Diseases Commons^™

Persistent Neurocognitive Impairment And Neurological Complications Following Covid-19: Challenges Of The Long Covid Syndrome, Timothy Wong, Sung Kang, Munaza Khan

Rowan-Virtua Research Day

Coronavirus disease 2019 (COVID-19) is a highly contagious respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2).(1) As of April 23, 2021, there are close to 150 million cumulative cases, with over 3 million deaths worldwide.(2) In terms of clinical presentation, individuals afflicted with COVID-19 vary greatly in terms of their disease progression and symptomatology.(3,4) During the acute phase of COVID-19, patients may experience flu-like symptoms including fever, cough, dyspnea, headache,(5,7) though gastrointestinal, renal, hepatological, rheumatological, and neurological symptoms and complications have been reported.(8,9) Recently, there has been increasing interest in the chronic sequelae of COVID-19.(10). One …

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

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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 …

A Peculiar Presentation Of Cardiac Sarcoidosis As Third-Degree Atrioventricular Heart Block Complicated By Right Ventricle Perforation, Yash Suthar, Pooja Patel, Nikhita Kothari, Kristofer Hillegas

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• Cardiac sarcoidosis is a rare, inflammatory multisystem disorder that manifests as noncaseating granulomas of multiple organs.

• The clinical presentation of sarcoidosis is variable and may be underrecognized by clinicians.

• Individuals may be asymptomatic during their lifetimes and may be incidentally diagnosed with the disease for the first-time during autopsy.

• Patients with cardiac involvement of sarcoidosis may initially present with complications including arrhythmias, heart block, bundle branch block, congestive heart failure, pericardial effusion, pulmonary hypertension, and/or sudden cardiac death.

Assessment Of Factors Preventing Adequate Decline In Cervical Cancer Rates Amongst Minority Women In New Jersey, Rosie Wenrich, Jillian Baker

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Background

• Nationally declining cervical cancer rates are still high amongst minority women in NJ, with Hispanic women being affected the most.

• The Human Papilloma Virus (HPV) is the most common sexually transmitted infection and can lead to cervical cancer

• Administration of the 9-valent HPV vaccine can prevent infection and progression to cancer

• Regular cervical cancer screenings allow for better outcomes

• Various barriers prevent people with a cervix receiving the vaccine

• Various barriers prevent people with a cervix aged >/= 30 from receiving regular cervical cancer screenings

Conclusions

• Improved physician recommendation is required for the …

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

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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.

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.

Case Report: Covid-19 Associated Guillain-Barre Syndrome, Matthew Aharonov, Neelesh Parikh, James Espinosa, Alan Lucerna

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We report a case of a 72-year-old female who presented to the emergency department with a complaint of generalized weakness. The patient was found to have ascending muscle weakness and subsequently diagnosed with Covid-19 related Guillain-Barre Syndrome. Our patient was negative for Campylobacter jejuni. It is noteworthy that the patient did not have fever, respiratory symptoms or loss of the sensation of taste.

Cushing’S Reflex And Bradycardic Arrest In Cryptococcal Meningitis, Scott Briggs, Trent Malcolm

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Cushing’s reflex is a physiologic response to maintain cerebral perfusion pressure with elevated systolic blood pressure, widened pulse pressure, and bradycardia occurring in the setting of elevated intracranial pressure (ICP). The proposed mechanisms for reflexive bradycardia include ischemia to medullary brain tissue and compression of the intracranial segment of the vagus nerve leading to parasympathetic activation. (1) In acutely elevated ICP, bradycardia is a late finding of worsening intracranial pathology suggestive of impending herniation and cardiovascular collapse.

Cryptococcal meningitis has been identified by Infectious Disease Society of America for its association with elevated ICP. (2) Variety of pathogenic mechanisms occurring …

Dynamic Left Ventricular Obstruction Post Transcatheter Aortic Valve Replacement (Tavr): The “Suicide Lv” Phenomenon, Brian Chen

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• The transcatheter aortic valve replacement (TAVR) has become a relatively common treatment option for aortic stenosis, especially given the growing number of older patients with severe degenerative aortic stenosis

• While the procedure is overall very safe, there are still a number of potentially serious complications including bleeding, stroke, and cardiac tamponade. One rare complication is a dynamic left ventricular obstruction post valve deployment, which has been called the “Suicide LV” phenomenon.

