Medicine and Health Sciences Commons^™

Pneumocephalus – Epidural Injection Nightmare, Mohammad A. Rattu, Frank A. Wheeler

Rowan-Virtua Research Day

Pneumocephalus (pneumatocele or intracranial aerocele) is defined as the presence of air in the intracranial space and most commonly occurs after a traumatic event (most commonly head or facial injury), epidural injection, cranial surgery, However, it may also be spontaneous. Classified into simple and tension types, the presentation varies based on severity and progression. Pneumocephalus with onset less than 72 hours prior to presentation is defined as acute, in contrast to a delayed presentation greater than the given timeframe. Symptoms vary based on the amount of air that is present as well as the exact location within the cranial cavity. …

Evaluation Of Unexplained Bone Fractures In A 3-Month-Old Infant – A Case Report, Hannah Ngo, Rachel Silliman Cohen

Rowan-Virtua Research Day

Child physical abuse is a significant cause of injury in infants and young children and can present in a variety of ways. Failure to recognize abuse in infants and young children can be life-threatening and is often recurrent until safety interventions occur. Consequently, it is of paramount importance that providers strongly consider child physical abuse on the differential, along with metabolic bone disease and accidental traumatic injury, when evaluating fractures in young children and infants. This case report will focus on the evaluation of a 3-month-old male infant who was admitted to the hospital with irritability and decreased right arm …

Ultrasound Versus Radiography For Evaluating Surgical Necrotizing Enterocolitis, Sayed H. Aftab, Santiago Martinez-Correa, Minh-Huy Huynh, Wondwossen T. Lerebo, Jorge Delgado, Rebecca Denis, Misun Hwang

Rowan-Virtua Research Day

Purpose:

Necrotizing enterocolitis (NEC) is an abdominal inflammatory condition that is common in premature neonates. Although abdominal radiograph (AR) remains the imaging standard for NEC, it may miss up to 50% of early signs of NEC and has been described to have a sensitivity as low as 15.4% for detecting pneumoperitoneum. Abdominal ultrasound (US) is portable, non-invasive, and allows real-time bowel integrity, movement, and perfusion assessment. We aim to evaluate the concordance between US and AR in detecting NEC features and the diagnostic performance of both modalities in detecting pneumoperitoneum.

Methods and materials:

We conducted an IRB-approved retrospective, cross-sectional, single-center …

Case Report: Epinephrine-Containing Topical Anesthetic Gel Inducing Systemic Epinephrine Toxicity, Md Fateha, Philip Willsie

Rowan-Virtua Research Day

Systemic epinephrine toxicity is a rare complication following inadvertent or excessively large or rapid subcutaneous, intramuscular or intravenous administration. Signs and symptoms of epinephrine toxicity include rapid onset of transient agitation, hypertension, tachycardia, lactic acidosis, and dysrhythmias with potentially fatal consequences. In this case report, we present a 33-year-old female who experienced epinephrine toxicity following the use of a topical anesthetic cream containing lidocaine and epinephrine. The patient had multiple applications to her chest before and during tattoo placement which led to tachycardia, elevated blood pressure, headache, chest pain, nausea, vomiting, and anxiety. The patient was brought into the ED …

Handheld Bedside Pocus In The Evaluation Of Neck Swelling: A Case Of Ludwig's Angina, Alex Gechlik, Frank Wheeler, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Ludwig's angina is a rare and life threatening cellulitic infection, first described by German physician, Wilhelm Frederick Von Ludwig in 1836, as a gangrenous infection of the soft tissue floor of the mouth and neck. The potential to spread rapidly to contiguous tissues surrounding the upper airways, notably the glottis, resulted in Ludwig's angina carrying a high mortality rate near 50% in the pre- antibiotic era. It necessitates rapid detection and management to assure respiratory compromise does not occur. This case study is novel as it illustrates handheld bedside POCUS utilization in diagnosing Ludwig’s Angina.

Herpesviriae Infection Of The Corneal Endothelium, Behnam Rabiee, Chandani Patel, Mansab Jafri, Hamad Hussain, Michael Gaspari, Muhamad Festok, Imtiaz Chaudhry, Iftikhar Chaudhry, Asim Farooq

Rowan-Virtua Research Day

Background

- The corneal endothelium plays a vital role in maintaining corneal clarity by regulating the amount of fluid in the corneal stroma.

- Corneal endotheliitis is defined as inflammation of the corneal endothelial layer that leads to corneal edema and haziness, and subsequent loss of vision.

- Most common causes include cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella zoster virus (VZV).

- Because corneal endothelial cells cannot regenerate following injury, early diagnosis is essential in proper management and preventing loss of corneal endothelial cells.

In this review we aim to gather the most recent knowledge on viral corneal …

A Rare Case Of Left Main Vasospasm Resulting In Sudden Cardiac Death, Trinava Roy, Anjeli Patel, Tania Maheshwari, Vasu Palli

Rowan-Virtua Research Day

Background: Coronary artery vasospasm (CAV) is transient spasm of a coronary artery that can lead to cardiac ischemia. We present a case with left main (LM) CAV identified on electrocardiogram (ECG) and cardiac catheterization resulting in appropriate therapy.

