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Jaundiced patient with unilateral scleral icterus
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prosthetic eye
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  • At last, a plausible explanation for the seemingly incredible statement that stroke victims may have unilateral jaundice! It is due to asymmetric edema, which probably results from asymmetric vascular tone:
    Meakins and others have commented on the absence of jaundice in edematous areas. This curious phenomenon explains the mechanism of the unilateral jaundice syndrome reported by Page [Am J Med Sci. 1929;177:273-276], who described it in 2 patients with cardiac failure and hemiplegia. Edema appeared only on the paralyzed side, whereas jaundice appeared on the other side.
  • "In another patient, who had suffered a hemiplegia, Osler lesions on the forearm of the paralyzed side became necrotic, while those on the normal side did not. This observation is of interest in connection with other variations in clinical phenomena on the paralyzed side of hemiplegics." [103]
  • The NEJM printed a picture of a woman with unilateral scleral icterus, labeled it a mystery, and invited readers to solve it. [104]
    Footnotes in Print Edition[Top] [Nav]
    (1) DeGowin & DeGowin's Bedside Diagnostic Examination. 5th ed.
  DeGowin RL. NY: Macmillian, 1987: 85.   Amazon.com
    (2) Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery. 17th ed.
  Clain A. Bristol, UK: John Wright, 1986: 239.   Amazon.com
    (3) The lessons of rare maladies.
  Garrod A.   Lancet. 1928;I:1055-1060.
Garrod, who was Osler's successor as Regius Professor at Oxford, writes: "In the 'Dictionnaire des Sciences Médicales,' published in 1813, there is an article by Fournier on rare cases which extends to no less than 120 pages. ... Fournier's article... refers to a large number of cases, gathered from different sources. Some of them are fantastic; spontaneous combustions, scorpions in the brain, and the like; some are of great interest, such as a pineal tumor, a large salivary calculus, and a family with hæmophilia; and yet others are most intriguing, such as the one quoted from Vepfer, which I have, as yet, failed to trace, of an elderly hemiplegic with yellowness of the skin limited to his paralysed side, and even to one half of his nose."
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Stroke and unilateral cutaneous effects
    101.Pigmentation of the skin.
  Jeghers H.   N Engl J Med. 1944;231:88-100,122-136,181-189.
    102.Asymmetrical skin temperature in ischemic stroke.
  Korpelainen JT, Sotaniemi KA, et al.   Stroke 1995 Sep;26(9):1543-7.  Pubmed+Abstract  Similars
    103.Subacute Bacterial Endocarditis.
  Libman E, Friedberg CK. London: Oxford, 1941: 35.

Why those clever folks at the NEJM should read Zebra Cards
    104.The NEJM printed a picture of a woman with unilateral scleral icterus, labeled it a mystery, and invited readers to solve it.
    105.A medical mystery [Images in Clinical Medicine].
  Kremer H.   New Engl J Med. 1997;336:846.
    106.Solution to "A medical mystery" [letter].
  Gordon RM.   N Engl J Med 1997 May 8;336(19):1393-4; discussion 1394.  Pubmed  Similars
    107.Solution to "A medical mystery" [letter].
  Greene JM.   N Engl J Med 1997 May 8;336(19):1394.  Pubmed  Similars
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:34 PDT on July 4, 2000.[Top]

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