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Stroke incidence and outcome disparity in Rural regions of Southern West Virginia
Conclusions: Stroke incidence and mortality were found to be higher than expected in many areas of rural West Virginia. The higher stroke risk populations correlate with area that may be impacted by socioeconomic factors and limited access to primary care. These high-risk areas may therefore benefit from investments in infrastructure, patient education, and unrestricted primary care.
Source: Journal of Emergencies, Trauma and Shock - December 24, 2021 Category: Emergency Medicine Authors: Frank Harrison Annie Mark C Bates Muhammad Khan Salman Zahid Syed Imran Shah Aravinda Nanjundappa Joshua R Wyner Elise Anderson Ali Farooq Megan Wood Abhiram Challa Source Type: research

Neurology Concepts: Young Women and Ischemic Stroke —Evaluation and Management in the Emergency Department
ConclusionUnique challenges exist in the evaluation and diagnosis of ischemic stroke in young women. There are still many opportunities for future research aimed at improving detection and treatment of this population.
Source: Academic Emergency Medicine - October 10, 2017 Category: Emergency Medicine Authors: Bernard P. Chang, Charles Wira, Joseph Miller, Murtaza Akhter, Bradley E. Barth, Joshua Willey, Lauren Nentwich, Tracy Madsen Tags: Original Contribution Source Type: research

Management of Acute Ischemic Stroke
Conclusions: Appropriate treatment of ischemic stroke is essential in the reduction of mortality and morbidity. Management of stroke involves a multidisciplinary approach that starts and extends beyond hospital admission.
Source: Critical Care Medicine - October 14, 2020 Category: Emergency Medicine Tags: Concise Definitive Review Source Type: research

Acute Stroke: From Prehospital Care to In-Hospital Management
Early recognition of stroke by clinical presentation and prehospital stroke assessment tools facilitate rapid prehospital and ED diagnosis. CanStockPhoto/focalpoint   Stroke is a leading cause of morbidity and mortality in the United States and requires prompt recognition by prehospital providers to ensure rapid transport. Stroke can present in a variety of different ways, some more readily apparent than others. Delays in diagnosis and treatment can have devastating effects on the outcomes for these patients. In this article, we describe a patient who initially presented with altered mental status and was subsequent...
Source: JEMS Patient Care - May 2, 2018 Category: Emergency Medicine Authors: Henry G. Colmer IV, MD Tags: Patient Care Cardiac & Resuscitation Source Type: news

An Update on Pediatric Stroke Protocol
Pediatric stroke is relatively rare, with approximately 1000 childhood strokes in the United States per year. However, the occurrence of stroke in children leads to significant morbidity and mortality, warranting the development proven screening tools, protocols, and treatment options. Because significant delays in seeking medical attention can occur, time to recognition of pediatric stroke in the emergency department is uniquely challenging and critical. Once recognized, a trained multidisciplinary team with a multifaceted approach is needed to provide the best possible outcome for the patient. Key elements of the pediatr...
Source: Pediatric Emergency Care - November 1, 2018 Category: Emergency Medicine Tags: CME Review Article Source Type: research

Squamous Cell Carcinoma of the Neck: An Unlikely Stroke Mimic
Stroke mimics are noncerebrovascular conditions that present with classical stroke symptoms. They account for up to 30% of stroke presentations in the emergency department (ED). Emergency physicians are faced with a diagnostic dilemma —rapid treatment of stroke, a leading cause or mortality and morbidity in the United States, or ruling out the ever-growing list of conditions that mimic strokes.
Source: The Journal of Emergency Medicine - October 14, 2021 Category: Emergency Medicine Authors: Vera Obinwanne, Laura Bauler, Dylan Bergeon, Timothy Trichler Source Type: research

Neighborhood-level stroke hot spots within major United States cities
Identifying communities at high risk of stroke is an important step in improving systems of stroke care. Stroke is known to show spatial clustering at the state and county levels, but it is not known if clusters are present within city boundaries.
Source: The American Journal of Emergency Medicine - June 24, 2019 Category: Emergency Medicine Authors: Daniel A. Dworkis, James Marvel, Nerses Sanossian, Sanjay Arora Source Type: research

A Shorter Door-In-Door-Out Time Is Associated with Improved Outcome in Large Vessel Occlusion Stroke
We examined the association between DIDO times and 90-day outcomes as measured by the modi fied Rankin scale.Results: A total of 435 patients were included in the final analysis. The mean DIDO time for patients with good outcomes was 17 minute shorter than patients with poor outcomes (122 minutes [min] vs 139 min, P = 0.04)....
Source: Western Journal of Emergency Medicine - August 30, 2023 Category: Emergency Medicine Authors: Sigal, Adam Source Type: research

How should we treat patients who wake up with a stroke? A review of recent advances in management of acute ischemic stroke
Acute ischemic strokes account for 85% of all strokes and are the fifth leading cause of mortality in the United States. About one in five of all ischemic strokes occur during sleep and are not noticed until the patient wakes up with neurological deficits. There is growing evidence to support that a significantly higher number of stroke patients could benefit from more aggressive care, especially those patients who wake up with strokes. There is increasing research to support a physiologically-based approach based on advanced imaging rather than simply a time-based determination of whether or not a patient would benefit from reperfusion.
Source: The American Journal of Emergency Medicine - February 21, 2019 Category: Emergency Medicine Authors: Danielle Biggs, Michael E. Silverman, Frank Chen, Brian Walsh, Peter Wynne Source Type: research

Cannabis-Associated Stroke Presentations: No Smoke Without a Fire
We read with great interest the first-ever case reported by Dr. Finch and Dr. Vilke regarding the tetrahydrocannabinol (THC) edible ingestion resulting in an acute stroke (1). We agree that this is a unique case of focal neurological deficits occurring in the setting of THC ingestion, and also, it is hard to deliberate that intoxication timing and an episode of transient ischemic attack was just an accidental co-occurrence. Interestingly, in our prior studies using nationally representative cohorts of cannabis users, we observed a positive association between cannabis use and the rising frequency of stroke admissions in th...
Source: The Journal of Emergency Medicine - October 1, 2020 Category: Emergency Medicine Authors: Rupak Desai, Tarang Parekh Tags: Letters to the Editor 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

Tenecteplase utility in acute ischemic stroke patients: A clinical review of current evidence
Acute ischemic stroke is leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA.
Source: The American Journal of Emergency Medicine - November 14, 2018 Category: Emergency Medicine Authors: Amelia Nelson, Gregory Kelly, Richard Byyny, Catherine Dionne, Candice Preslaski, Kevin Kaucher Source Type: research

An analysis of racial inequities in emergency department triage among patients with stroke-like symptoms in the United States
Racial inequities exist in treatment and outcomes in patients with acute stroke.
Source: BMC Emergency Medicine - August 14, 2023 Category: Emergency Medicine Authors: Gabriel Neves, John DeToledo, James Morris and K. Tom Xu Tags: Research Source Type: research

Debilitating Headache after an Excited Reaction
​BY GREGORY TAYLOR, DO, & MATTHEW WARPINSKI, DOA 35-year-old man with a history of uncontrolled hypertension and medical noncompliance was brought to the emergency department by EMS complaining of a headache. The family said the patient was watching football and developed an acute headache after he stood up screaming in excitement.His family said he had not taken his blood pressure medication for years. He was afebrile, his blood pressure was 245/129 mm Hg, his respiratory rate was 18 bpm, his heart rate was 68 bpm, and he weighed 340 pounds. The patient was obtunded with a Glasgow Coma Scale score of 4 and was subse...
Source: The Case Files - November 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

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