Query: stroke

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Total 197 results found since Jan 2013.

Wallenberg's lateral medullary syndrome in an adolescent
Concussion and sports-related injuries are common in children. Given the heightened awareness about concussion in recent years, there has been an increase in the diagnosis of concussion in children presenting to the emergency department with head injuries. Often, little consideration is given to other etiologies of neurologic symptoms such as stroke. This may be due to the fact that stroke is uncommon in children when compared to adults. However, there are several case reports of arterial dissection and stroke in the pediatric age group resulting from trivial trauma.
Source: The American Journal of Emergency Medicine - May 12, 2016 Category: Emergency Medicine Authors: Elizabeth Day Ruedrich, Mahesh Chikkannaiah, Gogi Kumar Tags: Case Report Source Type: research

Hyperthermia and Severe Rhabdomyolysis From Synthetic Cannabinoids Am J Emerg Med 2016;34:121.e1-2. Doi: 10.1016/j.Ajem.2015.05.052. Epub 2015 Jun 12
We read with great interest the case report by Sweeney et al. [1] discussing severe hyperthermia and rhabdomyolysis following a reported exposure to a synthetic cannabinoid receptor agonist (SCRA). SCRA exposures, first reported in NYC in 2010, were at an all-time high in 2015 [2]. Confirmed cases of significant SCRA-associated acute kidney injury, stroke, and acute psychosis are reported [3,4].
Source: The American Journal of Emergency Medicine - May 11, 2016 Category: Emergency Medicine Authors: Mark Su, Larissa Laskowski, Robert S. Hoffman Tags: Correspondence Source Type: research

The utility of bolus intravenous nicardipine for hypertensive emergencies in the ED
We describe the first 2 documented cases of use of nicardipine administered as an IV bolus dose in the emergency department (ED) for hypertensive emergencies involving acute ischemic stroke and hemorrhagic stroke.
Source: The American Journal of Emergency Medicine - March 21, 2016 Category: Emergency Medicine Authors: Stephanie N. Komura, Nadia I. Awad Tags: Case Report Source Type: research

Cerebral hyperperfusion syndrome: A rare postoperative complication of carotid endarterectomy
Acute neurological deficits are common presentations to the emergency department. Cerebral hyperperfusion syndrome, a rare phenomenon which can occur within one month following carotid surgical revascularization, may be challenging for the emergency physician to diagnose in the setting of an acute neurological presentation. Carotid arterial disease contributes 15 –20% of ischemic cerebrovascular accidents and surgical revascularization is the commonest intervention for preventing stroke in patients with significant carotid disease.
Source: The American Journal of Emergency Medicine - March 5, 2016 Category: Emergency Medicine Authors: Mina Guirgis, Kishore Sieunarine Tags: Case Report Source Type: research

Brugada electrocardiogram pattern induced by cannabis; is cannabis safe?
The objective of this study was to present a case report that brings attention to relationship between cannabis consumption and Brugada electrocardiogram pattern. Here, we present a case of a 19-year-old male patient with symptomatic Brugada electrocardiogram pattern induced after cannabis consumption. With the potential for more widespread legalization of cannabis, several studies are raising the issue of adverse vascular effects of cannabis, including myocardial infarction, sudden cardiac death, cardiomyopathy, stroke, transient ischemic attack, and cannabis arteritis.
Source: The American Journal of Emergency Medicine - December 30, 2015 Category: Emergency Medicine Authors: Joaqu ín Valle Alonso, Beatrix Huei-Yi Teo, F. Javier Fonseca del Pozo, Miguel Angel Aguayo, Almudena Sanchez Tags: Case Report Source Type: research

Intracerebral hemorrhage in a middle aged cocaine user despite normal blood pressures
We report the case of a 40-year-old woman with a not declared at admission with a 4 year history of intranasal cocaine hydrochloride who developed an intracerebral subcortical spontaneous hemorragie. She documented a normal blood pressure and a CT angiography did not shown vascular abnormalities and excluded the presence of arterial aneurisms.
Source: The American Journal of Emergency Medicine - September 3, 2016 Category: Emergency Medicine Authors: Antonio Siniscalchi, Walter Lentidoro, Ermanno Pisanil, Giovamabattista De Sarro, Luca Gallelli Tags: Case Report Source Type: research

