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Systemic thrombolysis for stroke in pregnancy
Pregnancy is an exclusion criterion for all clinical trials that validate alteplase in acute stroke, so our knowledge about its use in this condition is relative only to case reports and case series. Herein, we report the successful use of intravenous recombinant tissue-type plasminogen activator (rt-PA) in pregnant women with acute stroke. The patient was a 28-year-old who was 16 weeks pregnant. She presented to our hospital 1 hour after a sudden onset of mothor aphasia, hemiparesis, and hypoesthesia on the right side due to incipient ischemia in the left cerebral hemisphere resulting from ipsilateral middle cerebral arte...
Source: The American Journal of Emergency Medicine - August 6, 2012 Category: Emergency Medicine Authors: Rossana Tassi, Maurizio Acampa, Giovanna Marotta, Samuele Cioni, Francesca Guideri, Simone Rossi, Alfonso Cerase, Giuseppe Martini Tags: Case 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

Good outcome after intravenous thrombolysis for acute stroke in a patient under treatment with dabigatran
We describe an unusual case of treatment IV rt-PA for acute ischemic stroke in a patient receiving dabigatran for AF.
Source: The American Journal of Emergency Medicine - April 18, 2014 Category: Emergency Medicine Authors: Cátia Diogo, Josiana Duarte, Sofia Sobral, Paula Pestana, Hipólito Nzwalo, Henrique Rita, José Sousa e Costa Tags: Case Report 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

Spontaneous splenic rupture after thrombolysis for ischemic stroke
We present the first case of an atraumatic pathological splenic rupture following alteplase thrombolysis for ischemic stroke.
Source: The American Journal of Emergency Medicine - August 26, 2014 Category: Emergency Medicine Authors: Rachid Sirbou, Cindy Tissier, Yannick Bejot, Marc Freysz Tags: Case Report Source Type: research

Acute Vertebrobasilar Ischemic Stroke Due To Electric Injury
Electrical injuries are most commonly due to household accidents. Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of current and duration of contact with the body. Various types of neurological damage due to electrical injury have been described in literature. It may manifest as peripheral nerve injury, spinal cord damage, seizures, cerebellar ataxia, hypoxic encephalopathy and intracerebral hemorrhage. Acute ischemic stroke is an infrequent complication of electrical injury.
Source: The American Journal of Emergency Medicine - January 6, 2015 Category: Emergency Medicine Authors: Rajendra Singh Jain, Sunil Kumar, Desai Tushar Suresh, Rakesh Agarwal Tags: Case Report 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

Intraparenchymal hemorrhage after heroin use
Heroin-associated stroke is a rare complication of use. Various proposed mechanisms of heroin-associated ischemic stroke have been proposed, including the following: cardioembolism in the setting of infective endocarditis, hypoxic ischemic brain injury in the setting of hypoxemia and hypotension, and infective arteritis or vasculitis from drug adulterants. A previously healthy 28-year-old woman presented to the emergency department with altered mental status and normal vitals after she was found wandering outside her apartment.
Source: The American Journal of Emergency Medicine - January 16, 2015 Category: Emergency Medicine Authors: Neha Kumar, Mary Colleen Bhalla, Jennifer A. Frey, Alison Southern Tags: Case Report Source Type: research

The Utility of Bolus IV Nicardipine for Hypertensive Emergencies in the Emergency Department
We describe the first two documented cases of use of nicardipine administered as an IV bolus dose in the emergency department 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

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 20, 2016 Category: Emergency Medicine Authors: Stephanie N. Komura, Nadia I. Awad Tags: Case Report 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

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

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

Subconjunctival hemorrhage in a patient on dabigatran (Pradaxa)
Dabigatran is a direct thrombin inhibitor that has gained increasing popularity for prevention of thromboembolic events such as stroke, pulmonary embolism, and myocardial ischemia. Because of the increasing use of this drug, emergency department (ED) physicians are going to be evaluating patients taking this medication. It is important to understand the potential for ocular bleeding complications associated with this class of anticoagulant. Traditionally, patients have been placed on vitamin K antagonists to decrease the risk of thromboembolism. In the RE-LY and RE-COVER studies, dabigatran showed non-inferiority to coumad...
Source: The American Journal of Emergency Medicine - September 24, 2012 Category: Emergency Medicine Authors: Tam M. Nguyen, Michael P. Phelan, Xiang Q. Werdich, Paul J. Rychwalski, Christopher M. Huff Tags: Case Reports Source Type: research

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