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A 3-year-old boy presented to the emergency department with new onset lower extremity weakness after falling from a high chair two days prior. On examination, he had decreased strength and sensation in both lower extremities. Cervical spine films and CT were normal. He received a diagnosis of spinal cord injury without radiographic abnormality (SCIWORA) and was admitted to the neurosurgery service for MRI and further evaluation.
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SCIWORA Power Point
A 3 year old boy presented with new onset lower extremity weakness after falling from a high chair two days prior. On examination, he had decreased strength and sensation in both lower extremities. Cervical spine films and CT were normal. He received a diagnosis of SCIWORA (spinal cord injury without radiographic abnormality) and was admitted for MRI and further evaluation by neurosurgery.
Spinal cord injury without radiographic abnormalities (SCIWORA)
- SCIWORA refers to spinal cord injury without radiographic abnormality. It commonly occurs in children and involves the cervical spine.
- MRI is now considered the gold standard for diagnosis as it can detect abnormalities not seen on plain radiographs or CT scans like edema, hemorrhage or cord transection.
- Treatment involves immobilization, IV steroids may help, and surgery is indicated if MRI shows instability, compression or worsening neurological status. Prognosis depends on initial neurological status and MRI findings, with most patients showing improvement but some facing permanent impairments.
The physical manifestations of shaken baby syndrome. journal of forensic...
The physical manifestations of shaken baby syndrome can include:
1) Internal injuries like cerebral edema, retinal and cerebral hemorrhaging, bone fractures both old and new, cerebral atrophy, hydrocephalus, and cervical spine injury despite a lack of external injuries.
2) Hallmark symptoms include lack of external injury, bradypnea or apnea, changes in level of consciousness, bradycardia, bulging fontanels, and seizure activity.
3) Common physical findings that can help diagnose shaken baby syndrome include retinal hemorrhages present in 75% of cases, hematomas which are the most common injury, and cerebral atrophy found in over 90% of suspected intentional injury cases. Accurate
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2) The author's hypothesis is that vaccination or infection damages the beta cells in the pancreas, causing hypoinsulinemia. This inhibits cellular uptake of vitamin C, leading to "tissue scurvy" and failure of proteins involved in coagulation. This results in the bruising, bleeding, and fractures seen in the "triad".
3) Blood tests in the cases showed markers of coagulation disorders, vitamin deficiencies, and
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1) A 9-month-old male infant presented with repetitive seizures, poor muscle tone, and an enlarged head circumference. Imaging showed a subdural hematoma, initially leading to a diagnosis of shaken baby syndrome.
2) Further examination found pale skin, sparse hair with a pili torti pattern, low copper and ceruloplasmin levels, confirming a diagnosis of Menkes disease.
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Recommended
SCIWORA Power Point
A 3 year old boy presented with new onset lower extremity weakness after falling from a high chair two days prior. On examination, he had decreased strength and sensation in both lower extremities. Cervical spine films and CT were normal. He received a diagnosis of SCIWORA (spinal cord injury without radiographic abnormality) and was admitted for MRI and further evaluation by neurosurgery.
Spinal cord injury without radiographic abnormalities (SCIWORA)
- SCIWORA refers to spinal cord injury without radiographic abnormality. It commonly occurs in children and involves the cervical spine.
- MRI is now considered the gold standard for diagnosis as it can detect abnormalities not seen on plain radiographs or CT scans like edema, hemorrhage or cord transection.
- Treatment involves immobilization, IV steroids may help, and surgery is indicated if MRI shows instability, compression or worsening neurological status. Prognosis depends on initial neurological status and MRI findings, with most patients showing improvement but some facing permanent impairments.
The physical manifestations of shaken baby syndrome. journal of forensic...
The physical manifestations of shaken baby syndrome can include:
1) Internal injuries like cerebral edema, retinal and cerebral hemorrhaging, bone fractures both old and new, cerebral atrophy, hydrocephalus, and cervical spine injury despite a lack of external injuries.