• Rapid hemodynamic compromise resulting from this can result in significant morbidity and mortality if not diagnosed in time.

• Given the increasing frequency of patients undergoing …

Nutrition Education Intervention For Children In Low Socioeconomic Neighborhoods, Archana Menon, Kasmier Viciosi, Joshua Nsubuga

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Childhood obesity is a public health epidemic affecting 18.5% of children and adolescents in the United States. Children who are obese are more likely to obese as adults. Obesity leads to a number of comorbidities including chronic conditions like high blood pressure, Type II diabetes, and heart disease. Low socioeconomic status (SES), lack of healthy food access, and urban neighborhoods have been associated with childhood obesity. Additionally, convenience stores and other low-price stores tended to display and promote junk foods by the main entrance, whereas supermarkets and higher-income stores tended to display fruits and vegetables. We want to combat these …

Case Report: Post-Partum Headache, Alaleh Ebrahimi

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Cerebral venous sinus thromboses are rare and occur in 5 people/1,000,000, more commonly in women that are pregnant at about 202/100,000 deliveries with an 11.63% mortality rate. It is believed that pregnancy being a hypercoagulable state is one of the main reasons that it is more common in pregnant and post-partum women. Common symptoms include sudden onset headache, blurry vision, focal neuro deficits, seizures and altered mental status.

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

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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 …

Rare Variant Of Porokeratosis: A Case Report, Nardin Awad

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There are 5 clinically distinct variants of porokeratosis, including classic porokeratosis of Mibelli, disseminated superficial (actinic) porokeratosis, linear porokeratosis, punctate porokeratosis, and porokeratosis palmaris et plantaris disseminate. Porokeratosis ptychotropica (PP) is the sixth, lesser-known variant of the spectrum. PP is characterized by verrucous plaques, often resembling psoriasis plaques, that affect the buttocks, most commonly the gluteal cleft, and can also involve the extremities, most commonly the lower legs and feet. Due to its characteristic verrucous appearance, designations such as verrucous or hyperkeratotic porokeratosis are occasionally used. Besides its predilection for specific locations, PP also has a significant predilection for men …

The Application Of Point-Of-Care Ultrasound In Ed Intubations And Airway Access: A Systematic Review, Frank Wheeler, James Espinosa, Alan Lucerna, Jeffrey Gardecki

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Intubation is an essential procedure performed on a routine basis in the emergency room. Unsuccessful intubations are associated with deleterious outcomes. A systematic review was performed to investigate the accuracy of point of care ultrasound (POCUS) in successful Endotracheal Tube (ET) tube confirmation, utilizing ultrasonography, identification of the cricothyroid membrane utilizing ultrasound, and dynamically during use of ultrasonography in the process of intubation. This review demonstrated high sensitivity and specificity for ultrasound confirmation of ET tube placement, high success rate in ultrasound-guided intubation, and lower than expected accuracy in identifying the cricothyroid membrane. Ultrasonography should be considered for ET tube …

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

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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.

Case Of New Onset Alice In Wonderland Syndrome In Adolescent After Prolonged Hospitalization, Michaela Margolis, Timothy Wong, Richard Hadi

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Alice in wonderland syndrome (AIWS) has been described as body image illusions involving distortions of the size, mass, or shape of the patient’s own body or its position in space, often occurring with depersonalization and derealization. Most cases typically affect young children.

Common distortions are micropsia, macropsia, metamorphopsia, and pelopsia.

The term was adopted from the book by Lewis Carroll, wherein the main character perceived her size and shape to change in different scenarios.

These distortions are often expressed as sensory perceptions rather than illusions or hallucinations, and are often distressing to the patient.

