Julianna Schantz-Dunn

Meningovascular syphilis as a cause of basilar artery stenosis

Syphilis is a rare but treatable cause of stroke in certain patients. We present a case of basilar stenosis and pontine stroke from meningovascular syphilis with clinical and radiographic improvement following treatment. A 40-year-old right-handed man presented with left-sided weakness and a soft voice. The patient’s symptoms started with lightheadedness and nausea, and progressed over hours to left-sided weakness involving the face, arm, and leg. He was brought to his local emergency department, where he had a normal general examination and dense left hemiparesis. MRI showed an infarct in the medial aspect of the right pons and suggested decreased flow in the basilar artery. The patient was transferred to the Neurologic Intensive Care Unit at our hospital. The review of systems was notable for lightheadedness on standing during the past month and a transient rash over the forearms 8 years prior. There was no known history of sexually transmitted disease. The mental status was normal except for a pseudobulbar affect; it was unclear how long this symptom had been …

Striving for Respectful Maternity Care Everywhere

Purpose The mistreatment of women during childbirth in health facilities is a growing area of research and public attention. Description In many countries, disrespect and abuse from maternal health providers discourage women from seeking childbirth with a skilled birth attendant, which can lead to poor maternal and neonatal outcomes. This commentary highlights examples from three countries—Kenya, Mexico and the United States—and presents different forms of mistreatment during childbirth, which range from physical abuse to non-consented care to discriminatory practices. Assessment Building on the momentum from the United Nations Sustainable Development Goals, the International Federation of Gynecology and Obstetrics, and the Global and Maternal Neonatal Health Conference, the global community has placed respectful maternity care at the forefront of the maternal and neonatal health agenda. Conclusion Research efforts must focus on context-specific patient satisfaction during childbirth to identify areas for quality improvement.

Preparing for Urgent or Emergent Surgery

This chapter reviews a variety of core issues to consider while preparing for emergent gynecologic surgery, including assessment of surgical risk, preoperative testing, informed consent, prophylaxis against infection and thromboembolism, urgent anticoagulation reversal, and resuscitation of hemorrhagic shock.