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MRI of Cerebrovascular Injury Associated With COVID-19 and Non-COVID-19 Acute Respiratory Distress Syndrome: A Matched Case-Control Study
CONCLUSIONS: In a case-control study of selected ARDS patients with brain MRI, the frequencies of ischemic and hemorrhagic cerebrovascular injuries were similar between COVID-19 versus non-COVID-19 ARDS patients. However, the MRI pattern of disseminated hemorrhagic leukoencephalopathy was unique to the COVID-19 ARDS patients in this cohort.
Source: Critical Care Medicine - October 20, 2022 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

Subarachnoid hemorrhage in the emergency department
ConclusionSubarachnoid hemorrhages are frequently misdiagnosed; therefore, we believe it is imperative to address the diagnosis and initiation of early management in the emergency medicine department to minimize poor outcomes in the future.
Source: International Journal of Emergency Medicine - May 12, 2021 Category: Emergency Medicine Source Type: research

Neurologic Emergencies
I ’ll bet that if you ask most emergency physicians about which organ system’s emergencies cause them the most angst, it would be the neurologic system. Neurologic emergencies are the epitome of the proverbial “needle in a haystack.” For example, the overwhelming majority of cases of headache, back pain, weakness, and dizziness turn out to be a haystack of benign causes. Our job in the emergency department is to find those rare needles...the subarachnoid hemorrhage, the spinal infection, the stroke, or the vertebral dissection.
Source: Emergency Medicine Clinics of North America - November 4, 2020 Category: Emergency Medicine Authors: Amal Mattu Tags: Foreword Source Type: research

Neurological emergencies associated with COVID-19: stroke and beyond
We report five cases of COVID-19 presenting to the ER with acute neurological symptoms, over the course of 1  month. This includes two cases of ischemic stroke, one with large-vessel occlusion and one with embolic infarcts. The remainders of the cases include acute tumefactive demyelination, isolated cytotoxic edema of the corpus callosum with subarachnoid hemorrhage, and posterior reversible encephalopat hy syndrome (PRES).
Source: Emergency Radiology - August 10, 2020 Category: Emergency Medicine Source Type: research

Remote Ischemic Conditioning in Emergency Medicine—Clinical Frontiers and Research Opportunities
Time-critical acute ischemic conditions such as ST-elevation myocardial infarction and acute ischemic stroke are staples in Emergency Medicine practice. While timely reperfusion therapy is a priority, the resultant acute ischemia/reperfusion injury contributes to significant mortality and morbidity. Among therapeutics targeting ischemia/reperfusion injury (IRI), remote ischemic conditioning (RIC) has emerged as the most promising. RIC, which consists of repetitive inflation and deflation of a pneumatic cuff on a limb, was first demonstrated to have protective effect on IRI through various neural and humoral mechanisms. It...
Source: Shock - February 12, 2020 Category: Emergency Medicine Tags: Review Articles Source Type: research

Enhanced Renal Clearance in Patients With Hemorrhagic Stroke*
Objectives: To evaluate enhanced renal clearance over time in patients with aneurysmal subarachnoid hemorrhage or intracerebral hemorrhage via measured creatinine clearance and to compare measured creatinine clearance to creatinine clearance calculated by the Cockcroft-Gault equation and estimated glomerular filtration rate calculated by the Modification of Diet in Renal Diseases equation. Design: Prospective, observational study. Setting: Neurosciences ICU in a tertiary care academic medical center. Patients: Study participants had an admission diagnosis of aneurysmal subarachnoid hemorrhage or intracerebral he...
Source: Critical Care Medicine - May 16, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

A Fate Worse Than Death: Prognostication of Devastating Brain Injury
Conclusions: Intensivists should consider the modern literature describing prognosis for devastating brain injury and provide appropriate time for patient recovery and for discussions with the patient’s surrogates. Surrogates wish to have a prognosis enumerated even when uncertainty exists. These discussions must be handled with care and include admission of uncertainty when it exists. Respect for patient autonomy remains paramount, although physicians are not required to provide inappropriate medical therapies.
Source: Critical Care Medicine - March 16, 2019 Category: Emergency Medicine Tags: Concise Definitive Review Source Type: research

