Medicine and Health Sciences Commons^™

Case Report: Repeated Use Of Tetrahydrocannabinol Associated With Severe Cerebral Vasoconstriction, Pooja Patel, Ryna Then, Dena Little

Rowan-Virtua Research Day

Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a rare neurological syndrome. The classic presentation consists of recurrent, severe, ”thunderclap” headaches with neuroimaging findings consistent with segmental vasoconstriction of cerebral arteries. Sympathomimetics including cannabinoids have been found to be triggers in many cases of RCVS. Complications include subarachnoid hemorrhage, intracerebral hemorrhage, cerebral edema and ischemic infarction.

This case highlights the potential devastating and irreversible effects of RCVS precipitated by exposure to a sympathomimetic agent. The case emphasizes the importance of patient counseling regarding abstinence from agents that may provoke RCVS.

Case Study Of Pulmonary Embolism With Unusual Chief Complaint, Kajel Patel

Rowan-Virtua Research Day

Pulmonary embolism (PE) is a serious diagnosis that needs to be made in the Emergency department (ED). There are different categories of PE ranging from massive to non-massive/sub-segmental. Regardless of the categorization, the patient will need to be placed on anticoagulation. It is important to catch this diagnosis in the ED so further complications do no arise. Here is a case from the ED with a patient coming in with the chief complaint of acute right lower quadrant abdominal pain and was diagnosed with a pulmonary embolism.

An Unusual Ed Case: Aortic Aneurysm Presenting As Chf Exacerbation, Darren Finn, James Espinosa, Russell Mordecai, Kishan Patel

Rowan-Virtua Research Day

There has been a significant increase in the incidence of thoracic aortic aneurysms, currently making aneurysmal disease the 18th most common cause of death within the United States. This disease is typically an insidious one, with the aorta growing an average of only 0.1 cm per year. Consequently, most patients remain asymptomatic until late stages of the disease when dissection or worse, rupture has occurred. Under extremely rare circumstances, thoracic aortic aneurysms can present clinically due to mass effect. Airway, esophageal and vascular compression, secondary to aortic arch dilation has been previously documented. The condition can be acquired or congenital, …

A Case Of Spinal Epidural Lipomatosis Presenting As A Stroke Mimic, Jonas Salna Iv, James Lee, Eric Maddock, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Spinal Epidural Lipomatosis (SEL) an excess of normal adipose tissue in the epidural space of the spinal canal, typically becoming symptomatic when cord compression results. First described in 1975 by Lee et al (Lee M, 1975), it is a relatively rare disease. Unfortunately, it is often diagnosed once patients have developed marked symptoms and can have dire complications. Oftentimes SEL is completely asymptomatic, and symptoms on initial presentation are vague. Mostly commonly it presents as worsening chronic back pain (Daniel R. Fassett M.D. M.B.A., 2004) with progressive lower extremity weakness and occasional cauda equina syndrome (Wells AJ, 2014), but this …

Retinal Vasculitis: A Case Study, Peter Maduka, Sarah G. Bonaffini, Naman Shah, Deepika Malik

Rowan-Virtua Research Day

Purpose: To describe a case of idiopathic retinal vasculitis.

Methods: Case report and literature review.

Case: A healthy 25-year-old female presented with a one-week history of a large floater in her right eye. Patient’s subjective complaint of floaters, including the scotoma on VF and the FA findings were most consistent with retinal vasculitis displaying predominant venous involvement. However, findings for acute macular neuroretinopathy and multiple evanescent white dot syndrome (MEWDS) were present as well. Autoimmune and infectious disease panels were negative. Neuro consult and brain MRI showed nonspecific, non contributory findings. Several weeks later, following Medrol dose pack, patient reported …

Kidney Rupture: An Unusual Cause Of Abdominal Pain, Flank Pain And Hematuria In A 72-Year-Old Female, Monica Diep, Neelesh Parikh

Rowan-Virtua Research Day

Flank pain, abdominal pain and hematuria are common complaints in emergency medicine. We describe the case of a 72-year-old female who presented to the emergency department for worsening left lower quadrant abdominal pain and left flank pain associated with new-onset hematuria. The patient reports the pain started immediately after she accidentally tripped on a rock while trying to avoid a mailman in an attempt to socially distance due to the COVID-19 pandemic, which resulted in a forceful twist of her body and catching herself with her hands without any direct impact to her body. The patient reports the pain gradually …

Lip Biopsy Trends In The United States: A 7-Year Review Of Medicare Provider Utilization And Payment Database, Nardin Awad, Fady Awad, Amanda Azer

Rowan-Virtua Research Day

Biopsy of the lip is a procedure most used by dermatologists in order to obtain histopathological evaluation of a lesion. It has remained the definitive method of diagnosis for many pathologies, including malignancy. However, although the incidence of lip malignancy has been relatively unchanged since 2012, the number of lip biopsies performed has not followed the same trend, but rather steeply declined since. In this study, the national trends in lip biopsies are evaluated. The Medicare Provider Utilization and Payment (MPUP) database was used to evaluate these practice trends in Medicare providers.

Osteopathic Touch: The Best Diagnostic & Therapeutic Tool - Osteopathic Diagnosis & Treatment For Nephrolithiasis, Bilal Khan, Motasem Abul-Huda, Alexander King

Rowan-Virtua Research Day

Osteopathic Manipulative Therapy (OMT) is a set of osteopathic techniques that involves manipulation of the musculoskeletal system using the hands. It offers a supplement to standard modes of diagnosis and treatment, and is a key component of the osteopathic holistic approach to medicine.

