED as a screening test to rule out GCA. There have been documented cases in medicine and rheumatology journals of biopsy-proven giant cell arteritis with a normal or low ESR before steroid therapy. In the ED, the practitioner must use multiple resources to make the diagnosis of GCA, as there is no specific test that establishes the diagnosis.
Daniel C. Cohen, Alison Winstanley, Alec Engledow, Alastair C. Windsor, James R. Skipworth
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.033
Published in issue: February 2009
xWe present the case of a 31 year-old man who presented to the emergency department of University College Hospital London after collapsing upon finishing the London marathon. Contrast-enhanced multidetector computed tomography scanning revealed ischemic colitis of the cecum and ascending colon, which progressed to the development of clinical peritonism after 48 hours. This patient subsequently underwent a laparotomy and right hemicolectomy, with ileostomy formation, on the third day after admission.
Wei-Chun Chen, Chih-Yen Tu, Shinn-Jye Liang, Juhn-Cherng Liu, Wei Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.034
Published in issue: February 2009
xAortic aneurysm is usually a potentially life-threatening medical problem, with a 5-year survival rate of 20% if there is no surgical repair. Upper airway compression due to aortic aneurysm usually presents with wheezing, coughing, hemoptysis, dyspnea, or pneumonitis. We report a 78-year–old male patient with a history of chronic obstructive pulmonary disease who was admitted to our emergency department because of wheezing dyspnea for 2 days. Acute chronic obstructive pulmonary disease exacerbation with respiratory failure was impressed, but the patient had poor response to bronchodilators and systemic steroids treatment.
Ashish Kumar Panigrahi, D.K.S. Subrahmanyam, Kiran K. Mukku
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.035
Published in issue: February 2009
xImidacloprid is a systemic, chloronicotinyl insecticide. It is generally considered nontoxic to humans based on available literature. Its effects are mediated through acetylcholine receptor blockade. We report a patient with such poisoning who had respiratory arrest, for which he had to be mechanically ventilated, and who subsequently recovered. This is only the second such case report.
Ching-Hsing Lee, Wei-Chun Chen, Chao-I Wu, Te-Chun Hsia
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.036
Published in issue: February 2009
xThe study aimed to describe a patient with multiple skull bone fractures and a cerebrospinal fluid (CSF) leak who received hyperbaric oxygen therapy (HBOT). A 40-year-old man presented with subdural hemorrhage, skull bone fractures, facial bone fractures, sinus fractures, and CSF leakage after a one-story fall. He received HBOT as an adjunctive treatment to reduce brain edema and increase oxygen availability in brain tissue. Tension pneumocephalus developed after HBOT. Bur hole drainage was performed emergently to relieve the tension pneumocephalus.
Dmitry Volfson, Barbara Barnett
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.037
Published in issue: February 2009
xAn 81-year-old female presented to her local emergency department (ED) with symptoms of bronchitis and was treated with nebulized bronchodilators. The patient subsequently developed progressive worsening of her vision and presented to our ED with bilateral visual loss. The patient was diagnosed with bilateral acute angle glaucoma, and despite aggressive medical and surgical intervention, the patient did not have her vision restored to normal.
Yi-Hsien Chen, Hung-Jung Lin, Kuo-Tai Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2008.06.038
Published in issue: February 2009
xTypical presentations of hyperthyroidism are palpitation, nervousness, tremor, malaise, and weight loss. Hyperthyroidism affects nearly every system in the body, and some patients may manifest neurologic or hematologic symptoms. Atypical presentations of hyperthyroidism often pose a great challenge in diagnosis and treatment. We report a case of Basedow's paraplegia and pancytopenia that was precipitated by hyperthyroidism. The unusual manifestations led to unnecessary examinations and delayed the treatment of hyperthyroidism.
DOI: http://dx.doi.org/10.1016/S0735-6757(08)00834-6
Published in issue: February 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(08)00835-8
Published in issue: February 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(08)00836-X
Published in issue: February 2009
DOI: http://dx.doi.org/10.1016/S0735-6757(08)00837-1
Published in issue: February 2009
