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Tissue plasminogen activator for transient ischemic attack: the case for “off-label” use of thrombolytics
We describe an illustrative case of a patient with recurring middle cerebral artery (MCA) ischemia, where our risk benefit analysis led to the administration of thrombolytic therapy despite the patient’s score of 0 on the National Institute of Health Stroke Score (NIHSS).
Source: The American Journal of Emergency Medicine - November 6, 2013 Category: Emergency Medicine Authors: Richard M. Sobel, Daniel T. Wu, Kristina Hester, Kim Anda Tags: Correspondence Source Type: research

Hemichorea after multiple bee stings
We report the case of a 50-year-old man who developed involuntary movements of the left leg 24 hours after multiple bee stings, and the cause was confirmed to be a right temporal infarction on a diffusion magnetic resonance imaging scan. Thus, we concluded that the involuntary movement disorder was caused by right temporal infarction that occurred after multiple bee stings.
Source: The American Journal of Emergency Medicine - October 28, 2013 Category: Emergency Medicine Authors: Jin Young An, Ji Seon Kim, Jin Hong Min, Kyu Hong Han, Jun Ho Kang, Jung Soo Park, Hoon Kim, Suk Woo Lee Tags: Case Reports Source Type: research

Torsade de pointes indicates early neurologic damage in acute ischemic stroke
We report the case of a 78-year-old woman with ischemic stroke who presented with TdP as the initial manifestation of early neurologic deterioration. We hypothesized that an increase in intracranial pressure may result in neurohormonal activation, QT prolongation, and then myocardial damage, leading to TdP. We highlight that new onset of TdP in a patient with stroke may reflect neurologic deterioration, requiring further evaluation and specific intervention.
Source: The American Journal of Emergency Medicine - September 25, 2013 Category: Emergency Medicine Authors: Li-Yen Huang, Wei-Shiang Lin, Wen-Yu Lin, Cheng-Chung Cheng, Shu-Meng Cheng, Tsung-Neng Tsai Tags: Case Reports Source Type: research

Predictive value of the Cincinnati Prehospital Stroke Scale for identifying thrombolytic candidates in acute ischemic stroke
Abstract: Background: Despite the usefulness of the Cincinnati Prehospital Stroke Scale (CPSS) for rapid recognition of acute stroke, its ability to assess stroke severity is unclear. We investigated the usefulness of CPSS for assessment of stroke severity by comparing CPSS and National Institutes of Health Stroke Scale (NIHSS) scores in patients who were candidates for thrombolytic therapy at hospital admission within 6 hours of symptom onset.Methods: We conducted a retrospective analysis of a prospective registry database of consecutive patients included in the brain salvage through emergency stroke therapy program. In t...
Source: The American Journal of Emergency Medicine - September 23, 2013 Category: Emergency Medicine Authors: Je Sung You, Sung Phil Chung, Hyun Soo Chung, Hye Sun Lee, Jong Woo Park, Hyun Jong Kim, Shin Ho Lee, Incheol Park, Hahn Shick Lee Tags: Brief Reports Source Type: research

Community implementation of intravenous thrombolysis for acute ischemic stroke in the 3- to 4.5-hour window
Discussion: Our results show that the conclusions of the ECASS III trial can be applied to routine stroke treatment at a community center and that IV thrombolysis in the 3- to 4.5-hour window results in similar safety and efficacy functional outcome at 3 months compared with administration before 3 hours after onset.
Source: The American Journal of Emergency Medicine - September 23, 2013 Category: Emergency Medicine Authors: Arturo Montaño, Ilene Staff, Louise D. McCullough, Gil Fortunato Tags: Brief Reports Source Type: research

Admission rates of ED patients with transient ischemic attack have increased since 2000
This study is conducted in 6 New Jersey EDs with annual ED visits from 25000 to 65000. Consecutive patients seen by ED physicians between January 1, 2000, and December 31, 2010, were included. We identified TIA visits using the International Classification of Diseases, Ninth Revision, code. We analyzed the admission rates for TIA testing for significant differences using the Student t test and calculated 95% confidence intervals.Results: Of the 2622659 visits in the database, 8216 (0.3%) were for TIA. Females comprised 57%. There was a statistically significant increase in the annual admission rates for TIA patients from 2...
Source: The American Journal of Emergency Medicine - July 31, 2013 Category: Emergency Medicine Authors: Siama Durrani-Tariq, Barnet Eskin, John R Allegra Tags: Original Contributions Source Type: research

