Autonomic Dysfunction in the Setting of CADASIL Syndrome.

Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) syndrome is the most common monogenic inherited cause of stroke. Case Presentation: A female patient aged > 50 years with genetically proven CADASIL syndrome and an extensive stroke/transient ischemic attack (TIA) history experienced a bradycardic episode following hospitalization for new strokelike symptoms. The literature of cardiac involvement in CADASIL syndrome is limited, with no definitive recommendations for surveillance and screening. Conclusions: This case report postulates that cardiac surveillance and screening may be indicated for patients with CADASIL syndrome.

Pelvic plexiform neurofibroma during bowel/bladder dysfunction in an NF1 pediatric patient: A case report.

Individuals with Neurofibromatosis I may develop plexiform neurofibromas throughout the body, however they are rarely seen in the pelvis. We present a 15-year-old patient with NF1 with a large unresectable neurofibroma located between the prostate and bladder discovered incidentally on renal/bladder ultrasound during the evaluation of bowel/bladder dysfunction. Despite the extensive nature of the mass, the patient presented with minimal symptoms and the lesion was thought to be stool or enlarged prostate on subsequent evaluations. Urologists should be aware of NF1 related pelvic masses in the evaluation of bowel bladder dysfunction and specify NF1 on radiologic requisitions.

Cross-sectional analysis of online patient reviews of infertility care providers.

OBJECTIVE: To observe the effects of practice type, location, and mandated insurance coverage on infertility physician online reviews by patients. DESIGN: Retrospective cohort study. SETTING: Not applicable. PATIENTS: Patient online reviews of fertility specialists from 2016 to 2019. INTERVENTIONSS: None. MAIN OUTCOME MEASURES: The analysis consisted of the average rating out of 5 for each physician published on Vitals, RateMD, and Healthgrades. RESULTS: Data were collected on 1,097 specialists. Physicians practicing in states with versus without mandated insurance coverage received an average rating of 4.093 versus 4.076, respectively. The average rating was 3.964 for physicians affiliated with a university or hospital versus 4.128 for those working in a private practice. Significant differences were found in physician ratings from the four regions. It was revealed that physicians who practiced in the South (n = 354) received significantly higher mean average ratings than those in the Northeast (n = 327) and Midwest (n = 175). Physicians practicing in the West (n = 241) received significantly higher ratings than those in the Midwest (n = 175). CONCLUSIONS: The average online patient rating of infertility specialists was found to be significantly higher for physicians working in a private practice compared with those affiliated with a university or hospital system. No significant difference was found between the average rating in states with versus without mandated insurance coverage for infertility treatment. We propose that qualities other than patient financial responsibility are implicated in the factors used to rate physicians.