Migrainous infarction: A serious complication of a common condition.

ABSTRACT: Migrainous infarction is a rare neurologic condition that stems from an ordinary migraine with aura, and can cause ischemic stroke in young women. The pathophysiology of migrainous infarction is not entirely understood. An aura that is similar to previous auras but lasts longer than 60 minutes, along with evidence of acute ischemia on MRI, are diagnostic of migrainous infarction. Treatment aimed at minimizing migraine with aura is the most important preventive measure clinicians can take to help patients avoid this complication of migraine.

An overview of esophageal atresia and tracheoesophageal fistula.

ABSTRACT: Esophageal atresia and tracheoesophageal fistula are often-concomitant pathologies that primarily afflict neonates. The complications of these anomalies may lead to increased morbidity and mortality, and clinicians should be familiar with the diagnosis and management of these pathologies. Clinicians can improve patient outcomes by having a thorough understanding of the signs and symptoms, classification systems, diagnostic workup, and surgical intervention options for these patients. Early recognition and treatment are imperative in providing patients with the best opportunity for recovery.

ACE inhibitor-induced angioedema causing small bowel obstruction.

Mucosal angioedema of the face, lips, tongue, and throat is a well-recognized adverse reaction to angiotensin-converting enzyme (ACE) inhibitors that is experienced by a minority of patients. Rarely, this angioedema can involve the small bowel, and patients commonly present with abdominal pain and small bowel obstruction. Due to the increasing number of patients being treated for hypertension, clinicians should consider the diagnosis of small bowel angioedema secondary to ACE inhibitor use in all patients with this presentation who are using this class of medications.

Hijab pin inhalation.

Foreign body aspiration can be an acute life-threatening emergency and, if left untreated, can result in severe complications. Among Muslim women, the hijab pin can be accidentally aspirated. The article describes standard management with rigid bronchoscopy and a new technique involving magnets.

A review of Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) describes a group of heritable disorders of connective tissue comprising mutations in the genes involved in the structure and/or biosynthesis of collagen. Thirteen EDS subtypes are recognized, with a wide degree of symptom overlap among subtypes and with other connective tissue disorders. The clinical hallmarks of EDS are tissue fragility, joint hypermobility, and skin hyperextensibility. Appropriate diagnosis of EDS is important for correct multidisciplinary management and is associated with better clinical outcomes for patients.

Leber congenital amaurosis in a young female.

Leber congenital amaurosis is a rare congenital disorder caused by a mutation in any of several different genes that causes rod-cone dystrophy and may eventually lead to blindness. Characteristic findings on fundoscopic examination include retinal pigment migration and macular atrophy. Confirmation can be obtained using electroretinograms and the specific gene can be identified with genetic testing. No treatment is available, but multiple clinical trials are underway.

Recognizing abdominal wall endometriosis.

Abdominal wall endometriosis is ectopic endometrial tissue in the abdominal wall. Consider this condition in any woman presenting with chronic abdominal pain and a surgical history significant for exposure of the abdominal cavity to the endometrial canal. The diagnosis can be suspected with accurate history taking and a thorough physical examination. In patients with suspected abdominal wall endometriosis, MRI is the imaging study of choice and complete surgical resection is the treatment of choice.

Acute portal vein thrombosis in a 59-year-old male with JAK2 V617F mutation.

Portal vein thrombosis is an uncommon finding that typically arises in the context of cirrhosis. In the acute setting, it may present with abdominal pain, portal hypertension, ascites, gastrointestinal bleeding, or mesenteric ischemia. Local risk factors that predispose its formation include: cirrhosis, hepatocellular carcinoma, pancreatitis, and intraabdominal infection. Systemic factors, including hypercoagulable states and sepsis, also pose an increased risk. JAK2 V617F positive myeloproliferative disorders are associated with systemic prothrombotic states and are a less frequently identified cause of portal vein thrombosis. We present a case of acute unprovoked portal vein thrombosis diagnosed in a 59-year-old male without local disease factors. Computed tomography, magnetic resonance cholangiopancreatography, and ultrasound demonstrated the presence of portal vein thrombosis with neighboring periportal and pancreatic head edema. Peripheral blood testing detected the presence of JAK2 V617F mutation. The patient was discharged on 6-month anticoagulation therapy and outpatient follow-up.

Thoracic outlet syndrome presenting with subclavian vein thrombosis.

Thoracic outlet syndrome can present with a wide variety of upper extremity neurovascular symptoms. Timely clinical recognition is essential for prompt treatment and maximal recovery. This article describes a case of thoracic outlet syndrome in a volleyball player with an underlying hypercoagulable state who presented with a subclavian vein thrombosis.

Plantar fasciitis: A review of treatments.

Plantar fasciitis is the most common cause of heel pain in the United States. Many treatments are available and differ in efficacy and cost. This article discusses the theorized causes for plantar fasciitis and various treatments.

Complicated Meckel diverticulum in a 15-year-old boy.

Meckel diverticulum is the most common gastrointestinal (GI) anomaly, occurring in 2% of the population. This condition often presents symptomatically similar to acute appendicitis in children. The most common presentation is GI hemorrhage, followed closely by obstruction due to intussusception. Laparoscopy is the standard in both diagnosing and treating a complicated Meckel diverticulum.

Updated guidelines for lipid screening in children and adolescents.

Elevated serum lipoproteins in childhood and adolescence are associated with health consequences and poor outcomes in adulthood. Universal screening, recommended in recent guidelines from the National Heart, Blood, and Lung Institute and supported by the American Academy of Pediatrics, may help identify a significant number of children who would be missed by targeted screening.

A guideline to efficiently treating traumatic brachial artery injury.

In patients with traumatic arterial lacerations, the benefits of short-term tourniquet use may outweigh the risks and be life- and limb-saving. Duplex ultrasound is the most efficient diagnostic test.