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Source: The American Journal of Emergency Medicine
Condition: Stroke
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Total 254 results found since Jan 2013.
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
Fatal heat stroke associated with topiramate therapy
A 40-year-old man with diabetes and seizure disorder was found at home unresponsive and “very hot to touch” by his father 40 minutes before emergency medical services arrival. His usual medications included topiramate, divalproex sodium, and rosiglitazone/metformin. Paramedics administered oxygen, intravenous fluids, and naloxone. They did not witness or report seizure activity. Upon emergency department arrival, the patient was unresponsive (Glasgow Coma Scale 3), hypotensive (94/50 mm Hg), and tachypneic (32 breaths per minute), with a heart rate of 60 beats per minute and elevated rectal temperature peaking at 43.2...
Source: The American Journal of Emergency Medicine - September 3, 2013 Category: Emergency Medicine Authors: Stephen W Borron, Robert Woolard, Susan Watts Tags: Case Reports Source Type: research
S100B protein in children with carbon monoxide poisoning
S100B has been shown to increase in patients with cardiac arrest, stroke, subarachnoid hemorrhage, and traumatic and hypoxic brain damage . In contrast to adult studies, we found that serum S100B protein levels did not increase in pediatric patients with carbon monoxide (CO) poisoning . Patients with a positive history of CO exposure and elevated blood carboxyhemoglobin (>10%) levels associated with relevant clinical findings were diagnosed with CO poisoning. The most common complaints were headache (n = 27), dizziness (n = 27), nausea and vomiting (n = 28), syncope (n = 7), and convulsion (n = 2). In addition, we also cla...
Source: The American Journal of Emergency Medicine - August 12, 2013 Category: Emergency Medicine Authors: Ahmet Zulfikar Akelma, Aydin Celik,, Osman Ozdemir, Fatma Kavak Akelma Tags: Correspondence 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
The locked-in syndrome: posterior stroke in the ED
We present this report and brief review as it is unusual to watch locked-in syndrome evolve in the ED. Providers should be aware of the presenting symptoms and the differential diagnosis for bulbar muscle weakness as well as the management of posterior stroke.
Source: The American Journal of Emergency Medicine - May 22, 2013 Category: Emergency Medicine Authors: Corey Goldberg, Stephen Topp, Christopher Hopkins Tags: Case Reports 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
