Ischemic Stroke Differential Diagnose: Spontaneous Spinal Epidural Hematoma can be fatal

Spontaneous Spinal Epidural Hematoma (SSEH) is rarely seen, it is the important reason for the spinal cord compression. Patients generally visit the doctor due to the acute pain in the neck and interscapular area. The male patient 58years old was admitted to the emergency service of our hospital with the sudden onset neck pain and followed by rapidly right hemiparesis He arrived at our hospital 120minutes after the onset of her symptoms with suspected acute stroke. We assessed for acute stroke performed clinical examinations necessary for intravenous thrombolytic treatment with alteplase, No abnormality was observed in his brain tomography and diffusion magnetic resonance imaging (MRI).
Source: The American Journal of Emergency Medicine - Category: Emergency Medicine Authors: Source Type: research

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RARITAN, NJ, March 28, 2020 – The Janssen Pharmaceutical Companies of Johnson &Johnson today announced the VOYAGER PAD study met its primary efficacy and principal safety endpoints, demonstrating the XARELTO® (rivaroxaban) vascular dose (2.5 mg twice daily) plus aspirin (100 mg once daily) was superior to aspirin alone in reducing the risk of major adverse limb and cardiovascular (CV) events by 15 percent in patients with symptomatic peripheral artery disease (PAD) after lower-extremity revascularization, with similar rates of TIMI[1] major bleeding. VOYAGER PAD is the only study to show a significant benefit...
Source: Johnson and Johnson - Category: Pharmaceuticals Tags: Innovation Source Type: news
ConclusionHemiplegic spontaneous cervical EDH occurs very rarely. It is often misdiagnosed as ischemic stroke and is likely to be administered with thrombolytic agents, making the patient's symptoms worse. Early diagnosis and rapid management of cervical EDH increase the likelihood of complete recovery of the patient's symptoms. Therefore, if there are unilateral weakness and neck pain without cranial nerve dysfunction and there is no evidence of stroke in the brain imaging, spinal EDH should be considered.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regio...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath.This ECG was recorded on arrival:What do you think?This is technically a STEMI, with 1.5 mm STE in V1 and 1.5-2.0 mm in V2. The current criteria only require 1mm in V1 and 1.5mm in V2 for a female. However, I think many practitioners might not see this as a clear STEMI, and would instead call this " borderline. " The normal QRS complex with STE and large volume underneath the T-waves in V1-V3 confirm Occlusion MI (OMI). There is not technically STD in V6 and I, how...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Written by Pendell Meyers, edits by Steve SmithThis will be too easy for most long-time readers, but if you are at that level, sit back and enjoy noticing how few milliseconds it takes to recognize this thanks to so many prior examples on this blog!I was sent this ECG from EMS with only the information that it belonged to a middle aged male with left shoulder pain.What do you think?There are hyperacute T-waves in leads V1-V6, as well as in leads II, III, aVF. The J-points are all at baseline with the exception of leads V2-V3 which show a small amount of STD (which makes de Winter morphology in the presence of hyperacute T-...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
I was reading through ECGs on the system when I saw this one:Sinus tachycardia, rate 120Computerized QTc = 380 msWhat do you think? I was immediately worried about a proximal LAD occlusion.  Although sinus tachycardia generally argues against ACS, a large anterior MI may result in such poor stroke volume that there is compensatory tachycardia and possibly impending cardiogenic shock. I looked to see if there was an ED cardiac ultrasound, and there was:Parasternal Long Axis:Poor image, but one can see that there is poor apical functionParasternal short axis:This shows poor contractility of the anterior wall.C...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Time limit: 0 Quiz-summary 0 of 30 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
In this study, cangrelor was discontinued 1-6 hours prior to surgery, while aspirin was continued throughout the perioperative period. Bridging with cangrelor did not increase major bleeds prior to surgery, though minor bleeds, mostly ecchymosis at venipuncture site, was higher. P2Y12 assay documented sufficient platelet inhibition corresponding to levels required for anti thrombotic effect [1]. Cangrelor is awaiting approval and more large scale trials regarding the use of bridging are needed. Reference 1. Angiolillo DJ et al; BRIDGE Investigators. Bridging antiplatelet therapy with cangrelor in patients undergoing ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
CONCLUSION: AoD should be carefully considered in patients with acute ischemic stroke presenting with mandibular pain. A high clinical alert and urgent CT angiography may help identify AoD. PMID: 26082417 [PubMed - indexed for MEDLINE]
Source: Acta Neurologica Taiwanica - Category: Neurology Tags: Acta Neurol Taiwan Source Type: research
I just received this email today.  I receive these fairly frequently:Dear Dr. Smith:I am an Emergency physician working in an outlying hospital in _________. We have an interventional hospital to which we refer cath lab patients.  I had a 31 year old with typical chest pain and vomiting and the attached ECG. I was sure he was infarcting but couldn’t convince the interventionalist to take him (after emailing him the ECG).I treated the patient aggressively with medical management and transfered him to the tertiary center.  They did not take him to the cath lab emergently.  When he went to the cath l...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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