Aneurysmal subarachnoid hemorrhage is a life-threatening event that can cause permanent disability. This life-threatening event can be further complicated by subsequent cardiac and pulmonary disability. The presence of a neurogenic cardiomyopathy and pulmonary edema increases the morbidity and mortality of patients who suffer from aneurysmal subarachnoid hemorrhage. In this paper, we discuss a 39-year-old woman who presented to the emergency department (ED) with a chief complaint of a pounding headache with associated nausea and vomiting for the past three days. She had a past medical history significant only for migraines. During her stay in the ED, she began to exhibit signs of altered consciousness, hemoptysis, and respiratory compromise. Neuroimaging showed evidence of subarachnoid hemorrhage. The exact source of her subarachnoid hemorrhage could not be located with neuroimaging or angiography. Her clinical course was complicated by pulmonary edema and neurogenic stunned myocardium, and is still ongoing.

Hemoptysis is defined as the expectoration of blood or blood-tinged sputum. Blood-tinged sputum is a rare finding in the pediatric population. Finding the cause and treatment of the hemoptysis in pediatric patients is largely dependent on the history. In children, the most common causes of hemoptysis are infection and tracheostomy-related complications. Other causes include aberrant bronchial circulation, aspiration of foreign bodies, and bronchiectasis associated with cystic fibrosis. Due to the rarity of hemoptysis in pediatric patients, diagnosis and management of these patients can be difficult. It is important to refer to case reports and literature to best manage these patients. We report a case of a 3-year-old male patient who presented to the emergency department (ED) with a one-day history of hemoptysis. He presented with his adopted mother who was unable to provide a comprehensive past medical or family history other than stating that the patient has had recurrent bronchial infections since his adoption. She stated that the patient had only one episode of hemoptysis just prior to arrival. The patient did not appear to be in any respiratory distress and did not have any episodes of hemoptysis while in the ED. Due to his afebrile status and lack of evidence of current bleeding, the only intervention administered was an albuterol breathing treatment. He responded well to the breathing treatment and was discharged home with instructions to follow up with his primary care provider.

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ObjectiveTo describe 2 cases of Sjögren's syndrome sensory neuronopathy (SSSN) in which early intervention resulted in excellent clinical outcomes.BackgroundAcquired sensory neuronopathies (i.e. dorsal root ganglionopathies) are rare sensory neuropathies most commonly associated with Sjögren's syndrome (SS) and paraneoplastic syndromes.Design/MethodsWe describe 2 patients who presented with painful sensory symptoms, sicca symptoms and with positive SSA and antinuclear antibodies. The first patient presented with perceived symmetric hand weakness (despite no motor nerve conduction abnormalities), total body numbness and paresthesia, as well as sensory ataxia, while the other presented with asymmetric numbness and pain in the left foot and hand. The electrophysiological profiles varied considerably between the 2 patients. The first patient demonstrated complete absence of sensory nerve action potentials (SNAPs) whereas the second patient had only asymmetrical superficial peroneal and sural SNAPs, corresponding with his clinical deficit. The first patient was diagnosed with SSSN, while the other was diagnosed with asymmetrical sensory neuropathy in SS. The first patient was treated with mycophenolate mofetil (MMF) with dramatic symptomatic improvement and near recovery of clinical deficits. The second patient was treated with prednisone, methotrexate, and ultimately switched to MMF and rituximab with significant improvement in symptoms.ResultsNA.ConclusionsSS is commonly associated with sensory neuropathies including sensory neuronopathies. Both patients met diagnostic criteria for SSSN, though with differing severities. To date, there has been no randomized controlled trial evaluating treatments of SSSN. However, our findings suggest that early use of MMF could result in considerable benefit in a disease that is often functionally devastating.