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Validation of the use of B-type natriuretic peptide point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the ED
The aim of the study is to validate of the use of plasma B-type natriuretic peptide (BNP) point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the emergency department (ED).
Source: The American Journal of Emergency Medicine - January 16, 2015 Category: Emergency Medicine Authors: Zhixin Wu, Mingming Zhao, Mingfeng He, Hongke Zeng, Feng Tan, Kuangyi Li, Shenglong Chen, Qianpeng Han, Qiaosheng Wang Tags: Original Contribution 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

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

Neurogenic pulmonary edema following severe head injury: A transpulmonary thermodilution study
We report a fatal case of a 55-year old man who was admitted because of severe head injury. The diagnosis of NPE was considered according to clinical and radiological findings. Transpulmonary thermodilution (TPT) study showed decreased stroke volume index (SVI) and cardiac function index (CFI). Indexed extravascular lung water (EVLWI) was increased as well as pulmonary vascular permeability index (PVPI).
Source: The American Journal of Emergency Medicine - December 18, 2014 Category: Emergency Medicine Authors: Anis Chaari, Kamilia Chtara, Nozha Toumi, Mabrouk Bahloul, Mounir Bouaziz Tags: Case Reports Source Type: research

Neurogenic pulmonary edema after severe head injury: a transpulmonary thermodilution study
We report a fatal case of a 55-year-old man who was admitted because of severe head injury. The diagnosis of NPE was considered according to clinical and radiologic findings. Transpulmonary thermodilution study showed decreased stroke volume index and cardiac function index. Indexed extravascular lung water was increased as well as pulmonary vascular permeability index.
Source: The American Journal of Emergency Medicine - December 18, 2014 Category: Emergency Medicine Authors: Anis Chaari, Kamilia Chtara, Nozha Toumi, Mabrouk Bahloul, Mounir Bouaziz Tags: Case Report Source Type: research

Diagnostic value of plasma Signal Peptide-Cub-Egf domain-containing protein-1 (SCUBE-1) in an experimental model of acute ischemic stroke
Considering the critical role of early action in management of stroke, there is still a need for a biomarker that would reliably assist in the early diagnosis and patient selection for tissue plasminogen activator (t-PA) therapy, which has provided a considerable success in terms of mortality and morbidity of patients with stroke. This is particularly important if this novel biochemical marker that could give rapid results, specific for brain damage and that can be used in the emergency setting for early diagnosis and differentiation from other conditions that mimics some stroke findings [1,2].
Source: The American Journal of Emergency Medicine - December 2, 2014 Category: Emergency Medicine Authors: Turkmen Suha, Eryigit Umut, Karaca Yunus, Mentese Ahmet, Uzun Sumer Aysegul, Yulug Esin, Aksut Nurhak, Gazioglu Sibel, Gunduz Abdulkadir Tags: Original Contribution Source Type: research

Improved door-to-needle times and neurologic outcomes when IV tissue plasminogen activator is administered by emergency physicians with advanced neuroscience training
The neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give intravenous (IV) tissue plasminogen activator (tPA) independently for acute ischemic stroke patients. Door-to-needle (DTN) times, discharge location, and discharge National Institute of Health Stroke Scale (NIHSS) scores were studied between the neuro ED and main emergency department (ED) with the hypothesis that all measures would be better in the neuro ED group.
Source: The American Journal of Emergency Medicine - November 28, 2014 Category: Emergency Medicine Authors: Karen Greenberg, Christina R. Maxwell, Keisha D. Moore, Michael D’Ambrosio, Kenneth Liebman, Erol Veznedaroglu, Geri Sanfillippo, Cynthia Diaz, Mandy J. Binning Tags: Original Contribution Source Type: research

Improved Door-to-Needle Times and Neurological Outcomes when IV-tPA is Administered by Emergency Physicians with Advanced Neuroscience Training
The neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give IV tPA independently for acute ischemic stroke patients. Door-to-needle times (DTN), discharge location, and discharge NIHSS scores were studied between the neurologic emergency department and main emergency department with the hypothesis that all measures would be better in the neuro ED group.
Source: The American Journal of Emergency Medicine - November 28, 2014 Category: Emergency Medicine Authors: Karen Greenberg, Christina R. Maxwell, Keisha D. Moore, Michael D’Ambrosio, Kenneth Liebman, Erol Veznedaroglu, Geri Sanfillippo MSN, Cynthia Diaz, Mandy J. Binning Source Type: research

Improved door-to-needle times and neurologic outcomes when intravenous tissue plasminogen activator is administered by emergency physicians with advanced neuroscience training
The neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give intravenous (IV) tissue plasminogen activator (tPA) independently for acute ischemic stroke patients. Door-to-needle (DTN) times, discharge location, and discharge National Institute of Health Stroke Scale (NIHSS) scores were studied between the neuro ED and main emergency department (ED) with the hypothesis that all measures would be better in the neuro ED group.
Source: The American Journal of Emergency Medicine - November 28, 2014 Category: Emergency Medicine Authors: Karen Greenberg, Christina R. Maxwell, Keisha D. Moore, Michael D’Ambrosio, Kenneth Liebman, Erol Veznedaroglu, Geri Sanfillippo, Cynthia Diaz, Mandy J. Binning Tags: Original Contributions Source Type: research