Intracerebral hemorrhage in a middle-aged cocaine user despite normal blood pressures
We report the case of a 40-year-old woman who did not declare at admission her 4-year history of intranasal cocaine hydrochloride and developed an intracerebral subcortical spontaneous hemorrhage. She documented a normal blood pressure, and computer tomography angiography did not show vascular abnormalities and excluded the presence of arterial aneurisms.
Source: The American Journal of Emergency Medicine - September 3, 2016 Category: Emergency Medicine Authors: Antonio Siniscalchi, Walter Lentidoro, Ermanno Pisanil, Giovamabattista De Sarro, Luca Gallelli Tags: Case Report Source Type: research

Preclinical and clinical data for factor Xa and “Universal” reversal agents
Oral Factor Xa (FXa) inhibitors, a growing class of direct-acting anticoagulants, are frequently used to prevent stroke and systemic embolism in patients with atrial fibrillation and to prevent and treat venous thromboembolism. These drugs reduce the risk of clotting at the expense of increasing the risk of bleeding, and currently they have no specific reversal agent. However, andexanet alfa, a recombinant modified FXa decoy molecule, is in a late-phase clinical trial in bleeding patients, and ciraparantag, a small molecule that appears to reverse many anticoagulants including the FXa inhibitors, is in development.
Source: The American Journal of Emergency Medicine - September 28, 2016 Category: Emergency Medicine Authors: Truman J. Milling, Scott Kaatz Tags: Review Source Type: research

Safety of Direct Oral Anticoagulants: Insights from Postmarketing Studies
Direct oral anticoagulants (DOACs) have been marketed in the United States since 2010. While numerous large-scale prospective phase 3 outcomes studies have documented the effectiveness of DOACs for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, the primary safety concern with all of these drugs —as it is with the more established oral anticoagulant warfarin—is the risk of major bleeding. Postmarketing surveillance studies (PMSS) provide the opportunity to evaluate the safety of these recently approved drugs across a spectrum of patients that may be broader than those in...
Source: The American Journal of Emergency Medicine - September 28, 2016 Category: Emergency Medicine Authors: Todd C. Villines, W. Frank Peacock Tags: Review Source Type: research

Central venous sinus thrombosis presenting with generalized tonic –clonic seizures in a patient with no known risk factors
We present a case of a previously healthy woman with a new onset seizure, whose only other complaint was weakness despite a normal neurologic exam. Her head CT showed an intraparenchymal hemorrhage of the left frontal lobe, and signs of infarction of the right frontal lobe.
Source: The American Journal of Emergency Medicine - October 10, 2016 Category: Emergency Medicine Authors: Patricia Khatib, Omar Mostafa, Erin Simon Tags: Case Report Source Type: research

Hemorrhagic stroke following consumption of an energy drink
We present here the first-ever reported case of an intracranial hemorrhage associated with the consumption of an energy drink. Our patient developed symptoms of sensory changes in the right arm and leg, with ataxia, within minutes of consuming a bottle of Redline, a well-known energy drink. A CT head revealed a small intracranial hemorrhage near the left thalamus. The Redline bottle notes that the serving size is only half a bottle, and also recommends that people with hypertension not use it, but our patient had not read these instructions.
Source: The American Journal of Emergency Medicine - October 11, 2016 Category: Emergency Medicine Authors: A Venkatraman, A Khawaja, AH Shapshak Tags: Case Report Source Type: research

Re: Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke: strength of association
To the Editor,
Source: The American Journal of Emergency Medicine - October 18, 2016 Category: Emergency Medicine Authors: Kayla Montgomery, A. Brad Hall Tags: Correspondence Source Type: research

