RESUMO
While musculoskeletal pain is cited as the primary cause of disability and reason for visiting the emergency department in the United States, secondary etiologies should be considered. In this case report, we are reporting a unique case of a 38-year-old multiparous healthy female who presented to multiple emergency departments with fleeting pain on the shoulders and upper back. She was diagnosed with muscle spasms and joint arthritis and discharged home multiple times. The patient then developed vaginal bleeding, belt-line numbness, and was found to have T6 spinal cord compression. Imaging prompted workup for malignancy, which revealed small cell neuroendocrine cervical cancer (SCNECC) with metastasis to intra-abdominal lymph nodes, bone, and brain. SCNECC is very rare, aggressive, occurs in less than 3% of cervical cancers, and does not have established treatment guidelines. Because it is commonly misdiagnosed and has an overall poor prognosis, SCNECC can be missed if it is not part of the differential.
RESUMO
Cryptogenic stroke is a subtype of ischemic stroke for which no identifiable cause is found after routine diagnostic evaluation. It accounts for roughly 25% of ischemic strokes. Structural cardiac abnormalities such as patent foramen ovale, atrial septal defect (ASD), and a large left atrial appendage (LAA) are commonly associated risk factors in patients with cryptogenic stroke. We report a case of a patient with a history of a surgically repaired ASD found to have a large LAA without identifiable thrombus on both transthoracic echocardiogram and transesophageal echocardiogram after presenting with an acute cryptogenic stroke in the absence of any arrhythmias. We aim to emphasize the importance of the LAA, particularly if large, in the pathogenesis and development of cryptogenic strokes. Additionally, we discuss the necessity for clearly defined guidelines on whether to start anticoagulation in these patients.