2) Hallmark symptoms include lack of external injury, bradypnea or apnea, changes in level of consciousness, bradycardia, bulging fontanels, and seizure activity.
3) Common physical findings that can help diagnose shaken baby syndrome include retinal hemorrhages present in 75% of cases, hematomas which are the most common injury, and cerebral atrophy found in over 90% of suspected intentional injury cases. Accurate
Autoimmunity and non
1) The document discusses several cases of infants who experienced fractures, retinal hemorrhages, and brain injuries. In each case, the injuries were attributed to Shaken Baby Syndrome but the author argues they were actually due to an autoimmune response triggered by vaccination or infection.
2) The author's hypothesis is that vaccination or infection damages the beta cells in the pancreas, causing hypoinsulinemia. This inhibits cellular uptake of vitamin C, leading to "tissue scurvy" and failure of proteins involved in coagulation. This results in the bruising, bleeding, and fractures seen in the "triad".
3) Blood tests in the cases showed markers of coagulation disorders, vitamin deficiencies, and
MRI markers to understand progression
MRI markers to understand progression mechanisms by Maria A. Rocca
Neuroimaging Research Unit, Institute of Experimental
Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Pain leaflet brittle bone disease
The document discusses unexplained fractures in children that may indicate brittle bone disease rather than non-accidental injury. It summarizes 128 cases referred to the author related to unexplained fractures in children living in the UK. In many cases, the author determined the children had forms of brittle bone disease like osteogenesis imperfecta or temporary brittle bone disease. For those returned to parents, no subsequent evidence of non-accidental injury was found in long-term follow-ups of over 400 patient-years. The document concludes some rare cases of brittle bone disease can be difficult to diagnose but falsely accusing parents of abuse in such cases can cause significant harm to families.
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1) A 9-month-old male infant presented with repetitive seizures, poor muscle tone, and an enlarged head circumference. Imaging showed a subdural hematoma, initially leading to a diagnosis of shaken baby syndrome.
2) Further examination found pale skin, sparse hair with a pili torti pattern, low copper and ceruloplasmin levels, confirming a diagnosis of Menkes disease.
3) Menkes disease can mimic signs of abuse like subdural hematomas due to brain atrophy and fragile blood vessels. This case highlights the importance of considering alternative diagnoses to avoid misdiagnosing child abuse.
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This document summarizes Leigh syndrome, a rare neurological disorder caused by defects in mitochondrial energy production. It describes Dr. Denis Leigh's original 1951 case report that defined the syndrome. Over time, MRI and genetic testing allowed diagnosis of different mitochondrial disorders collectively termed Leigh syndrome. Current understanding is that Leigh syndrome has various genetic causes but commonly involves symmetrical brain lesions and early developmental regression. No effective treatments exist but research continues into therapies like idebenone, sodium pyruvate, and rapamycin.
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- The history and exam should be tailored based on a child's age and development. For infants, attachment to caregivers is important to respect, and the birth history and family's coping ability are relevant.
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This document summarizes the neurological implications of von Hippel-Lindau disease. It is an autosomal dominant genetic disorder caused by mutations in the VHL tumor suppressor gene. Patients with VHL frequently develop benign tumors called hemangioblastomas in the brain and spinal cord. While these tumors are non-cancerous, they can cause neurological problems due to their location and mass effect. Younger patients and those with more tumors have worse outcomes and faster tumor progression. Regular screening and surgical removal of tumors can help prevent disability. However, hemangioblastomas remain the most common cause of morbidity and reduced life expectancy in patients with VHL disease.
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- The history and exam should be tailored based on a child's age and development. For infants, attachment to caregivers is important to respect, and the birth history and family's coping ability are relevant.
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Congenital Diseases of the Spine
This document provides an overview of congenital diseases of the spine, including:
1. Spinal dysraphism - abnormalities involving incomplete closure of bone and soft tissues in the spine. This includes spina bifida.
