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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

Computed tomography angiography in acute stroke (revisiting the 4Ps of imaging)
Imaging in acute stroke has traditionally focussed on the 4Ps—parenchyma, pipes, perfusion, and penumbra—and has increasingly relied upon advanced techniques including magnetic resonance imaging to evaluate such patients. However, as per European Magnetic Resonance Forum estimates, the availability of magnetic resonance imaging scanners for the general population in India (0.5 per million inhabitants) is quite low as compared to Europe (11 per million) and United States (35 per million), with most of them only present in urban cities.
Source: The American Journal of Emergency Medicine - November 3, 2015 Category: Emergency Medicine Authors: Shriram Varadharajan, Jitender Saini, Ullas V. Acharya, Arun Kumar Gupta Tags: Brief Report Source Type: research

Association of physician risk tolerance with emergency department computed tomography use for isolated dizziness/vertigo patients
Dizziness/vertigo is one of the most common principal complaints in the emergency department (ED) [1], accounting for 2.5% of all ED presentations [2]. Although the most common causes of dizziness/vertigo are benign, potential life-threatening stroke especially cerebellar or brain stem infarction should be considered in the differential diagnosis, because isolated dizziness without other concurrent neurological symptoms can be the sole presentation of these conditions [3-5]. Non-contrast brain computed tomography (CT) provides the necessary information for emergency management of most patients with suspected stroke and is ...
Source: The American Journal of Emergency Medicine - July 30, 2014 Category: Emergency Medicine Authors: Fu-Jen Cheng, Chien-Hung Wu, Yuan-Jhen Syue, Pai-Chun Yen, Kuan-Han Wu Source Type: research

Association of physician risk tolerance with ED CT use for isolated dizziness/vertigo patients
Dizziness/vertigo is one of the most common principal complaints in the emergency department (ED) [1], accounting for 2.5% of all ED presentations [2]. Although the most common causes of dizziness/vertigo are benign, potential life-threatening stroke especially cerebellar or brain stem infarction should be considered in the differential diagnosis because isolated dizziness without other concurrent neurologic symptoms can be the sole presentation of these conditions [3-5]. Noncontrast brain computed tomography (CT) provides the necessary information for emergency management of most patients with suspected stroke and is the...
Source: The American Journal of Emergency Medicine - July 30, 2014 Category: Emergency Medicine Authors: Fu-Jen Cheng, Chien-Hung Wu, Yuan-Jhen Syue, Pai-Chun Yen, Kuan-Han Wu Tags: Correspondence Source Type: research

A patient with altered mental status and possible seizure reveals an atypical aortic dissection upon workup
In this report, we present the case of a 57-year-old woman who was transported to the emergency department with an acute episode of altered mental status, presenting as a possible stroke with possible seizures. The patient's only complaint was mild low back pain. Physical examination revealed disorientation to time with no other neurologic deficits or abnormal findings. Results from initial noncontrast head computed tomography, chest radiograph, and laboratory studies were all normal, except for an elevated d-dimer and serum creatinine. Chest computed tomography with contrast demonstrated a type A aortic dissection. The pa...
Source: The American Journal of Emergency Medicine - November 18, 2013 Category: Emergency Medicine Authors: Olufolahan J. Lawal, Harinder S. Dhindsa, Joshua W. Loyd Tags: Case Reports 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

Differentiating contrast staining after acute ischemic stroke from hemorrhagic transformation during emergency evaluation
A hyperdense lesion observed in a computed tomography (CT) image of the brain is usually suspected to be a hemorrhage during an emergency evaluation. Other rare differential diagnoses include contrast-induced encephalopathy (CIN) and acute cerebral infarction with contrast staining (CS). Recent contrast administration is a common risk factor for both CIN and CS. The former has been associated with favorable neurological outcomes, whereas CS might have complications, such as hemorrhagic transformation (HT).
Source: The American Journal of Emergency Medicine - May 17, 2016 Category: Emergency Medicine Authors: Sing-Kong Ho, Jen-Kuang Lee, Yen-Jun Lai, Tzu-Chiao Lin, Cheng-Wei Liu Source Type: research

Central venous sinus thrombosis presenting with generalized tonic-clonic seizures in a patient with no known risk factors
We present a case of a previously healthy woman with a new onset seizure, whose only other complaint was weakness despite a normal neurological examination. Her head computed tomography (CT) showed an intraparenchymal hemorrhage of the left frontal lobe and signs of infarction of the right frontal lobe.
Source: The American Journal of Emergency Medicine - October 9, 2016 Category: Emergency Medicine Authors: Patricia Khatib, Omar Mostafa, Erin L. Simon Tags: Case Reports Source Type: research

Paradoxical brain embolism shadowing massive pulmonary embolism
Patent foramen ovale is frequently observed in the general population. In case of massive pulmonary embolism, the sudden increase in the right heart cavity's pressure may cause a right-to-left shunting across this foramen, which could be associated with conflicting outcomes. Herein, we report a case of reversible cardiac arrest preceded by seizures, and followed by hemodynamic stability without any vasopressor. A brain CT-scan showed a limited ischemic stroke. Initial echocardiographic assessment revealed an acute cor pulmonale and a right-to-left intracardiac shunt across a large patent foramen ovale, suggesting the diagn...
Source: The American Journal of Emergency Medicine - May 15, 2018 Category: Emergency Medicine Authors: Fran çois Bagate, Alexandre Bedet, Armand Mekontso Dessap, Guillaume Carteaux 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