Acute Spinal Cord Infarction Presenting With Chest Pain and Neurogenic Shock: A Case Report.

BACKGROUND: Spinal cord infarction (SCI) is rare, accounting for approximately 1% of strokes. CASE REPORT: We present the case of a 63-year-old male who presented to the emergency department (ED) with chest pain and acute-onset generalized weakness and was ultimately diagnosed with SCI secondary to suspected occlusion of the artery of Adamkiewicz. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: SCI may present diagnostic challenges, with its predilection for mimicking other major emergency conditions, such as acute aortic dissection, aortic aneurysm rupture, spinal cord compressive myelopathy, or transverse myelitis. Its consequences are often significantly disabling initially, though patients may experience subsequent clinical improvement. It is important to include SCI in the differential for patients with chest or back pain coupled with neurologic symptoms.

An uncommon cause of acute back pain: spinal subarachnoid hemorrhage progressing to spinal cord compression.

BACKGROUND: Spinal subarachnoid hemorrhage (SSH) is an uncommon occurrence responsible for <1% of all cases of subarachnoid hemorrhage (SAH). CASE REPORT: We present the case of a 53-year-old man who presented to the emergency department (ED) with acute onset of "tearing" back pain that began during activity, and who was diagnosed with an SSH that ultimately progressed to spinal cord compression. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although uncommon, the consequences of SSH are potentially devastating, yet reversible, making awareness of this condition critical. Several rare yet potentially devastating causes of acute back pain are deserving of consideration when approaching back pain in the ED setting; SSH is among them. Pain that is described as "tearing" or that is unresponsive to ordinary analgesic dosages should prompt strong consideration of vascular or other serious pathology, including arterial dissection or spinal cord compression.

Utilization of the social media platform Snapchat in the care of an acutely suicidal individual.

Background/Case Presentation: An 18-year-old female college student shared an electronic message with her friends in which she discussed plans to harm herself through the ingestion of a highly toxic substance. Concerned friends activated emergency healthcare resources, who were dispatched to the individual's residence. Based on the known toxicity of the substance, locating the individual expeditiously to ensure her safety and well-being remained paramount. Upon arrival of collegiate-based health services, emergency medical services, and law enforcement, however, the individual was unable to be located. University healthcare and prehospital providers quickly recognized that the individual's recent location was visible to her friends through the social media platform Snapchat. Based on information gathered from her shared friends on the social media platform, a geo-location was identified. Law enforcement and EMS personnel canvased the identified area, successfully locating the individual. Conclusion: This case highlights the innovative use of smartphone technology to locate a person experiencing an acute medical emergency who hadn't summoned the services on her own.

Thunderclap headache with orgasm: a case of basilar artery dissection associated with sexual intercourse.

BACKGROUND: Headaches associated with sexual intercourse (coital cephalgia) have many different causes and are often divided in the literature into pre-orgasmic and orgasmic headaches. OBJECTIVE: To present a case of orgasmic headache caused by a basilar artery dissection and to present a literature-based guide to the diagnosis and management of patients presenting with headaches related to sexual activity. CASE REPORT: We report the case of a 34-year-old man without significant past medical history who presented to the Emergency Department with two episodes of orgasmic headache caused by basilar artery dissection. CONCLUSIONS: The cause of headaches related to sexual activity range from the benign to the life-threatening. Due to the dynamics of cerebral blood flow during sexual intercourse, basilar artery dissections and aneurysms should be considered in patients with sudden-onset headaches during orgasm. Appropriate brain imaging and, possibly, lumbar puncture may assist in identifying potentially life-threatening causes of coital headaches.

An unusual cause of neck pain: acquired Chiari malformation leading to brainstem herniation and death.

BACKGROUND: Chiari malformations are structural defects in which portions of the cerebellum are located below the foramen magnum. Of the four types of Chiari malformation, emergency physicians are most likely to encounter Type I (Chiari I). Chiari I malformations may be congenital or acquired. Congenital Chiari I malformations are most frequently encountered in the emergency department (ED) setting due to an exacerbation of subacute or chronic Chiari-related symptoms. However, acute Chiari-associated symptoms from an occult congenital or a secondary (acquired) Chiari malformation may occur. OBJECTIVE: To present a literature-guided approach to the identification and initial management of patients with Chiari I malformations in the ED setting. CASE REPORT: We present the case of a 30-year-old man who presented to the ED with isolated cervical region pain, and who subsequently died as a result of acute brainstem herniation from an acquired Chiari I malformation. CONCLUSIONS: Although rare, acute Chiari I malformation may present to the ED. The new finding of a Chiari I malformation should be presumed acquired until proved otherwise, and should trigger an evaluation for central nervous system lesions or hydrocephalus. Brain imaging to exclude increased intracranial pressure and, in certain cases, specialty consultation, are important considerations.