AIWS onset has been found to …

Flexor Tenosynovitis After Bite By Sugar Glider, Dominick Siconolfi, James Espinosa, Alan Lucerna, Russell Mordecai

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Flexor tenosynovitis is one of the few orthopedic emergencies, often first identified in the emergency department. Pyogenic flexor tenosynovitis is an infection of the flexor tendon sheath of a finger causing local inflammation and tissue destruction. The pathognomonic symptoms of flexor tenosynovitis are known as Kanavel’s signs, a constellation of symptoms that include: pain with passive extension of the finger, tenderness over the flexor tendon sheath, fusiform swelling of the affected finger, and the finger held in passive flexion. The most common cause of flexor tenosynovitis is penetrating trauma into the flexion tendon sheath. Our case involves a 59-year-old male …

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

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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 …

Triad Of Acute Pancreatitis Coexisting With Diabetic Ketoacidosis And Very Severe Hypertriglyceridemia Successfully Resolved With Insulin Therapy Alone, Akash Patel, Monica Patel, Yvette Wang

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Diabetic ketoacidosis (DKA) is known to cause mild elevations in triglyceride levels.

Severe hypertriglyceridemia (HTG) is a well-known cause of acute pancreatitis; however, in unique cases, DKA has been shown to cause severe HTG leading to the development of acute pancreatitis (AP).

HTG causing AP only accounts for 1-4% of cases of AP

From the few cases in literature that have reported this triad of DKA, HTG, and AP, even fewer have shown to be successfully treated with insulin therapy alone with the severe degree of HTG that we discuss.

In our case, we have treated a triad of DKA, …

Effect Of High Intensity Interval Training Vs Low Intensity Training On Fat Loss In Patients With Obesity, Jonathan Aaron Deck, Adarsh Gupta

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Nowadays, there are several exercise modalities to lose weight, retain, and or build lean body mass. A widely known training philosophy that has gained increased popularity is high intensity interval training (HIIT). HIIT is based on exercising at submaximal or maximal intensity for a brief period then reducing work to minimal intensity for a longer duration in a series of repeated bouts. The benefit of HIIT is to increase fat loss through the scientific principle of EPOC (excess post exercise oxygen consumption). Low intensity training (LIT) also has its benefits in that it is more sustainable but with the caveat …

Meralgia Paresthetica As A Complication Of Laparoscopic Cholecystectomy In A Post Partum Teenager, Puthenmadam Radhakrishnan, Wajihah Memon, Prasanna Tati

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An 18 year old G1P1 female, 3 months postpartum presented to the emergency department with abdominal pain that was diagnosed as cholelithiasis and choledocholithiasis. Following a cholecystectomy surgery, the patient developed weakness and gait abnormality that was diagnosed as neuralgia.

Meralgia paresthetica is such an understudied diagnosis that its incidence is unknown. Patients who are 30-85 years old, obese, diabetic, and/or pregnant are at an increased risk for the condition. This case calls attention to the underdiagnosis of meralgia paresthetica in pediatric patients with comorbidities. As aforementioned risk factors increase in the pediatric population due to societal and environmental factors, …

Stercoral Colitis Leading To Hypotension And Ivc Syndrome With Respiratory Failure Following Fecal Disimpaction, Kelly Schuitema, Nicholas Tomasello

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Constipation is an extremely common chief complaint in the emergency department, contributing to approximately 700,000 emergency department visits in 2011. Severe constipation can result in stercoral colitis, which in turn can lead to development of ulceration and colonic perforation leading to fatal peritonitis. As a result, prompt recognition and treatment of this condition with bowel cleansing and fecal disimpaction are often recommended. Here, we will discuss a case of a 62-year-old male with a history of schizoaffective disorder who came into the Emergency Department (ED) hypotensive with stercoral colitis secondary to severe constipation. Following bedside fecal disimpaction, the patient developed …

Alteplase Used In A Child With An Acute Ischemic Stroke, Shah Nawaz Chaudhary, James Espinosa, Alan Lucerna, Adam Richards

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Stroke, also known as cerebrovascular accident (CVA), is a neurological injury caused by inadequate brain perfusion due to either ischemia or hemorrhage. There is an abundance of literature on the management of ischemic strokes in adults and this has led to well-defined diagnostic and treatment guidelines. However, the management of pediatric ischemic strokes is currently based on clinical experience of experts, recommendations of consensus guidelines, case studies and extrapolation from adult clinical trials. In this case report, a pediatric patient suffering from an ischemic stroke is successfully treated with IV alteplase (tPA).