Despite growing numbers of osteopathic physicians in the United States, OMT continues to be an underutilized asset in a plethora of medical conditions. With the merger of osteopathic and allopathic residency programs, restructuring of standardized curricula to a pass/fail format, and further changes uniting the two tracks of physician education, OMT remains one of the few facets …

Retrograde Thromboembolism From The Proximal Descending Thoracic Aorta Leading To Recurrent Acute Cerebrovascular Events, Mark Staroelsky, Akash Patel, Gregory Holland, Nishant Parikh, Peter Bulik

Rowan-Virtua Research Day

In the United States, approximately 800,000 individuals experience a stroke every year

Nearly 25% of strokes are recurrent

Cryptogenic strokes, or those with unknown causes after testing, make up a significant portion of ischemic strokes, as many as 32%

Retrograde thromboembolic events originating from the proximal descending thoracic aorta should be considered as a potential etiology in cryptogenic strokes

The appropriate management of embolic events from aortic atheroma needs further research

Here, we present a case of a 55-year-old male who had recurrent cryptogenic strokes whose origin was discovered to stem from retrograde embolic phenomena from atheroma located within the …

The Coumadin Ridge: Incidental Finding Mimicking Thrombus On Echocardiogram, Keith Brown Jr., Matthew Everwine, Keith R. Anacker, Jose Nieves

Rowan-Virtua Research Day

The left atrial ridge or “coumadin ridge” is a cardiac anatomic structure located between the left pulmonary vein and the orfice of the left atrial appendage. Historically, patients were misdiagnosed with intra-atrial thrombus and were incorrectly placed on anticoagulation with warfarin, ultimately acquiring the name of the “coumadin ridge”. Fortunately this anatomical variant is now more commonly recognized, however when improperly identified can lead to unnecessary testing, cost, diagnosis anxiety, and inappropriate treatment for the patient. This purpose of this case is to bring awareness to this common clinical dilemma in an attempt to reduce ambiguity and unnecessary workups surrounding …

Terson-Like Syndrome Associated With Familial Retinal Arteriolar Tortuosity (Frat) And A Spontaneous Spinal Hemorrhage, Peter Maduka, David R. Lally

Rowan-Virtua Research Day

Background: Familial retinal arteriolar tortuosity (fRAT) is an autosomal dominant disorder that is characterized by tortuosity of the second and third order retinal arterioles in the macular and peripapillary areas. The genetics of fRAT are incompletely understood but have been associated with a missense mutation in the COL4A1 gene in some cases. fRAT is not typically associated with visual loss and prognosis is good. However, the tortuous arterioles can bleed, causing intraretinal, preretinal, and/or subretinal hemorrhages.

Objective: To describe a case of Terson-like syndrome associated with familial retinal arteriolar tortuosity (fRAT) in the setting of spontaneous spinal hemorrhage.

Results: A …

Retrospective Analysis Of Post-Operative Sepsis Rates, Stone Composition, And Ureteral Stent Duration After Ureteroscopy And Laser Lithotripsy During Covid-19, Young Son, Julia T. Scali, Ian Madison, Paul Chialastri, Thomas Mueller

Rowan-Virtua Research Day

Ureteroscopy with laser lithotripsy is routinely used to remove stones but results in manipulation of the genitourinary mucosa and has a well-established relationship with post-operative sepsis under certain conditions. Postoperative sepsis represents a significant morbidity and mortality cost to patients and the healthcare system. Several studies to determine risk factors for sepsis after ureteroscopy have been completed. Such risk factors include positive preoperative urine cultures, female gender, prolonged preoperative stent time > 1 month, and patients with sepsis at the time of initial stenting. To improve sepsis rates, procedural alterations such as the use of disposable ureteroscopes have been introduced, as …

Brachial Artery Aneurysm After Arteriovenous Fistula Ligation Status Post-Kidney Transplant, Alyssa Imperatore, Justin Adibi, Rahul Sharma, Yury Bak

Rowan-Virtua Research Day

Arteriovenous fistulas (AVF) are the most common and effective method of receiving hemodialysis; However, these access techniques do not come without consequence. Aneurysmal degeneration after creation and even years after ligation of such AVF can occur. This is still considered a rare complication. A true brachial artery aneurysm has an overall incidence of 0.17% among peripheral artery aneurysms. Factors that increase incidence of this complication include trauma, age and immunosuppression. Research on this topic is becoming more prevalent, but more answers are still needed. Below is a case of brachial artery aneurysm presenting years after AVF ligation in a patient …

Bilateral Lower Extremity Ischemia Following Cardiac Catheterization, Moses Avedikian, Alan Lucerna, Trent Malcolm

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Acute limb ischemia is a rare yet limb-threatening presentation where rapid diagnosis and intervention is warranted. Bilateral lower extremity ischemia can be a rare complication following procedures, such as a cardiac catheterization with access obtained in the groin. We describe a case of a 79-year-old female who presented with bilateral lower extremity ischemia following a cardiac catheterization 2 weeks prior. The patient underwent CT angiography, which demonstrated occlusion with no contrast present in the bilateral femoral arteries.

Incidental Malrotation In Adolescent Diagnosed With Appendicitis, David Ho, Jinsy Jacob, Russell Mordecai, Adam Richards

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17-year-old male patient with a history of autism presenting with right lower quadrant pain that started in the morning. The appendix was not able to be visualized by ultrasonography. An abdominal and pelvic CT with contrast showed a dilated appendix with surrounding inflammation. Malrotation was not identified on CT Scan. Patient was transferred to a nearby Children’s Hospital for laparoscopic appendectomy. During the procedure, the pediatric surgeon noted that initially, neither the appendix nor cecum was present in the right lower quadrant. This case represents an uncommon finding for a patient in the adolescent age group.