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Diagnostic accuracy of the physical exam in emergency department patients with acute vertigo or dizziness: Systematic review and meta-analysis for GRACE-3
CONCLUSION: Most neurological exam findings have low sensitivity and high specificity for a central cause in patients with acute vertigo or dizziness. In acute vestibular syndrome (monophasic, continuous, persistent dizziness), HINTS and HINTS+ have high sensitivity when performed by trained clinicians.PMID:36453134 | DOI:10.1111/acem.14630
Source: Accident and Emergency Nursing - December 1, 2022 Category: Emergency Medicine Authors: Vishal Paresh Shah Lucas Oliveira J E Silva Wigdan Farah Mohamed O Seisa Abdalla Kara Balla April Christensen Magdoleen Farah Bashar Hasan Fernanda Bellolio M Hassan Murad Source Type: research

Successful outcome in an adolescent with artery of percheron occlusion who was treated with tissue plasminogen activator
Ischemic stroke is relatively rare in children, leading to a low index of suspicion and delayed diagnosis, particularly in cases of posterior circulation occlusion when symptoms are less indicative. Occlusion of the artery of Percheron (AOP) results in nonspecific neurologic symptoms, including drowsiness, aphasia or dysarthria, ophthalmoplegia, ataxia, and dysmetria. Previous reports, mainly in adults, described late diagnosis and severe residual disability.
Source: The Journal of Emergency Medicine - May 4, 2022 Category: Emergency Medicine Authors: Elihay Berliner, Evelyn Hessing, Elena Zharkov, Adi Aran Tags: Clinical Communications: Pediatrics Source Type: research

Successful outcome in an adolescent with artery of Percheron occlusion who was treated with tPA
Ischemic stroke is relatively rare in children, leading to a low index of suspicion and delayed diagnosis, particularly in cases of posterior circulation occlusion when symptoms are less indicative. Occlusion of the Artery of Percheron (AOP) results in non-specific neurological symptoms including drowsiness, aphasia or dysarthria, ophthalmoplegia, ataxia, and dysmetria. Previous reports, mainly in adults, described late diagnosis and severe residual disability.
Source: The Journal of Emergency Medicine - May 4, 2022 Category: Emergency Medicine Authors: Elihay Berliner, Evelyn Hessing, Elena Zharkov, Adi Aran Source Type: research

Can emergency physicians accurately rule out a central cause of vertigo using the HINTS exam? A systematic review and meta-analysis.
CONCLUSIONS: The HINTS exam when used in isolation by emergency physicians has not been shown to be sufficiently accurate to rule out a stroke in those presenting with AVS. PMID: 32167642 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - March 12, 2020 Category: Emergency Medicine Authors: Ohle R, Montpellier RA, Marchadier V, Wharton A, McIsaac S, Anderson M, Savage D Tags: Acad Emerg Med Source Type: research

Intravenous Thrombolysis at 3.5 Hours From Onset of Pediatric Acute Ischemic Stroke
We report the case of a 14-year-old girl who presented with right-sided weakness and ataxia, loss of sensation, and altered mental status. Magnetic resonance imaging with diffusion-weighted imaging showed an acute lesion in the distribution of the left posterior cerebral artery, and magnetic resonance angiogram demonstrated occlusion of the third branch of the left posterior cerebral artery. With parental consent, clinicians decided to infuse an adult dose of weight-adjusted intravenous alteplase at 3.5 hours from onset of symptoms, with subsequent improvement in National Institutes of Health Stroke Scale score from 11 to ...
Source: Pediatric Emergency Care - January 1, 2020 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Ataxia and Headache in a Child: A Case of Acute Cerebellar Infarction
Abstract: A 4-year-old female patient presents to the pediatric emergency department with acute onset of ataxia and occipital headache. Initial investigation, including computed tomography imaging, failed to demonstrate any focal neurologic lesion. Subsequent studies, however, reveal an acute thrombosis of the superior cerebellar artery. Further work up identified the likely causative factor to be a heterozygous mutation at the methylene tetrahydrofolate reductase gene. In this case report, we will discuss the work-up of pediatric ataxia, the evaluation and management of cerebrovascular accidents in children, and the assoc...
Source: Pediatric Emergency Care - August 1, 2017 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Cerebellar Stroke: A Missed Diagnosis
Cerebellar strokes account for less than 10% of all strokes but lead to significantly poor outcomes. Cerebellar strokes that are initially missed have a mortality rate of 40%, and half of the patients who survive have long-term deficits. The patient's history may provide clues that point to a cerebellar stroke. Signs and symptoms include vertigo, headache, vomiting and ataxia. It is important to note the presence of stroke risk factors, such as a history of strokes or transient ischemic attacks, diabetes mellitus, hypertension, hypercholesterolemia, advanced age, atrial fibrillation, and cigarette smoking. The importance o...
Source: Advanced Emergency Nursing Journal - July 1, 2017 Category: Emergency Medicine Tags: Cases of Note Source Type: research

Man with Ataxia and Aortic Mass
A 59-year-old man with a history of testicular cancer in remission and dyslipidemia undergoing outpatient evaluation for ataxia was referred to our emergency department after a magnetic resonance imaging scan of the brain led to a diagnosis of a cerebellar stroke and comprehensive transthoracic echocardiogram visualized a mass in the proximal ascending aorta. Upon arrival to the emergency department, point-of-care echocardiography confirmed the presence of a mobile echogenic 2.0-  × 1.9-cm mass distal to the aortic valve.
Source: The Journal of Emergency Medicine - November 13, 2016 Category: Emergency Medicine Authors: Michael R. Ehmann, Geoffrey S. Kelly Tags: Visual Diagnosis in Emergency Medicine Source Type: research

Vertebral Artery Dissection Causing Stroke After Trampoline Use
Conclusions: Vertebral artery dissection is a relatively common cause of stroke in the pediatric age group. Trampoline use has been associated with significant risk of injury to the head and neck. Patients who are small and/or young are most at risk. In this case, minor trauma secondary to trampoline use could be a possible mechanism for vertebral artery dissection and subsequent strokes. The association in this case warrants careful consideration because trampoline use could pose a significant risk to pediatric users.
Source: Pediatric Emergency Care - November 1, 2015 Category: Emergency Medicine Tags: Illustrative Cases 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

Complete resolution of a solitary pontine abscess in a patient with dental caries
A solitary brainstem abscess is a rare fatal intracranial infection, which can be mistaken for an acute stroke complicated with a systemic infection. Dental caries without abscess formation can be a possible source of infection. Herein, we describe the case of a 59-year-old man with dental caries who presented with a 4-day history of progressive dizziness, double vision, gait ataxia, emesis, and left facial and body numbness. Fever, suboccipital headache, and difficulties in urinating and defecating were noted on admission. Acute brainstem infarction and suspected aspiration pneumonia were then diagnosed. Magnetic resonanc...
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Ming-Hua Chen, Hung-Wen Kao, Chun-An Cheng Tags: Case Reports Source Type: research