The patient A 41-year-old pregnant patient at 38 weeks’ gestation was admitted for elective cesarean section. Her medical history included three pregnancies, two live births, two prior cesarean sections, anterior placenta with polyhydramnios (amniotic fluid index 35), pituitary macroadenoma, gastroesophageal reflux disease (GERD), and headaches. Echocardiogram in 2019 demonstrated an ejection fraction (EF) of 56%….
The patient A man in his forties with a history of epilepsy and ankylosing spondylitis presented with acute onset neck pain after he was found down on the ground next to his bed by his father. The patient is amnesic to the event. The challenge The care team The solution The patient was placed in…
The patient A 4-year-old child with complex form of long QT syndrome needed surgical revision of her implantable cardioverter-defibrillator (ICD) due to device malfunction. Long QT syndrome is a congenital heart condition that predisposes affected patients to suddenly develop serious heart rhythm disturbances (for example, ventricular tachycardia/fibrillation) that can be life-threatening. In addition to taking…
The patient A 12-year-old male initially was seen for significant bowing of the right tibia, causing knee pain — and his mom noted increasing deformity as he was growing older. There was concern for continued bowing of the leg, causing long-term issues with the right knee. He was having mild to moderate knee pain, which…
The Patient A 52-year-old male with a long-standing history of poorly controlled high blood pressure despite adherence to a four-drug antihypertensive regimen (including a calcium channel blocker, ACE inhibitor, thiazide diuretic and beta-blocker). The patient reported persistent systolic blood pressures in the range of 170–190 mmHg, confirmed by ambulatory monitoring. He had no evidence of…
The patient A 79-year-old man with essential tremor in the bilateral hands for at least 10 years Over the years, the severity of the tremor worsened, along with its negative impact on his life. First-line medications, propranolol and primidone, both were tried, without significant impact on the severity of tremor and the patient’s disability. Feeding…
The patient A 45-year-old man with bilateral thumb carpometacarpal joint arthritis for several years (Figures 1 and 2): He tried bracing and steroid injections, which eventually provided diminishing relief. He works as a mechanic for UPS but was having an increasingly difficult time at work due to pain and loss of pinch and grip strength….
The patient A 48-year-old male with a past medical history significant for malignant thymoma status post thymectomy and right lower lobe lobectomy, and myasthenia gravis, presented to Norton Women’s & Children’s Hospital emergency department with dyspnea on exertion (DOE). His CT was concerning for possible pulmonary embolism. His labs on this admission showed B-type natriuretic…
The patient An 18-year-old male with a history of heart transplantation for cardiomyopathy after a durable ventricular assist device presented with progressive cardiac allograft vasculopathy (CAV) and severe diastolic graft failure. The patient presented to the cardiac intensive care unit after a recovered cardiac arrest in extremis with impending multiorgan failure. He initially underwent placement…
Provider Team The patient The patient is a now 13-year-old girl with a history of anxiety and headaches dating back to approximately age 7, although she did not present to neurology until age 9. At that time, she was reporting approximately 15 out of 30 headache days per month and was meeting criteria for chronic…
The patient A 75-year-old male presented with a left neck mass, referred by his community otolaryngologist. The patient reported a history of sleep apnea, cough and recurrent upper respiratory infections. Imaging and fine needle aspiration of the neck mass confirmed p16 positive squamous cell carcinoma (SCC). Positron emission tomography (PET)/CT demonstrated a hypermetabolic left level…
The patient A 15-year-old female with congenital complete heart block needed a pacemaker battery change or pacemaker update. Congenital complete heart block leads to interruption of electrical signals between the top chambers of the heart and the bottom chambers of the heart. This often causes clinically significant slow heart rates and eventually requires implantation of…