2. Congenital spinal stenosis - a narrowing of the spinal canal that can put pressure on the spinal cord.
3. Scoliosis - abnormal curving of the spine to one side.
4. Tethered cord syndrome - the lower end of the spinal cord is stuck down in the spinal canal.
5. Syringohydromyelia - a disorder where a fluid-filled cyst forms within the spinal cord.
6. Several other conditions like neurofibromat
Traumatismo de columna cervical
1) El documento describe la anatomía y lesiones más comunes de la columna cervical. 2) Incluye las causas, exámenes de imagen recomendados como TC y RM, y clasificaciones de lesiones como fracturas del axis y luxaciones vertebrales. 3) Explica cómo evaluar la estabilidad de las lesiones y el riesgo de daño a la médula espinal.
SPiNAL INJURY AND IT'S CURRENT MANAGEMENT : CME -
This document provides an overview of spinal injuries including:
1. It defines spinal injuries as injuries to the spinal column, spinal cord, or both and classifies them.
2. It discusses the epidemiology, mechanisms, clinical features, investigations, diagnosis, management, and prognosis of spinal injuries.
3. It describes the anatomy and functions of the spine, mechanisms of primary and secondary spinal cord injury, and factors that affect the severity of spinal cord lesions.
Espondilolistesis
El documento describe la espondilolistesis, incluyendo su definición, epidemiología, biomecánica, clasificaciones, historia natural y tratamientos. La espondilolistesis implica el deslizamiento de una vértebra sobre la inferior, generalmente en L5-S1. Se clasifica según su origen y grado de deslizamiento. El tratamiento conservador es usualmente exitoso, mientras que la cirugía se reserva para casos de progresión, compromiso neurológico o falla del tratamiento conservador. Se introduce una nueva clasificación biomecán
Espondilolisis y espondilolistesis
La espondilólisis consiste en la rotura de la lámina vertebral, separando la articulación facetaria del resto de la vértebra. Puede ser congénita, debido a que la lámina no se osifica completamente, o traumática, por microtraumatismos repetidos. La espondilolistesis ocurre cuando una vértebra se sale de posición sobre la inferior, generalmente entre la quinta lumbar y la primera sacra. Los síntomas incluyen dolor lumbar y en las piernas. El diagnóstico se realiza con rayos X, TC o IRM
Espondilolistesis
La espondilolistesis es el deslizamiento de una vértebra sobre la siguiente. Puede clasificarse según la causa en displásica, ístmica, degenerativa o traumática. La clasificación de Meyerding determina el grado de deslizamiento. Los síntomas incluyen dolor lumbar, ciática y alteraciones sensitivas. El diagnóstico se realiza mediante radiografía simple de columna lumbar.
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CNS.pptx
The patient is a 6 year old girl presenting with fever, headache, vomiting and seizures over the past 3 weeks. She is now unconscious with left hemiparesis and 6th cranial nerve palsy. The differential diagnoses include meningitis. Investigations would include lumbar puncture. Management would involve antibiotics, anticonvulsants, monitoring of vital signs, and supportive care.
HEAD INJURY Dr. Shitsama.pdf
1. Severe head injury is a leading cause of mortality and disability worldwide, especially in children under 5, teens and young adults, and those over 70. In Kenya it accounts for 10-14% of brain injuries.
2. The pathophysiology of brain injury involves both primary injury on impact and secondary injury developing over hours to days from processes like edema, increased intracranial pressure, and ischemia.
3. Treatment involves stabilizing the patient's airway, breathing, and circulation according to ATLS protocols, assessing neurological status including Glasgow Coma Scale, monitoring for increased intracranial pressure, and managing complications like seizures. S
Pediatric neurology for ug part 1
This document contains information from a pediatric neurology department including goals, common exam questions, topics related to relationships and neuroanatomy/neurochemistry, exam answers, clinical cases, imaging findings, and treatment guidelines. It discusses various pediatric neurological conditions like seizures, meningitis, hydrocephalus, neurocutaneous syndromes, and more. The document is intended as a study aid and reference for a pediatric neurology exam.