Case: A 52 year old female with months of spontaneously resolving episodic neck pain, flushing, and diaphoresis presented to the emergency department after a resuscitated cardiac arrest. Initial ECG was without evidence of ischemia, however high-sensitivity troponin (522) was elevated. Telemetry monitoring and ECG showed transient ST elevations in V1 and diffuse ST depressions with left bundle branch block. LV Function was …

Case Report: Carbon Monoxide Poisoning: A Sleuth, Joel Collins, Wayne Tamaska, Anna Barton, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 18 year old male who presented via EMS who was called for an unconscious male in his car diagnosed initially with opioid overdose and later found to have carbon monoxide poisoning. The differential diagnosis of carbon monoxide poisoning is someone broad and non specific, but in general, carbon monoxide poisoning can be initially elusive in diagnosis and requires continued consideration. This remains true especially in this case of an unconscious male with initial responsiveness to naloxone. It is predictable that as with time the preponderance and relative commonality of this condition will decrease with …

The Utility Of An Inpatient Consult For Paradoxical Vocal Fold Motion, Pankti P. Acharya, Jason Cohn

Rowan-Virtua Research Day

Paradoxical vocal fold motion (PVFM) is vocal fold adduction during inspiration

Patients often present with dyspnea, throat tightness, and cough

Common risk factors that predispose patients to PVFM include gastroesophageal reflux disease, psychiatric disease, chronic cough, airway irritation, and female gender

This study was conducted to identify possible risk factors and associated conditions for PVFM; additionally, a novel scoring system was developed to aid in diagnosis of PVFM

Initial Multiple Sclerosis Diagnosis In The Emergency Department, Adam Kandil, James Espinosa, Henry Schuitema

Rowan-Virtua Research Day

Multiple sclerosis is a chronic autoimmune disease consisting of inflammation, demyelination and loss of axon integrity in the central nervous system. Like many autoimmune diseases, its severity, initial presentation and symptomatology vary. MS is typically onset in young adults between twenty to forty years old, and has been found two-three times more likely in women than in men. As a chronic illness, like many others, it can present in the emergency department as an undifferentiated neurologic complaint. This is a case report of new onset multiple sclerosis in the emergency department, outlining the importance of a broad set of differential …

Spontaneous Conus Medullary Infarction In The Absence Of Cardiovascular Risk Factors, Bavica Gummadi, Jaffer Ahmed, Swarna Rajagopalan

Rowan-Virtua Research Day

Spinal cord infarction (SCI) is rare and most often occurs in individuals with predisposing cardiovascular risk factors and traumatic injuries

As there are no distinct diagnostic criteria for SCI, diagnosis is difficult in patients presenting without predisposing factors and is often mistaken for transverse myelitis.

Delay in early diagnosis contributes to the high case fatality rate of SCI.

This case highlights the importance of including SCI in the differential of a patient with acute paraparesis even in the absence of co-existing risk factors.

Septic Arthritis With Concomitant Pseudogout, Ravin Patel, James Schuck, Nicole Zucconi, David Aderholdt

Rowan-Virtua Research Day

Monoarticular joint pain is a common complaint, however it demands a broad differential diagnosis. These differentials include fracture, dislocation, septic arthritis, gout, pseudogout and several others. The diagnosis of septic arthritis requires a high index of suspicion as early diagnosis is a vital part of initial treatment.

We present a case with multifactorial joint pathology contributing to a patient’s presentation, specifically septic joint and pseudogout. The incidence of these entities being present in the same patient, let alone the same joint, is not well documented in the literature.

The presentation of these diseases have a multitude of similarities and differences, …

The Efficacy Of Mirnas As A Diagnostic Tool For Endometriosis, Maura Franey

Capstone Showcase

Abstract

Introduction: Endometriosis is a chronic inflammatory gynecological condition. Laparoscopic abdominopelvic exploration is the gold standard of diagnosis, but is not performed until patients experience severe symptoms. This review analyzes the levels of circulating micro-RNAs (miRNAs) (I) for diagnosis of endometriosis (O) in women diagnosed with endometriosis (P) compared to laparoscopic exploration (C).

Methods: A literature search was conducted through PubMed and Cochrane Library in November 2019. A total of nine articles consisting of case-control or systematic reviews were selected based on publication date, main outcome, and the use of miRNAs or laparoscopy for diagnosis of endometriosis.

Results: The eight …

Efficacy Of Anti-Mullerian Hormone In The Diagnosis Of Polycystic Ovarian Syndrome, Cassidy Prewitt

Capstone Showcase

Introduction: Polycystic ovarian syndrome (PCOS) is a complex condition that presents with a wide variety of symptoms. The PCOS diagnosis standard is the Rotterdam criteria, which includes hyperandrogenism, oligo-anovulation, and polycystic ovarian morphology (PCOM). Transvaginal ultrasounds have traditionally been used to evaluate PCOM, however, they are highly dependent on technician skill. This paper will evaluate research regarding the use of anti-Mullerian (AMH) in PCOS diagnosis as an alternative to transvaginal ultrasound.

Methods: A literature search was conducted using PubMed and Academic Search Ultimate in January 2020. A total of eight articles were selected based on relevance to the research topic …