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Neurosarcoidosis Presenting as Cauda Equina Syndrome: Case Report and Review of the Literature
Get PDFBackground
Sarcoidosis is a systemic immune disease with an unknown trigger, identified histologically by non-caseating granulomas. Neurosarcoidosis is a subset in which granulomatous inflammation infiltrates the central or peripheral nervous system. Sarcoid myelopathy affects a very small fraction of sarcoidosis patients. We present here the case of a 35 year old male who presented primarily for cauda equina symptoms.
Case Presentation
A 35-year-old Caucasian male with past history of hypertension, Hashimoto\u27s thyroiditis, and type II diabetes mellitus presented to the emergency department complaining of a headache with left sided face numbness and periorbital swelling. He reported two months of gradual, progressive lower extremity weakness, erectile dysfunction, and bowel and bladder incontinence. Spine MRI found abnormal enhancement of the cervical, thoracic, and lumbar spinal cord. Suspicion for sarcoidosis grew after thorough workup to rule out other etiologies Methylprednisolone one gram daily was started, and the patient rapidly improved over the next five days. A diagnosis of sarcoidosis was confirmed by non-caseating granulomas on hilar lymph node biopsy, and the patient was discharged on maintenance steroid therapy with plans to taper and switch to steroid-sparing therapy.
Discussion
This case presents learning opportunities in its unusual epidemiology, neurological symptoms at presentation, diagnostic complexity, and its treatment course. Neurosarcoidosis is especially rare in young males, and even fewer patients have such debilitating disease. Patients with neurosarcoidosis have highly variable involvement and severity of their diseases, with each case requiring its own diagnostic and treatment plan
Integrating Global Health Concepts into Pediatric Emergency Medicine Training and Practice: A Narrative Review.
No full textThe integration of global health (GH) principles into pediatric emergency medicine (PEM) is essential to addressing disparities in child health outcomes, particularly in low- and middle-income countries (LMICs), where preventable diseases remain a leading cause of mortality. This narrative review explores the intersection of PEM and GH, emphasizing the need for comprehensive training, sustainable infrastructure, and policy frameworks tailored to resource-limited settings. Key barriers, including limited critical care resources, delayed presentation, and workforce shortages, are discussed alongside the transformative potential of strategies such as telemedicine, cultural competence, and international collaboration. The review highlights successful models from both high-resource and low-resource settings, illustrating how innovative training programs, bidirectional partnerships, and equitable resource allocation can enhance pediatric emergency care globally. By advocating for capacity building, evidence-based policymaking, and integration of GH into PEM training, this review provides actionable insights to ensure resilient, inclusive, and high-quality pediatric emergency care systems worldwide
You\u27re So Special
No full textBronchopulmonary sequestration (BPS) is a rare congenital anomaly of the lower airway, with a less than 6% incidence. It consists of a nonfunctional lung or a segment that receives an anomalous systemic vascular supply. The clinical presentation is nonspecific and variable. Hence BPS is mostly diagnosed incidentally in the radiograph and/or intra-operatively by identifying the systemic vascular supply. It is commonly misdiagnosed as consolidative/cavitary pneumonia, lung abscess, lung cancer, and pulmonary cyst. The mean incorrect preoperative diagnosis rate is as high as 58.3%. The interval from the onset of initial symptoms to diagnosis ranged from 2 weeks to more than 40 years-the misdiagnosis and delay in diagnosis subject such patients to numerous unnecessary invasive and harmful diagnostic procedures. Here, we present a case of a 46-year-old lady who was admitted under the impression of suspected tuberculosis and was placed in isolation, and bronchoscopy was requested for further evaluation. The radiology had mentioned the finding as cavitary pneumonia, and she was started on empiric antibiotics. Upon re-analysis of the CTA chest, the left lower lung was found to have an anomalous supply from the aorta, confirming the diagnosis. The careful review and identification of lung radiographs provided the correct diagnosis and prevented the patient from unnecessary invasive diagnostic procedures. The patient was taken out of isolation, discharged with outpatient referral to Thoracic surgery and close pulmonary follow. up
Trauma in pregnancy: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma.
No full textBACKGROUND: The care of the injured pregnant patient presents unique challenges. There is no consensus on how best to approach certain aspects of injury during pregnancy. In this review, we aim to clarify the current care of the injured pregnant patient by reviewing the existing literature guided by clinical experience.
METHODS: Clinically relevant questions regarding the management of pregnant trauma patients with defined Population, Intervention, Comparison, and Outcomes (PICOs) were determined specific to resuscitative hysterotomy (RH), fetal monitoring, pregnancy-specific laboratory tests, imaging, and timing of fetal evaluation. A systematic literature review and meta-analysis were conducted using Grading of Recommendations Assessment, Development, and Evaluation methodology. Appropriate studies that met the inclusion criteria did not exist for PICO1 on RH and PICO5 on timing of fetal evaluation. We therefore relied on a literature review and expert consensus to address these PICOs.
