- Email: [email protected]
Minimal oculomotor nerve paresis secondary to unruptured intracranial aneurysm
Abstracts in this issue were prepared by residents in the Universityof Arizona Emergency Medicine Residency Program, Steven Seifert, MD, FACEP,on-site co-editor.
ABSTRACTS Vincent J Markovchick, MD, FACEP Co-Editor Emergency Medical Services Denver General Hospital
Harvey W Meislin, MD, FACEP Co-Editor Section of Emergency Medicine University of Arizona College of Medicine
tachycardia, supraventricurar
Effective termination of re-entrant supraventricular t a c h y c a r d i a by single dose oral combination therapy with pindolol and verapamil Am Heart J 111;4:759-765
Oct 1986
The efficacy of a single oral dose of 20 mg pindolol and 120 mg of verapamil versus placebo in terminating PSVT in 12 patients with a history of recurrent, symptomatic PSVT was evaluated. Patients selected had a history of documented recurrent sustained SVT, which was determined by electrophysiologic study to be AV or AV nodal re-entrant. Patients were excluded if they had any history of organic heart disease, contraindications to beta blockers, or tachycardia that was not sustained for 30 minutes after induction by programmed stimulation. Patients served as their own control. With placebo, SVT lasted 186 ± 8 minutes with five patients converting spontaneously. With therapy, nine patients converted spontaneously with a mean duration of SVT of 28 ± 8 minutes (P < .001). The remaining three required p r o g r a m m e d s t i m u l a t i o n for termination. In the treatment group, tachycardia slowed to 164 ± 7 before termination from a baseline of 182 ± 5, as compared with no significant change for the placebo group (P < .05). Side effects in the treatment group included lightheadedness (one), severe palpitations (three), and transient first-degree AV block (two). None demonstrated sinus pauses, high-grade AV block, or significant ventricular arrhythmias. It is concluded that a single oral dose of pindolol and verapamil is relatively safe and effective in terminating acute attacks of re-entrant SVT in selected patients.
gorize clinically. Third nerve compression resulted in mydriasis, ptosis, or extraocular muscle weakness, and though combined impairments were present in 11 of 12 patients, all had at least one element of function spared, and all deficits were partial. Pupillary function was most often affected, and extraocular movements were most likely to be spared. All aneurysms were unmptured and varied in size from 5 x 6 m m to 25 x 35 ram. Six of the symptomatic aneurysms arose from the internal carotid artery, and six from the distal basilar artery. Three patients had multiple aneurysms. The sensitivity of CT scanning in detecting unruptured aneurysms could not be determined due to incomplete data. Of the seven patients who were known to have had contrast enhanced scans, six scans were diagnostic. One 6 x 10 mm aneurysm was missed in this group. The generation of CT scanners in use during this period (1978 through 1984) was not reported. Partial third nerve deficits occurring with headache suggests intracranial aneurysm, and subtle deficits should be sought by careful neurological examination. A minority of such aneurysms may be missed by high-resolution CT scanning with contrast enhancement, and thus the presence of slight cranial third nerve deficits associated with headache is an indication for four-vessel angiography, as these aneurysms have a high incidence of subsequent rupture once becoming symptomatic.
Steve Whiteley, MD lymph node, neonate
Palpable lymph nodes in healthy newborns and infants Bamji M, Stone RK, Kaul A, et al Pediatrics 78:573-575
©ct 1986
Katherine Hurlbut, MD
aneurysm, intracranial, oculomotor nerve
Minimal oculomotor nerve paresis secondary to unruptured intracranial aneurysm Arch Neurol 43;1015-1020
Oct 1986
Records of patients with partial, cranial, third nerve palsy secondary to compressive effects of intracranial aneurysms were reviewed retrospectively in 12 patients. Eleven patients complained of headache symptoms that were hard to cate132/465
The authors examined a total of 548 children (214 neonates and 334 infants) for the presence of cervical, inguinal, axillary, and supraclavicular nodes 3 m m and more in size. All children had normal antenatal and postnatal histories. All had completely normal physical examinations and negative cord VDRL results. Palpable nodes were found in 34% of neonates and 57% of infants. In infants less than four weeks of age, the most c o m m o n site of adenopathy was inguinal followed by cervical and axillary, In infants over four weeks of age, the most c o m m o n site was cervical followed by inguinal and axillary. Supraclavicular nodes were not detected on any patients. Because nodes noted in the neonatal period generally persist, such knowledge is useful in helping to determine when adenopathy might be abnormal later on.
