Category: Neurology
Keywords: DAWN, thrombectomy, mismatch, wake-up, stroke, penumbra (PubMed Search)
Posted: 12/13/2017 by WanTsu Wendy Chang, MD
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Bottom Line: The use of neuroimaging to identify an ischemic penumbra that may benefit from thrombectomy may be considered even for patients with time of last known well beyond 6 hours.
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2017 Nov 11. [Epub ahead of print]
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Category: Neurology
Keywords: GBS, weakness, intubation, CSF, LP (PubMed Search)
Posted: 11/22/2017 by Danya Khoujah, MBBS
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Allen JA. Chronic Demyelinating Polyneuropathies. Continuum 2017;23(5):1310–1331
Category: Neurology
Keywords: aphasia, stroke, middle cerebral artery, MCA, mimic, NIHSS (PubMed Search)
Posted: 11/8/2017 by WanTsu Wendy Chang, MD
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Take Home Point: This small but interesting study looked at the incidence of isolated aphasia presenting for concern of stroke. They found that none of their patients had evidence of an infarct, suggesting that strokes affecting language without motor or sensory deficits are uncommon.
Casella G, Llinas RH, Marsh EB. Isolated aphasia in the emergency department: The likelihood of ischemia is low. Clin Neurol Neurosurg 2017:163:24-26.
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Category: Neurology
Keywords: weakness, infection, paralysis, intubation, influenza, vaccine (PubMed Search)
Posted: 10/25/2017 by Danya Khoujah, MBBS
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It's respiratory infection and flu vaccine season! Time to brush up on Guillain-Barré Syndrome..
- It is the most common cause of acute or subacute flaccid weakness worldwide
- 70% of cases are preceded by an infection in the past 10-14 days, but most are minimized or forgotten by the patient. 40% of these infections are by Campylobacter jejuni.
- 30% develop respiratory failure requiring intubation and ventilation
- Half of the patients will develop their maximum weakness by 2 weeks, most will develop it by 4 weeks.
Donofrio PD. Guillain-Barré Syndrome. Continuum 2017;23(5):1295–1309.
Category: Neurology
Keywords: traumatic brain injury, TBI, fall, subdural hematoma, SDH, elderly (PubMed Search)
Posted: 10/11/2017 by WanTsu Wendy Chang, MD
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Traumatic brain injury (TBI) is associated with close to half of major trauma admissions in adults over age 65 in the U.K.
Falls accounted for 85% of all TBIs, while 45% of patients had subdural hematomas (SDH).
More than 3/4 of patients were treated conservatively, though outcomes were not significantly better than those who underwent neurosurgical intervention.
Higher age is associated with higher mortality and greater disability.
Bottom Line: Trauma in older adults is increasing and fall prevention is important in reducing significant injuries.
Hawley C, Sakr M, Scapinello S, et al. Traumatic brain injuries in older adults - 6 years of data for one UK trauma centre: retrospective analysis of prospectively collected data. Emerg Med J 2017;0:1-8.
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Category: Neurology
Keywords: stroke, tPA, thrombolytics, ICH, hemorrhage, adverse events (PubMed Search)
Posted: 9/28/2017 by Danya Khoujah, MBBS
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Category: Neurology
Keywords: seizure, status epilepticus, benzodiazepine, RAMPART, pediatric (PubMed Search)
Posted: 9/13/2017 by WanTsu Wendy Chang, MD
(Updated: 9/14/2017)
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IV vs. Non-IV Benzodiazepines for Cessation of Seizures
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Category: Neurology
Keywords: meningitis, CSF, glucose, glucometer (PubMed Search)
Posted: 8/24/2017 by WanTsu Wendy Chang, MD
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Category: Neurology
Keywords: pituitary apoplexy, subarachnoid hemorrhage, meningitis, headache, CT, MRI (PubMed Search)
Posted: 8/9/2017 by Danya Khoujah, MBBS
(Updated: 11/1/2024)
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Bottomline: Keep pituitary apoplexy in your differential when considering SAH or meningitis, especially in the presence of risk factors, and have a low threshold to order an MRI.
