A case of neck pain in emergency department

Neck pain is a common presentation to the emergency department (ED) and a prominent source of disability in the adult population, accounting for about 10�% of the population. Neck pain can be challenging for ED clinicians to accurately diagnose and manage. The vital role of ED remains in diagnosing the musculoskeletal red flag conditions such as cervical spine fractures or dislocations, radiculopathies, and disk disruptions. However, most non-traumatic causes of neck pain do not have a specific pathoanatomical etiology that can be identified on imaging to identify the cause of pain in the absence of red flags signs. In this article, we would like to discuss one such case, wherein our patient, a 49-year-old gentleman presented to our ED with neck pain which rapidly progressed to quadri paresis within a short duration of ED stay and the diagnostic hurdles faced and the outcome of the patient.

Apoplexy in pregnancy

Headache during pregnancy is a common complaint in the emergency room. In pregnancy, pituitary disorders include both hormone active and hormone inactive tumors. Apoplexy may be the first clinical presentation of an underlying pituitary tumor. Red flag signs of presenting symptoms, to be assessed for identifying life-threatening etiology. Various pathophysiological mechanisms have been passed for pituitary apoplexy in pregnancy. Magnetic resonance imaging of the brain is the gold standard investigation. The mainstay of management is the initiation of steroids. Transnasal transsphenoidal removal of the tumor is the definitive treatment that requires a multidisciplinary approach. The indications of surgery are the presence of symptoms due to compression and endocrine abnormalities; however, gestational period should be taken into consideration. We report a case of headache in antenatal women who presented to our emergency room diagnosed with pituitary apoplexy managed with steroids and early surgery, and discharged with good clinical outcome. We recommend a methodical approach to common symptoms that assist in diagnosing forgotten etiology.