Palmetto General Hospital

Background: Lipomatous hypertrophy of the interatrial septum (LHIS) is a rare, benign cardiac anomaly involving non-encapsulated fat infiltration of the septum, typically sparing the fossa ovalis. Though often asymptomatic, LHIS may be associated with arrhythmias and, very rarely, embolic events. It can mimic myxomas on imaging and is seldom considered a direct cause of ischemic stroke. Research Questions: Can LHIS serve as a source of paradoxical embolism leading to ischemic stroke? Could structural changes from LHIS precipitate atrial fibrillation? Approach: An 82-year-old woman with hypertension, diabetes, and dementia presented with acute right gaze deviation, left hemineglect, and generalized weakness. CT perfusion confirmed a right middle cerebral artery (MCA) infarct, and she underwent mechanical thrombectomy. Workup included echocardiography, which revealed normal ejection fraction but a right atrial mass and a positive bubble study, indicating a patent foramen ovale (PFO). Transesophageal echocardiogram and cardiac CT angiography identified a 1×1 cm mass in the interatrial septum. Initially presumed to be a myxoma, the patient underwent mass excision, PFO closure, MAZE procedure, and left atrial appendage ligation following development of new-onset atrial fibrillation. Results: Histopathology confirmed lipomatous hypertrophy of the interatrial septum, not myxoma. The stroke was attributed to embolization of LHIS fragments through the PFO into systemic circulation, resulting in a right MCA infarction. Atrial fibrillation was likely precipitated by atrial distortion from the septal mass. The patient was discharged on metoprolol, diltiazem, and amiodarone in stable condition. Conclusion: This case highlights a rare cause of embolic stroke—LHIS—as both a source of paradoxical embolism and a trigger for atrial fibrillation. Accurate diagnosis requires histopathological confirmation, as imaging may misidentify LHIS as a myxoma. Clinicians should consider LHIS in cryptogenic stroke, especially in the presence of a PFO and interatrial masses.

Abstract Disclosure: S. Verma: None. S. Hermida: None. P. Godspower: None. C. Dos Santos: None. D. Alame: None. L. Yousif: None. F. Shifaly: None. A. Perera: None. A. Dominguez-Bali: None. Inguinal ovarian hernia are most commonly seen in pediatric population or reproductive age females, the cases of inguinal ovarian hernia in postmenopausal women are exceedingly rare. This abstract explores the pathophysiological link between estrogen deficiency and the development of inguinal ovarian hernia in post-menopausal women. The structural integrity of pelvic connective tissue and musculature depends heavily on estrogen. As the level of estrogen declines with age, the pelvic floor weakens, muscle atrophies, and there is decreased uterosacral ligament resilience, as supported by studies in Bone, British Journal of Surgery, and Menopause. Such changes in tissues predisposes postmenopausal women, or women who have low estrogen to herniation by weakening the supportive structures around the inguinal canal. A case of a 69-year-old woman presenting with a left-sided tender groin mass was reviewed alongside 17 prior cases of adult ovarian hernias. CT scans and MRI imaging confirmed an ovary within the hernial sac, and surgery successfully repositioned the structure. There was no evidence of mullerian anomalies further supporting an acquired rather than congenital etiology. This case underlines the importance of recognizing estrogen deficiency induced musculoskeletal weakening as a modifiable factor for herniation in postmenopausal women or women with low estrogen. Imaging and diagnosis are crucial to avoid complications such as strangulation. Education and awareness of this mechanism can improve detection and management in post menopausal patients. This disorder could be an unknown described part of what has been recently published as the musculoskeletal syndrome of menopause. Presentation: Monday, July 14, 2025

Obesity is a complex and increasingly prevalent condition associated with significant morbidity and mortality. Increased susceptibility to skin and soft tissue infections is attributable to multiple factors, including immune dysregulation, impaired mobility, and the anatomical challenges posed by excess adipose tissue. In morbidly obese individuals, limited access to intertriginous areas, difficulties with repositioning, and overlapping comorbidities can delay the recognition and treatment of infections, potentially worsening clinical outcomes. This case report describes a 50-year-old morbidly obese Cuban American male who presented to a hospital serving an underserved community with suspected cellulitis or lymphangitis of the lower extremity. No definitive source of infection was identified. Despite early empiric treatment, clinical deterioration ensued, resulting in respiratory failure and septic shock. The patient ultimately required tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement, as well as long-term acute care. The case underscores the diagnostic challenges inherent in evaluating cutaneous and subcutaneous infections in patients with severe obesity. It highlights the importance of maintaining a high index of suspicion and employing a methodical approach to skin assessment in this population to ensure timely diagnosis and intervention in order to optimize clinical outcomes.