RESULTS: Sixteen studies were identified for systematic review, and a subset was deemed appropriate for meta-analysis. In trauma patients with pregnancies (estimated gestational age, ≥20 weeks) undergoing resuscitative thoracotomy for traumatic arrest, we conditionally recommend RH as soon as possible. In trauma patients with viable pregnancies, we conditionally recommend a formal observation period of at least 4 to 6 hours. In trauma patients with viable pregnancies, we cannot recommend for or against pregnancy-specific laboratory tests and nonionizing radiation imaging being performed. The workgroup suggests that possible effects of ionizing radiation exposure should not prevent medically indicated diagnostic imaging. Kleihauer-Betke testing should be performed in patients who are Rh negative to determine an appropriate dose of Rh D immunoglobulin. In trauma patients with viable pregnancies, we conditionally recommend that fetal assessment should be performed at the end of the primary survey after a rapid maternal evaluation.
CONCLUSION: This work summarizes the best available evidence pertaining to the management of trauma in pregnancy, as the best early treatment of the fetus is the optimal resuscitation of the mother.
LEVEL OF EVIDENCE: Systematic Review/Meta-analysis; Level III
Risk Factors for Significant Injury After Inpatient Falls.
No full textInpatient (IP) falls present substantial challenges to health care institutions. We aimed to characterize injuries after IP falls and evaluate if there were risk factors for these injuries. Adult inpatients who fell in an acute care hospital from 2018 to 2023 were studied. Severity of injury were retroactively assigned using the Abbreviated Injury Scale (AIS) for each of nine body regions and calculating the Injury Severity Score (ISS). The primary outcome was any significant injury (SI), which was defined as an ISS of ≥2. Patients with SI were matched 1:2 for age and whether the fall was witnessed to those without SI (controls). The risk of SI was estimated for each plausible variable using conditional logistic regression, wit
Palpation-Induced Thyrotoxicosis—An Underrecognized Complication of Parathyroidectomy
No full textDescription: Case Report: We present a case of a 70-year-old woman who presented to the hospital 5 days after partial parathyroidectomy (PTX), with removal of 3 glands. The initial presentation was for altered mental status, diagnosed with urinary tract infection. Initial lab workup revealed free T4 elevated at 1.84 and thyroid-stimulating hormone suppressed at 0.05. In discussion with family, the patient had no prior history of thyroid abnormalities. She had normal thyroid function 1 year earlier, and normal thyroid ultrasound prior to PTX. Additionally, she had not been on any thyrotoxic medications. Given the acute timing post-PTX and lack of other precipitants, thyrotoxicosis was thought to be most likely palpation-induced. The patient’s thyroid function was monitored during the hospital course and returned to baseline without medical intervention. Discussion: Common causes of thyroiditis include autoimmune, subacute, postpartum, fibrous, and infectious thyroiditis. Palpation thyroiditis is a much rarer cause, in which the thyroiditis is thought to occur through vigorous manual stimulation of the thyroid follicles causing release of thyroid hormone. Many patients with thyroiditis can be asymptomatic. Symptoms, when present, indicate thyrotoxicosis and include fatigue, palpitations, diaphoresis, tremors, and hyperreflexia. Most of these symptoms are caused by sympathetic activation due to the excess thyroid hormone in the circulation. Management depends on the cause, but can include beta blockade for symptomatic relief. Conclusion: While PTX is not a common cause of symptomatic thyroiditis, it is important to recognize the signs and symptoms in the correct clinical context as this will help determine an appropriate treatment plan. Both patients and providers should be made aware of the potential for thyrotoxicosis post-PTX
Autism screening and diagnostic outcomes among toddlers born preterm.
No full textAIM: To examine the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F), with follow-up screening and diagnostic outcomes for children born preterm. A secondary aim was to examine diagnostic evaluation attendance after screening to inform clinical practice.
METHOD: Using a cross-sectional design, 9725 toddlers (4951 males; 4774 females) whose gestational age was reported were screened at 15-month, 18-month, or 24-month well-child visits; screen-positive children were invited for an autism evaluation. Screening measure performance and diagnostic outcomes were evaluated according to preterm classification (Screening: n
RESULTS: Screen-positive rates were highest for children born extremely preterm (51.35%) and lowest for children born at term (6.95%). Evaluation attendance for screen-positive cases did not differ according to preterm classification. Rates of autism diagnoses differed depending on preterm birth status: for children born extremely preterm, it was 16.05%; for children born very preterm, it was 2.00%; for children born moderately preterm, it was 2.89%; and for children born at term, it was 1.49%. M-CHAT-R/F sensitivity decreased with increasing gestational age, whereas specificity improved with increasing gestational age. Positive predictive value was highest for children born extremely preterm and children born at term. Negative predictive value was consistently strong across all groups. The likelihood ratio for positive screening increased with gestational age.
INTERPRETATION: The sensitivity and specificity of the M-CHAT-R/F are acceptable in toddlers born preterm. Autism screening-positive rates and prevalence increased with earlier preterm birth. Those born extremely preterm showed the greatest likelihood of an autism diagnosis; screening should not be delayed based on adjusted age
