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A common side effect of Fioricet (butalbital-acetaminophen-caffeine) is high blood pressure caused by the caffeine content. We report a case of a 54-year-old female who developed the worst headache of her life after taking 2 tablets of butalbital-acetaminophen-caffeine every six hours for three days before presenting to the emergency department, where her blood pressure was 178/87 mmHg. A brain MRI showed edema in the subcortical white matter of the right occipital lobe, right parietal lobe, and left occipital lobe. Posterior reversible encephalopathy syndrome (PRES) was diagnosed. The patient returned within the week with severe headaches, visual hallucinations, and a blood pressure of 150/80 mmHg. Repeat brain MRI showed slight improvement of edema. Her brain imaging studies completely normalized at 10 months after diagnosis. Although the patient received appropriate treatment, she was unable to make full recovery. Due to her inability to work and the constant pain, the patient continues to struggle with depression.
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Lymphomatoid granulomatosis (LG) is an EBV-associated angiodestructive lymphoproliferative disease with multiorgan involvement that predominantly affects the lungs. We present a case of a 72-year-old man with a history of chronic lymphocytic leukemia who presented with upper respiratory symptoms and multiple erythematous skin papules. Chest CT showed ill-defined, irregular solid pulmonary nodules with peripheral ground-glass opacities in a peribronchovascular distribution. The differential for this pattern of lung disease is vast which includes but is not limited to infection, vasculitis, sarcoidosis, lymphoma, and Kaposi sarcoma. Subsequent PET/CT showed rapid progression of lung opacities and marked FDG uptake of pulmonary opacities and skin nodules, which raised the question of Richter syndrome. Wedge biopsy under video-assisted thoracoscopic surgery was performed. Pathology showed an extensive lymphoid infiltrate involving lymphatic and bronchovascular bundles and consisting of a mixture of large lymphocytes and inflammatory cells. Special stains showed that the large lymphocytes expressed B-cell markers and EBV virus. Overall, the findings were consistent with LG.
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PURPOSE: Americans with limited English proficiency (LEP) face significant barriers to health care that result in health disparities in the LEP population. LEP could delay an MRI, potentially increasing morbidity and mortality in the LEP population. This study compares the time to obtain a neurological MRI in English versus non-English language preference patients. METHODS: 24,219 unique patients at a single health system who underwent inpatient neurological MRI were included in the study. Bivariate and multivariate analyses were used to identify characteristics predictive of time to examination (TTE) from the set: patient-preferred language, gender, race, age, performing hospital, and order priority (routine versus stat). RESULTS: Bivariate analysis showed a longer TTE is associated with increasing age category, non-English language preference, and routine priority. A multivariate analysis showed non-English language preference effect on TTE is reduced in magnitude and is no longer significant in a model that includes age group, priority, and hospital (P = .23, effect estimate = 4%, 95% CI: -2.5%, 11.0%). Routine order priority (P < .0001) and increasing age (P < .0001) were associated with increased TTE. In a model that included interactions, the effect of language preference did not depend on order priority (P = .59) or age group (P = .11). CONCLUSION: There is no significant difference in the time to obtain a neurological MRI in English versus non-English language preference patients when age, order priority, and performing hospital are accounted for. This finding supports the effectiveness of the protocols and resources in place to support patients with LEP at the sponsoring health system.