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Specialty: Emergency Medicine
Condition: Hemorrhagic Stroke

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Total 233 results found since Jan 2013.

Direct oral anticoagulants in the secondary prevention of stroke and transient ischemic attack in patients with atrial fibrillation
Abstract In patients with non-valvular atrial fibrillation (NVAF) and history of transient ischemic attack (TIA) or stroke, the rate of vascular events is higher in comparison to patients without history of stroke or TIA. A meta-analysis of direct oral anticoagulants (DOACs) studies, including only patients with history of stroke or TIA, report a significant reduction of 15 % in the rates of composite of stroke and systemic embolism in patients treated with DOACs, compared to those treated with warfarin. Furthermore, a reduction of 14 % for major bleeding, as well as a 56 % reduction for hemorrhagic stroke over...
Source: Internal and Emergency Medicine - April 11, 2015 Category: Emergency Medicine Source Type: research

Reversible Cerebral Vasoconstriction Syndrome
Reversible cerebral vasoconstriction syndrome (RCVS) is an underappreciated and poorly understood cause of thunderclap headache (TCH). Although self-limited in the majority of patients, incidence is increasing, with presentations overlapping considerably with life-threatening conditions, such as aneurysmal subarachnoid hemorrhage and stroke. In addition, radiographic findings seen in RCVS are also present in primary angiitis of the central nervous system (PACNS). Misdiagnosis of RCVS might subject patients to unnecessary invasive testing and immunosuppressive therapy.
Source: The Journal of Emergency Medicine - April 6, 2015 Category: Emergency Medicine Authors: Kenneth R.L. Bernard, Morris Rivera Tags: Selected Topics: Neurological Emergencies Source Type: research

Iodinated Contrast Prior to Thrombolysis Was Not Associated With Worse Intracranial Hemorrhage.
CONCLUSIONS: No consistent harms were observed in association with intravenous iodinated contrast prior to rt-PA administration. It is reasonable to continue CTA prior to thrombolysis as clinically indicated. PMID: 25731593 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - March 2, 2015 Category: Emergency Medicine Authors: Radecki RP, Azam A, Doshi PB, Banuelos RC Tags: Acad Emerg Med Source Type: research

Iodinated Contrast Prior to Thrombolysis Was Not Associated With Worse Intracranial Hemorrhage
ConclusionsNo consistent harms were observed in association with intravenous iodinated contrast prior to rt‐PA administration. It is reasonable to continue CTA prior to thrombolysis as clinically indicated.
Source: Academic Emergency Medicine - March 2, 2015 Category: Emergency Medicine Authors: Ryan P. Radecki, Arif Azam, Pratik B. Doshi, Rosa C. Banuelos Tags: Original Contribution Source Type: research

Are the current MRI criteria using the DWI-FLAIR mismatch concept for selection of patients with wake-up stroke to thrombolysis excluding too many patients?
Conclusions: In this small series DWI-FLAIR mismatch was not associated with worse outcome or ICH. This suggests that selecting WUS patients using DWI-FLAIR mismatch in clinical trials may exclude a large group of patients who might benefit.
Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine - February 19, 2015 Category: Emergency Medicine Authors: Audun OdlandPål SærvollRajiv AdvaniMartin KurzKathinka Kurz Source Type: research

Evaluation and Management of the Child With Suspected Acute Stroke
Pediatric stroke occurs at an incidence of 1.6 to 13/100 000 and may be acute ischemic, hemorrhagic, or of sinus venous thrombosis etiology. As these children present to the emergency department, early consideration for this diagnosis is paramount in beginning medical management to optimize cerebral perfusion and minimize secondary injury. There are many identified risk factors in pediatric stroke including arteriopathies, cardiac disease (specifically congenital heart disease), and infection. Modifiable adult risk factors including hypertension, hyperlipidemia, and diabetes are rarely seen in pediatrics.
Source: Clinical Pediatric Emergency Medicine - February 4, 2015 Category: Emergency Medicine Authors: Lindsey Morgan Source Type: research

Out-of-Hospital Cardiac Arrest From Brain Cause: Epidemiology, Clinical Features, and Outcome in a Multicenter Cohort*
Conclusions: Presentation of cerebrovascular event complicated with out-of-hospital cardiac arrest may mimic coronary etiology, but several clinical elements may help to identify brain causes. Even if survival is null, the high proportion of brain deaths provides opportunity for organ donation.
Source: Critical Care Medicine - January 17, 2015 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Intraparenchymal hemorrhage after heroin use
Heroin-associated stroke is a rare complication of use. Various proposed mechanisms of heroin-associated ischemic stroke have been proposed, including the following: cardioembolism in the setting of infective endocarditis, hypoxic ischemic brain injury in the setting of hypoxemia and hypotension, and infective arteritis or vasculitis from drug adulterants. A previously healthy 28-year-old woman presented to the emergency department with altered mental status and normal vitals after she was found wandering outside her apartment.
Source: The American Journal of Emergency Medicine - January 16, 2015 Category: Emergency Medicine Authors: Neha Kumar, Mary Colleen Bhalla, Jennifer A. Frey, Alison Southern Tags: Case Report Source Type: research

