Alejandro Biglione’s scientific contributions

Posterior reversible encephalopathy syndrome (PRES) is a neurologic condition defined by symptoms and imaging findings secondary to vasogenic edema in the brain. Even though not all hypertensive individuals will progress to PRES, high blood pressure is the most frequent risk factor associated with the condition. The pathophysiology of PRES is not clearly understood, but the most accepted proposed mechanism focuses on the brain's inability to regulate cerebral blood flow through constriction or dilation of vessels during extreme blood pressure. This case report is about a 38-year-old male patient who presented to the hospital complaining of a headache and was found to have severe hypertension associated with PRES and a pontine infarct. The epidemiology, etiology, pathophysiologic mechanism, clinical presentation, radiologic findings, management, and prognosis of PRES syndrome are discussed.

Transverse sinus stenosis (TSS) is an abnormality in the cerebral venous system in which the narrowing of the transverse sinus of the brain leads to obstructed cerebral venous outflow. It is an infrequent, incidental radiological finding. However, it is not uncommon among patients with chronic headaches of unclear cause, particularly those that remain unexplained after initial evaluation or those that are refractory to medical treatment. Its diagnosis frequently eludes the initial workup, and a high degree of suspicion should be maintained since its identification can lead to potentially curative treatment. This report describes the case of a 36-year-old female with a history of chronic headache who was found to have TSS. This paper discusses its etiology, pathophysiology, clinical presentation, radiological findings, and management.

Diffuse large B-cell lymphoma (DLBCL) is the most prevalent type of non-Hodgkin lymphoma (NHL), and typically presents in patients who are at least 60 years old with gastrointestinal (GI) tract involvement. We report a case of a young patient with DLBCL. A 27-year-old African American male presented to the emergency room with complaints of abdominal distention. Imaging showed hepatosplenomegaly with multiple nodular lesions in both the liver and spleen. The biopsy confirmed a diagnosis of DLBCL. This case report highlights a rare clinical presentation of DLBCL due to the uncommon hepatic initial presentation of the disease paired with the patient’s age and race varying significantly from the demographic norm. Clinicians should maintain a high index of suspicion for DLBCL in patients with atypical extranodal involvement, such as in this patient, to optimize patient outcomes.

Lower abdominal pain is a common complaint for patients presenting for evaluation in the emergency department. Among other life-threatening complications, acute appendicitis needs to be ruled out in the case of right-lower quadrant pain (RLQ). Sigmoid perforation caused by an ingested foreign body is an uncommon cause of RLQ pain. This report presents the case of an otherwise healthy, 29-year-old male who presented to the emergency department with RLQ pain. His initial evaluation raised concern for acute appendicitis. However, during his exploratory laparoscopy, he was found to have a perforated sigmoid colon due to a skewer stick; the patient had no recollection of having ingested any foreign body. This paper highlights the importance of considering the possibility of sigmoid perforation by an ingested foreign body as a possible cause of RLQ pain. The article also reviews the most common causes of ingested foreign bodies, their potential complications and management.

The prevalence of cannabis use for recreational and medicinal purposes has steadily increased. While it is commonly used to alleviate pain, its use is also associated with many acute and chronic adverse effects. There are cases reported on the negative impact of cannabis use on gastrointestinal (GI) disorders; however, there have been few reported cases linking cannabis use to acute pancreatitis. This case report discusses a 37-year-old female presenting to the emergency department for cannabis-induced acute pancreatitis. The purpose of this case report is to educate on the importance of recognizing the potential GI complications resulting from marijuana use.

Unilateral diaphragmatic paralysis, resulting from nerve or muscle injuries, is an uncommon phenomenon often missed due to its asymptomatic nature. This condition can lead to decreased pulmonary function, particularly in patients with underlying comorbidities or cardiopulmonary issues. Identification and understanding of the underlying cause of the paralysis are essential for effective management and improved patient outcomes. Here, we present a case of a 49-year-old male who presented with left flank pain and complained of dyspnea on exertion. Further workup and a sniff test confirmed the diagnosis of left hemidiaphragm paralysis.