Spinal Schwannoma in a Patient with Chronic Right Flank Pain Presenting at an Emergency Department

Many patients with flank pain present to an emergency department (ED). The differential diagnosis of flank pain is difficult, especially in the case of women. Spinal schwannoma (SS) is one of the most common intraduralextramedullary spinal tumors. SS can present as symmetrical pain in the back or pain that radiates to both the lower extremities, which is commonly observed in clinical practice. We report the case of a 47-year-old woman with pain in her right flank area that began 2 months before she presented to our ED. Abdominal contrast computed tomography was performed to identify an intra-abdominal cause for the pain. Incidentally, we found a schwannoma, a spinal cord tumor, at the 10th thoracic vertebrae level. The pain disappeared after the tumor was surgically resected. On the basis of our findings, we conclude that the pain in her right flank pain area was caused by the SS.

Acute Respiratory Failure and Hypotension with Acute Imidacloprid Poisoning

Imidacloprid belongs to a relatively new class of insecticides, chloronicotinyl neonicotinoid compounds that are agonists of insect postsynaptic nicotinic acetylcholine receptors (nAChrs). Imidacloprid insecticides have been believed to be of low toxicity to humans causing only mild symptoms such as vomiting, abdominal pain and headache in the majority of cases due to nicotinic receptor resistance. Despite the original belief that imidacloprid has low mammalian toxicity, evidence is increasing evidence that imidacloprid may cause heart, kidney and other organ damages and even death, besides gastrointestinal irritation and neurological symptoms. We report a case of acute ingestion of an imidacloprid-containing insecticide. Clinical manifestrations included hypotension and respiratory failure. A literature review is included.