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. 2023 Feb;7(1):24-28.
doi: 10.5811/cpcem.2022.10.57491.

A Rare Cause of Headache and an Unorthodox Transfer: A Case Report

Samuel L Burleson  1 , Joe Butler  2 , Gabrielle Gostigian  1 , Matthew S Parr  3 , Matthew P Kelly  1
Affiliations

A Rare Cause of Headache and an Unorthodox Transfer: A Case Report

Samuel L Burleson et al. Clin Pract Cases Emerg Med. 2023 Feb.

Abstract

Introduction: Emergency department (ED) crowding and hospital diversion times are increasing nationwide, with negative effects on patient safety and an association with increased mortality. Crowding in referral centers makes transfer of complex or critical patients by rural emergency physicians (EP) more complicated and difficult. We present a case requiring an unorthodox transfer method to navigate extensive hospital diversion and obtain life-saving neurosurgical care.

Case report: We present the case of a previously healthy 21-year-old male with two hours of headache and rapid neurologic decompensation en route to and at the ED. Computed tomography revealed obstructive hydrocephalus recognized by the EP, who medically managed the increased intracranial pressure (ICP) and began the transfer process for neurosurgical evaluation and management. After refusal by six referral centers in multiple states, all of which were on diversion, the EP initiated an unorthodox transfer procedure to the institution at which he trained, ultimately transferring the patient by air. Bilateral external ventricular drains were placed in the receiving ED, and the patient ultimately underwent neurosurgical resection of an obstructive colloid cyst.

Conclusion: First, our case illustrates the difficulties faced by rural EPs when attempting to transfer critical patients when large referral centers are refusing transfers and the need for improvements in facilitating timely transfers of critically ill, time-sensitive patients. Second, EPs should be aware of colloid cysts as a rare but potentially catastrophic cause of rapid neurologic decline due to increased ICP, and the ED management thereof, which we review.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
Axial computed tomography revealing enlarged lateral ventricles (white arrows) and hydrocephalus. No dilation of third or fourth ventricles or definitive signs of herniation were noted.
Image 2
Image 2
Axial computed tomography after bilateral external ventricular drains (white arrows) were placed, with post-procedural epidural hematomas (white triangle) and pneumocephalus (black arrows).
Image 3
Image 3
A) Sagittal and B) axial magnetic resonance image of the brain revealing 18.2-millimeter T1 hyperdense colloid cyst (white arrows) obstructing bilateral foramina of Monro.
See this image and copyright information in PMC

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References

    1. Berg LM, Ehrenberg A, Florin J, et al. Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels with need of acute hospital care on departure from the emergency department. Ann Emerg Med. 2019;74(3):345–56. - PubMed
    1. Epstein SK, Huckins DS, Liu SW, et al. Emergency department crowding and risk of preventable medical errors. Intern Emerg Med. 2012;7(2):173–80. - PubMed
    1. Kelen G, Peterson S, Pronovost P. In the name of patient safety, let’s burden the emergency department more. Ann Emerg Med. 2016;67:737–40. - PubMed
    1. Morley C, Unwin M, Peterson M, et al. Emergency department crowding: a systematic review of causes, consequences, and solutions. PLoS One. 2018;13(8):e0203316. - PMC - PubMed
    1. Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey 2016 Emergency Department Summary Tables. 2021. [Accessed June 6, 2022]. Available at: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2016_ed_web_tables.pdf.