Publications by authors named "Erika Tvedten"

3 Publications

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Horner Syndrome Secondary to Osteochondroma of the First Rib: A Case Report.

Cureus 2021 Apr 17;13(4):e14531. Epub 2021 Apr 17.

Internal Medicine, Detroit Medical Center (DMC), Detroit, USA.

Osteochondroma is the most common benign tumor of bone that often produces no symptoms unless the enlarged mass affects nearby structures. Rarely, Horner syndrome can be caused by an osteochondroma. A five-year-old female with a past medical history of seizure-like activity presented to the emergency department on three separate occasions within one month. She exhibited neurological deficits, including miosis and ptosis, resulting in the diagnosis of Horner syndrome. Computerized tomography (CT) demonstrated a calcified and ossified lesion arising from the right first rib and transverse process that was suspicious for an osteochondroma or chondrosarcoma with neuroblastoma lower on the differential diagnosis. Given the patient's escalating clinical symptomatology and suspicious features of the lesion, a CT guided-bone biopsy was performed. Pathology revealed an osteochondroma that was eventually resected by neurologic and orthopedic surgeries. In this case report, we review the sympathetic innervation to the head, eye, and neck, the most common etiologies of Horner syndrome, and elucidate imaging modalities useful for diagnosing osteochondroma. Horner syndrome secondary to osteochondroma of the first rib has been documented only once before.
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http://dx.doi.org/10.7759/cureus.14531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159331PMC
April 2021

Squamous Cell Carcinoma of the Lung in McCune-Albright Syndrome.

Cureus 2021 Mar 28;13(3):e14159. Epub 2021 Mar 28.

Internal Medicine, Detroit Medical Center (DMC) Harper Hospital, Detroit, USA.

McCune Albright Syndrome (MAS) is caused by a mutation in the GNAS gene that results in multiple endocrinopathies such as Cushing syndrome, acromegaly, hyperthyroidism, and precocious puberty. Despite the presence of pleiotropy coupled with a GNAS gene mutation, malignancy is a rare occurrence in MAS. There is minimal literature showcasing squamous cell carcinoma (SCC) of the lung in patients with MAS. Here, we report a case of altered mental status and hypercalcemia in a 72-year-old female with a past medical history of fibrous dysplasia. On examination there was an expansive lesion of the left hemipelvis that had been present since birth; it was determined to be a characteristic of polyostotic fibrous dysplasia seen in MAS. Lab results revealed an elevated parathyroid hormone-related protein (PTHrP) and a chest X-ray (CXR) displayed masses in the right upper lobe. Computed tomography (CT)-guided lung biopsy confirmed the masses to be SCC of the lung. This case primarily highlights the importance of investigating other malignancies found in patients with MAS. Current literature shows that the GNAS mutation is an oncogenic driver in many tumor types such as pancreatic adenocarcinoma, adrenocortical carcinoma, and thyroid carcinoma; however, current data are limited on the role of GNAS mutations in SCC of the lung. In addition, it is important to investigate malignant causes of hypercalcemia in patients with MAS. The clinical features and treatments of MAS can lead to hypercalcemia and hypophosphatemia and thus mask a malignancy. Clinicians must be wary of a masked malignancy, as it could delay treatment and negatively impact overall outcomes for patients with MAS.
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http://dx.doi.org/10.7759/cureus.14159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078556PMC
March 2021

Attitudes toward use and timing of deep brain stimulation: a patient's with DBS perspective.

Clin Neurol Neurosurg 2021 Apr 10;203:106553. Epub 2021 Feb 10.

Department of Neurology, Weill Cornell Medicine, New York, NY, USA.

Objective: To guide responsive policy and better understand factors that might shape patients' decisions to have DBS earlier, we explore perspectives and attitudes toward earlier deep brain stimulation (DBS) of Parkinson disease (PD) patients with DBS.

Introduction: Before the US Food and Drug Administration released its change of indication for the use of DBS for PD, several groups had performed DBS earlier in disease course.

Methods: We designed an online survey comprising Likert-type, multiple choice, and rank-order questions and distributed it to PD patients. We analyzed patient considerations for having chosen DBS and for choosing or rejecting to have DBS earlier, as well as factors potentially shaping perspectives around DBS and its timing. Data was analyzed using descriptive and inferential statistics.

Results: Among the 160 participants in the sample, the most important consideration for choosing DBS was the possibility of better symptomatic control compared to medication alone. The most important consideration for delaying DBS was possible ineffectiveness. 41.3 % (n = 66) of respondents supported earlier DBS use, 38.8 % (n = 62) did not, and the remainder (n = 30) were uncertain. Patients who supported earlier DBS use cited the possibility of better symptomatic control than with medication alone, while those who did not support earlier use felt that medication options should be exhausted first.

Conclusion: Our results suggest that there are multiple factors shaping patient perceptions around earlier DBS implantation. Future work should compare perceptions before and after DBS implantation, as well as pair perceptions with clinical outcomes.
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http://dx.doi.org/10.1016/j.clineuro.2021.106553DOI Listing
April 2021