Appraisal of Health States Worse than Death in Patients with Acute Stroke (S714)

Goals of care discussions are frequently indicated after acute stroke. Many of these conversations happen without direct patient participation secondary to aphasia or encephalopathy.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Source Type: research

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An elderly woman with h/o stroke and aphasia seemed different to her daughter, and was pointing all over her body as if in pain.They called 911.She had a history of PCI to the circumflex and also of severe mitral regurgitation, status post bioprosthetic valve replacement.  Also a h/o LV aneurysm with thrombus, on anticoagulation, as well as a dual chamber pacemaker. On arrival, the BP was 60/30.Here is the initial ECG:There is atrial pacing and Right Bundle Branch Block (RBBB)There is STE in I and aVL, V5, V6, with reciprocal STD in II, III, aVFThere is appropriately discordant ST depression in V1-V3 (appropriate...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
rg F, Palm U, Paulus W, Poulet E, Quartarone A, Rachid F, Rektorová I, Rossi S, Sahlsten H, Schecklmann M, Szekely D, Ziemann U Abstract A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the p...
Source: Clinical Neurophysiology - Category: Neurology Authors: Tags: Clin Neurophysiol Source Type: research
Abstract: A 34-year-old man with chronic neck pain was treated with regular cervical paravertebral ozone injections. After his last injection, he experienced a syncopal episode and, upon awakening, was found to have ataxia, aphasia, hemiparesis, and left sixth nerve palsy. Computed tomographic angiography demonstrated intra-arterial gas in the right vertebral artery; multiple posterior circulation infarcts were seen on brain MRI. This case illustrates the potential dangers of paravertebral injections of ozone.
Source: Journal of Neuro-Ophthalmology - Category: Opthalmology Tags: Photo Essay Source Type: research
Conclusions: Acute cholecystitis and stroke are closely associated, and anti-thromboembolic drugs may cause hemorrhagic cholecystitis. Stroke patients tend to have atherosclerotic risk factors resulting in ischemic injury of the gallbladder. Furthermore, severe hemiparesis, a fasting state, dehydration, or bacteremia, which are occasionally exhibited by stroke patients, are known risk factors for acalculous cholecystitis. Stroke patients, especially patients with aphasia and consciousness disturbance, require immediate abdominal examination, if acute cholecystitis is suspected.
Source: Neurology India - Category: Neurology Authors: Source Type: research
Christophe Duret1,2*, Anne-Gaëlle Grosmaire1 and Hermano Igo Krebs3,4,5,6,7,8 1Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France 2Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France 3Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States 4Department of Neurology, University of Maryland, Baltimore, MD, United States 5Department of Physical Medicine and Rehabilitation, Fujita Health University, Nago...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Self-report pain scales are the most common way to assess pain in stroke patients with aphasia. The use of self-report pain scales in patients with aphasia is challenging due to communication or cognitive problems. A feasible, reliable and valid instrument to assess pain in patients with aphasia is yet not available. The aim of this study is to examine the reliability and validity of the Pain Assessment Checklist for Seniors with Severe Dementia-Dutch version (PACSLAC-D) in stroke patients with and without aphasia.
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Tags: Research Source Type: research
Trousseau syndrome was first described by Armand Trousseau in 1865 and is characterized by hypercoagulation resulting from malignant tumors. This complication can markedly impact quality of life (QOL). This is the first report of a terminally ill patient who developed large-vessel occlusion stroke from Trousseau syndrome and underwent mechanical thrombectomy. A 75-year-old woman presented with stage IV ovarian cancer. Goals of care were transitioned to palliative care. The patient was hospitalized with vertebral compression fracture, and suddenly developed right hemiparesis and total aphasia during admission.
Source: Journal of Pain and Symptom Management - Category: Palliative Care Authors: Tags: Palliative Care Rounds Source Type: research
A 76-year-old Japanese man was admitted to our department because of aphasia and right hemiparesis. Brain magnetic resonance imaging showed cerebral infarction caused by occlusion of the left middle cerebral artery, and alteplase therapy was started. Thrombectomy was subsequently performed, resulting in recanalization. On day 4 after admission, he complained of epigastric pain when coughing. On day 8, contrast-enhanced computed tomography showed a left abdominal rectus sheath hematoma without extravasation.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Case Report Source Type: research
I learned how to talk again. It’s been 17 months since a life-changing event left me without words. I want you to know, from a patient’s perspective, how speech-language pathologists affected my life. I don’t know if I will ever truly be able to explain what it feels like to find yourself without the power to speak. My rehabilitation team helped me conquer my world once again. To understand where I am now, you must know who I was. I graduated with honors from The Citadel and The Military College of South Carolina, and worked for the Naval Services, Department of Defense, then the U.S. Air Force and, event...
Source: American Speech-Language-Hearing Association (ASHA) Press Releases - Category: Speech-Language Pathology Authors: Tags: Health Care Slider Speech-Language Pathology Aphasia Cognitive Rehabilitation Traumatic Brain Injury Source Type: blogs
AbstractBackgroundStanford type A acute aortic dissection requires emergency surgery. Because patients with ischemic stroke as a complication of Stanford type A acute aortic dissection do not often complain of chest or back pain, probably due to consciousness disturbance, amnesia, or aphasia, a fatal course following inappropriate intravenous rt-PA therapy and delay of appropriate surgical treatment sometimes occur.Review and proposed recommendationsWhen treating any suspected stroke patients, emergency services and initial urgent care doctors should always suspect aortic dissection. Even in the absence of chest or back pa...
Source: General Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
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