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Value of Eye Movement Exam in Aiding Precise Localization in Stroke (P1.016)
We present an unusual presentation of midbrain stroke presenting with bilateral ptosis in an African American male with vascular risk factors and concurrent use of bevacizumab. This case illustrates how detailed knowledge of anatomy and detailed neurologic exam remain valuable tools for localizing and diagnosing subtle presentations of common neurologic disease. Case description: A 69 year-old African American man with vascular risk factors including hypertension, hyperlipidemia and poorly controlled diabetes experienced sudden onset horizontal diplopia associated with fatigue. The patient presented to the Emergency Depart...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Khandker, N., Schmerler, D., Mahajan, S., Serra, A., Strbian, D. Tags: Cerebrovascular Disease and Interventional Neurology I ePosters Source Type: research

Recurrent Intra-Luminal Aortic Thrombus And Ischemic Stroke In A Patient With Essential Thrombocythemia (P6.262)
CONCLUSIONS: This case highlights the importance of recognizing essential thrombocythemia as an entity that can lead to devastating complications, including acute coronary syndrome and either arterial and venous thrombosis. Early recognition and effective cytoreductive therapy are cornerstones to the prevention of recurrent embolism. This case demonstrates that Intra-luminal thrombus may resolve and reappear, and can vary greatly in its clinical consequences.Disclosure: Dr. Vela-Duarte has nothing to disclose. Dr. Flaster has nothing to disclose.
Source: Neurology - April 9, 2014 Category: Neurology Authors: Vela-Duarte, D., Flaster, M. Tags: Cerebrovascular Disease and Interventional Neurology: Case Reports Source Type: research

Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Antithrombotic therapy for atrial fibrillation and coronary artery disease in older patients
Conclusions Among older patients with AF and CAD, overall warfarin use was low. Patients ≥80 years old at highest stroke risk received warfarin in similar proportions to the overall cohort. Further investigation into optimizing antithrombotic strategies in this population is warranted.
Source: American Heart Journal - October 20, 2014 Category: Cardiology Source Type: research

A Serious Diagnosis Lacking Common Symptoms
​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 regi...
Source: The Case Files - May 28, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Capsular warning syndrome and its clinical awareness and therapeutic approach: two case reports and a systematic review of the literature
ConclusionOur cases fit with the description of patients with partial recovery and risk factors (hypertension, diabetes, and smoking) in male patients. There is a lack of evidence regarding the best treatment option; dual antiplatelet therapy and anticoagulation therapy are strong contenders for a favorable result.
Source: Frontiers in Neurology - May 16, 2023 Category: Neurology Source Type: research

E-248 Postpartum vertebral artery dissections: a report of 7 cases and literature review
ConclusionA limited cohort of 33 ppVADs exist in the literature. This study contributes 7 additional cases and suggests that, despite heterogenous management of ppVAD, the resulting outcomes were favorable.Disclosures V. Lazarov: None. A. Monteiro: None. F. Almayman: None. M. Waqas: None. J. Cappuzzo: None. E. Levy: None. A. Siddiqui: None.
Source: Journal of NeuroInterventional Surgery - July 23, 2022 Category: Neurosurgery Authors: Lazarov, V., Monteiro, A., Almayman, F., Waqas, M., Cappuzzo, J., Levy, E., Siddiqui, A. Tags: SNIS 19th annual meeting electronic poster abstracts Source Type: research

Clinical Reasoning: An 87-year-old woman with left-sided numbness
An 87-year-old woman with a history of hypertension, hyperlipidemia, and peripheral vascular disease presented with acute left paresthesias. On evaluation, blood pressure was 152/77 mm Hg and heart rate 78 and regular. Physical examination had normal results. On neurologic examination, she had normal mental status, decreased sensation on the left face, and normal strength, tone, and reflexes. Cerebellar examination and gait were normal. There was reduced light touch and pinprick sensation of the left arm and leg, with no extinction. Complete blood count and comprehensive metabolic panel were within normal limits, and ECG s...
Source: Neurology - October 12, 2015 Category: Neurology Authors: Yaghi, S., Elkind, M. S. V. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Cardiac, Embolism, Infarction RESIDENT AND FELLOW SECTION Source Type: research