OSCE IN PEDIATRICS (March 4th 2008) SGRH
This OSCE document describes 12 clinical spots or cases presented to a pediatric resident. For each spot, key details are provided such as the patient's history, examination findings, and any relevant investigations. The resident is asked to identify diagnoses, interpretations, treatment plans, and other clinical information. This OSCE evaluates the resident's ability to synthesize clinical data and demonstrate sound medical knowledge and reasoning for various common and important pediatric presentations.
Case Discussion - TBI
A 4-year-old female child presented to the emergency room after a fall down 3 stairs at home, experiencing head injury and multiple episodes of vomiting. She arrived in status epilepticus. Imaging showed biparietal skull fractures with no mass effect. She was admitted to the pediatric intensive care unit for management of increased intracranial pressure, seizures, hypotension requiring vasopressors, and fever. Over several days her condition gradually improved with treatment, she was weaned off support, and later discharged home on anti-seizure medications. Proper management aims to prevent secondary brain injury from factors like increased pressure, seizures, and fever.
Dr Chong Shu Ling - Paediatric head injury
The document discusses the management of a 7-year-old girl who presented to the emergency department after being hit by a taxi while crossing the road. On examination, she was crying and oriented but became agitated and drowsy. Her GCS score was assessed and she displayed abnormal flexion in response to pain. The document discusses various clinical decision rules for determining which pediatric patients with head injuries require CT imaging, including the CHALICE, PECARN, and CATCH rules. It considers the risks of radiation exposure from CT scans for children and how to balance these risks with clinical need.
Double Jeopardy: Risk in Neurology
This document presents 4 case studies to discuss barriers to correct diagnosis in neurology. Case 1 describes a woman misdiagnosed with back pain who later presented with spinal epidural abscesses. Case 2 involves a man diagnosed with labyrinthitis who later had a cerebellar infarct. Case 3 is about a woman discharged with headaches who returned with a cerebellar infarct. The document emphasizes considering alternative diagnoses and thorough neurological exams to avoid missed diagnoses.
Pediatric head injury public
This document presents a case of pediatric head injury. It discusses a case of an 11-year-old boy who was unrestrained in a motor vehicle collision and was ejected. He presented with a Glasgow Coma Scale of 4 and required intubation. Imaging showed open skull fractures, brain swelling, and hemorrhages. The document then reviews the epidemiology, pathophysiology, clinical features, decision rules, and management of minor, moderate and severe pediatric head injuries. Special considerations for pediatric head injuries include the increased risk of abuse in young children and anatomical differences that make the skull more vulnerable to injury compared to adults.
Adems
1. The document describes a case of a 4-year old boy who presented with slurred speech and difficulty swallowing along with fever and altered mental status.
2. MRI of the brain showed lesions in multiple areas including the basal ganglia, pons, midbrain, medulla, thalami and frontal cortex. CSF analysis was normal.
3. The boy was diagnosed with Acute Disseminated Encephalomyelitis (ADEM), an initial inflammatory demyelinating condition affecting multiple areas of the brain, and treated with steroids which improved his symptoms.
Musculoskeletal and the neurologic systems
A 58-year-old female presented with neck and back pain after a renal transplant. Her lab work showed elevated calcium and low hematocrit and hemoglobin. The underlying cause of her symptoms and labs is likely rapid bone mineral density loss common after renal transplant. Frequent monitoring of phosphate levels and imaging tests would help assess bone loss and inflammation.
Multiple sclerosis
This case report describes a young female patient with a diagnosis of multiple sclerosis (MS). She initially presented at age 2 with ataxia. MRI of the brain showed widespread white matter lesions. She had two relapses over the next 8 months with new neurological symptoms and MRI lesions each time. Differential diagnoses considered included acute disseminated encephalomyelitis (ADEM) but she did not meet criteria. Her disease course and imaging supported a diagnosis of pediatric MS. She was treated with steroids during relapses with clinical improvement.
