A 29-year-old male with no significant past medical history presents to the emergency department for evaluation of progressive numbness and burning sensation to his bilateral hands and feet. He reports the symptoms have become so severe that he has started to have difficulty using his hands. He also states that he has had difficulty ambulating at times. He endorses neck pain and intermittently experiences a sensation that feels like “shocks down my spine” with movement of his neck…
Read MoreA 20-year-old female presents to the emergency department (ED) with a chief complaint of a headache. Her headache started 8 days ago and is described as bifrontal. It is positional and gets worse when she bends forward but improves when she is sitting or standing. She had presented to 3 other EDs prior to this visit for her symptoms, and each time she was discharged with an intractable headache after receiving a migraine cocktail to no effect…
Read More…3 days of floaters and “lightning bolt” white flashes in the temporal field of her right eye in the absence of eye trauma. She also reported right periorbital pain. She did not have blurry vision, diplopia, loss of vision, scalp tenderness, jaw claudication, fevers, chills, or weight loss. She denied photophobia despite wearing sunglasses in the Emergency Department. Her mother had died from choroidal melanoma, but the patient had not seen an ophthalmologist in 15 years.
Her uncorrected visual acuities were 20/60 OD and 20/40 OS. Intraocular pressure, pupillary reaction, and extraocular movements were normal. Point of care ultrasound (POCUS) revealed three hyperechoic, solid lesions with posterior acoustic shadowing in her right eye….
Read MoreA 17-year-old female presents via EMS from her boyfriend’s home after a report of two separate episodes of generalized tonic-clonic seizure like activity. She has no previous history of seizures. Per EMS, she was given versed on scene for seizure like activity lasting roughly 5 minutes. She was also febrile to 100.8°F. The emergency department team is unable to obtain a detailed history from the patient and unable to reach the family when the patient first presents to the ED…
Read MoreWhat prompted her emergency department visit was the onset of a right sided facial droop which began about eight hours prior to arrival. She was unable to fully close her right eye and noticed drooping at the corner of her lip. She denied shortness of breath or difficulty breathing. The patient noted that she had a diarrheal illness several weeks prior to the onset of the symptoms. …
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