Hemorrhagic stroke after consumption of an energy drink
We present here the first-ever reported case of an intracranial hemorrhage associated with the consumption of an energy drink. Our patient developed symptoms of sensory changes in the right arm and leg, with ataxia, within minutes of consuming a bottle of Redline, a well-known energy drink. A computed tomography of the head revealed a small intracranial hemorrhage near the left thalamus. The Redline bottle notes that the serving size is only half a bottle, and also recommends that people with hypertension not use it, but our patient had not read these instructions.
Source: The American Journal of Emergency Medicine - October 11, 2016 Category: Emergency Medicine Authors: A. Venkatraman, A. Khawaja, A.H. Shapshak Tags: Case Report Source Type: research

Akinetic mutism revealing an ischemic stroke
We describe a 44-year-old man who developed akinetic mutism following a cerebrovascular accident involving his left middle cerebral artery. We discuss this rare condition and its unusual clinical picture.
Source: The American Journal of Emergency Medicine - November 4, 2016 Category: Emergency Medicine Authors: Zidouh Saad, Jidane Said, Belkouch Ahmed, Bakkali Hicham, Belyamani Lahcen Source Type: research

Central venous sinus thrombosis presenting with generalized tonic-clonic seizures in a patient with no known risk factors
We present a case of a previously healthy woman with a new onset seizure, whose only other complaint was weakness despite a normal neurological examination. Her head computed tomography (CT) showed an intraparenchymal hemorrhage of the left frontal lobe and signs of infarction of the right frontal lobe.
Source: The American Journal of Emergency Medicine - October 10, 2016 Category: Emergency Medicine Authors: Patricia Khatib, Omar Mostafa, Erin L. Simon Tags: Case Reports Source Type: research

Cardiac Direct Access Centers and the Mission of Emergency Medicine
In the past 60 years, rigorous emphasis on rapid diagnosis, evidence-based treatment, team dynamics and targeted resuscitation of critically ill and injured patients has led to dramatic improvements in emergency department patient outcomes including mortality [1,2]. This is especially true in severely injured trauma patients, those suffering from ST-elevation myocardial infarctions (STEMI), sepsis and stroke [3-5]. In an effort to distinguish themselves as providers of sophisticated specialty and general emergency care, many organizations and departments seek designations as “centers of excellence,” such as the America...
Source: The American Journal of Emergency Medicine - January 19, 2017 Category: Emergency Medicine Authors: Emily Brumfield, Corey Slovis Source Type: research

Simple and effective method to lower body core temperatures of hyperthermic patients
Hyperthermia is a potentially life threatening scenario that may occur in patients due to accompanying morbidities, exertion, or exposure to dry and arid environmental conditions. In particular, heat stroke may result from environmental exposure combined with a lack of thermoregulation. Key clinical findings in the diagnosis of heatstroke are (1) a history of heat stress or exposure, (2) a rectal temperature greater than 40 °C, and (3) central nervous system dysfunction (altered mental state, disorientation, stupor, seizures, or coma) (Prendergast and Erickson, 2014 [1]).
Source: The American Journal of Emergency Medicine - January 30, 2017 Category: Emergency Medicine Authors: John P. O'Connor Source Type: research

Impact of an emergency medicine pharmacist on time to thrombolysis in acute ischemic stroke: strength of association
We appreciate your insight and review of our manuscript in the American Journal of Emergency Medicine [1]. We acknowledge that measures such as odds ratio (OR) or relative risk may help the reader further understand the strength of association of our outcomes.
Source: The American Journal of Emergency Medicine - October 18, 2016 Category: Emergency Medicine Authors: Kayla Montgomery, A. Brad Hall Tags: Correspondence Source Type: research

Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups
ONSD (optic nerve sheath diameter) is a method used for indirect measurement of the increased intracranial pressure. In previous studies, the relation between the increased intracranial pressure and ONSD was analyzed in the patients suffering from cerebrovascular diseases (CVD). In our study, the patients suffering from ischemic CVD were categorized into 4 subgroups according to Oxfordshire Community Stroke Project classification (OCSP); the relationship between each group and ONSD, and the influence on each eye were analyzed.
Source: The American Journal of Emergency Medicine - April 29, 2017 Category: Emergency Medicine Authors: Emre G ökcen, İbrahim Caltekin, Atakan Savrun, Hilal Korkmaz, Şeyda Tuba Savrun, Gökhan Yıldırım Source Type: research

