In the recent past, eight cases of transient ischaemic attack or cerebral vascular accident related to foam sclerotherapy have been reported. The following case is reported to add to the world clinical experience and raises the concern that foam sclerotherapy should continue to be evaluated and reported rigorously to establish the incidence of potentially devastating complications. While waiting for clinical studies to further establish best practice in this area of treatment, it may be in our patients' best interests to reserve the option of foaming sclerosants for selected rather than routine cases of venous insufficiency.

Introduction: The Ultrasound Screening Exam for Underlying Lesions (USEFUL) was developed in an attempt to establish a role for bedside ultrasound in the primary and preventive care setting. It is the purpose of our pilot study to determine if students were first capable of performing all of the various scans required of our USEFUL while defining such an ultrasound-assisted physical exam that would supplement the standard hands-on physical exam in the same head-to-toe structure. We also aimed to assess the time needed for an adequate exam and analyze if times improved with repetition and previous ultrasound training.Methods: Medical students with ranging levels of ultrasound training received a 25-minute presentation on our USEFUL followed by a 30-minute hands-on session. Following the hands-on session, the students were asked to perform a timed USEFUL on 2–3 standardized subjects. All images were documented as normal or abnormal with the understanding that an official detailed exam would be performed if an abnormality were to be found. All images were read and deemed adequate by board eligible emergency medicine ultrasound fellows.Results: Twenty-six exams were performed by 9 students. The average time spent by all students per USEFUL was 11 minutes and 19 seconds. Students who had received the University of California, Irvine School of Medicine's integrated ultrasound curriculum performed the USEFUL significantly faster (p< 0.0025). The time it took to complete the USEFUL ranged from 6 minutes and 32 seconds to 17 minutes, and improvement was seen with each USEFUL performed. The average time to complete the USEFUL on the first standardized patient was 13 minutes and 20 seconds, while 11 minutes and 2 seconds, and 9 minutes and 20 seconds were spent performing the exam on the second and third patient, respectively.Conclusion: Students were able to effectively complete all scans required by the USEFUL in a timely manner. Students who have been a part of the integrated ultrasound in medicine curriculum performed the USEFUL significantly faster than students who had not. Students were able to significantly improve upon the time it took them to complete the USEFUL with successive attempts. Future endpoints are aimed at assessing the feasibility and outcomes of an ultrasound-assisted physical exam in a primary care setting and the exam's effect on doctor-patient satisfaction. [West J Emerg Med. 2014;15(3):260–266.]

Objective: The authors report a case of meningioma causing incomprehensible and excessive text messaging in a postpartum woman. Case Report: We report the case of expressive dystextia related to a postpartum, progesterone receptor-positive meningioma. Growth of meningiomas can accelerate during pregnancy and the postpartum period due to expression of hormone receptors, particularly progesterone. This is the first study describing dystextia related to a brain tumor; previous cases of dystextia are associated with stroke and complex migraine. Here expressive dystextia, the inability to compose syntactically comprehensible text messages, preceded acute neurologic signs by several months, and surgical resection of the meningioma eliminated all neurologic sequelae. Possible genetic etiologies for meningioma are discussed since this patient's prior thyroid cancer at age 18 suggests a relationship between the two neoplasms. Conclusions: Since text messaging is becoming one of the principal forms of communication in our society and requires both cognitive and motor skills, clinicians should be aware that dystextia may be the initial sign of significant neurologic pathology. We propose that an inquiry about altered text messaging frequency and comprehensibility should be a standard part of the neurologic evaluation.