Shoulder and Upper Back Pain: An Unusual Initial Presentation of Rare Stage IV Small Cell Neuroendocrine Cervical Cancer.

While musculoskeletal pain is cited as the primary cause of disability and reason for visiting the emergency department in the United States, secondary etiologies should be considered. In this case report, we are reporting a unique case of a 38-year-old multiparous healthy female who presented to multiple emergency departments with fleeting pain on the shoulders and upper back. She was diagnosed with muscle spasms and joint arthritis and discharged home multiple times.

Large Left Atrial Appendage Causing Cryptogenic Stroke.

Cryptogenic stroke is a subtype of ischemic stroke for which no identifiable cause is found after routine diagnostic evaluation. It accounts for roughly 25% of ischemic strokes. Structural cardiac abnormalities such as patent foramen ovale, atrial septal defect (ASD), and a large left atrial appendage (LAA) are commonly associated risk factors in patients with cryptogenic stroke.