We report on a case of spontaneous intramedullary hemorrhage initially misdiagnosed as a lumbar nucleus pulposus prolapse due to the clinical appearance and findings on CT-scan.

Diagnosis, Differential↗

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[Rare differential diagnosis of a degenerative cervical syndrome: an arteriovenous meningeal fistula of the sigmoid sinus].

A 65-year-old patient was referred to our clinic with persisting, severe tinnitus aurium. Due to the facts that prior otolaryngological as well as neurological assessment had been unremarkable and that the patient showed marked degenerative changes in the cervical spine the referring orthopaedic surgeon suggested the cause to be of vertebral origin. Case history showed that the tinnitus had spontaneously occurred and was pulse synchronous. Overall clinical evaluation of the cervical spine was inconspicuous. A brachialgia or other symptoms typically associated with a degenerative cervical syndrome could not be provoked. On the basis of this atypical clinical picture we performed a digital subtraction angiography (DSA) to exclude pathology in the vicinity of the cerebral vessels. This revealed an arteriovenous fistula of the sigmoid sinus which was then, under the auspices of our neurosurgeons, successfully closed by Gugliemo coil embolism. The patient reported that the tinnitus subsided almost immediately. This case demonstrates that despite the manifold pathology that is associated with degenerative cervical syndrome, pulse synchronous tinnitus aurium needs further clarification. Had the case history been taken more accurately and the quality of the tinnitus assessed earlier, the period between onset of symptoms and correct treatment could have been decreased significantly.

Aged↗

PubMedDate not supplied

Withdrawal of nutritional support: a family's choice.

Facilitating the death of a loved one through the withdrawal of nutritional support is a difficult choice. This case study illustrates the ethical principles used by a family and a health team during the decision to terminate tube feeding and hydration for a patient. Patient autonomy, beneficence, justice, and professional integrity are discussed. Also addressed are use of ordinary versus extraordinary means of treatment, futility of treatment, and quality of life. Nursing interventions used to assist the family with their fears and concerns during the decision-making process, and eventually the dying process, of their husband and father are described.

Aged↗

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