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Source: The American Journal of Emergency Medicine
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Total 261 results found since Jan 2013.
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
Rescue thrombolysis in the treatment of cardiac shock and acute stroke
The patients with ST-elevation myocardial infarction are primarily managed with percutaneous coronary intervention (PCI) or thrombolysis. It is well accepted that rescue PCI should be implemented in case of unsuccessful thrombolysis. However, the reverse, rescue thrombolysis, that is, administering of thrombolytic therapy in a patient in whom primary PCI fails, is not well defined. There are no available data about rescue thrombolysis so far. We represent a 43-year-old male patient with Buerger disease (thromboangiitis obliterans) who was admitted to our emergency department for cardiac shock related to inferior and right ...
Source: The American Journal of Emergency Medicine - April 19, 2013 Category: Emergency Medicine Authors: Sukru Akyuz, Mustafa Azmi Sungur, Cevdet Donmez, Aylin Sungur, Nese Cam 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
Lung transplant of extrahospitalary donor after cardiac death
The objective of this study is to describe the results of lung transplantation of after cardiac death program, specifically the section regarding lung extraction donation. Twenty potential lung donors were obtained during the study. Most patients were male (19 cases), with a mean age of 42 years (36.5-49.5 years). A total of 33 lungs were donated (18 right and 15 left lungs). Most extractions were multiorganic (19 cases). One liver, 19 kidneys, 2 pancreas, and 19 corneas were obtained from these donors; bone tissue was obtained from all donors. The transplantation was bipulmonary in 13 cases and unipulmonary in 7. Thirty d...
Source: The American Journal of Emergency Medicine - March 5, 2013 Category: Emergency Medicine Authors: Alonso A. Mateos Rodríguez, José Maria Navalpotro Pascual, Francisco del Río Gallegos Tags: Brief Reports Source Type: research
Factors associated with use of emergency medical services in patients with acute stroke
Abstract: Purposes: The aim of this study was to investigate the factors associated with use of emergency medical services (EMS) in patients with acute stroke.Methods: Prospective data on consecutive patients with acute stroke who presented to the emergency department of a university medical center from January 1, 2010, to July 31, 2011, were analyzed. Patients were excluded if they had an unknown residence, had onset of stroke at a nursing home or hospital, or were transferred from another hospital. Variables for all patients with stroke and ischemic stroke who did and did not use EMS were compared.Results: In total, 1344...
Source: The American Journal of Emergency Medicine - March 4, 2013 Category: Emergency Medicine Authors: Nai-Chuan Chen, Ming-Ju Hsieh, Sung-Chun Tang, Wen-Chu Chiang, Kuang-Yu Huang, Li-Kai Tsai, Patrick Chow-In Ko, Matthew Huei-Ming Ma, Jiann-Shing Jeng Tags: Original Contributions Source Type: research
Prehospital stroke diagnosis and treatment in ambulances and helicopters—a concept paper
Abstract: Stroke is the second common cause of death and the primary cause of early invalidity worldwide. Different from other diseases is the time sensitivity related to stroke. In case of an ischemic event occluding a brain artery, 2000000 neurons die every minute. Stroke diagnosis and treatment should be initiated at the earliest time point possible, preferably at the site or during patient transport. Portable ultrasound has been used for prehospital diagnosis for applications other than stroke, and its acceptance as a valuable diagnostic tool “in the field” is growing. The intrahospital use of transcranial ultrasou...
Source: The American Journal of Emergency Medicine - February 14, 2013 Category: Emergency Medicine Authors: Thilo Hölscher, James V. Dunford, Felix Schlachetzki, Sandra Boy, Thomas Hemmen, Brett C. Meyer, John Serra, Jeff Powers, Arne Voie Tags: Reviews Source Type: research
Complete resolution of a solitary pontine abscess in a patient with dental caries
A solitary brainstem abscess is a rare fatal intracranial infection, which can be mistaken for an acute stroke complicated with a systemic infection. Dental caries without abscess formation can be a possible source of infection. Herein, we describe the case of a 59-year-old man with dental caries who presented with a 4-day history of progressive dizziness, double vision, gait ataxia, emesis, and left facial and body numbness. Fever, suboccipital headache, and difficulties in urinating and defecating were noted on admission. Acute brainstem infarction and suspected aspiration pneumonia were then diagnosed. Magnetic resonanc...
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Ming-Hua Chen, Hung-Wen Kao, Chun-An Cheng Tags: Case Reports Source Type: research
Abnormal troponin level as short-term predictor of poor outcome in acute atrial fibrillation
Abstract: Background: The link between minor troponin (cardiac troponin I [cTnI]) elevations and atrial fibrillation (AF) is still debated.Methods: A total of 948 patients with AF lasting less than 48 hours participated in the study and were required to undergo 1-month and 12-month follow-up. The exclusion criteria were represented by younger than 18 years, the presence of hemodynamic instability, or severe comorbidity. Primary end point was the composite of ischemic vascular events inclusive of stroke, acute coronary syndrome, revascularization, and death.Results: In the short term, 4 patients (5%) of 78 with abnormal cTn...
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Alberto Conti, Yuri Mariannini, Gabriele Viviani, Claudio Poggioni, Gabriele Cerini, Margherita Luzzi, Maurizio Zanobetti, Francesca Innocenti, Luigi Padeletti, Gian Franco Gensini Tags: Original Contributions Source Type: research
Identification of painless aortic dissection before thrombolytic treatment for acute ischemic stroke
We reported a 57-year-old man with acute right hemisphere watershed ischemic stroke caused by painless type A aortic dissection was diagnosed in time with computed tomographic (CT) angiography. The possible detrimental impact which may have been incurred by thrombolytic therapy was avoided. We suggest that cerebral CT angiography, covering from the aortic arch to intracranial arteries, should be performed in acute ischemic stroke patients, particularly in those with watershed CT perfusion deficits, to exclude the possibility of aortic dissection before thrombolytic treatment.
Source: The American Journal of Emergency Medicine - February 11, 2013 Category: Emergency Medicine Authors: Chen-Hsiung Huang, Hui-Chun Huang, Kang-Hsu Lin, Wei-Kung Chen, Chon-Haw Tsai Tags: Case Reports Source Type: research