The challenge of coprescription of antiplatelet therapy and oral anticoagulants
The coexistence of symptomatic carotid artery stenosis and nonvalvular atrial fibrillation (NVAF) in the recently reported 85year old man [1] bears out the findings of the study which documented a 24.3% prevalence of high-grade (50% or more) carotid artery stenosis among 103 consecutive NVAF patients (mean age 69) who presented with stroke [2]. Among these patients with high-grade stenosis 66.7% had stenosis ipsilateral to the cerebral infarct [2]. Given the fact that patients with symptomatic carotid artery stenosis are at high risk of stroke recurrence and/or worsening neurological disability during the first 14days foll...
Source: The American Journal of Emergency Medicine - May 22, 2017 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

Bi-objective approach for placing ground and air ambulance base and helipad locations in order to optimize EMS response
Shortening the travel time of patient transfer has clinical implications for many conditions such as cardiac arrest, trauma, stroke and STEMI. As resources are often limited precise calculations are needed. In this paper we consider the location problem for both ground and aerial emergency medical services. Given the uncertainty of when patients are in need of prompt medical attention we consider these demand points to be uncertain. We consider various ways in which ground and helicopter ambulances can work together to make the whole process go faster.
Source: The American Journal of Emergency Medicine - June 15, 2017 Category: Emergency Medicine Authors: Milad Shahriari, Ali Bozorgi-Amiri, Shayan Tavakoli, Abolghasem Yousefi-Babadi Source Type: research

Investigation of UCH-L1 levels in ischemic stroke, intracranial hemorrhage and metabolic disorder induced impaired consciousness
We aimed to determine the levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) in patients admitted to the emergency department with impaired consciousness due to metabolic or neurological reasons.
Source: The American Journal of Emergency Medicine - June 21, 2017 Category: Emergency Medicine Authors: Ihsan Yigit, Metin Atescelik, Mustafa Yilmaz, Mehmet Cagri Goktekin, Mehtap Gurger, Nevin Ilhan Source Type: research

Management of Factor Xa inhibitor-associated life-threatening major hemorrhage: A retrospective multi-center analysis
This study describes a cohort of patients with FXa inhibitor-associated life-threatening bleeding events, their clinical characteristics, interventions and outcomes.
Source: The American Journal of Emergency Medicine - August 19, 2017 Category: Emergency Medicine Authors: Truman J. Milling, Carol L. Clark, Charles Feronti, Shlee S. Song, Sam S. Torbati, Gregory J. Fermann, Jeffrey Weiss, Dony Patel Source Type: research

Predictors of false negative diffusion-weighted MRI in clinically suspected central cause of vertigo
Vertigo is classified as peripheral and central. Differentiation of stroke mimics is the most important diagnostic challenge. There is no clinical guidance for the indications of neuroimaging in isolated vertigo patients. The primary aim of this study is to test the diagnostic value of a DWI-MRI protocol to rule-out a central cause in patients with acute isolated vertigo in the ED.
Source: The American Journal of Emergency Medicine - September 23, 2017 Category: Emergency Medicine Authors: Ebru Unal Akoglu, Haldun Akoglu, Tuba Cimilli Ozturk, Bahaeddin Onur, Serkan Emre Eroglu, Ozge Onur, Arzu Denizbasi Source Type: research

Cannabis can augment thrombolytic properties of rtPA: Case report of an intracranial hemorrhage in a heavy cannabis user
Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke.
Source: The American Journal of Emergency Medicine - September 28, 2017 Category: Emergency Medicine Authors: Amar Shere, Hemant Goyal Source Type: research

Red blood cell distribution width is associated with mortality in elderly patients with sepsis
RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients.
Source: The American Journal of Emergency Medicine - October 25, 2017 Category: Emergency Medicine Authors: An-Yi Wang, Wei-Fong Kao, Shin-Han Tsai Source Type: research

