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Recognition and Management of the Sick Child
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Julian Gaskin, Raymond W. Clarke, Claire Westrope
Observing the posture of the child can be helpful. Often, hypotonia (‘floppy’ child) is present if the child has had a significant neurological insult. Sometimes there are specific positions a child will adopt depending on the location of intracranial pathology. Flexed arms and legs is known as a decorticate posture and extended arms and legs is known as a decerebrate posture, which is usually in keeping with a more severe injury. With meningitis, there may be neck stiffness.
Case 5: Fever, headache and a rash
Published in Eamon Shamil, Praful Ravi, Dipak Mistry, Janice Rymer, 100 Cases in Emergency Medicine and Critical Care, 2018
Eamon Shamil, Praful Ravi, Dipak Mistry
Physical examination reveals a pale man who intermittently follows commands. GCS is 12/15 (Eyes 3, Verbal 4, Motor 5). There is a purpuric rash on his arms and legs, and bleeding from his gums. Neurologic examination is notable for neck stiffness. Cardiorespiratory examination is unremarkable.
Clinical and biochemical differences between hantavirus infection and leptospirosis: a retrospective analysis of a patient series in Belgium
Published in Acta Clinica Belgica, 2020
Emma Bakelants, Willy Peetermans, Katrien Lagrou, Wouter Meersseman
Table 1 summarizes history, signs and symptoms of leptospirosis. Four patients got sick abroad; in Thailand, Vietnam and Cambodia. The group existed of two women and six men, mean age was 36.1 years. Patients presented at the emergency department on average 7.0 days after onset of symptoms. They all complained about general malaise and fever. Mean, measured body temperature was 39.2°C, within a range of 37.9°C–40.2°C. Five patients complained about myalgia. Two patients experienced a dry cough without dyspnea. Seven patients had a headache and five out of them complained about photo- or sonophobia. Five patients vomited. Four patients were constipated, one patient had loose stools without blood loss. No urinary problems were mentioned. Multiple symptoms could be found in one patient. Figure 1 shows the complaints per person in more detail. Clinical examination was normal in three cases. Three patients had a tender right upper abdomen. Two patients showed neck stiffness. Lung auscultation revealed basal crackles in one patient. None of them were icteric.
A risk–benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review
Published in Annals of Medicine, 2019
Aleksander Chaibi, Michael Bjørn Russell
Unfortunately, most clinical examinations have little or no proven usefulness, unless radiculopathy or serious structural disease is strongly suspected [83]. Musculoskeletal pain is often reproducible, namely, the pain can be provoked by active or passive provocative movements and relieved by certain movements that diminish the muscle tension, which is not the case if the pain is of vascular origin. Furthermore, vascular pain is not typically relieved by analgesics, but in VAD, the pain progresses around its known location, which is often occipital and medially along the nucheal line (Figure 2) [84]. Musculoskeletal neck stiffness often presents with a reduced rotational and/or lateral flexion range of motion with sharp, stabbing and/or stinging pain characteristics. A recent study of patients with acute neck pain investigated 1235 distinct cervical SMTs conducted by chiropractors and found that 74% of the cervical SMTs were conducted in the lower cervical spine [85]. Thus, although the literature is sparse on specific locations of mechanical musculoskeletal pain, mechanical neck pain appears to usually present in the lower cervical spine.
Listeria monocytogenes sepsis in the nursing home community: a case report and short review of the literature
Published in Acta Clinica Belgica, 2018
Griet Buyck, Veronique Devriendt, Anne-Marie Van den Abeele, Christian Bachmann
Listeria often presents as an invasive disease, such as meningitis, meningoencephalitis, or bacteremia, without gastrointestinal symptoms. Meningitis is the most common manifestation of central nervous system infection with Listeria. These patients frequently report headache, nausea, a change in mental status, seizures, movement disorders, and fever. Neck stiffness is less common compared with meningitis caused by other frequent bacterial etiologies. Because a simultaneous infection of the brain parenchyma is often present (meningoencephalitis), a focal neurologic deficit can be found. The presentation can be subacute, with symptoms persisting for more than 24 h at the time of clinical evaluation [11].