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28-Year-Old Man With Joint Pain
A 28-year-old man presented to the emergency department with right shoulder pain that radiated to the right arm as well as pain of the right hip and lower back. His medical history is significant for sickle cell disease (SCD) with the HbSS genotype (homozygous for the S globin). He had a hemorrhagic stroke in the setting of venous sinus thrombosis 2 years earlier with no persisting neurologic deficits as well as osteonecrosis of bilateral hips and right knee requiring right total hip arthroplasty and right total knee arthroplasty.
Source: Mayo Clinic Proceedings - June 1, 2022 Category: Internal Medicine Authors: Emily B. Butts, Albert Bui, Razvan M. Chirila Tags: Residents ’ clinic Source Type: research

Craniocervical Artery Dissections: A Concise Review for Clinicians
Craniocervical artery dissection (CAD), although uncommon, can affect the young and lead to devastating complications, including stroke and subarachnoid hemorrhage. It starts with a tear in the intima of a vessel with subsequent formation of an intramural hematoma. Most CAD occurs spontaneously or after minor trauma. Patients with CAD may exhibit isolated symptoms of an underlying subclinical connective tissue disorder or have a clinically diagnosed connective tissue disorder. Emergent evaluation and computed tomography angiography or magnetic resonance imaging/angiography of the head and neck are required to screen for and to diagnose CAD.
Source: Mayo Clinic Proceedings - April 1, 2022 Category: Internal Medicine Authors: Zafer Keser, James F. Meschia, Giuseppe Lanzino Tags: Concise review Source Type: research

Intracerebral Hemorrhage
Spontaneous intracerebral hemorrhage (ICH) is a medical emergency and is disproportionately associated with higher mortality and long-term disability compared with ischemic stroke. The phrase “time is brain” was derived for patients with large vessel occlusion ischemic stroke in which approximately 1.9 million neurons are lost every minute. Similarly, this statement holds true for ICH patients due to a high volume of neurons that are damaged at initial onset and during hematoma expan sion. Most cases of spontaneous ICH pathophysiologically stem from chronic hypertension and rupture of small perforating vessels off of l...
Source: Mayo Clinic Proceedings - May 2, 2021 Category: Internal Medicine Authors: Cumara B. O ’Carroll, Benjamin L. Brown, W. David Freeman Tags: Solicited review Source Type: research

Predicting Who Will Experience Cerebral Hemorrhage When Anticoagulated
The most feared hemorrhagic complication of anticoagulating patients with atrial fibrillation is intracerebral hemorrhage (ICH). However, not anticoagulating high-risk patients with atrial fibrillation can lead to cardioembolic stroke, another disastrous outcome. Physicians may tend to avoid blame by inaction, which can result in underprescribing. Such clinical inertia is not unique to anticoagulating patients with atrial fibrillation. Clinical inertia has been noted in the treatment of several common chronic conditions, such as treating blood pressure in patients with hypertension and treating hyperglycemia in patients wi...
Source: Mayo Clinic Proceedings - September 30, 2020 Category: Internal Medicine Authors: James F. Meschia Tags: Editorial Source Type: research

Telestroke in the Time of COVID-19: The Mayo Clinic Experience
On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic, and in the weeks following, public health organizations, medical associations, and governing bodies throughout the world recommended limiting contact with others to “flatten the curve” of COVID-19. Although both ischemic and hemorrhagic strokes have been reported with COVID-19, there has been anecdotal suggestion of an overall decrease in stroke admissions. To date, the effects of any pandemic on telestroke service lines have not been described.
Source: Mayo Clinic Proceedings - June 12, 2020 Category: Internal Medicine Authors: Josephine F. Huang, Melanie R.F. Greenway, Deena M. Nasr, Felix E. Chukwudelunzu, Bart M. Demaerschalk, Cumara B. O ’Carroll, Charisse A. Nord, Emily A. Pahl, Kevin M. Barrett, Lindsy N. Williams Tags: Brief Report Source Type: research

Telestroke in the Time of COVID-19: The  Mayo Clinic Experience
On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic, and in the weeks following, public health organizations, medical associations, and governing bodies throughout the world recommended limiting contact with others to “flatten the curve” of COVID-19. Although both ischemic and hemorrhagic strokes have been reported with COVID-19, there has been anecdotal suggestion of an overall decrease in stroke admissions. To date, the effects of any pandemic on telestroke service lines have not been described.
Source: Mayo Clinic Proceedings - June 12, 2020 Category: Internal Medicine Authors: Josephine F. Huang, Melanie R.F. Greenway, Deena M. Nasr, Felix E. Chukwudelunzu, Bart M. Demaerschalk, Cumara B. O ’Carroll, Charisse A. Nord, Emily A. Pahl, Kevin M. Barrett, Lindsy N. Williams Tags: Brief report Source Type: research

79-Year-Old Man With Shortness of Breath and Fevers
A 79-year old man with a history of myocardial infarction and coronary artery bypass grafting in 2000, biventricular systolic heart failure with an ejection fraction of 27%, hypertension, persistent atrial fibrillation for which he was taking high-dose aspirin given a previous history of hemorrhagic stroke, stage 3 chronic kidney disease, left cerebellar ischemic stroke, and implantable cardioverter-defibrillator (ICD) placement 5 years previously presented to his local medical facility with a 2-day history of breathlessness, fevers, and chills.
Source: Mayo Clinic Proceedings - November 7, 2018 Category: Internal Medicine Authors: Jaskanwal D. Sara, Megha Prasad, Suraj Kapa Tags: Residents' clinic Source Type: research