“Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis” Background/Study Question This article aimed to answer the question: How sensitive is a CT head performed within 6 hours of symptom onset in a patient whom there is concern for spontaneous SAH and who is neurologically intact? A little…
Author: Shivon Manchanda We recently had a wonderful guest lecture from Elizabeth Pieroth, PsyD, ABPP, the Director of the Concussion Program at Midwest Orthopedics, about how to approach concussions in the ED. This post is a summary of that lecture. Initial Assessment: The initial assessment of a suspected concussion patient requires the examination of three…
“Combined Corticosteroid and Antiviral Treatment for Bell’s Palsy A Systematic Review and Meta-analysis” Background/Study Question This article aimed to answer the question: Do steroids PLUS antivirals offer reduced risk of unsatisfactory facial recovery in patients with Bell’s Palsy? A little background about Bell’s Palsy; it is a cranial nerve 7 palsy thought to be viral…
Author: Dr. Trevor Landas Defined as inflammation of the meninges, or covering layers of the central nervous system, meningitis has a high morbidity and mortality if not identified and treated promptly. The incidence is approximately 1.38 per 100,000 people. Clinical Presentation: Presenting symptoms include the classic triad of fever, neck stiffness, and altered mental status,…
Author: Dr. Calloway Pichette Article: IV Fluids for the treatment of Emergency Department patients with migraine headache: a randomized controlled trial Background: Headache, a common complaint in the ED. Many times a day we see patients with migraine headaches in the ED. Give them a migraine cocktail (sadly, no martinis involved…) and then viola! They…
Background: About 1 to 2% of ER visits deal with Syncope. Most of these are vaso-vagal episodes that do not require more work up. But, beside the obvious slam dunk: you passed out because you have a giant PE or your Accucheck reads 2, there is a middle ground of patients that have no obvious…
Last week we had the opportunity to learn about posterior circulation ischemic strokes from vascular neurologist, Dr. Osteraas.
Diagnosing posterior circulation ischemic strokes can be challenging in the emergency department, largely because posterior circulation ischemic strokes frequently lack “traditional” stroke signs and symptoms and the symptoms that you do see are often non-specific and can be slow onset. Despite this, it is important to do our best to diagnose these as about 20% of ischemic events involve the posterior circulation and posterior circulation ischemic strokes can lead to some of the most devastating neurologic outcomes, including massive cerebellar infarcts with subsequent herniation and locked in syndrome.
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At last month’s mortality and morbidity conference, we discussed a case of Posterior Reversible Encephalopathy Syndrome (PRES). Our consultant, a neuro-intensivist, told us that PRES is not always posterior, not always reversible nor always presenting with encephalopathy. Thanks whoever named that syndrome. The presentation is extremely variable. Typically presenting with: headache, altered mental status, visual…
Stroke or Vestibular Neuritis? Use the HINTS
The other day, Tom and I had a patient with the symptom of continuous vertigo. This is to be distinguished from someone with episodic triggered vertigo, such as when turning their head to the right, which we associate with benign paroxysmal positional vertigo (BPPV). The differential for continuous vertigo includes vestibular neuritis (a relatively benign…
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