Acute Vertebrobasilar Ischemic Stroke Due To Electric Injury
Electrical injuries are most commonly due to household accidents. Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of current and duration of contact with the body. Various types of neurological damage due to electrical injury have been described in literature. It may manifest as peripheral nerve injury, spinal cord damage, seizures, cerebellar ataxia, hypoxic encephalopathy and intracerebral hemorrhage. Acute ischemic stroke is an infrequent complication of electrical injury.
Source: The American Journal of Emergency Medicine - January 6, 2015 Category: Emergency Medicine Authors: Rajendra Singh Jain, Sunil Kumar, Desai Tushar Suresh, Rakesh Agarwal Tags: Case Report Source Type: research

Identification of Acute Stroke Using Quantified Brain Electrical Activity
ConclusionsDespite a small population and the use of a classifier without the benefit of training on a stroke population, these data suggest that a rapidly acquired, easy‐to‐use system to assess brain electrical activity at the time of evaluation of acute stroke could be a valuable adjunct to current clinical practice.
Source: Academic Emergency Medicine - January 6, 2015 Category: Emergency Medicine Authors: Edward A. Michelson, Daniel Hanley, Robert Chabot, Leslie S. Prichep Tags: Original Contribution Source Type: research

Outcomes of Patients Requiring Blood Pressure Control Before Thrombolysis with tPA for Acute Ischemic Stroke. Darger, Bryan; Gonzales, Nicole R.; Banuelos, Rosa C.; Radecki, Ryan P.; Peng, Hui; Doshi, Pratik B.
Introduction: The purpose of this study was to assess safety and efficacy of thrombolysis in the setting of aggressive blood pressure (BP) control as it compares to standard BP control or no BP control prior to thrombolysis. Methods: We performed a retrospective review of patients treated with tissue plasminogen activator (tPA) for acute ischemic stroke (AIS) between 2004-2011. We compared the outcomes of patients treated with tPA for AIS who required aggressive BP control prior to thrombolysis to those requiring standard or no BP control prior to thrombolysis. The primary outcome of interest was safety, defined b...
Source: Western Journal of Emergency Medicine - January 1, 2015 Category: Emergency Medicine Source Type: research

Identification of acute stroke using quantified brain electrical activity.
CONCLUSIONS: Despite a small population and the use of a classifier without the benefit of training on a stroke population, these data suggest that a rapidly acquired, easy-to-use system to assess brain electrical activity at the time of evaluation of acute stroke could be a valuable adjunct to current clinical practice. PMID: 25565489 [PubMed - in process]
Source: Accident and Emergency Nursing - January 1, 2015 Category: Emergency Medicine Authors: Michelson EA, Hanley D, Chabot R, Prichep LS Tags: Acad Emerg Med Source Type: research

Isolated middle cerebral artery dissection: a systematic review
Abstract Acute stroke can be missed in the emergency department, particularly in younger patients and in those with more vague symptoms such as headache or dizziness. Cervicocephalic dissections are one group of etiologies for acute stroke in the young. While cervicocephalic dissections are not uncommon in clinical practice, isolated middle cerebral artery dissection (MCAD) has been rarely reported as a cause for stroke. We sought to review the clinical implications and pathophysiology of an isolated MCAD. We searched the medical literature for isolated MCAD in clinical stroke patients using MEDLINE, HighWire, an...
Source: International Journal of Emergency Medicine - December 17, 2014 Category: Emergency Medicine Source Type: research

Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease.
Abstract Cerebrovascular neurologic emergencies including ischemic and hemorrhagic stroke, subarachnoid hemorrhage (SAH), and migraine are leading causes of death and disability that are frequently diagnosed and treated in the emergency department (ED). Although sex and gender differences in neurologic emergencies are beginning to become clearer, there are many unanswered questions about how emergency physicians should incorporate sex and gender into their research initiatives, patient evaluations, and overall management plans for these conditions. After evaluating the existing gaps in the literature, a core group...
Source: Accident and Emergency Nursing - November 24, 2014 Category: Emergency Medicine Authors: Madsen TE, Seigel TA, Mackenzie RS, Marcolini EG, Wira CR, Healy ME, Wright DW, Gentile NT Tags: Acad Emerg Med Source Type: research

Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease
Abstract Cerebrovascular neurologic emergencies including ischemic and hemorrhagic stroke, subarachnoid hemorrhage (SAH), and migraine are leading causes of death and disability that are frequently diagnosed and treated in the emergency department (ED). Although sex and gender differences in neurologic emergencies are beginning to become clearer, there are many unanswered questions about how emergency physicians should incorporate sex and gender into their research initiatives, patient evaluations, and overall management plans for these conditions. After evaluating the existing gaps in the literature, a core group of ED re...
Source: Academic Emergency Medicine - November 24, 2014 Category: Emergency Medicine Authors: Tracy E. Madsen, Todd A. Seigel, Richard S. Mackenzie, Evie G. Marcolini, Charles R. Wira, Megan E. Healy, David W. Wright, Nina T. Gentile Tags: Proceedings Breakout Session Source Type: research