Case presentation on seizure and status epilepticus
The document outlines a presentation on seizures and status epilepticus. It covers definitions, pathophysiology, classification, etiology, epidemiology, prognosis, and management of seizures. The case presentation describes a 28-year-old female who presented with status epilepticus and was treated with anti-seizure medications but later died of possible respiratory arrest. Key points discussed include different seizure types, phases of seizures, causes of seizures, prognosis, and appropriate treatment approaches.
Ct hypodensity accidpedinj_neurosurg_steinbok_poskitt
1) The document reports on 5 pediatric patients who had early diffuse cerebral hypodensities on CT scans within 5 hours of well-documented accidental head injuries.
2) All 5 patients presented with severe head injuries and immediate, unremitting coma, rapidly progressing to brain death within 48 hours.
3) This suggests that it is possible, though unusual, to develop CT hypodensities as early as 1 hour after accidental head injury in pediatric patients.
Ct hypodensity accidpedinj_neurosurg_steinbok_poskitt
1) The document reports on 5 pediatric patients who had early diffuse cerebral hypodensities on CT scans within 5 hours of well-documented accidental head injuries.
2) All 5 patients presented with severe head injuries and immediate, unremitting coma, rapidly progressing to brain death within 48 hours.
3) This suggests that it is possible, though unusual, to develop CT hypodensities as early as 1 hour after accidental head injury in pediatric patients.
Ct Hypodensity Accid Ped Inj Neurosurg Steinbok Poskitt
1) The document reports on 5 pediatric patients who had early diffuse cerebral hypodensities on CT scans within 5 hours of well-documented accidental head injuries.
2) All 5 patients presented with severe head injuries and immediate, unremitting coma, rapidly progressing to brain death within 48 hours.
3) This suggests that it is possible, though unusual, to develop CT hypodensities as early as 1 hour after accidental head injury in pediatric patients.
Benign neonatal and_infantile_ seizures_ Dr Santhosh Dash NIMHANS
Benign neonatal and infantile seizures can be difficult to diagnose but it is important to identify the benign types to avoid unnecessary treatment. The document discusses several types of benign seizures including benign idiopathic neonatal seizures (BINC), benign familial neonatal convulsions (BFNC), and benign neonatal sleep myoclonus. It also covers symptomatic seizures with good outcomes and benign infantile seizures such as benign familial infantile seizures. The clinical features, investigations, genetics, and management of these conditions are reviewed through case examples and research findings.
Barnes article
This case report describes a 21-month-old boy who presented with a Glasgow Coma Score of 3 after reportedly falling from a kitchen chair. Imaging showed subdural hemorrhage, subarachnoid hemorrhage, hypoxic-ischemic encephalopathy, and retinal hemorrhages. The autopsy revealed an impact site on the head and a fatal spinal cord injury at the cervicomedullary junction. Biomechanical analysis found that the injuries could have resulted from the described accidental fall rather than presumed nonaccidental trauma.
Barnes Article
This document describes the case of a 21-month-old boy who presented to the emergency room with a Glasgow Coma Score of 3 after reportedly falling from a standing position on a kitchen chair. Imaging showed subdural hemorrhage, subarachnoid hemorrhage, hypoxic-ischemic encephalopathy, and retinal hemorrhages. The autopsy later revealed an impact site on the skull and fatal injury to the cervicomedullary junction, as well as traumatic spinal cord injury without radiographic abnormality from T5 to T12. Biomechanical analysis could not rule out nonaccidental injury but found the injuries were also consistent with an accidental fall as described.
Febrile seizures
- A 2-year-old boy presented to the emergency department after experiencing a seizure associated with a fever of 104°F. His examination in the emergency department was normal.
- Febrile seizures are relatively common in young children, occurring in 4-8% of children between the ages of 6 months and 6 years. They are generally self-limited and do not require extensive evaluation unless prolonged or focal.
