Case Report ABSTRACTS

More documents

Recommendations

Info

Orthostatic headache in a 21-year old free runner Malin Persson The Hillingdon Hospitals NHS Foundation Trust Paresh Mistry Introduction Headache caused by intracranial hypotension is often reported as being orthostatic in nature. 1 Low cerebrospinal fluid (CSF) volumes and pressure can results from dural trauma or can be spontaneous. 2 <strong>Case</strong> report We present the case of a 21-year old free runner who was admitted to our Acute Medical Unit in a London District General Hospital with a worsening headache. The patient reported an orthostatic headache since sustaining a head injury 10 days previously. He experienced no loss of consciousness but complained of dizziness, photophobia and vomiting on more than 2 occasions. The patient’s GCS was 15/15 and a full neurological examination demonstrated diplopia on right lateral gaze but was otherwise normal. A CT head scan, and subsequently an MRI head scan was performed, that showed no skull fractures or intracranial haemorrhages but low-lying cerebellar tonsils – initially thought to be an incidental finding of Chiari malformation. After a review by a neurology consultant, the patient was diagnosed with a headache secondary to intracranial hypotension. Inferior displacement of cerebellar structures is one of the known potential MRI findings in intracranial hypotension. 3 The patient was managed conservatively with bed rest and IV hydration, and made an uneventful recovery. Discussion CSF leak from a dural tear, in this case caused by head trauma, is a recognised cause of intracranial hypotension. 2 Headache can also occur from spontaneous intracranial hypotension, which is rare with a reported annual incidence of 5 per 100,000. 4 These patients are often misdiagnosed or it may be months to years before a diagnosis is made. 4 We want to highlight intracranial hypotension as a rare, but possible, diagnosis in patients presenting with a headache to the Acute Medical Unit, and emphasise the importance to establish the orthostatic nature of headaches. References 1. Scott S, Davenport R. Low pressure headaches caused by spontaneous intracranial hypotension. The British Medical Journal. 349. 2014. 2. Posser JD, Vender JR, Solares CA. Traumatic cerebrospinal leaks. Otalyrongolic Clinics of North America. 44. 857-873. 2011. 3. Rabin BM, Rowchoudhury S, Meyer JR et al. Spontaneous intracranial hypotension: spinal MRI findings. American Journal of Neuroradiology. 19. 1034-1039. 1998. 4. Schievink WI. Spontaneous cerebrospinal fluid leaks and intracranial hypotension. The Journal of the American Medical Association. 295. 19. 2006.
Snap! Crackle! Pop! The perils of complementary therapy Nerys Conway University Hospitals Bristol Shiva Sreenivasan Aim Complementary therapy is often considered as either benign or equivalent to placebo. We discuss two patients admitted with life-threatening complications of complementary therapy for chronic back pain. <strong>Case</strong>s A 76-year-old lady was admitted with pleuritic chest pain and dyspnoea six hours after having acupuncture. Chest radiography confirmed a left pneumothorax (Figure 1), which required intercostal drainage. A 65-year-old lady was admitted with severe back pain and dyspnoea following chiropractic therapy the previous day. Computed tomographic imaging confirmed a leaking thoracic aneurysm with features of a type B aortic dissection (Figure 2), which necessitated urgent transfer to a national cardiothoracic centre. We postulate that her chronic back pain was secondary to an expanding thoracic aneurysm. Discussion and conclusion Acupuncture-induced pneumothorax is rare, occurring only twice in nearly a quarter of a million treatments. 1 We also discuss other reported complications, which include spinal cord injury, hepatitis B, and cardiac tamponade. 1 Serious complications of chiropractic therapy include vertebrobasilar strokes, disc herniation, and cauda equina syndrome. 2 Few prevalence studies exist of serious adverse effects after chiropractic therapy. 3 Patients should be fully informed of potential risks of complementary therapy. References 1. Saifeldeen K, Evans M. Acupuncture associated pneumothorax. Emerg Med J. 2004;21(3):398. 2. Stevinson C, Ernst E. Risks associated with spinal manipulation. Am J Med. 2002;112(7):566-71. 3. Gouveia LO, Castanho P, Ferreira JJ. Safety of chiropractic interventions: a systematic review. Spine 2009;34(11):E405-13.
Page 1 and 2: Case Report ABSTRACTS
Page 3 and 4: A hobby with an unusual consequence
Page 5 and 6: A rare differential diagnosis of un
Page 7 and 8: Allopurinol related deranged liver
Page 9 and 10: An unusual case of breathlessness C
Page 11 and 12: An Unusual Cause of Breathlessness
Page 13 and 14: Atrioventricular block associated w
Page 15 and 16: Bilateral Internal Jugular Thrombos
Page 17 and 18: Cannabis Induced Hyperemesis Syndro
Page 19 and 20: Doctor I feel listless, please tell
Page 21 and 22: 3. Joseph F et al. Starvation-induc
Page 23 and 24: Iatrogenic disseminated Bacillus Ca
Page 25: Ocular myasthenia gravis mimicking
Page 29 and 30: The Double-edged Sword of Dsypnoea
Page 31 and 32: Think before you treat a Troponin!
Page 33 and 34: Type 1 spontaneous diaphragmatic ru
Page 35 and 36: Vertebral Artery Dissection - not a
Page 37 and 38: You take my breath away- another ca

Case Report ABSTRACTS

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

Delete template?

Save as template?