Annals of EmergencyMedicine
Alan Goldner, MD
16:4April1987
ABSTRACTS Vincent J Markovchick, MD, FACEP Co-Editor Emergency Medical Services Denver General Hospital
Harvey W Meislin, MD, FACEP Co-Editor Section of Emergency Medicine University of Arizona College of Medicine
tachycardia, supraventricurar
Effective termination of re-entrant supraventricular t a c h y c a r d i a by single dose oral combination therapy with pindolol and verapamil Am Heart J 111;4:759-765
Oct 1986
The efficacy of a single oral dose of 20 mg pindolol and 120 mg of verapamil versus placebo in terminating PSVT in 12 patients with a history of recurrent, symptomatic PSVT was evaluated. Patients selected had a history of documented recurrent sustained SVT, which was determined by electrophysiologic study to be AV or AV nodal re-entrant. Patients were excluded if they had any history of organic heart disease, contraindications to beta blockers, or tachycardia that was not sustained for 30 minutes after induction by programmed stimulation. Patients served as their own control. With placebo, SVT lasted 186 ± 8 minutes with five patients converting spontaneously. With therapy, nine patients converted spontaneously with a mean duration of SVT of 28 ± 8 minutes (P < .001). The remaining three required p r o g r a m m e d s t i m u l a t i o n for termination. In the treatment group, tachycardia slowed to 164 ± 7 before termination from a baseline of 182 ± 5, as compared with no significant change for the placebo group (P < .05). Side effects in the treatment group included lightheadedness (one), severe palpitations (three), and transient first-degree AV block (two). None demonstrated sinus pauses, high-grade AV block, or significant ventricular arrhythmias. It is concluded that a single oral dose of pindolol and verapamil is relatively safe and effective in terminating acute attacks of re-entrant SVT in selected patients.
gorize clinically. Third nerve compression resulted in mydriasis, ptosis, or extraocular muscle weakness, and though combined impairments were present in 11 of 12 patients, all had at least one element of function spared, and all deficits were partial. Pupillary function was most often affected, and extraocular movements were most likely to be spared. All aneurysms were unmptured and varied in size from 5 x 6 m m to 25 x 35 ram. Six of the symptomatic aneurysms arose from the internal carotid artery, and six from the distal basilar artery. Three patients had multiple aneurysms. The sensitivity of CT scanning in detecting unruptured aneurysms could not be determined due to incomplete data. Of the seven patients who were known to have had contrast enhanced scans, six scans were diagnostic. One 6 x 10 mm aneurysm was missed in this group. The generation of CT scanners in use during this period (1978 through 1984) was not reported. Partial third nerve deficits occurring with headache suggests intracranial aneurysm, and subtle deficits should be sought by careful neurological examination. A minority of such aneurysms may be missed by high-resolution CT scanning with contrast enhancement, and thus the presence of slight cranial third nerve deficits associated with headache is an indication for four-vessel angiography, as these aneurysms have a high incidence of subsequent rupture once becoming symptomatic.
Steve Whiteley, MD lymph node, neonate
Palpable lymph nodes in healthy newborns and infants Bamji M, Stone RK, Kaul A, et al Pediatrics 78:573-575
©ct 1986
Katherine Hurlbut, MD
aneurysm, intracranial, oculomotor nerve
Minimal oculomotor nerve paresis secondary to unruptured intracranial aneurysm Arch Neurol 43;1015-1020
Oct 1986
Records of patients with partial, cranial, third nerve palsy secondary to compressive effects of intracranial aneurysms were reviewed retrospectively in 12 patients. Eleven patients complained of headache symptoms that were hard to cate132/465
The authors examined a total of 548 children (214 neonates and 334 infants) for the presence of cervical, inguinal, axillary, and supraclavicular nodes 3 m m and more in size. All children had normal antenatal and postnatal histories. All had completely normal physical examinations and negative cord VDRL results. Palpable nodes were found in 34% of neonates and 57% of infants. In infants less than four weeks of age, the most c o m m o n site of adenopathy was inguinal followed by cervical and axillary, In infants over four weeks of age, the most c o m m o n site was cervical followed by inguinal and axillary. Supraclavicular nodes were not detected on any patients. Because nodes noted in the neonatal period generally persist, such knowledge is useful in helping to determine when adenopathy might be abnormal later on.
Annals of EmergencyMedicine
Alan Goldner, MD
16:4April1987