Myoclonus is a sudden, involuntary jerking of a muscle or a group of muscles. Myoclonus may present in form of a pattern or, sporadically and infrequently. It is usually associated with neurological disorders such as epilepsy, multiple sclerosis or infections, and tumors of the central nervous system. Myoclonus is not commonly known to be caused by tramadol. We present a case of a 59-year-old male who developed myoclonus in the muscles of his trunk, 10 days after initiating tramadol for chronic pain. The myoclonus disappeared after withholding the medication. The purpose of this case report is to make clinicians aware of a rare reversible side effect from the use of tramadol.

Obstructive sleep apnea (OSA) is a breathing disorder secondary to collapsing upper airways while sleeping. The collapse leads to a significant decrease or a complete cessation of airflow despite an ongoing effort to breathe. OSA leads to poor sleep quantity and quality, which, in turn, causes temporary cognitive impairments. Systematic manifestations of OSA can be seen as hypertension, arrhythmias, heart failure, obesity, and worsening of existing pulmonary or cardiac conditions. Severe untreated OSA also leads to significant sleep deprivation, which may eventually lead to sleep attacks. We present a case of a sleep attack leading to a motor vehicle accident that was presumptively diagnosed as syncope. During hospitalization, workup revealed that the patient had very severe OSA. He was treated with a continuous positive airway pressure device, which improved his daytime sleepiness with no new episodes of sleep attacks.

Obstructive sleep apnea (OSA) is a breathing disorder during sleep secondary to collapsing upper airways that leads to a significant decrease or a complete cessation of airflow despite an effort to breathe. As the name suggests, an obstruction, likely caused by an inherited narrow airway, is the most common cause. But there are less known factors that may contribute to the worsening of OSA. We present a case of very severe OSA contributed by weight gain, opioid use, and anterior cervical discectomy and fusion (ACDF), in addition to a genetically narrow airway. This case highlights the importance of battling OSA on many different fronts. Our patient eventually was able to stop positive airway pressure (PAP) therapy, once the contributing factors were addressed appropriately.

Abstract:Congenital diaphragmatic hernia (CDH) is rare congenital condition that primarily presents in infants. Bochdalek hernia is the most common of them. Late presentation is unusual, and in most cases is diagnosed in adolescents or early adulthood. Morgagni hernia is the one that usually presents late in adults. The finding of CDH in adults is mostly incidental. We report a case of CDH, posterolateral (Bochdalek type), with left lung hypoplasia, in a 60 year old female, who primarily presented with sudden shortness of breath.

Obstructive Sleep Apnea (OSA), a common variant of sleep-disordered breathing, is characterized by repeated complete or partial collapse of upper airways during sleep, leading to oxyhemoglobin desaturations. The obstruction may be iatrogenically induced in patients undergoing Anterior Cervical Discectomy and Fusion (ACDF). Damage to the pharyngeal plexus during the procedure may predispose to a new collapse of the upper airway, and the placement of the hardware for the fusion may lead to further narrowing of the upper airway. Literature does not exist associating this possible etiology prospectively. The association of ACDF and OSA has only been retrospectively documented by Guiilleminault and associates. We are reporting a case of a 49-year-old female who was evaluated pre and post surgery and established the evidence of worsening OSA in a patient who underwent ACDF.