Cannabis can augment thrombolytic properties of rtPA: Intracranial hemorrhage in a heavy cannabis user
Cannabis is one of the most commonly used illicit drugs in the United States and is considered to have several adverse health effects. There is evidence suggesting that its recreational use is associated with both increased cardio- and cerebrovascular events. Recently, multiple cases of ischemic and hemorrhagic strokes associated with cannabis use were reported in the literature (Goyal et al., 2017). It has been suggested that cannabis can affect cerebral auto-regulation and vascular tone leading to vasoconstriction and acute ischemic stroke.
Source: The American Journal of Emergency Medicine - September 28, 2017 Category: Emergency Medicine Authors: Amar Shere, Hemant Goyal Tags: Case Report Source Type: research

Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the emergency department
Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence.
Source: The American Journal of Emergency Medicine - December 28, 2017 Category: Emergency Medicine Authors: Stacy A. Trent, Michael A. Johnson, Erica A. Morse, Edward P. Havranek, Jason S. Haukoos Source Type: research

Emergency medicine considerations in atrial fibrillation
Atrial fibrillation (AF) is an abnormal heart rhythm which may lead to stroke, heart failure, and death. Emergency physicians play a role in diagnosing AF, managing symptoms, and lessening complications from this dysrhythmia.
Source: The American Journal of Emergency Medicine - February 2, 2018 Category: Emergency Medicine Authors: Brit Long, Jennifer Robertson, Alex Koyfman, Kurian Maliel, Justin R. Warix Source Type: research

Icatibant for the treatment of orolingual angioedema following the administration of tissue plasminogen activator
Angioedema is swelling of the dermis and mucosal tissues caused by hyper permeability of post capillary venules due to the release of vasodilators such as histamine and bradykinin. It is a rare, but potentially life-threatening side effect of alteplase with a reported incidence of 0.9 –5.1% in ischemic stroke patients [1,2]. Alteplase is a recombinant tissue plasminogen activator (rt-PA) that works by binding to fibrin in a blood clot, and subsequently converting plasminogen to plasmin which initiates fibrinolysis [3].
Source: The American Journal of Emergency Medicine - March 12, 2018 Category: Emergency Medicine Authors: Emily Brown, Christina Campana, Jacob Zimmerman, Steven Brooks Source Type: research

Retrospective assessment of succinylcholine use in acute stroke care: What are the risks?
Dear Sir,
Source: The American Journal of Emergency Medicine - March 22, 2018 Category: Emergency Medicine Authors: Jenna Fancher, Gregory Meola, William Paolo, Robert Seabury Source Type: research

The use of an emergency department dysphagia screen is associated with decreased pneumonia in acute strokes
Dysphagia is a common problem for patients after an acute stroke which can lead to hospital acquired pneumonia (HAP) increasing morbidity and mortality. The Joint Commission has directed that stroke certified hospitals perform a dysphagia screen at the time of initial presentation. We sought to evaluate if our ED dysphagia screen was correlated with lower rates of pneumonia in acute stroke patients.
Source: The American Journal of Emergency Medicine - March 22, 2018 Category: Emergency Medicine Authors: Jon W. Schrock, Linda Lou, Benjamin A.W. Ball, J. Van Etten Source Type: research

Acute aortic occlusion in a patient without risk factors
A 94-year-old female with a history of ischemic stroke, mild right hemiparesis, vascular dementia, breast cancer with right mastectomy, colon cancer resulting in colectomy, hyperlipidemia, and hypertension presented to the emergency department (ED) with bilateral leg pain. Patient had no smoking history, and her medications included Donepezil, Aspirin, Citalopram, Losartan, and Pantoprazole.
Source: The American Journal of Emergency Medicine - March 28, 2018 Category: Emergency Medicine Authors: Trina Stoneham, Erin L. Simon Source Type: research

Retrospective assessment of succinylcholine use in acute stroke care: What are the risks?
Dear Sir,
Source: The American Journal of Emergency Medicine - March 22, 2018 Category: Emergency Medicine Authors: Jenna Fancher, Gregory Meola, William Paolo, Robert Seabury Source Type: research

The use of an emergency department dysphagia screen is associated with decreased pneumonia in acute strokes
Dysphagia is a common problem for patients after an acute stroke which can lead to hospital acquired pneumonia (HAP) increasing morbidity and mortality. The Joint Commission has directed that stroke certified hospitals perform a dysphagia screen at the time of initial presentation. We sought to evaluate if our ED dysphagia screen was correlated with lower rates of pneumonia in acute stroke patients.
Source: The American Journal of Emergency Medicine - March 22, 2018 Category: Emergency Medicine Authors: Jon W. Schrock, Linda Lou, Benjamin A.W. Ball, J. Van Etten Source Type: research