Blood Pressure Management Goals in Stroke Care
Blood pressure management goals in stroke care You arrive at a small rural emergency healthcare facility to transport a 72-year-old female who presents to the ED with the worst headache of her life. She’s to be transported to a tertiary center with neurosurgical services. Upon further questioning you determine her headache was sudden onset with maximum intensity. When reviewing her history and medications, you note that she’s currently on Coumadin (warfarin) with an international normalized ratio (INR) of 3.5, with the following vital signs noted on the monitor upon entering the room: blood pressure of 209/75 mmHg; hea...
Source: JEMS Patient Care - May 1, 2018 Category: Emergency Medicine Authors: Ken Davis, BA, EMT-P, FP-C Tags: Patient Care Cardiac & Resuscitation Source Type: news

Spontaneous Vertebral Artery Dissection in a Healthy 26 Year Old Female Patient: A Case Study
Spontaneous vertebral artery dissection (SVAD) is an extremely rare, yet life-threatening, event that can potentially result in ischemic stroke or subarachnoid hemorrhage, depending on the origin and extension of the dissection. Vertebral artery dissection is more commonly associated with traumatic injury to the neck, resulting in compromised structural integrity of the vertebral artery wall. This case study discusses the clinical presentation, physical examination, diagnosis, clinical course, and outcome for a young, otherwise healthy, female patient who presented to the emergency department with a SVAD.
Source: Advanced Emergency Nursing Journal - January 1, 2018 Category: Emergency Medicine Tags: Cases of Note Source Type: research

Rupture of an Occult Intracranial Mycotic Aneurysm after Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke
We present a case of a stroke patient who was an appropriate candidate and was treated with rtPA who experienced a fatal subarachnoid hemorrhage due to a ruptured mycotic aneurysm (MA).
Source: The Journal of Emergency Medicine - October 6, 2017 Category: Emergency Medicine Authors: Jared Glenn, Margaret Strecker-McGraw, Ian McGraw, Karim Jabbar, Nathan A. James, C. Keith Stone Tags: Selected Topics: Neurological Emergencies Source Type: research

Pre-hospital ct diagnosis of subarachnoid hemorrhage
Subarachnoid hemorrhage (SAH) is associated with higher mortality in the acute phase than other stroke types. There is a particular risk of early and devastating re-bleeding. Patients therefore need urgent ass...
Source: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine - February 28, 2017 Category: Emergency Medicine Authors: Maren Ranhoff Hov, Annette Ryen, Katrine Finsnes, Janne Storflor, Thomas Lindner, Jostein Gleditsch and Christian Georg Lund Source Type: research

Hypothermia for Neuroprotection in Convulsive Status Epilepticus
This study aims to see if there are any similar advantages to therapeutic hypothermia in mechanically ventilated status epilepticus patients as neuroprotective properties were previously detected in animal studies of hypothermia.
Source: The Journal of Emergency Medicine - February 17, 2017 Category: Emergency Medicine Authors: Stephanie Diebold Tags: Abstract Source Type: research

Neurologic Emergencies in the Elderly
This article discusses the elderly patient presenting to the emergency department with acute ischemic stroke, transient ischemic attack, intracerebral hemorrhage, subarachnoid hemorrhage, chronic subdural hematoma, traumatic brain injury, seizures, and central nervous system infections. This article reviews the subtle presentations, difficult workups, and complicated treatment decisions as they pertain to our older patients. ”
Source: Emergency Medicine Clinics of North America - July 28, 2016 Category: Emergency Medicine Authors: Lauren M. Nentwich, Benjamin Grimmnitz Source Type: research

Analgesia in Neurocritical Care: An International Survey and Practice Audit*
Conclusions: Opiates and acetaminophen are preferred analgesic agents, and gabapentin is a contextual third choice, in neurocritically ill patients. Other agents are rarely prescribed. The discordance in physician self-reports and objective audits suggest that pain management optimization studies are warranted.
Source: Critical Care Medicine - April 16, 2016 Category: Emergency Medicine Tags: Neurologic Critical Care Source Type: research

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