A 38-year-old male complains of a right-sided retro-orbitaltemporal headache of 2-day duration. It is described as intermittent and pressure-like, and is preceded by bouts of left arm numbness. He denies diplopia, visual changes, nausea, vomiting, or alterations in his consciousness. No acute trauma is reported, but he gives a history of airline travel within the past 24 h. His parents are present at the bedside and volunteer that the patient and his wife were involved in a motorcycle crash 3 months ago in which his wife was killed.The patient is alert and oriented with normal vital signs and a normal physical exam. A CT of the head without contrast is performed and reveals an acute-on-chronic subdural hematoma with a 1.6-cm midline shift (Figs 1, 2 and 3). Neurosurgery is performed emergently.Subdural hematoma (SDH) is a collection of blood between the dura and arachnoid membranes not restricted by cranial sutures. They do not cross the midline because of the menigeal reflections and are classified as: acute, chronic, or as in this case, acute-on-chronic. An acute SDH is hyperdense (white) on CT, whereas a sub-acute

Patient: Male, 16Final Diagnosis: Effort thrombosis (Paget-Schroetter Sydnrome)Symptoms: Swollen armsMedication: —Clinical Procedure: —Specialty: Metabolic Disorders and DiabeticsObjective:Rare diseaseBackground:Thrombotic events in otherwise healthy pediatric patients are rare. In patients presenting with limb swelling, thrombosis must be considered in the differential diagnosis. In pediatric patients with thrombosis, there has been wide variability in the rates of associated thrombophilia. Many pediatric patients may instead have other contributors such as venous catheters or physical activity.Case Report:We present a case of bilateral upper extremity deep venous thrombi in a previously healthy 16-year-old male. The patient presented with swelling and pain in both arms after several days of weight-bearing exercise. Following emergency department evaluation with ultrasound and laboratory testing, the patient was diagnosed with effort thrombosis – also known as Paget-Schroetter syndrome – and rhabdomyolysis.Conclusions:This case of Paget-Schroetter syndrome is distinguished by elevation in creatine kinase and transaminases. While these findings can be due to physical exertion and effort, effort thrombosis is not classically associated with laboratory abnormalities except an elevated D-dimer. The significance of these laboratory test result abnormalities remains unclear. Given the rarity of effort thrombosis, further epidemiological study is warranted to determine if these laboratory findings are seen in other cases, and, if so, what implications they may have for management and prognosis.

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