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Symptomatic intracranial hemorrhage in patients with admission hyperglycemia and diabetes after mechanical thrombectomy: A systematic review and meta-analysis
Symptomatic intracranial hemorrhage (sICH) is a severe complication of revascularization therapy. We aimed to investigate the association of admission hyperglycemia and sICH after mechanical thrombectomy in patients with acute ischemic stroke.
Source: The American Journal of Emergency Medicine - February 22, 2021 Category: Emergency Medicine Authors: Lin Zang, Dan Zhang, Yanyan Yao, Yujie Wang Source Type: research

Idarucizumab (PRADAXA ®) as a sole reversal agent in an unstable hemorrhagic shock patient on an unknown anticoagulant with elevated protime/international normalized ratio (PT/INR).
We present a case of an 85-year-old female with an unknown medication history, shortness of breath and severe anemia due to an upper gastrointestinal bleed. Laboratory abnormalities were significant for INR 6.43 and serum creatinine 2.21  mg/dL.
Source: The American Journal of Emergency Medicine - February 5, 2021 Category: Emergency Medicine Authors: Sara Kutner, Nicholas Scaturo, Brett Williams Source Type: research

Utilization of lysis percentage via thromboelastography for tissue plasminogen activator-induced symptomatic intracranial hemorrhage
Alteplase, the only FDA approved tissue plasminogen activator (tPA), remains one of the cornerstones of acute ischemic stroke (AIS) management. Just as with endogenous tPA, recombinant tPA promotes the activation of plasmin and the subsequent degradation of cross-linked fibrin to fibrin byproducts [1]. The most feared complication of recombinant tPA administration is the development of symptomatic intracranial hemorrhage (sICH), which occurs in approximately 5.6% of tPA administrations, utilizing the European Cooperative Acute Stroke Study definition, with roughly half of these cases resulting in death [2].
Source: The American Journal of Emergency Medicine - January 16, 2021 Category: Emergency Medicine Authors: Brian W. Gilbert, J. Spencer Dingman, Joel B. Huffman Source Type: research

Rapid and severe neurologic deterioration due to influenza associated encephalopathy in a healthy child
We present the clinical details of a previously well child with two days of mild viral symptoms who progressed from playful and active to severe neurologic injury over the course of eight hours.
Source: The American Journal of Emergency Medicine - January 2, 2021 Category: Emergency Medicine Authors: Dominic DiPrinzio, Taylor Roth, Jay D. Fisher Source Type: research

Case series: Hyperdense basilar artery identified on unenhanced head CT in three cases of pediatric basilar artery occlusion
Acute basilar artery occlusion (BAO) is an easily missed, potentially devastating type of ischemic stroke. Children with BAO can present with a range of clinical symptoms, from headache, dizziness, nausea and/or vomiting [1-3] to profound alterations of consciousness, including locked-in syndrome and coma [2]. Typically in children with BAO, only an unenhanced head Computed Tomography (CT) is initially performed. When an obvious finding is not identified, such as intracranial hemorrhage, the unenhanced CT is rarely carefully further scrutinized by emergency physicians.
Source: The American Journal of Emergency Medicine - November 26, 2020 Category: Emergency Medicine Authors: Jennifer K. Potter, Jonathan D. Clemente, Andrew W. Asimos Source Type: research

Delayed vertebral artery dissection after mild trauma in a motor vehicle collision
We present the case of a 42-year-old patient who presented to the emergency department with diaphoresis and a complaint of neck pain one month after a low speed motor vehicle collision. The patient was transferred to a stroke center where cerebral angiography showed severe vertebral artery stenosis with likelihood of dissection after a noncontrast CT was negative for hemorrhage.
Source: The American Journal of Emergency Medicine - November 16, 2020 Category: Emergency Medicine Authors: Gregory Kacprzynski, Joshua Bucher, Gregory Nicholas Kacprzynski, Joshua Bucher Source Type: research

The significance of repetitive yawning in the emergency patient - A warning of imminent death or disability
Premortem yawning is absent from almost all major medical textbooks but has been associated for more than 2000  years with impending death from acute infections and hemorrhage and was commonly known during the Bubonic Plague pandemic [1,2]. Medical reports of premortem yawning identify multiple causes of shock including vasovagal reflex, severe hypoxia/anemia/hypoglycemia, stroke, and intracranial hyperten sion [3-5].
Source: The American Journal of Emergency Medicine - July 2, 2020 Category: Emergency Medicine Authors: Joan E. Rothenberg Tags: Correspondence Source Type: research

Thromboelastography for prediction of hemorrhagic transformation in patients with acute ischemic stroke
Thromboelastography (TEG) provides a rapid assessment of the hemostatic processes of a patient in emergency settings. There are limited data on TEG as a predictive tool for hemorrhagic transformation in patients with acute ischemic stroke. We investigated whether TEG values on admission could predict hemorrhagic transformation in patients with acute ischemic stroke.
Source: The American Journal of Emergency Medicine - May 22, 2020 Category: Emergency Medicine Authors: Gina Yu, Youn-Jung Kim, Sang-Beom Jeon, Won Young Kim 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 13, 2019 Category: Emergency Medicine Authors: Snaha Sanghvi, Anna Van Tuyl, Josh Greenstein, Barry Hahn 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

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

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

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

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

Neutrophil to lymphocyte ratio and the hematoma volume and stroke severity in acute intracerebral hemorrhage patients
Neutrophil to lymphocyte ratio (NLR) serves as a powerful inflammatory marker for predicting cardiovascular events. Here, we investigate whether admission NLR is associated with hematoma volume, stroke severity, and 3-month outcomes in patients with acute intracerebral hemorrhage (ICH).
Source: The American Journal of Emergency Medicine - November 15, 2016 Category: Emergency Medicine Authors: Yaming Sun, Shoujiang You, Chongke Zhong, Zhichao Huang, Lifang Hu, Xia Zhang, Jijun Shi, Yongjun Cao, Chun-Feng Liu Source Type: research

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