Transverse myelitis (TM) is an inflammatory disorder of the spinal cord often associated with autoimmune diseases, such as systemic lupus erythematosus (SLE) or neuromyelitis optica spectrum disorder (NMOSD); however, it is rarely linked to rheumatoid arthritis (RA). We present the case of a 28-year-old woman with subacute ascending numbness, lancinating pain, and bilateral lower extremity weakness resulting in significant functional impairment. Despite upper motor neuron signs on examination and supportive cerebrospinal fluid findings, including elevated gamma globulins and positive myelin basic protein, spinal MRI remained negative. The patient failed to improve with corticosteroids but showed a significant response to intravenous immunoglobulin. Electrophysiological studies indicated a central process, and serologic workup later revealed rheumatoid factor positivity. She was ultimately diagnosed with seropositive RA and started on certolizumab pegol. Alternative diagnoses, including multiple sclerosis (MS), NMOSD, Guillain-Barré syndrome, and compressive or ischemic myelopathy, were ruled out. This case highlights the diagnostic challenge of MRI-negative TM and its potential association with systemic autoimmune disease, specifically RA. It emphasizes the importance of clinical vigilance, early cerebrospinal fluid analysis, and prompt immunotherapy even in the absence of imaging abnormalities. Our findings broaden the neurologic spectrum of RA and support the role of infection-triggered immune dysregulation in autoimmune myelitis.

Epilepsy remains a major therapeutic challenge, with approximately one-third of patients experiencing drug-resistant epilepsy (DRE) despite the availability of multiple antiseizure medications (ASMs). This review aims to evaluate emerging ASMs—cenobamate, fenfluramine, ganaxolone, ezogabine (retigabine), and perampanel—with a focus on their mechanisms of action, pharmacological profiles, and potential role in precision medicine. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science to identify preclinical and clinical studies evaluating the pharmacodynamics, pharmacokinetics, efficacy, and safety of the selected ASMs. Relevant trials, reviews, and mechanistic studies were reviewed to synthesize the current understanding of their application in DRE and specific epilepsy syndromes. Each ASM demonstrated unique mechanisms targeting hyperexcitability, including the modulation of γ-aminobutyric acid receptor A (GABA-A) receptors, sodium and potassium channels, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA receptors), and serotonin systems. These mechanisms correspond with specific pathophysiological features in syndromes such as Dravet and Lennox–Gastaut. Evidence from clinical trials supports their use as adjunctive therapies with generally favorable tolerability, though adverse events and variable efficacy profiles were noted. The mechanistic diversity of these emerging ASMs supports their value in personalized epilepsy management, particularly in treatment-resistant cases. While the promise of precision medicine is evident, further studies are required to address challenges related to long-term safety, cost, and equitable access.

There is a need for Artificial Intelligence (AI) curricula that are developmentally appropriate and appeal to students' interests (Lee and Perret, 2022).Embracing a Community of Learners theoretical perspective (Rogoff, 1994) and employing a Project-based Learning framework (Krajcik and Shin, 2014) we designed a unit on Machine Learning (ML) using Google Teachable Machine for early adolescents that incorporates interest-driven practices with the help of two Learner-Teachers.We implemented this unit in a summer camp with 9-14yo campers and documented the learning progress of our primary participants (high school students that assumed hybrid roles as Learner-Teachers) and the campers.The findings suggest that the curriculum produces quality learning outcomes including improved knowledge about ML, the process of training ML models, and a greater appreciation of the role of student interest in our Learner-Teachers in designing and implementing activities.

Pulmonary embolism (PE) is a critical and potentially life-threatening condition necessitating prompt diagnosis and intervention due to its significant risk of morbidity and mortality. We present a case of a 42-year-old male with a history of cocaine abuse who was admitted with a massive PE (high risk), defined by hemodynamic instability or evidence of significant right ventricular dysfunction. In this case, the severity was suggested by syncope, right heart strain, and elevated cardiac biomarkers. The patient reported sudden onset shortness of breath, sharp chest pain exacerbated by inspiration, and a syncopal episode. Clinical evaluation revealed tachycardia and hypoxemia. Diagnostic tests showed elevated D-dimer levels and signs of right ventricular strain on echocardiography. Computed tomography pulmonary angiography (CTPA) confirmed acute bilateral pulmonary emboli, with a large clot burden predominantly in the right pulmonary artery. The patient underwent a mechanical thrombectomy, which significantly reduced the clot burden and improved pulmonary artery perfusion.