Management and clinical outcome of stable coronary artery disease in Austria : Results from 5  years of the CLARIFY registry.
CONCLUSION: Characteristics of Austrian outpatients with stable CAD corresponded to those of patients with CAD in other developed countries. Medical treatments following the recommendations of the European guidelines were prescribed in the majority of patients; however, recommended goals of life style interventions including a heart rate less than 60 bpm and general risk factor management were not achieved by a high proportion of patients. Heart rate control and life style changes remain unmet needs of cardiovascular care in Austria. PMID: 28913755 [PubMed - as supplied by publisher]
Source: Wiener Klinische Wochenschrift - September 14, 2017 Category: General Medicine Authors: Lang IM, Badr-Eslam R, Greenlaw N, Young R, Steg PG Tags: Wien Klin Wochenschr Source Type: research

Agitation and somnolence by bilateral paramedian thalamic infarct
Key Clinical MessageBilateral thalamic infarction in paramedian artery territory may present with severe acute illness, confusion, coma and memory impairment. However, subtle clinical presentation as in our case should alert the clinician to consider such a diagnosis as it can be associated with good prognosis.AbstractBilateral thalamic infarct is a rare form of stroke. Mostly thalamic infarcts are unilateral. In most cases, bilateral thalamic infarction leads to cognitive dysfunction, opthalmoparesis, conscious impairment, behavioral disturbance, and corticospinal dysfunction. Here, we describe the case of a 75-year-old m...
Source: Clinical Case Reports - June 20, 2023 Category: General Medicine Authors: Mohamed Sheikh  Hassan, Nor Osman Sidow, Abdiladhif Mohamed Ali, Mohamed Farah Osman, Abdiwahid Ahmed Ibrahim, Said Abdirahman Ahmed Tags: CASE REPORT Source Type: research

Acute coronary syndrome in young women under 55 years of age: clinical characteristics, treatment, and outcomes
Conclusions Modifiable risk factors such as smoking, obesity, diabetes, and hypertension should be addressed in young women. Following ACS, young women received fewer evidence-based medications, were treated less invasively, and had higher readmission rates within 6 months compared to young men.
Source: Clinical Research in Cardiology - February 17, 2015 Category: Cardiology Source Type: research

Recurrent ischemic strokes and headaches originating from Lambl's excrescence (P2.273)
CONCLUSIONS: The association between recurrent strokes and late-age onset migraine with aura should raise clinical suspicion of a cardiogenic valvular etiology. Early TEE use is necessary to diagnose cardiac valvular strands like LE. LE associated with migraine headaches should prompt a treatment with anti-thrombotic agent. While anticoagulants and cardiothoracic surgery are indicated for recurrent strokes, a combined antiplatelet therapy was effective in our patient.Disclosure: Dr. Dumitrascu has nothing to disclose. Dr. Tsimerinov has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Dumitrascu, O., Tsimerinov, E. Tags: Cerebrovascular Disease and Interventional Neurology: PFO and Other Cardiac Disease Source Type: research

P-021 Very Delayed Monocular Blindness Following Flow Diversion Treatment of Ophthalmic Artery Aneurysm
ConclusionMonocular vision loss remains a risk, even months to years following flow diversion of ICA aneurysms. Long term clinical follow-up is necessary to define the incidence of this complication.Abstract P-021 Figure 1DisclosuresT. Higashimori: None. D. Sandhu: None. J. Kim: None. A. Grande: None. M. Ezzeddine: None. R. Tummala: None. B. Jagadeesan: None.
Source: Journal of NeuroInterventional Surgery - July 28, 2016 Category: Neurosurgery Authors: Higashimori, T., Sandhu, D., Kim, J., Grande, A., Ezzeddine, M., Tummala, R., Jagadeesan, B. Tags: Oral poster abstracts Source Type: research

Fool Me Once: An Uncommon Presentation of PE
​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; & AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and i...
Source: The Case Files - November 27, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Not Just Acid Reflux: The Need to Think Worst First
Discussion Heart disease is the leading cause of death in the United States.1 This year, 720,000 Americans will have a new coronary event—defined as first hospitalized myocardial infarction (MI) or coronary heart disease death—and around 335,000 will have a recurrent event. Approximately 35% of people who experience a coronary event in a given year and around 14% of patients who have an acute coronary syndrome will die from it.1 Roughly 60% of patients with an acute coronary syndrome are transported to the emergency department via ambulance.2–4. Up to one-third of patients experiencing an MI may not complain of chest...
Source: JEMS Special Topics - January 13, 2019 Category: Emergency Medicine Authors: Stephen Sanko, MD, FACEP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

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