Category: Neurology
Keywords: Terson syndrome, vitreous hemorrhage, intraocular hemorrhage, subarachnoid hemorrhage (PubMed Search)
Posted: 7/12/2017 by WanTsu Wendy Chang, MD
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50 YOF with acute onset of worst headache of life associated with nausea and vomiting. Patient is somnolent, will rouse to noxious stimuli and complains of a headache as well as decreased vision.
Image courtesy of Dr. Nasir Siddiqui, Radiopaedia.org. From the case rID: 36469
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Category: Neurology
Keywords: autoimmune, cancer, encephalopathy (PubMed Search)
Posted: 6/28/2017 by Danya Khoujah, MBBS
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Category: Neurology
Keywords: seizure, electroencephalogram, EEG, epilepsy, antiepileptic (PubMed Search)
Posted: 6/14/2017 by WanTsu Wendy Chang, MD
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What is the role of EEG for first-time seizures in the ED?
Take Home Point: A 30-minute routine EEG in the ED in adults with an uncomplicated first-time seizure revealed a substantial number of epilepsy diagnosis and can change ED management with immediate initiation of antiepileptic medication.
Background:
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Category: Neurology
Keywords: syncope, vasovagal, orthostatic, blood pressure (PubMed Search)
Posted: 5/24/2017 by Danya Khoujah, MBBS
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Vasovagal syncope is a subtype of neurally mediated syncope, and it is distinctly different from orthostatic hypotension.
Patients with orthostatic syncope have severe orthostatic hypotension that results in transient loss of consciousness immediately or within moments of standing up. This is different from neurally mediated syncope, which develops gradually under conditions of prolonged orthostatic stress such as standing for several minutes. Tilt table testing is useful for true orthostatic syncope, but not for neurally mediated syncope. In addition, checking for “orthostatic hypotension” may not capture patient with orthostatic syncope, because the hypotension occurs so quickly after standing up. Of note, patients may still have orthostatic tachycardia or intolerance with neurally mediated syncope.
Category: Neurology
Keywords: syncope, vasovagal, seizures, orthostatic, blood pressure (PubMed Search)
Posted: 5/10/2017 by Danya Khoujah, MBBS
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Cheshire WP. Syncope. Continuum 2017;23(2):335–358.
Category: Neurology
Keywords: vasogenic cerebral edema, white matter, blood-brain-barrier, steroids (PubMed Search)
Posted: 4/26/2017 by WanTsu Wendy Chang, MD
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Case image courtesy of Dr David Cuete, Radiopaedia.org, rID: 23178
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1704262312_20170426_Figure.jpg (60 Kb)
Category: Neurology
Keywords: Glasgow Coma Scale, GCS, motor GCS, mGCS, Simplified Motor Scale, SMS (PubMed Search)
Posted: 4/12/2017 by WanTsu Wendy Chang, MD
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Bottom Line: The motor GCS and Simplified Motor Scale (SMS) have similar discrimination when compared with the total GCS, and may be easier to use.
Chou R, Totten AM, Carney N, et al. Predictive Utility of the Total Glasgow Coma Scale Versus the Motor Component of the Glasgow Coma Scale for Identification of Patients with Serious Traumatic Injuries. Ann Emerg Med. 2017 Jan 11. [Epub ahead of print].
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Category: Neurology
Keywords: CT, MRI, tPA, peripartum, PRES (PubMed Search)
Posted: 3/22/2017 by Danya Khoujah, MBBS
(Updated: 11/1/2024)
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Majerisk JJ. Inherited and Uncommon Causes of Stroke. Continuum 2017;23(1):211–237.
Category: Neurology
Keywords: headache, migraine, intravenous fluids, IVF (PubMed Search)
Posted: 3/8/2017 by WanTsu Wendy Chang, MD
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Category: Neurology
Keywords: stroke, alcohol, substance abuse, mimics (PubMed Search)
Posted: 2/22/2017 by Danya Khoujah, MBBS
(Updated: 11/1/2024)
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Category: Neurology
Keywords: aphasia, fluency, comprehension, repetition, Broca's aphasia, Wernicke's aphasia, conduction aphasia (PubMed Search)
Posted: 2/8/2017 by WanTsu Wendy Chang, MD
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Types of aphasia [Online image]. Retrieved February 8, 2017 from https://www.aphasia.org/
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1702082322_20170208_Figure.jpg (84 Kb)