Acute neurology in the emergency department

A 66-year-old woman presented with sudden onset tearing interscapular pain 1 h after gentle neck exercises. Over the next 3 h, she developed flaccid left arm and leg paralysis and a left Horner's syndrome. Her initial CT scan revealed no evidence of cerebral ischaemia or aortic/carotid dissection but did reveal what was thought to be a calcified arteriovenous malformation in the right frontal lobe. Thrombolysis for a presumed acute stroke was considered but not initiated. By 5 h, the patient had lost light touch sensation and proprioception of her left side, and additionally she developed grade 3/5 right-sided weakness with absence of pain sensation below the C6 dermatome. We diagnosed a progressive left-sided cervical Brown-Séquard syndrome. MRI scan confirmed a large cervical epidural haematoma with predominantly left dorsolateral spinal cord compression but normal spinal cord signal (figure 1). The patient underwent an emergency C3–C7 laminectomy and haematoma evacuation. As no...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: Eye Diseases, Spinal cord injury, Pain (neurology), Spinal cord, Stroke, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Ethics, Trauma Images in emergency medicine Source Type: research