Diffuse esophageal spasm (DES)

Diffuse esophageal spasm (DES) is a condition characterized by uncoordinated contractions of the esophagus, which may cause difficulty swallowing (dysphagia) or regurgitation. In some cases, it may causes symptoms such as chest pain, similar to heart disease.

Etiology: Etiology of esophageal spasm is unknown. Increased release of acetylcholine appears to be a factor (sensitive to cholinergic stimulation), but the triggering event is not known. Other theories include gastric reflux or a primary nerve or motor disorder. 

Pathology: Diffuse esophageal spasms occur when the propagative waves do not progress correctly. Usually, several segments of the esophagus contract simultaneously, preventing the propagation of the food bolus. In addition, diffuse esophageal spasms can be characterized by rapid wave progression down the esophagus or distinguished by a nonperistaltic response to swallowing.

Clinical Features: DES manifests as intermittent difficulty swallowing (dysphagia) for solid foods

Intravenous Solutions -- Charts

A 38 Year Old Woman Presents With A 2 Day History Of Severe Headache And Neck Stiffness.

A 38 year old woman is seen in the emergency department with the complains of severe headache and neck stiffness for the last 2 days. On examination she had a temperature of 101 F and BP of 120/70 mmHg. There was no rash seen on the skin. On neurological examination there was mild nuchal rigidity.
CSF analysis was done and the report is given below:

• Appearance = clear
• WCC = 20/ cubic mm (60% lymphocytes)
• Protein = 0.48 gm/l
• Glucose = 2.3 mmol/l ( simultaneous blood glucose = 4.5 mmol/l)
• Gram stain = No organism identified. 

A CT scan Of the brain was done and the image is shown below:

Normal CT scan of the brain.

What is the Differential Diagnosis?

• Aspectic Meningitis
• Viral Meningitis
• Partially treated Bacterial Meningitis
• Tuberculous Meningitis.
• Listeria infection
• Lymes Disease
• Herpes Simplex Encephalitis.

The Final Diagnosis was

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