during these past two weeks. He denied convulsions or loss of consciousness with these falls, chest pain or palpitations, or any use of drugs or alcohol. Vital signs were unremarkable on admission except for mild hypertension. A physical exam revealed a flat affect and a broad-based, unstable, shuffling gait. EKG and echocardiogram were reassuring for the absence of electrical or obstructive cardiac abnormalities and toxicology was normal. CT and MRI imaging showed ventriculomegaly out of proportion to the degree of atrophy, remote frontal and cerebellar infarctions, and subacute infarctions of the paramedian right parietal lobe abutting the corpus callosum and lateral ventricle. Lumbar puncture indicated normal opening pressure and unremarkable cerebrospinal fluid (CSF) studies. He also was found to have a positive CSF
tap test with improvement in “timed-up-and-go” testing and 360-degree turn testing after 30 minutes, as well as improved cognitive function following his lumbar puncture. After neurology consultation, he was referred to neurosurgery for consideration for placement of a ventriculoperitoneal shunt. Discussion: Recent literature further affirms a higher prevalence of NPH in aging populations with 2.1% in those 65-79 and 8.9% in those 80 or older. The prevalence of NPH in patients under the age of 65 is not clearly defined. While the current literature suggests that NPH increases dramatically with advanced age, this case demonstrates that NPH should still be considered in younger patients if the history and objective findings suggest it.
LABIA MINORA HAIR TOURNIQUET SYNDROME IN AN ADULT FEMALE: A RARE PRESENTATION Jared M Robinson BS 1 , Hannah M Robinson BE 1 , Blake R Denley MD 2 ; LSU School of Medicine, New Orleans, LA 1 ; Department of Medicine, Ochsner Medical Center, New Orleans LA 2 .
Introduction: Tourniquet Syndrome (TS) refers to the constriction of appendages due to hair or fibrous material. Predominantly observed in pediatric populations, it commonly affects toes or fingers. TS results from the strangulation of the appendage, impairing blood circulation, and potentially leading to tissue necrosis. Prompt intervention is crucial to prevent complications. Case: A healthy 25-year-old female presented with complaining of genital pain. She discovered a single bump on her genitals the previous evening while showering. At first, there was diffuse vaginal itching, but by the next day, the irritation intensified, becoming painful over most of the labia minora. This is her first encounter with such a symptom. She reported no recent illnesses, her bowel and bladder functions were normal, and she had no other genitourinary symptoms. She is in a long-term monogamous, heterosexual relationship. She states that her partner has not had similar symptoms. Her immunizations are up to date. The patient leads a healthy lifestyle; she is well-nourished, maintains good hygiene, exercises daily, runs frequently, and
engages in high-intensity interval training. Physical examination illuminated a 3-millimeter markedly tender, red-purple papule on the outer portion of her right labia minora. A constricted loop of hair was discernible at the papule’s base. The remainder of the examination was unremarkable. The diagnosis of Labia Minora Hair Tourniquet Syndrome was made. A small incision was made using a suture needle post-sterilization to release the entangled hair, and the patient recovered without any complications. Discussion: While TS is documented in pediatric populations, its occurrence in adults, especially involving the labia minora, is seldom reported. This case emphasizes that despite its rarity in adults, TS should be considered in differential diagnosis for acute genital pain in the absence of other genitourinary symptoms considering the detrimental clinical consequences of delayed treatment. It reiterates the importance of prompt recognition and intervention, regardless of the patient's age. This case offers a novel instance of TS in adults, underscoring
the need for awareness among clinicians to ensure timely diagnosis and management.
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