Icatibant for the treatment of orolingual angioedema following the administration of tissue plasminogen activator
Angioedema is swelling of the dermis and mucosal tissues caused by hyper permeability of post capillary venules due to the release of vasodilators such as histamine and bradykinin. It is a rare, but potentially life-threatening side effect of alteplase with a reported incidence of 0.9 –5.1% in ischemic stroke patients [1,2]. Alteplase is a recombinant tissue plasminogen activator (rt-PA) that works by binding to fibrin in a blood clot, and subsequently converting plasminogen to plasmin which initiates fibrinolysis [3].
Source: The American Journal of Emergency Medicine - March 12, 2018 Category: Emergency Medicine Authors: Emily Brown, Christina Campana, Jacob Zimmerman, Steven Brooks Source Type: research

Emergency medicine considerations in atrial fibrillation
Atrial fibrillation (AF) is an abnormal heart rhythm which may lead to stroke, heart failure, and death. Emergency physicians play a role in diagnosing AF, managing symptoms, and lessening complications from this dysrhythmia.
Source: The American Journal of Emergency Medicine - February 2, 2018 Category: Emergency Medicine Authors: Brit Long, Jennifer Robertson, Alex Koyfman, Kurian Maliel, Justin R. Warix Source Type: research

Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the emergency department
Myocardial infarction and stroke are two of the leading causes of death in the U.S. Both diseases have clinical practice guidelines (CPGs) specific to the emergency department (ED) that improve patient outcomes. Our primary objectives were to estimate differences in ED adherence across CPGs for these diseases and identify patient, provider, and environmental factors associated with adherence.
Source: The American Journal of Emergency Medicine - December 28, 2017 Category: Emergency Medicine Authors: Stacy A. Trent, Michael A. Johnson, Erica A. Morse, Edward P. Havranek, Jason S. Haukoos Source Type: research

Red blood cell distribution width is associated with mortality in elderly patients with sepsis
RDW is a prognostic biomarker and associated with mortality in cardiovascular disease, stroke and metabolic syndrome. For elderly patients, malnutrition and multiple comorbidities exist, which could affect the discrimination ability of RDW in sepsis. The main purpose of our study was to evaluate the prognostic value of RDW in sepsis among elderly patients.
Source: The American Journal of Emergency Medicine - October 25, 2017 Category: Emergency Medicine Authors: An-Yi Wang, Hon-Ping Ma, Wei-Fong Kao, Shin-Han Tsai, Cheng-Kuei Chang Source Type: research

Paradoxical brain embolism shadowing massive pulmonary embolism
Patent foramen ovale is frequently observed in the general population. In case of massive pulmonary embolism, the sudden increase in the right heart cavity's pressure may cause a right-to-left shunting across this foramen, which could be associated with conflicting outcomes. Herein, we report a case of reversible cardiac arrest preceded by seizures, and followed by hemodynamic stability without any vasopressor. A brain CT-scan showed a limited ischemic stroke. Initial echocardiographic assessment revealed an acute cor pulmonale and a right-to-left intracardiac shunt across a large patent foramen ovale, suggesting the diagn...
Source: The American Journal of Emergency Medicine - May 15, 2018 Category: Emergency Medicine Authors: Fran çois Bagate, Alexandre Bedet, Armand Mekontso Dessap, Guillaume Carteaux Source Type: research

Sonographic diameter of optic nerve sheath in differentiation of ischemic and hemorrhagic strokes; a diagnostic accuracy study
Differentiating between ischemic and hemorrhagic types is of special importance in the treatment process of patients with stroke. The present study was designed with the aim of evaluating the diagnostic accuracy of ultrasonographic optic nerve sheath diameter (ONSD) in differentiation of ischemic from hemorrhagic stroke.
Source: The American Journal of Emergency Medicine - August 17, 2018 Category: Emergency Medicine Authors: Mohammad Manouchehrifar, Masoumeh Lakestani, Parvin Kaskani, Saeed Safari Source Type: research