- The diagnosis of a febrile seizure must consider the possibility of central nervous system infection as the underlying cause, though for this patient the examination was normal and he likely experienced a simple febrile seizure.
Ogungbo Neurosurgeon
The document discusses cervical spine injuries and cervical spondylotic myelopathy. It presents early experience with anterior decompression, fusion and plating for cervical spine injuries in Abuja, Nigeria. It describes surgical techniques used including anterior cervical discectomy and fusion. It highlights the importance of early referral for surgery and discusses challenges including lack of intensive care and rehabilitation facilities.
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Case presentation on seizure and status epilepticus
Case presentation on seizure and status epilepticus
Ct hypodensity accidpedinj_neurosurg_steinbok_poskitt
Ct hypodensity accidpedinj_neurosurg_steinbok_poskitt
Ct hypodensity accidpedinj_neurosurg_steinbok_poskitt
Ct hypodensity accidpedinj_neurosurg_steinbok_poskitt
Ct Hypodensity Accid Ped Inj Neurosurg Steinbok Poskitt
Ct Hypodensity Accid Ped Inj Neurosurg Steinbok Poskitt
Benign neonatal and_infantile_ seizures_ Dr Santhosh Dash NIMHANS
Benign neonatal and_infantile_ seizures_ Dr Santhosh Dash NIMHANS
More from Todd Peterson
Pneumothorax Power Point
A 34-year-old man presents with 2 days of right-sided chest pain that worsens with deep breathing and radiates to his neck and shoulderblade. He has a history of tobacco use but no other medical problems. Examination finds him in no distress. Chest x-ray shows a right-sided pneumothorax. Treatment depends on size and symptoms, with small primary pneumothoraces sometimes observed as outpatients and larger or recurrent ones requiring chest tube placement in the hospital. Pneumothoraces are classified as primary spontaneous, secondary spontaneous, or traumatic based on associated lung disease or injury history.
Pneumomediastinum
A 34-year-old man presents with sharp chest pain for 2 hours following crack cocaine use. He has no other symptoms. On examination, he has a heart rate of 148, blood pressure of 98.7/105, respiratory rate of 18, and clear lungs. Chest x-ray shows pneumomediastinum. The patient is admitted for observation and treatment with oxygen and IV fluids.
Aortic dissection
A 56-year-old man presents with 4 hours of epigastric abdominal pain described as sharp and stabbing. He has a history of hypertension and coronary artery disease. On examination, he is tachycardic with cool extremities. Imaging shows an enlarged aorta, particularly for his age, which should prompt consideration of an aortic disorder as the cause of his pain. He requires aggressive blood pressure control and emergent surgical consultation given concern for aortic dissection.
Aortic dissection
A 56-year-old man presents with 4 hours of epigastric abdominal pain described as sharp and stabbing. He has a history of hypertension and coronary artery disease. On examination, he is tachycardic with cool extremities. Imaging shows an enlarged aorta, particularly for his age, which should prompt consideration of an aortic disorder as the cause of his pain. He requires aggressive blood pressure control and emergent surgical consultation given concern for aortic dissection.
Lung cancer Power Point
A 69-year-old woman presents with a 3-month history of dry cough, chest pain, weight loss, and exercise intolerance. She has a history of smoking and lung issues. Examination finds her thin but stable. Chest x-ray shows a visible mass in her right upper lung. She may need biopsy or admission depending on stability and ability to follow up as an outpatient. The presentation of lung cancer can vary but often includes nonspecific symptoms. Different types have characteristics like location and growth patterns visible on x-ray.
Pleural effusion Power Point
A 65-year-old man with a history of diabetes, hypertension, coronary artery disease, and end-stage renal disease presented with a 3-day history of dry cough and worsening shortness of breath with exertion. On examination, he had bilateral basilar rales and chest x-ray showed bilateral pleural effusions. He was admitted for supportive respiratory therapy and treatment of the underlying pleural effusions through thoracentesis or tube thoracostomy.
