Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. The etiology is insufficiently understood. Autoimmune, genetic, viral, and environmental factors have been hypothesized. MS is twice as common in women as in men between the ages of 20 and 50 years. There is no known cure for MS. Current medical treatment helps to prevent new attacks and improve function after an attack. MS is diagnosed by physical examination, diagnostic imaging, and examination of cerebral spinal fluid. The most common physical signs and symptoms of MS include constitutional symptoms, muscle weakness, motor and autonomic spinal cord symptoms, paresthesias, and vision changes. Here we present a case of MS diagnosed in a 33-year-old male with facial myokymia of left eyelid, which progressed to left hemifacial spasm. This is an unusual presentation for multiple sclerosis. An awareness of this presentation not only may lead to an earlier diagnosis in some patients but can be a sign of relapse in patients with established multiple sclerosis.
Abdominal pain is a common presentation in emergency medicine. We describe the case of a 54-year-old female who presented to the emergency department due to worsening abdominal pain. She had a history of right upper quadrant (RUQ) abdominal pain that had been ongoing for several months. The pain had been thought by the primary care team to be related to gastritis and she had been prescribed a proton pump inhibitor (PPI). Her abdominal pain increased in the three days prior to her presentation to the emergency department (ED). The computed tomography (CT) scan of the abdomen showed a foreign body (FB) in the liver which was successfully removed surgically. Pathology results showed that the FB was consistent with a small bone fragment. Ingestions of FB are common but seldom result in complications. When complications do arise, perforation of a hollow viscous is typically seen. Rarely, transmigration of the FB can occur.
Pulmonary embolus (PE) and deep vein thrombosis are diagnoses that are commonly made in the emergency department. Well known risk factors for thromboembolic events include immobility, malignancy, pregnancy, surgery, and acquired or inherited thrombophilias, obesity, cigarette smoking, and hypertension. We present a case of a 59-year-old female who watched TV and developed leg swelling and was found to have PE and DVT.
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