Throwing it in reverse: An update on reversal of oral factor Xa inhibitors
In recent years, the use of oral Factor Xa (FXa) inhibitors such as rivaroxaban and apixaban, have seen more extensive utilization for stroke prevention in non-valvular atrial fibrillation and the prevention/treatment of venous thromboembolisms [1,2]. Some studies have shown a similar bleed risk between FXa inhibitors and warfarin while other studies demonstrated a decreased risk for a bleed with FXa inhibitors. Despite a possible decreased risk, the paucity of data available for treating an acute major bleed due to FXa inhibitors has led some clinicians to shy away from their use.
Source: The American Journal of Emergency Medicine - April 8, 2019 Category: Emergency Medicine Authors: Brian W. Gilbert, Jacob A. Reeder, Mohammed A. Alkhalifah, David A. Moran, Michael A. Corvino Source Type: research

Comparing Pleth variability index (PVI) variation induced by passive leg raising and Trendelenburg position in healthy volunteers
Hypovolemia, which is the main cause of circulatory failure in emergency medical settings, can often be managed by volume expansion [1]. However, the fluid responsiveness (FR) varies between the patients, and volume status of the patient can be evaluated by some predictors. Studies have demonstrated that static hemodynamic measurements (e.g., central venous pressure, mean arterial pressure) were of little value in discriminating between the patients who will or will not respond to volume expansion, and dynamic indices (e.g., arterial pressure wave form, stroke volume) were more accurate in evaluating volume status [1].
Source: The American Journal of Emergency Medicine - May 7, 2019 Category: Emergency Medicine Authors: Osman L ütfi Demirci, Gülşah Çıkrıkçı Işık, Şeref Kerem Çorbacıoğlu, Yunsur Çevik Source Type: research

Tranexamic acid for treatment of pulmonary hemorrhage after tissue plasminogen activator administration for intubated patient
The risk of tPA in the treatment of stroke, is that approximately 5% of patients may have significant intracranial bleeding, increasing mortality to 45%. Use of tPA can also cause other forms of life-threatening bleeding, most commonly gastrointestinal bleeding. In this case review, we discuss the presentation and management of a patient with post-tPA pulmonary hemorrhage and the use of tranexamic acid (TXA) for the cessation of bleeding.
Source: The American Journal of Emergency Medicine - May 14, 2019 Category: Emergency Medicine Authors: Snaha Sanghvi, Anna Van Tuyl, Josh Greenstein, Barry Hahn Source Type: research

A change of heart: Transformation of the electrocardiogram in a patient with apical hypertrophic cardiomyopathy
An asymptomatic 83-year-old man with a history of hypertension, prior stroke with no residual deficits, and bilateral carotid artery stenosis, presented for evaluation prior to cataract surgery. His transthoracic echocardiogram was typical for apical hypertrophic cardiomyopathy (AHCM), and his electrocardiograms (ECG) showed large precordial R-waves and inverted T-waves, previously associated with AHCM, while his ECG 7  years earlier was normal. Mechanistic explanations for the developed ECG abnormalities, and their importance for the detection and monitoring of patients with AHCM are provided.
Source: The American Journal of Emergency Medicine - March 5, 2020 Category: Emergency Medicine Authors: Benjamin Gold, John Madias Source Type: research

COVID-19 infection with extensive thrombosis: A case of phlegmasia cerulea dolens
Reports have been published from multiple countries regarding increased thrombus formation in COVID-19 patients, especially critically ill patients. These include DVT formation as well as pulmonary embolism and stroke. Currently, the exact mechanism as to why COVID-19 patients are at higher risk for thrombotic complications has not been determined. It has been thought to be due to endothelial injury, blood stasis or a hypercoagulable state [1]. To our knowledge this is the first reported case of phlegmasia cerulea dolens in a patient diagnosed with COVID-19.
Source: The American Journal of Emergency Medicine - May 15, 2020 Category: Emergency Medicine Authors: Michael H. Morales, Candace L. Leigh, Erin L. Simon Source Type: research