Rejected

Vertebral artery dissection (VAD) is increasingly identified as a cause of ischemic stroke in young adults. Patients most commonly present with neck pain, headache, visual disturbance, or focal extremity weakness. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. A 42-year-old male presented to the emergency department with one week of left neck pain and headache. Computed tomography (CT) neck with contrast was initially ordered for neck pain. CT neck revealed an incidental anterior communicating artery (ACOM) aneurysm. Digital subtraction angiography (DSA) performed for ACOM aneurysm coiling demonstrated a left VAD, which was the attributable etiology to the patient's presentation. Subsequent magnetic resonance angiogram (MRA) neck confirmed this finding. Follow-up brain MRI revealed a small acute left occipital lobe infarct secondary to thromboembolism from the VAD. The patient underwent endovascular coiling of the ACOM aneurysm and received aspirin for the VAD, obtaining resolution of his symptoms. VAD involves an intimal tear of the vasa vasorum leading to narrowing of the vessel lumen that can result in thromboembolic complications. Risk factors for development of VAD include neck manipulations, trauma, or abnormal posturing. DSA remains the gold standard imaging exam for diagnosis of VAD. However, recognition of VAD on more common non-invasive modalities, such as computed tomography angiogram or MRA, remains critical for establishing the correct diagnosis. Although the clinical presentation of VAD is highly variable, dissection should be considered in a young patient with craniocervical pain, even in the absence of neurological symptoms. Early diagnosis and treatment of VAD can lower the risk of long-term neurologic sequelae.

Pediatric intestinal pseudoobstruction (PIPO) is the "tip of the iceberg" of the most severe gut motility disorders. In patients with PIPO, the impairment of gastrointestinal propulsive patterns is such as to result in progressive obstructive symptoms without evidence of mechanical causes. PIPO is an important cause of intestinal failure and affects growth and pubertal development. Bowel loop and abdominal distension represent one of the main features of intestinal pseudo-obstruction syndromes, hence intestinal decompression is a mainstay in the management of PIPO. So far, pharmacologic, endoscopic, and surgical treatments failed to achieve long-term relief of bowel distension and related symptoms, including pain. Recent data, however, indicated that percutaneous endoscopic gastrojejunostomy (PEG-J) might be a minimally invasive approach for intestinal decompression, thereby improving abdominal symptoms and nutritional status in adult patients with chronic intestinal pseudo-obstruction. Based on these promising results, we treated for the first time a 12-y-old patient affected by PIPO refractory to any therapeutic options to obtain intestinal decompression by PEG-J. We showed that PEG-J yielded sustained small bowel decompression in the reported PIPO patient with considerable improvement of both abdominal symptoms and nutritional status. The positive outcome of the present case provides a basis to test the actual efficacy PEG-J versus other therapeutic approaches to intestinal decompression in patients with PIPO.

Petroclival meningiomas (PCM) are challenging tumors to manage. Observation, Stereotactic radiosurgery (SRS) and surgical resection have typically been offered as treatment options. A percentage of patients with PCMs present with trigeminal pain. We present four patients with small PCMs presenting with Trigeminal neuralgia (TN) that were treated with radiosurgery and continued to have debilitating trigeminal pain afterwards. All of them underwent microsurgical resection (MR) of their tumor to manage their trigeminal pain.

Stroke survivors dissatisfied with their progress often seek complementary and alternative interventions (CAI). This paper reviews the evidence for CAIs in stroke recovery.

The Faroe Islands was one of the first countries in the Western Hemisphere to eliminate coronavirus disease (COVID-19). During the first epidemic wave in the country, 187 cases were reported between March 3 and April 22, 2020. Large-scale testing and thorough contact tracing were implemented early on, along with lockdown measures. Transmission chains were mapped through patient history and knowledge of contact with prior cases. The most common reported COVID-19 symptoms were fever, headache, and cough, but 11.2% of cases were asymptomatic. Among 187 cases, 8 patients were admitted to hospitals but none were admitted to intensive care units and no deaths occurred. Superspreading was evident during the epidemic because most secondary cases were attributed to just 3 infectors. Even with the high incidence rate in early March, the Faroe Islands successfully eliminated the first wave of COVID-19 through the early use of contact tracing, quarantine, social distancing, and large-scale testing.

Psychological comorbidity is common in patients with chronic rhinosinusitis (CRS) and is correlated with decreased overall and disease-specific quality of life (QoL). Prior research reported that anxiety and depression, as measured by the hospital anxiety and depression scale (HADS), are associated with worse CRS-specific QoL, as assessed via the Rhinosinusitis Disability Index (RSDI). Furthermore, patients prone to anxiety/depression may display an exaggerated response to real or anticipated discomfort; the pain catastrophizing scale (PCS) is a validated instrument designed to measure this phenomenon. This study is intended to explore the role of pain catastrophizing in relation to anxiety, depression, and disease-specific QoL in patients with facial pain attributed to CRS.

The aim of this study was to compare the effects of local infiltration analgesia and interscalene brachial plexus block techniques on postoperative pain control and shoulder functional scores in patients undergoing arthroscopic rotator cuff repair.

The beneficial effects of SGLT2 inhibitors in patients with chronic kidney disease (CKD) have been demonstrated. Whether inhibition of both SGLT1 and SGLT2 confers additional benefits is unknown. This study investigated the glucosuric, renal and hemodynamic effects of a dual SGLT1/2 inhibitor, licogliflozin, in patients with CKD.

Chronic post-thoracotomy pain is a debilitating condition after traumatic multiple rib fractures and surgery. We aimed to estimate the prevalence of chronic post-thoracotomy pain after traumatic multiple rib fractures in South Korea and explore factors associated with it. From October 2017 to June 2019, a cross-sectional survey of 100 adults, who had undergone thoracotomy due to traumatic fractures of two or more ribs 2 years to 3 months prior to the survey, was conducted in the regional trauma center in South Korea. In total, 80% and 65% patients reported any level and above moderate chronic pain, respectively. Quality of life was mostly below the normative value of the US general population. Forty-six percent patients had restrictive respiratory dysfunction, and 47% and 59% patients were classified as being at risk of above mild-level anxiety and depression, respectively. More than 70% of patients had a current opioid prescription. Multivariable logistic regression analysis showed weak evidence of association between acute, severe postoperative pain and chronic postsurgical pain (adjusted odds ratio 2.4, 95% confidence intervals 0.9 to 6.4). Collectively, chronic post-thoracotomy pain and associated incomplete recovery regarding respiratory, functional, and psychological outcomes were prevalent in patients with traumatic multiple rib fractures in South Korea.