jwells78 Posted March 23, 2015 Share Posted March 23, 2015 Interesting case in the ER yesterday:64 y/o female 10 day post-op ACDF presented for increased discharge from the surgical wound that started 3d ago; couldnt get in to see surg because it was sunday. Also c/o mild dyspnea.Neck pain improving post-op.ROS: As above plus sleeplessness, HA. No fevers, chills, weakness, dysphagia or cough. No recent illness; no other trauma. All other ROS NEG.PMH: cervical radiculopathy/ DDD, Fibromyalgia, HTNPEGen: Alert, restless.HEENT: normocephalic. Noted Ptosis on RT; Pupils: 4-5mm on RT, non-reactive to light; 3mm on LT, brisk response. No consensual response noted OU; defect similar in lit/unlit room. EOMs intact. IOP- 15-17 OU; Vis acuity 20/20 OU.NECK: Removed from Hard Collar; 6 cm, healing, vertical surgical scar to LT anterior neck. Scant purulence to dsg, minimal soft tissue swelling/erythema, no indurationor fluctuance. No dehiscence. No palpable adenopathy.NEURO: RT III CN defecit as above; all other CN intact. Grips weak BIL- chronic per pt. A/Ox3. No other focal findings.-ALL other PE WNLLabs: cbc, cmp, ua/tox, cta neck ordered out front (ended up having non-con when gfr was <60); final imaging was MRI/MRA brain Any Neuro PA's out there who can school me on this a little? Link to comment Share on other sites More sharing options...
FBIDoc Posted March 24, 2015 Share Posted March 24, 2015 1) infection in the surgical bed 2) septic embolic stroke And not a very thorough case presentation from my former student...you forget what I taught you ... =P Link to comment Share on other sites More sharing options...
jwells78 Posted March 24, 2015 Author Share Posted March 24, 2015 Yes, my apologies. Not a very fleshed out case presentation. Originally just wanted to talk about Horner's syndrome in the cervical fusion patient post-operatively. Figured there would be a handful of Neuro guys that could explain to me if the approach side means anything, or if contra-lateral Aniscoria could still fall into that DX. My Attending was scratching his head; I couldn't find anything specific enough on UTD or in the literature. -J Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 25, 2015 Moderator Share Posted March 25, 2015 1) infection in the surgical bed 2) septic embolic stroke And not a very thorough case presentation from my former student...you forget what I taught you ... =P ouch i thought it was pretty good, succinct, to the point.... ? position during surgery, palsy? as well as above Link to comment Share on other sites More sharing options...
FBIDoc Posted March 27, 2015 Share Posted March 27, 2015 ouch i thought it was pretty good, succinct, to the point.... ? position during surgery, palsy? as well as above Jeremy knows I was yanking his chain...he's a competent clinician and one of my past students... Link to comment Share on other sites More sharing options...
UGoLong Posted March 27, 2015 Share Posted March 27, 2015 I enjoy this posts because I often learn something. In this case, I have no idea what a ACDF is! Acronyms are OK, but they sometimes make it tough for people in other specialties to know what you're talking about. Link to comment Share on other sites More sharing options...
jwells78 Posted March 28, 2015 Author Share Posted March 28, 2015 Sorry guys. ACDF- anterior cervical discectomy and fusion. The patient in question had a Lt sided approach for her fusion; presented as above. Interesting, because if she had damage to the sympathetic chain on the Lt, you would expect miosis and ptosis on the Lt for the diagnosis of post-operative Horner's. In this pt, she had ptosis on the RIGHT, and I couldn't discriminate definitively whether the pupillary defect was Rt or Lt sided. (She had a 4-5 mm Rt pupil, non-reactive to light, 3 mm Lt - sluggishly reactive) Either way, she got the MRI/MRA brain and it was negative. Her original CT neck showed no acute pathology. Referred to Ophtho, back to her Neurosurg, and DC'd home with family. Link to comment Share on other sites More sharing options...
KMD16 Posted March 28, 2015 Share Posted March 28, 2015 Former neurosurgery PA here. What you described are to be expected in some pt post ACDF. Won't had gotten MRI/MRA brain. Instead, a MRI neck would been OK. d/c home on abx w/ recom to f/u surgeon. What describing post ACDF. It's important to state what level e.g. S/p C3/4, and c4/5 ACDF. Link to comment Share on other sites More sharing options...
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