Tuberculosis Power Point
A 34-year-old homeless white male presented with a 5-6 week history of intermittent fever, cough producing blood-tinged sputum, and right-sided chest pain with deep breathing. Examination found decreased breath sounds in the right upper lung field. A chest x-ray showed a cavitary lesion in the right upper lobe and hilar adenopathy, suggestive of tuberculosis. The patient was discharged with instructions for close follow-up and definitive treatment, as admission was not required due to clinical stability and ability to follow-up.
Atypical pneumonia Power Point
A 67-year-old man with diabetes and hypertension presented with worsening fever, malaise, dyspnea, and abdominal pain over two days. On examination, he had a fever, rapid heart rate, diffuse lung rhonchi, and normal abdomen. A chest X-ray showed patchy infiltrates and peri-hilar prominence. Given his atypical presentation and chest X-ray findings, he was started on a macrolide or respiratory fluoroquinolone antibiotic for suspected atypical pneumonia.
Lobar pneumonia Power Point
A 76-year-old female presented with worsening dyspnea, cough producing yellow sputum, subjective fevers and chills, weakness and decreased appetite. Her vital signs and physical exam showed signs of infection. Chest x-rays revealed consolidation in the right middle lobe, suggesting lobar pneumonia. She was treated with oxygen, IV fluids, antibiotics and admitted to the hospital based on her condition.
Pulmonary Embolism Power Point
A 58-year-old female presented to the emergency room with anxiety and shortness of breath after climbing stairs. She has been feeling stressed due to social stressors and recently took a trip to Italy. On examination, she was tachycardic but her lungs were clear to auscultation. A chest x-ray showed blunted costophrenic sulci and opacity of the left lung bases indicating increased blood flow to the left lung. The patient was given oxygen and intravenous fluids, and anticoagulation therapy was started given her risk for pulmonary embolism.
Salter harris 2 Power Point
A 10-year-old boy presented with an obvious deformity to his right wrist following a football injury. X-rays showed a Salter Harris Type II fracture extending from the growth plate through the bone with part of the bone broken off. The boy's wrist was splinted and he was referred to orthopedics for follow-up.
Pitcher's Elbow Power Point
A 10-year-old male pitcher presents with right arm pain after pitching in a little league baseball game. On examination, he is rubbing his right elbow and has tenderness over the medial epicondyle. X-rays are normal but this is likely a case of pitcher's elbow or medial apophysitis from overuse. The parents and patient are instructed that the child must cease pitching for 4-6 weeks and gradually return to avoid further injury.
Salter harris 4 Power Point
An 11-year-old male presented to the emergency department after being kicked by a cow, unable to bear weight on his right leg and experiencing excruciating pain. Examination revealed swelling and bruising around the right ankle with pain on movement. X-rays showed a fracture extending from the metaphysis through the epiphysis, classified as a Salter-Harris Type IV injury. This type of injury crosses the physis and involves both the epiphysis and metaphysis, is associated with a worse prognosis than other types, and may affect growth even with perfect reduction. Orthopedic consultation was recommended for possible open reduction and internal fixation if any displacement was present.
Salter harris 1 Power Point
A 9 year old female presented to the emergency department after falling from a horse at summer camp and injuring her right wrist. She complained of pain with palpation and movement of the wrist. Examination revealed mild swelling and tenderness over the wrist, but plain films did not show any obvious abnormalities. Due to the possibility of a Salter Harris I fracture that may not be visible on initial x-rays, the patient was splinted and advised to follow up with orthopedics in 7-10 days for repeat films to check for any delayed findings.
SCFE Power Point
An 11-year-old boy presented with left hip and knee pain for over a week. On examination, he had pain with internal rotation of the left hip. The document emphasizes that slipped capital femoral epiphysis (SCFE) can present as knee pain referred from the hip, so knee complaints should prompt evaluation of the hip. Failure to diagnose SCFE can lead to avascular necrosis, so orthopedic consultation is considered emergent and SCFE is ultimately treated with surgical repair.
