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Background/Objectives: Quantitative assessments of facial muscle function and cognitive responses can enhance the clinic evaluations in neuromuscular disorders such as Bell’s palsy and psychiatric conditions including anxiety and depression. This study explored the application of Digital Image Speckle Correlation (DISC) in detecting enervation of facial musculature and assessing reaction times in response to visual stimuli. Methods: A consistent video recording setup was used to capture facial movements of human subjects in response to visual stimuli from a calibrated database. The DISC method utilizes the displacement of naturally occurring skin pores to map the specific locus of underlying muscular movement. The technique was applied to two distinct case studies: Patient 1 had unilateral Bell’s palsy and was monitored for 1 month of recovery. Patient 2 had a comorbidity of refractory depression and anxiety disorders with ketamine treatment and was assessed over 3 consecutive weekly visits. For patient 1, facial asymmetry was calculated by comparing left-to-right displacement signals. For patient 2, visual reaction time was measured, and facial motion intensity and response rate were compared with self-reported depression and anxiety scales. Results: DISC effectively mapped biomechanical properties of facial motions, providing detailed spatial and temporal resolution of muscle activity. In a control cohort of 10 subjects, when executing a facial expression, the degree of left/right facial asymmetry was determined to be 13.2 (8)%. And showed a robust response in an average of 275 (81) milliseconds to five out of the five images shown. For patient 1, obtained an initial asymmetry of nearly 100%, which decreased steadily to 20% in one month, demonstrating a progressive recovery. Patient 2 exhibited a prolonged reaction time of 518 (93) milliseconds and reduced response rates compared with controls of 275 (81) milliseconds and a decrease in the overall rate of response relative to the control group. The data obtained before treatment in three visits correlated strongly with selected depression and anxiety scores. Conclusions: These findings highlight the utility of DISC in enhancing clinical monitoring, complementing traditional examinations and self-reported measures.

In our report, we discuss the case of a young adult female who presented to our institution's emergency department with new-onset third-degree heart block and psychotic-like symptoms. The patient had a psychiatric history remarkable for presumed bipolar disorder, anxiety, depression, and cannabis use disorder, with no inpatient admissions or suicide attempts and not taking any psychotropic medications. While in our care, the patient expressed grandiose delusions and hallucinations. All laboratory and diagnostic testing (including tick-borne diseases) were within the normal limits. The patient did not meet strict criteria for involuntary hospitalization in New York State, but the care team faced a dilemma about the patient's safety and fitness for discharge. Here, we discuss this commonly encountered scenario and the bioethics and clinical decision-making to ensure the presenting patient's health, safety, and rights.

Tectal gliomas are rare brainstem tumors. These tumors typically cause obstructive hydrocephalus due to mass effect on the cerebral aqueduct; however, intratumoral hemorrhage is exceedingly rare, with only one previously documented case to our knowledge. Patients typically present with symptoms of hydrocephalus, including headaches, nausea, and visual disturbances. We report the case of a 43-year-old man with a known tectal plate glioma who presented with acute obstructive hydrocephalus secondary to intratumoral hemorrhage. Following the patient's rapid neurological decline, computed tomography (CT) and magnetic resonance imaging (MRI) confirmed the diagnosis. The patient underwent an endoscopic third ventriculocisternostomy (ETV) for cerebrospinal fluid diversion, along with an endoscopic biopsy of the tectal mass. The patient's postoperative course was favorable, with gradual resolution of symptoms, including diplopia and headaches. A follow-up MRI revealed reduced tumor size and stable ventriculomegaly. Histopathological analysis suggested the tumor to be of glial origin and low-grade in nature, based on its contrast enhancement on MRI and the patient's clinical trajectory. This case illustrates a rare presentation of intratumoral hemorrhage in tectal gliomas, emphasizing the need for heightened clinical suspicion in such cases. ETV remains an effective treatment for obstructive hydrocephalus, though the potential for hemorrhagic complications warrants close monitoring.

Background While the use of the failure-to-rescue (FTR) metric, or death after complication, has expanded beyond elective surgery to emergency general surgery (EGS), little is known about the trajectories patients take from index complication to death. Methods We conducted a retrospective cohort study of EGS operations using the National Surgical Quality Improvement Project (NSQIP) dataset, 2011-2017. 16 major complications were categorized as infectious, respiratory, thrombotic, cardiac, renal, neurologic, or technical. We tabulated common combinations of complications. We then use logistic regression analyses to test the hypotheses that (1) increase in the number and frequency of complications would yield higher FTR rates and (2) secondary complications that span a greater number of organ systems or mechanisms carry a greater associated FTR risk. Results Of 329 183 EGS patients, 69 832 (21.2%) experienced at least 1 complication. Of the 11 195 patients who died following complication (16.0%), 8205 (63.4%) suffered more than 1 complication. Multivariable regression analyses revealed an association between the number of complications and mortality risk (odds ratio [OR] 2.37 for 2 complications vs 1, P < .001). There was a similar increase in mortality with increased complication accrual rate (OR 3.29 for 0.2-0.4 complications/day vs <0.2, P < .001). Increasing the number of types of complication were similarly associated with mortality risk. Discussion While past FTR analyses have focused primarily on index complication, a broader consideration of ensuing trajectory may enable identification of high-risk cohorts. Efforts to reduce mortality in EGS should focus on attention to those who suffer a complication to prevent a cascade of downstream complications culminating in death.

Background While the use of the failure-to-rescue (FTR) metric, or death after complication, has expanded beyond elective surgery to emergency general surgery (EGS), little is known about the trajectories patients take from index complication to death. Methods We conducted a retrospective cohort study of EGS operations using the National Surgical Quality Improvement Project (NSQIP) dataset, 2011-2017. 16 major complications were categorized as infectious, respiratory, thrombotic, cardiac, renal, neurologic, or technical. We tabulated common combinations of complications. We then use logistic regression analyses to test the hypotheses that (1) increase in the number and frequency of complications would yield higher FTR rates and (2) secondary complications that span a greater number of organ systems or mechanisms carry a greater associated FTR risk. Results Of 329 183 EGS patients, 69 832 (21.2%) experienced at least 1 complication. Of the 11 195 patients who died following complication (16.0%), 8205 (63.4%) suffered more than 1 complication. Multivariable regression analyses revealed an association between the number of complications and mortality risk (odds ratio [OR] 2.37 for 2 complications vs 1, P < .001). There was a similar increase in mortality with increased complication accrual rate (OR 3.29 for 0.2-0.4 complications/day vs <0.2, P < .001). Increasing the number of types of complication were similarly associated with mortality risk. Discussion While past FTR analyses have focused primarily on index complication, a broader consideration of ensuing trajectory may enable identification of high-risk cohorts. Efforts to reduce mortality in EGS should focus on attention to those who suffer a complication to prevent a cascade of downstream complications culminating in death.