Hydration therapy: critical intervention in the ED to prevent stroke in evolution after acute ischemic stroke
We read the original article by Lin et al [1] with great enthusiasm. The authors have revealed the role of simple hydration therapy to prevent stroke in evolution (SIE) after acute ischemic stroke (AIS), which was done according to World Health Organization hydration protocol 2005 for diarrhea. They have concluded that providing hydration therapy to patients who present with a blood urea nitrogen/creatinine (BUN/Cr) ratio greater than or equal to 15 after ischemic stroke may help prevent the development of SIE, and such prevention is likely to improve prognosis given that SIE is a key indicator of poor prognosis after stroke.
Source: The American Journal of Emergency Medicine - September 25, 2014 Category: Emergency Medicine Authors: Meera Ekka, Sashi Bhusan Lakra, Praveen Aggarwal, Nayer Jamshed Tags: Correspondence Source Type: research

Prevention of emergency physician migratory contamination in a cluster randomized trial to increase tissue plasminogen activator use in stroke (the INSTINCT trial)
Cluster randomized trials (CRTs) are increasingly used to evaluate quality improvement interventions aimed at health care providers. In trials testing emergency department (ED) interventions, migration of emergency physicians (EPs) between hospitals is an important concern, as contamination may affect both internal and external validity. We hypothesized that geographically isolating EDs would prevent migratory contamination in a CRT designed to increase ED delivery of tissue plasminogen activator (tPA) in stroke (the INSTINCT trial).
Source: The American Journal of Emergency Medicine - September 6, 2014 Category: Emergency Medicine Authors: Victoria C. Weston, William J. Meurer, Shirley M. Frederiksen, Allison K. Fox, Phillip A. Scott Tags: Research Seminar Source Type: research

Intramural hematoma of the esophagus after thrombolysis for ischemic stroke
We report the case of an 88-year-old woman who developed an intramural hematoma of the esophagus after intravenous thrombolysis for an acute ischemic stroke. Before thrombolysis, nasogastric intubation was attempted unsuccessfully. She was kept on nil by mouth, intravenous hydration, proton pump inhibitor, antiemetics, and an antibiotic initiated 2 days before for periodontal disease.
Source: The American Journal of Emergency Medicine - August 29, 2014 Category: Emergency Medicine Authors: Mario Jorge Silva, Joana Saiote, Vera Salvado, Ana Paiva Nunes, Pedro Duarte Tags: Case report Source Type: research

Approach to the diagnosis and treatment of acute subarachnoid hemorrhage in a patient with sickle cell disease
We report a case of subarachnoid hemorrhage in a 38-year-old patient with sickle cell anemia. This case highlights the limitations of noncontrast computed tomography in the diagnosis of subarachnoid hemorrhage in patients with sickle cell disease as well as the special needs of this patient population in addressing the treatment of stroke.
Source: The American Journal of Emergency Medicine - August 29, 2014 Category: Emergency Medicine Authors: Matthew Lyon, Justin Jeter, Richard Lottenberg Tags: Case Report Source Type: research

Dabigatran-related coagulopathy: when can we assume the effect has “worn off”?
This issue of American Journal of Emergency Medicine presents a timely report that should be noted by all practicing emergency physicians. Nzwalo et al [1] describe a 61-year-old man with nonvalvular atrial fibrillation, taking 150 mg dabigatran twice daily for stroke protection, who presented to their emergency department (ED) with an acute ischemic stroke (AIS). The patient had a normal creatinine clearance and a normal thrombin time (TT). He was treated with intravenous recombinant tissue plasminogen activator (rt-PA) with good neurologic outcome and no bleeding complications.
Source: The American Journal of Emergency Medicine - August 28, 2014 Category: Emergency Medicine Authors: Charles V. Pollack, Jerrold H. Levy, John Eikelboom, Jeffrey I. Weitz, Frank W. Sellke, Menno V. Huisman, Thorsten Steiner, Pieter Kamphuisen, Richard A. Bernstein Tags: Controversies Source Type: research

Nonconvulsive status epilepticus masquerading as stroke
This case describes a patient with multiple stroke risk factors—including prior stroke—who presented to the emergency department with symptoms suggestive of stroke and who received a rapid stroke work up but was later found to be in nonconvulsive status epilepticus (NCSE). This case report highlights the challenge and importance of making an accurate diagnosis in NCSE, and we have included teaching points to help clinicians understand the clinical manifestations and diagnosis of NCSE as well as how it may impact a patient's prognosis.
Source: The American Journal of Emergency Medicine - August 28, 2014 Category: Emergency Medicine Authors: Christopher Kennel, Andreas Michas-Martin, Brian D. Berman, Sharon Poisson Tags: Case Report Source Type: research

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