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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 4, 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 29, 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

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 3, 2016 Category: Emergency Medicine Authors: Zidouh Saad, Jidane Said, Belkouch Ahmed, Bakkali Hicham, Belyamani Lahcen 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 17, 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

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

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

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

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

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

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

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

Is caval index an appropriate tool for predicting hypovolemia in stroke
We have read with interest the recent article, “Challenge of Intravascular Volume Assessment in Acute Ischemic Stroke” by Miller J.B. et al. [1].
Source: The American Journal of Emergency Medicine - March 11, 2020 Category: Emergency Medicine Authors: Engin Ozakin, Kadir Ugur Mert Source Type: research

Priapism in a patient with coronavirus disease 2019 (COVID-19): A case report
Thromboembolic complications related to SARS-CoV-2 have been extensively reported. They include deep vein thrombosis, pulmonary embolism, ischemic stroke, and acute coronary syndrome. Penile thrombosis has not been reported as a thrombotic complication of SARS-CoV-2 infection with hypercoagulability.Here we describe a case of priapism as a thromboembolic complication in a patient with COVID-19 who recovered from acute respiratory distress syndrome (ARDS). We discuss the underlying pathophysiological mechanisms mainly related to an hypercoagulability state.
Source: The American Journal of Emergency Medicine - June 16, 2020 Category: Emergency Medicine Authors: Myriam Lamamri, Ala Chebbi, Jordan Mamane, Sofia Abbad, Milena Munuzzolini, Florence Sarfati, St éphane Legriel Source Type: research

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