Category Archives: 2016 EMage Winners

3rd Place EMage Winner-Ventriculitis and Pronounced Hydrocephalus from Neisseria meningitidis

Charles Hwang, MD and Carolyn Holland, MD, MEd

UF Health

Department of Emergency Medicine

A previously healthy, unvaccinated 10-month-old boy presented to the emergency department with a 3-day history of fatigue and somnolence.  Examination revealed an obtunded infant with sluggish pupils, bulging anterior fontanelle, bradycardia, hypertension, and extensor posturing with no purposeful movement.  His workup revealed a white blood cell count of 50.6 x 103 mm-3, bandemia of 8%, and hyponatremia of 119 mmol L-1.  A computed tomographic (CT) scan (Figure 1) of his brain showed hydrocephalus with fluid levels in bilateral ventricles with debris within the cerebrospinal fluid (CSF).  He was started on broad-spectrum antibiotics, and an external ventricular drain was placed.  CSF studies demonstrated WBC 905 mm-3, RBC 21 mm-3, glucose < 2 mg dL-1, protein 302 mg dL-1.  CSF culture confirmed Neisseria meningitidis.  Magnetic resonance imaging (MRI) (Figure 2) of the brain showed severe, diffuse meningitis and ventriculitis with purulent accumulation in the ventricles, sulci, and cisterna magni. read more

2nd Place EMage Winner-Increased Head Size

Susan Chigorom MD; Robert Barricella, MD; Maria Theresa Alvarez‐Ballway, MD; Diane Sin Quee, MD

Department of Pediatrics, Rutgers New Jersey Medical School

Luigi Bassani, MD

Department of Neurosurgery, Rutgers New Jersey Medical School

Case Presentation

3 month old female born via normal spontaneous vaginal delivery at term with 1 week NICU stay for indirect hyperbilirubinemia presents to the emergency department for increasing head size for 2 weeks. Prior to this patient has been active and playful with no change in behavior, except for a 2 day fever 1 week prior to presentation which resolved. Patient had prior nasal congestion which mother attributed to common cold. Mother denied recurrent or chronic sinusitis or infections. Patient initially presented to her pediatrician who started monitoring head circumference and subsequently referred to the Emergency department for further evaluation. Prenatal history was negative for fever, infection or sexually transmitted diseases. read more

1st Place EMage Winner: Her Skin is Cracking

Mary Claiborne, MD; Shilpa Dass, MD; Robert M Lapus, MD; Samuel J Prater, MD

Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, Texas

Children’s Memorial Hermann Hospital

Case Presentation:

An 11 year old African American female with trisomy 21, corrected congenital heart defect, and atopic dermatitis presented with generalized pruritus and scaliness for 2-3 days. Mom has been putting petroleum jelly on the lesions, however because of the worsening appearance, she presented to the emergency department. read more