ABSTRACT
BACKGROUND: Dizziness is a common presenting complaint to emergency departments (ED) worldwide, with causes ranging from benign to life-threatening incidents. Computerized tomography (CT) of the brain remains a common diagnostic tool used by emergency physicians; however, it appears to be of low diagnostic value, especially in patients with normal neurological assessment while carrying multiple negative implications on both the patients and the healthcare systems. Our study aims to evaluate the diagnostic value of brain CT scans in assessing patients presenting to the ED with acute dizziness. MATERIALS AND METHODS: Retrospective review of medical records of patients presenting with complaints of dizziness to the ED at Salmaniya Medical Complex (SMC) who underwent a brain CT scan from January to June 2023. Collected data included patients' demographic information, presenting complaints, and CT scan results. A multivariable analysis of factors associated with positive CT scans was performed. RESULTS: A total of 481 participants were enrolled in the study, representing diverse age groups as follows: 18-30 years (12.3%), 31-40 years (15.8%), 41-50 years (17.7%), 51-60 years (22.0%), and those aged over 60 years (32.2%). Among the participants, 56.3% identified as male and 43.7% as female. In terms of head trauma history, 7.1% of participants reported such incidents, while the majority (92.9%) had no history of head trauma. Exploring comorbidities, 43.5% of participants had at least one associated medical condition. Among the 481 study participants, brain CT scans revealed that the majority (93.1%) exhibited unremarkable results. The remaining cases exhibited acute events, including 5.4% with infarcts, 1.1% with hemorrhages, and 0.4% with space-occupying lesions. CONCLUSION: This study provides evidence of the limited value of brain CT scans in dizzy patients with unremarkable clinical examinations. As for clinicians, it can serve as a steppingstone toward the formulation of a policy and a set of guidelines for requesting brain CT scans in patients presenting to the ED with dizziness. Future studies are suggested to provide more insights into the cost-effectiveness and utility of head CT scans in providing valuable findings.
ABSTRACT
A wide spectrum of multi-organ complications have been associated with Down syndrome. Pulmonary complications are a leading cause of morbidity and mortality in Down syndrome. A four-year-old boy with Down syndrome presented to our emergency department with a cough and shortness of breath. He had signs of respiratory distress and decreased air entry in the right lung. A chest radiograph revealed airspace opacity and an air bronchogram in the right lung, both consistent with pneumonia. Oxygen saturation was not maintained on a non-rebreather mask, and the patient required admission to the intensive care unit, where he underwent intubation and mechanical ventilation. With the aggressive antibiotic therapy, the patient had improvements in terms of laboratory and radiographic findings. However, clinical symptoms persisted. Hence, a computed tomography (CT) scan was performed, which demonstrated findings of pulmonary edema and unexpected findings of subpleural cystic lung changes bilaterally with significant replacement of the right middle lobe with these cysts. Initially, these cysts caused significant confusion for the treating physicians and were misinterpreted as honeycombing changes related to end-stage lung disease. However, radiologists confirmed the incidental nature of these cysts in patients with Down syndrome. Appropriate recognition of this entity is crucial to avoid its misinterpretation, which may cause unnecessary laboratory and radiological investigations.
ABSTRACT
Down syndrome is a common chromosomal abnormality, which is associated with a wide spectrum of multiorgan complications, including gastrointestinal disorders. Superior mesenteric artery syndrome is a rare type of small intestinal obstruction caused by compression of the duodenum between the superior mesenteric artery anteriorly and the abdominal aorta posteriorly. A 12-year-old boy with Down syndrome came to the emergency department with a first seizure secondary to electrolyte disturbances. He had been having recurrent episodes of bilious vomiting. Computed tomography of the abdomen revealed a markedly distended stomach and proximal duodenum with a narrow aortomesenteric angle consistent with superior mesenteric artery syndrome. The patient received successful conservative treatment with aggressive fluid resuscitation, bowel decompression, and electrolyte correction. Child protection services found that the patient had rapid weight loss recently after parents were confronted with the confirmed diagnosis of Down syndrome in their child. Physicians need to consider superior mesenteric artery syndrome in any child with an intellectual disability presenting with a clinical picture of intestinal obstruction.
