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What is the diagnostic value of head MRI after negative head CT in ED patients presenting with symptoms atypical of stroke?
The objective of this study is to detect the subgroup of patients with such presentations having minor strokes whom may benefit from primary and secondary stroke prevention. We conducted a retrospective analysis and stratified patient risk factors associated with positive findings on subsequent head MRI ordered by the emergency department physician following a normal head CT. Two hundred fifty-two patients presenting with atypical stroke symptoms to the emergency department had a negative head CT followed by head MRI within 24 h ordered by emergency department clinician (123 males and 129 females; mean age of 59.4). Twent...
Source: Emergency Radiology - May 23, 2016 Category: Emergency Medicine Source Type: research

Benedictine hand of 'central' origin
A 67-year-old man was admitted to emergency room to investigate a left hand weakness started on awakening. Anamnesis revealed only a mild hypertension currently treated with ACE-inhibitors. Antigravitary tests in upper limbs showed a ‘benedictine’ hand (figure 1A,B). Sensory examination was unremarkable although the patient complained of nocturnal paraesthesias in left hand. Brain CT scan was negative. Initial diagnosis was ischaemic stroke even if a proximal median nerve injury was mimicked. Nerve conduction study and electromyographic examination of left arm, performed the day after, showed only a ‘mild...
Source: Emergency Medicine Journal - January 24, 2013 Category: Emergency Medicine Authors: Luigetti, M., Ranieri, F., Profice, P., Pilato, F., Capone, F., Di Lazzaro, V. Tags: Workplace injury, Pain (neurology), Stroke, Hypertension, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Ethics, Trauma Images in emergency medicine Source Type: research

Otitis Media Leads to Brain Abscess Presenting as Stroke
By Mikhail Elfond, DO; Esi Quayson, MD; & Joseph V.M. Kelly, MD, MBA   A 65-year-old man presented to the ED via EMS with symptoms of stroke. The paramedics stated his right-sided weakness and speech difficulty started 40 minutes prior to presentation in the ED. En route to the hospital, paramedics observed four episodes of facial twitching.     Vitals signs were significant for a rectal temperature of 100.2°F and a fingerstick blood sugar of 220 mg/dL. History of present illness was significant for a diagnosis of left otitis media treated with Augmentin and Vicodin at an urgent care center one day prior to prese...
Source: The Case Files - January 20, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Radial palsy in the emergency department
Clinical introduction A 73-year-old patient with a medical history of hypertension and hypercholesterolaemia presents to the emergency department with sudden onset of weakness in the right hand and numbness in the right forearm and hand that began 5 h prior to his arrival. There was no history of trauma, he did not drink or smoke and review of systems was otherwise negative. On physical examination, there was right wrist drop with weakness of right wrist and finger extension (figure 1). Finger and wrist flexion were normal, reflexes were intact and there were no sensory alterations. The rest of the physical examinatio...
Source: Emergency Medicine Journal - October 20, 2015 Category: Emergency Medicine Authors: Camacho Velasquez, J. L., Rivero Sanz, E., Garcia Arguedas, C. Tags: Drugs: infectious diseases, EMJ Image Challenge, Stroke, Hypertension, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Ethics Source Type: research

Otitis Media Leads to Brain Abscess Presenting as Stroke
By Mikhail Elfond, DO; Esi Quayson, MD; & Joseph V.M. Kelly, MD, MBA A 65-year-old man presented to the ED via EMS with symptoms of stroke. The paramedics stated his right-sided weakness and speech difficulty started 40 minutes prior to presentation in the ED. En route to the hospital, paramedics observed four episodes of facial twitching.       Vitals signs were significant for a rectal temperature of 100.2°F and a fingerstick blood sugar of 220 mg/dL. History of present illness was significant for a diagnosis of left otitis media treated with Augmentin and Vicodin at an urgent care center ...
Source: The Case Files - January 20, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Severe Symptoms, but a Truly Treatable Disease
​BY NOURA MAHDI; DARRON LEWIS; JEREMY OSBORNE; & AHMED RAZIUDDIN, MDA 73-year-old man was brought to the emergency department from his nursing home for rectal bleeding and anemia. The patient mentioned he had had episodes of bright red rectal bleeding and constipation for a few months. A colonoscopy had been done prior to the visit, which revealed a large intestine tumor and biopsy confirming adenocarcinoma. He was awaiting an appointment with his surgeon.The patient reported bloody rectal leakage, and a CBC done at the nursing home showed a hemoglobin level of 7.2. He also complained of dyspnea but denied any other ...
Source: The Case Files - March 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Hemodialysis with end-stage renal disease did not raise the risk of intracranial hemorrhage after a head injury
Conclusions: HD +ESRD did not increase the post-HI risk of ICH. Therefore, it may not be necessary to lower the threshold of head CT in HD +ESRD patients.
Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine - October 28, 2015 Category: Emergency Medicine Authors: Hsin-Hung ChenChien-Chin HsuShih-Feng WengHung-Jung LinJhi-Joung WangHow-Ran GuoShih-Bin SuChien-Cheng HuangJiann-Hwa Chen Source Type: research

Predictor variables of abnormal imaging findings of syncope in the emergency department
ConclusionsOur data offer that the identification of predictor variables has a potential to decrease the routine use of head CT and MRI in patients admitting to the ED with syncope.
Source: International Journal of Emergency Medicine - March 12, 2018 Category: Emergency Medicine Source Type: research