Optic Perineuritis Presenting as the Initial Manifestation of Central Nervous System Involvement in Rai Stage 0 Chronic Lymphocytic Leukemia.

BACKGROUND: To describe the first case of optic perineuritis because of meningeal involvement of early stage chronic lymphocytic leukemia (CLL). METHODS: A case report and review of the literature. RESULTS: A case of unilateral optic neuropathy associated with enhancement of the optic nerve sheath is described in a patient with a prior 2-year history of Rai Stage 0 CLL. Lumbar puncture revealed a lymphocytic pleocytosis. Cerebrospinal fluid flow cytometry revealed a monoclonal expansion of CD5+ B cells compatible with CLL, matching the flow cytometry characteristics of his peripheral blood. CONCLUSIONS: Optic perineuritis is often initially diagnosed as optic neuritis, yet the 2 have different etiologies and follow a different clinical course. Orbital MRI with contrast structurally separates the 2, revealing a characteristic pattern of peripheral optic nerve sheath rather than primary optic nerve enhancement. Etiologies of optic perineuritis are varied and include inflammatory, infectious, neoplastic, and toxic entities. Central nervous system (CNS) involvement by chronic lymphocytic leukemia is unusual, but cranial nerve and meningeal involvement have been reported. This case adds central nervous system chronic lymphocytic leukemia to the list of differential diagnostic possibilities for optic perineuritis. It also alerts clinicians to consider optic perineuritis as a potential presenting feature of CNS involvement in otherwise asymptomatic and stable CLL.

Inspirational Professional Practice Model Redesign Using Shared Decision-Making.

An integrated health system including 12 hospitals, an expansive network of ambulatory settings, and health insurance plans began a systematic review of the existing nursing professional practice model (PPM) created in 2007 to assess current relevancy. The goal was to determine PPM concepts and imagery that represent present-day nursing workforce. This article shares how a formal review of literature, utilization of focus groups, and system-wide shared decision-making influenced creation and evaluation of a revised PPM.

Discovery of unsuspected thyroid pathologic conditions after trauma to the anterior neck area attributable to a motor vehicle accident: relationship to use of the shoulder harness.

OBJECTIVE: To alert physicians to the possibility of antecedent trauma to the neck in patients presenting with a thyroid nodule or with symptoms and signs related to the thyroid gland. METHODS: We present five case reports in which the cause of thyroid nodular disease was suspected to have been trauma to the anterior neck area during an earlier motor vehicle accident in which the shoulder harness impacted the neck. RESULTS: In five female patients, shoulder harness trauma from an automobile accident led to the subsequent discovery of a thyroid lesion. Four of the five patients underwent surgical removal of the thyroid nodule. Although traumatic injury of the thyroid may be common, we found only one report in the medical literature regarding the discovery of a thyroid nodule or thyroiditis in the setting of traffic accident-related trauma to the thyroid gland. CONCLUSION: In the initial assessment of patients with thyroid nodular disease, we emphasize the importance of obtaining a detailed and comprehensive history, including inquiry about trauma to the neck. Prompt diagnostic accuracy will help avoid unnecessary costs and risks in the workup of such patients.