Pubic Diastasis Power Point
A 27-year-old male was brought to the trauma bay after a high-speed motor vehicle collision and is complaining of severe abdominal and pelvic pain. On examination, he appears pale and uncomfortable with tenderness to palpation in the lower abdomen and instability of the pelvis. Treatment should include fluid resuscitation, pain control, stabilizing the unstable pelvis to avoid movement, and evaluating for other injuries, as pelvic fractures from high-impact accidents can cause life-threatening hemorrhage or urethral injuries.
Legg calve perthes Power Point
A 7-year-old boy presented with several weeks of left hip and knee pain. On physical exam, he had decreased range of motion of the left hip, especially with internal rotation and abduction. He was diagnosed with Legg-Calve-Perthes disease, which is caused by interruption of blood flow to the capital femoral epiphysis, resulting in bone infarction and fractures. Differential diagnoses included sickle cell disease and septic hip. NSAIDs were prescribed for pain control and orthopedic follow-up was recommended.
Femoral neck fracture Power Point
A 78-year-old woman presented to the emergency department after falling at home and landing on her left hip. On examination, her left hip was tender to touch, her left leg appeared externally rotated and shortened. She was diagnosed with a left femoral neck fracture based on her mechanism of injury and physical exam findings.
Femoral neck fracture
A 78-year-old woman presented to the emergency department after falling at home and landing on her left hip. On examination, her left hip was tender to touch, her left leg appeared externally rotated and shortened. She was diagnosed with a left femoral neck fracture based on her mechanism of injury and physical exam findings.
Acetabular fracture Power Point
A 25-year-old male was brought to the emergency room after a head-on motor vehicle collision where the passenger cabin was intruded. He complained of severe right hip pain. On examination, he had a right hip deformity and tenderness. He was given pain management and an orthopedics consult, and was admitted for operative repair of an acetabular fracture.
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Sciwora
- 2. 3 year old boy is brought into ED T:98.9F P:90 R:19 BP:90/64 by parents after being sent by O2:99% pediatrician for new onset lower extremity weakness. Per the parents, the child is normally Gen: well appearing, NAD active, but woke up this morning HENT: no contusion;ecchymosis and was unable to get out of bed Chest/Resp:nml of his own accord. With further questioning, mom relates that MSK:no obvious abnormalities he fell out of his high chair 2 Neuro: 2/5 MS in bil LE with days ago but has been behaving decreased sensation to fine normally since this time. He has touch no history of seizures and mom denies that he struck his head Of note, child is unable to void during the incident.
- 4. Standard cervical spine films demonstrate no appreciable abnormality. CT scan of entire c/t/l spine and head=nml. Family receives dx of SCIWORA and child admitted to nsgy for MRI and further work up
- 5. ABC’s / standard work up including probable ct scans to r/o obvious osseous abnormalities. Studies have shown that high dose methylprednisolone if administered within 8 hours of injury is beneficial—but pro’s and con’s must be weighed (i.e. immunosuppression, etc.) Will ultimately need an MRI and inpatient evaluation by neurosurgery.
- 6. Occurs most often in pediatric population <8yo Thought to be due to elasticity of pediatric cervical spine. Is diagnosis of exclusion and will likely need MRI to evaluate for cord edema vs. ligamental injury May have up to a 4 day delay in presentation Needs an obs admission and nsgy consult. Keep neck immobilized.
- 7. http://www.wheelessonline.com/ortho/sciwora_syndr ome_spinal_cord_injury_wo_radiologic_abnormality Hauda, W.E. Tintinalli’s Emergency Medicine: A Comprehensive study Guide. Chapter 252: Pediatric Trauma. Veena, K., et al. SCIWORA-Spinal Cord Injury Without Radiological Abnormality. Indian J Pediatr 2006; 73 (9) : 829-831