Simultaneous thrombosis of 2 vascular territories: is thrombolytic therapy a better option?
We have read with great interest the article by Akyuz and colleagues in the American Journal of Emergency Medicine and congratulate them for their observation. Their case exemplifies the concurrent occurrence of ST-segment elevation myocardial infarction (STEMI) and posterior circulation stroke that was eventually managed with thrombolytic therapy. Simultaneous thrombosis of 2 distant vascular territories is a rare and complicated clinical scenario. In these instances, there is usually an underlying cause linking both thrombotic events rather than being a mere coincidence. We have previously described the myocardial infarc...
Source: The American Journal of Emergency Medicine - July 1, 2013 Category: Emergency Medicine Authors: Hesham R. Omar, Devanand Mangar, Enrico M. Camporesi Tags: Correspondence Source Type: research

Isolated basilar artery dissection—a rare cause of stroke in young adult
Syncope accounts for approximately 1% to 2% of emergency department visits each year and up to 6% of hospital admissions . The causes of syncope are numerous, from common benign disorders to life-threatening processes including transient ischemic attack and even stroke. Although cervicocerebral artery dissection is an uncommon etiology in ischemic stroke, it is the second leading cause in patients younger than 45 years, and most of them predominantly involved the extracranial artery . Dissections of intracranial arteries are increasingly being recognized with advanced imaging study; however, isolated basilar artery dissect...
Source: The American Journal of Emergency Medicine - June 17, 2013 Category: Emergency Medicine Authors: Yu-Wei Tsao, Jiann-Hwa Chen, Pai-Hao Huang, Wei-Lung Chen Tags: Case Reports Source Type: research

Troponin rise and poor outcome in patients with acute atrial fibrillation: rationale and criteria of selection of patients
The role of new onset atrial fibrillation (AF) as a marker of thromboembolic risk has been demonstrated in the setting of acute myocardial infarction . Thus, someone might inquire the role of acute AF in patients with abnormal troponin not fulfilling criteria of acute myocardial infarction and might question if the minor reported range of troponin I (cTn-I) values in the study population of Conti et al (from 0.15 to 7.0 ng/mL) may not be linked with a secondary ischemic mechanism, likely an imbalance between demand and supply . However, the independent predictive value of abnormal troponin for a composite of stroke, acute ...
Source: The American Journal of Emergency Medicine - May 22, 2013 Category: Emergency Medicine Authors: Alberto Conti, Yuri Mariannini, Erica Canuti Tags: Correspondence Source Type: research

Painless aortic dissection: thrombolytic and antithrombotic vigilance
We thank Huang et al for their interesting article on identification of painless aortic dissection (AD) before thrombolytic treatment for acute ischemic stroke. We would like to emphasize the importance of being vigilant to AD before initiating any contraindicated therapy. We recently had an 84-year-old man with history of atrial fibrillation and transient ischemic attack who presented to the emergency department with acute shortness of breath without chest pain. The symptom contributed to atrial fibrillation with rapid ventricular response. Chest x-ray showed increased soft tissue prominence of the aortic arch suspicious ...
Source: The American Journal of Emergency Medicine - May 20, 2013 Category: Emergency Medicine Authors: Promporn Suksaranjit, Kunatum Prasidthrathsint, Wonngarm Kittanamongkolchai, Supawat Ratanapo, Narat Srivali, Daych Chongnarungsin Tags: Correspondence Source Type: research

Computed tomographic and magnetic resonance abnormalities of basal ganglion secondary to nonketotic hyperglycemia in a patient with stroke
Ischemic stroke is a disease that frequently presents to the emergency department (ED). Diabetes mellitus is a well-known risk factor for stroke. Here, we present a diabetic patient who visited our ED with muscle weakness of unilateral side but who was found to have hyperattenuation on computed tomography and hyperintensity on T1-weighted magnetic resonance imaging at his unilateral basal ganglion, which is frequently found in patients with hyperglycemia-induced chorea-ballismus.
Source: The American Journal of Emergency Medicine - May 3, 2013 Category: Emergency Medicine Authors: Chih-Yu Liang, Jiun-Nong Lin Tags: Case Reports Source Type: research

Ischemic stroke presenting as fluctuating focal weakness in an otherwise healthy young man
A 32-year-old man presented to our emergency department (ED) with no complaints after paramedics responded to a fall. Medics noted left-sided weakness on scene. Symptoms were initially absent in the ED, although later recurred, and included dramatically waxing and waning focal weakness. An acute middle cerebral artery ischemic stroke was diagnosed, and tissue plasminogen activator was administered. Despite a fluctuating course of symptoms, our patient ultimately achieved a complete recovery.
Source: The American Journal of Emergency Medicine - March 13, 2013 Category: Emergency Medicine Authors: Melanie J. Lippmann, Adam H. Miller Tags: Case Reports Source Type: research

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