I started off the week observing a spinal tap procedure in which a needle punctures into the subarachnoidal space 💉. On the first attempt to perform the procedure, the patient was lying on her side. When this didn’t work, they shifted the patient to a sitting position. I wondered what difference these two positions made to the procedure…so I decided to explore this question further when I would later work on my needs finding. Here are the pictures of the positions I mentioned.
Lumbar Puncture Positions [1]
I also noticed discrepancies between neurologists’ and radiologists’ interpretation of CT scans. When the neurologist viewed the CT, he saw a venous sinus thrombosis. However, the radiologist’s findings indicated the CT scan was normal. When I inquired, I learned that pulmonologists face similar discrepancies with radiologists’ interpretations.
This week, a stroke patient I’d previously seen, had new angiograph CT findings. Initially, the team was aware of the two blocked carotid arteries but additionally found one of her vertebral arteries was also blocked. This meant there was only one artery providing blood to the brain, a dangerous situation for the patient. Without a diagnosis for the patient, the next step was obtaining a biopsy of the carotid artery to find what was causing this issue. The doctor suspected primary arteriopathy but wanted to confirm this with a pathologist’s analysis of the biopsy. Getting the biopsy required surgery, so the neurology team consulted a vascular surgeon. The vascular surgeon first checked the arteries using an ultrasound in preparation for the procedure. The vascular surgeon mentioned the carotid endarterectomy would not be an option for this patient because her arteries were 100% occluded, and an endarterectomy could cause further damage if any of the debris in the artery dislodged and potentially caused a stroke. It was interesting to learn this and I look forward to exploring the treatment options available for patients with full occlusion of their carotid arteries.
A particularly interesting consult from the ER involved a girl with asymmetric pupil sizes. The doctor wanted to ensure this uneven pupil size wasn’t due to Horner syndrome – a condition caused by disruption of a nerve pathway connecting the brain to the head and neck; it usually only affects one side of the face. One symptom of Horner syndrome is little sweating on the affected side of the face [3]. They used a resourceful method to test for this condition. The doctor applied iodine to the patient’s face and let it dry, Then, her covered her face in yuca flour. The patient did a lot of jumping jacks and running around to induce sweating 💦. When we came back 20 minutes later, the areas where she’d sweated had oxidized to a different color [4]. Luckily, she did not have asymmetrical sweating, therefore, likely did not have Horner syndrome. But I did notice the patient felt self conscious walking around with flour caked on her face. Check out a picture of Minor’s test.
Minor’s Test [5]
[1] South Sudan Medical Journal, “How to Perform a Lumbar Puncture,” Nov. 2016. [Online]. Available: http://www.southsudanmedicaljournal.com/archive/november-2016/how-to-perform-a-lumbar-puncture.html. [Accessed: Jul. 27, 2024].
[2] Cleveland Clinic, “Spinal Headaches,” [Online]. Available: https://my.clevelandclinic.org/health/diseases/17927-spinal-headaches. [Accessed: Jul. 27, 2024].
[3] Mayo Clinic, “Horner Syndrome: Diagnosis and Treatment,” [Online]. Available: https://www.mayoclinic.org/diseases-conditions/horner-syndrome/diagnosis-treatment/drc-20373551. [Accessed: Jul. 27, 2024].
[4] Wikipedia, “Minor Test,” [Online]. Available: https://en.wikipedia.org/wiki/Minor_test. [Accessed: Jul. 27, 2024].
[5] A. Kumar and M. Yadav, “Management of Nasal Septal Abscess: Our Experience,” Indian J Otolaryngol Head Neck Surg., vol. 67, no. 4, pp. 339-342, Oct. 2015. [Online]. Available: https://link.springer.com/article/10.1007/s12070-015-0852-5. [Accessed: Jul. 27, 2024].
[6] ChatGPT to format citations