Implementing Diagnostic Reasoning to Differentiate Todd's Paralysis From Acute Ischemic Stroke

Emergency department clinicians with limited resources are relied upon to deliver safe and timely patient care. Clinicians rely on cognitive biases such as anchoring, availability, and premature closure based on experience and quick mental algorithms to streamline medical data and arrive at a diagnosis. Although this is a time-saving and efficient method in the management of uncomplicated illnesses, it can result in a wrong diagnosis when managing patients with complicated presentations such as a stroke or a stroke mimic. Two conditions that present similarly, making it difficult to differentiate between them, are Todd's paralysis (a stroke mimic seen in selected patients with epilepsy) and acute ischemic stroke. However, by clinical reasoning, clinicians can formulate an accurate diagnosis while avoiding diagnostic biases. Incorporating clinical reasoning into the diagnostic process consists of gathering pertinent data, performing a diagnostic time-out, and arriving at a diagnosis reflective of data findings.
Source: Advanced Emergency Nursing Journal - Category: Emergency Medicine Tags: Cases of Note Source Type: research

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Authors: Fu CY, Chen SJ, Cai NH, Liu ZH, Zhang M, Wang PC, Zhao JN Abstract OBJECTIVES: We attempted to determine whether a functional polymorphism of TRPM6 (rs2274924) is associated with susceptibility to epilepsy following ischemic stroke, and to further explore the effect of this polymorphism on serum levels of Mg2+ in post-stroke patients. METHODS: We carried out a case-control study on 378 post-stroke epilepsy patients and 420 controls (stroke patients without secondary epilepsy). We used DNA sequencing to determine the genotypes of the TRPM6 rs2274924 polymorphism, and used the ion selective electrode met...
Source: Neurological Research - Category: Neurology Tags: Neurol Res Source Type: research
This study aimed to evaluate the burden of leukoaraiosis, a marker of cerebral SVD, and hippocampal atrophy in patients with late-onset epilepsy (LOE).MethodsBrain magnetic resonance imaging (MRI) studies were retrospectively analyzed by two blinded radiologists. The Fazekas and Scheltens scales were used to assess the degree of leukoaraiosis and hippocampal atrophy in 33 patients with non-lesional LOE, 41 patients with clinical signs of SVD (eg, recent history of transient ischemic attack [TIA] or lacunar stroke), and 26 healthy controls, all>60 years of age.ResultsMean age in epilepsy patients was 70.9 (±6.6) y...
Source: Seizure - Category: Neurology Source Type: research
Conclusion: Cardioembolic stroke and frontal lesion were significant risk factors of NCSE after stroke.Eur Neurol 2018;80:256 –260
Source: European Neurology - Category: Neurology Source Type: research
We report a CADASIL family with epilepsy as an early symptom due to a novel NOTCH3 mutation.
Source: Seizure: European Journal of Epilepsy - Category: Neurology Authors: Tags: Clinical letter Source Type: research
Conclusion: The burden of disease was higher in the population with disabilities than that in the general population. Cardiovascular diseases and cancer had a higher burden of disease than did other diseases in the population with disabilities; thus, overall, non-communicable diseases have a higher burden of disease than communicable diseases or injuries in the population with disabilities than in the general population. PMID: 30636948 [PubMed - in process]
Source: Journal of Korean Medical Science - Category: Biomedical Science Tags: J Korean Med Sci Source Type: research
Conclusion: Non-communicable diseases in Iraq continue to show as a new developing burden after the 2003 war. Hypertension and diabetes mellitus demonstrate rapidly rising trends which may, in turn, enhance the occurrence of ischemic heart diseases and cerebrovascular accidents. PMID: 30617384 [PubMed - in process]
Source: Saudi Medical Journal - Category: Middle East Health Tags: Saudi Med J Source Type: research
A 54-year-old male with a history of left posterior parietal ischemic stroke, epilepsy, tobacco and marijuana smoking, and alcohol abuse, presented with acute left visual loss and diplopia. On examination, he had reduced left visual acuity and a left oculomotor nerve palsy. CT angiogram from aortic arch to circle of Willis identified extensive thrombus occluding the left common and internal carotid arteries, extending to the left ophthalmic artery. This case demonstrates acute visual loss from ophthalmic artery occlusion, and left oculomotor nerve palsy from occlusion of the inferolateral trunk of the internal carotid arte...
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Case Report Source Type: research
Publication date: March 2019Source: Biomedicine &Pharmacotherapy, Volume 111Author(s): Bahram Bibak, Manouchehr Teymouri, Ameneh Mohammadi, Ali Haghbin, Yanshu Pan, Jamal Kasaian, Peiman AlesheikhAbstractThe pressing need to discover more effective drugs for various CNS disorders has resurrected the idea of investigating the effectiveness of traditional medicines in modern science. Tongluojiunao (TLJN) is an example of revived modern herbal preparation based on traditional Chinese medicine (TCM) with a long history of administration for various types of cerebrovascular injuries and neurodegenerative diseases. TLJN is p...
Source: Biomedicine and Pharmacotherapy - Category: Drugs & Pharmacology Source Type: research
Abstract The pressing need to discover more effective drugs for various CNS disorders has resurrected the idea of investigating the effectiveness of traditional medicines in modern science. Tongluojiunao (TLJN) is an example of revived modern herbal preparation based on traditional Chinese medicine (TCM) with a long history of administration for various types of cerebrovascular injuries and neurodegenerative diseases. TLJN is prepared from the herbal roots of Panax notoginseng (Sanchi) and dried fruits of Gardenia jasminoides (Cape Jasmine), and so far, it has demonstrated promising results in patients with vascul...
Source: Biomedicine and pharmacotherapy = Biomedecine and pharmacotherapie - Category: Drugs & Pharmacology Authors: Tags: Biomed Pharmacother Source Type: research
ConclusionsIn front of a patient with a MAS, an organic lesion of the brain must be suspected, until a complete negative vascular and neuroradiological diagnostic workup has been performed. A spectrum of underlying pathologies (vascular or demyelinating diseases, epileptic or degenerative conditions) may cause a MAS-like clinical onset. The variability of aura symptoms may result in a real diagnostic challenge.
Source: Neurological Sciences - Category: Neurology Source Type: research
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