Atypical Presentation Of Non-Aneurysmal Subarachnoid Hemorrhage, Aleks Spirollari, James Espinosa, Kevin Dwyer

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When most clinicians think of subarachnoid hemorrhages (SAH), they think of “most severe headache of my life” as the most common chief complaint. However, it is only reported in about 70% of patients with SAH. Other symptoms may include nausea and/or vomiting, stiff neck, visual disturbances, loss of consciousness, weakness, and seizures. Patient history may involve previous SAH, hypertension, oral contraceptives in women, recent trauma, family history of intracranial aneurysms, history of smoking, alcohol, and drug use. However, there are atypical causes of SAH that may be missed upon initial evaluation for patients that may not have the above mentioned …

Case Report: Splenic Infarct S/P Sleeve Gastrectomy, Dhara Patel, James Espinosa, Kishan Patel

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A case of splenic infarct s/p sleeve gastrectomy is presented. A 28-year-old female presented with LUQ pain s/p sleeve gastrectomy POD7. CT scan with IV contrast revealed an area of nonenhancement at the superomedial aspect of the spleen consistent with a small splenic infarct. She was transferred out to the hospital under the service of the surgeon who had performed her sleeve gastrectomy. Splenic infarction is a rare post-op complication s/p sleeve gastrectomy. The spleen has dual blood supply via the splenic artery and short gastric arteries making complete infarction rare. It is usually diagnosed via CT with IV contrast. …

Dazed And Confused: A Complex Migraine Variant, David Parkes, Christopher Schwartz, Alan Lucerna, James Espinosa, Bhumi Shah

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While most migraine headaches are benign, easily treatable, and able to be discharged home, there is a small percentage that blur the lines and raise concern for neurological compromise. We describe one such rare case of a 26-year-old male with no known history of migraine that presented to the emergency department with acute onset obtundation, confusion, aphasia, and weakness. Labs and imaging of the patient were grossly unremarkable. Treatment with a migraine cocktail and valproate led to full recovery within 24 hours of initial presentation. Infrequently, complex migraines can present with significant and concerning mental status changes. Early imaging, neurologic …

From Left Arm Numbness To Incidental Pituitary Macroadenoma, Melissa Itidiare Locke

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Pituitary adenomas are the most common tumors in the sella turcica. The symptoms of vision loss or change is due to the anatomical location of the pituitary tumor beneath the optic nerve. (2) As the tumor grows in size it can compress the optic nerve and vision changes will occur. Our case demonstrates a 40 year old male who had one brief 1 time episode of blurry vison and dull intermittent headaches that was not debilitating in nature. A discovery of pituitary adenoma prior to onset of symptoms of constant vision changes or elevated hormones are crucial to a more …

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

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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 Dopamine D3 Receptor Antagonist Vk4-40 Attenuates Morphine-Induced Hyperactivity But Not Cocaine-Induced Hyperactivity In Mice, Desta M. Pulley, Jessica J. Debski, Daniel Manvich

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In light of the increasing rates of opioid abuse in the US, the search for viable medications to treat opioid abuse disorder (OUD) has become ever more urgent. Opioids exert their abuse-related effects in part by indirectly increasing dopamine (DA) neurotransmission in the mesolimbic system, a dopaminergic projection arising in the ventral tegmental area and terminating in the nucleus accumbens. The DA D3 receptor (D3R), which belongs to the D2 family of dopamine receptors (D2, D3 , D4 receptor subtypes), is highly expressed in these brain regions and has shown strong potential as a pharmacotherapeutic target for the treatment of …

Acute Flecainide Toxicity Treated With Intravenous Lipid Emulsion, Joseph S. Schreiner

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Flecainide is a Vaughn-Williams class IC antiarrhythmic used in the treatment of supraventricular tachycardias including atrial fibrillation. While overdose is rare, its negative effects on cardiac inotropy and conduction pathways can be readily fatal. This is further complicated by the redistribution of the drug out of the plasma and deposition in tissue, rendering reversal by sodium bicarbonate (the standard first line treatment agent) relatively ineffective. A case study of the successful treatment of hemodynamic collapse using sodium bicarbonate in conjunction with intravenous lipid emulsion (ILE) in a patient who ingested a large amount of flecainide in a suicide attempt will …