Contributor: Ricky Dhaliwal, MD Educational Pearls: CRASH 3 Trial looked at over 12,000 patients with traumatic intracranial bleeds, randomizing patients to a therapy with TXA or standard of care without TXA Dosing was 1 gram over 10 min for loading dose and then an infusion of 1 gram over 8 hours Found Improvement in survival…
Read Moredon’t pick your brain Chief Complaint: Generalized Weakness HPI: 69-year-old male with a self-diagnosis of obsessive-compulsive disorder (OCD) presents to the ED via EMS for being “sick”. The patient reports he has not been able to get up so he has not eaten in 4 days. The patient reports he has not seen a doctor…
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the silent killer strikes Chief Complaint: Stroke Alert HPI: 68 year old female with past medical history of coronary artery disease status post stent, hypertension, hypothyroidism, hyperlipidemia is brought in by EMS as a stroke alert after being found unresponsive in bed by family prior to arrival. Last known normal is 10pm last night when…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: When evaluating a thunderclap headache, don’t forget RCVS! RCVS: reversible cerebral vasoconstriction syndrome Due to reversible spasms of cerebral blood vessels Can sometimes be seen on CTA or MRA, but often the imaging is normal and formal angiograms only occasionally show it It can be caused by medications, intense…
Read MoreContributor: Tom Seibert, MD Educational Pearls: High altitude cerebral edema (HACE) is the end stage of acute mountain sickness and is diagnosed when patients develop neurologic dysfunction, ataxia, and altered mental status. The pathophysiology of HACE is thought to be due to increased cerebral blood flow and increased capillary permeability causing vasogenic edema and brain…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Serum prolactin levels can be used to help differentiate epileptic seizures from non-epileptic seizures It is also released and elevated after epileptic seizures but not non-epileptic seizures A level must be checked 10-20 minutes after the episode and if possible a next day level should be checked to…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Hand raising test: a simple but effective tool to diagnose carpal tunnel Patients hold their hands over their head and if symptoms of carpal tunnel develop within 2 minutes, it is considered positive, meaning they likely have carpel tunnel Symptom included numbness and dull pain in the distribution of…
Read MoreAuthor: Eric Miller, MD Educational Pearls: Brown-Sequard Syndrome is a neurological deficit that results from hemisection of the spinal cord This is usually from traumatic injury (blunt or penetrating), but can rarely be seen with cancer, disc herniation, or infection It presents with flaccid paralysis and loss of sensation to touch/vibration/position on the same side…
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Author: Charlene Gnisci Melton, PharmD Educational Pearls: Status Epilepticus is defined as continuous seizure activity for >5 minutes, or 2 or more seizures without full return to consciousness between events Status epilepticus is a true neurologic emergency with significant morbidity and mortality Aggressive, early treatment of status epilepticus is essential as GABA receptors will regress…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Locked in syndrome results typically from an infarct of the basilar artery leading to infarction of the brainstem but typically preservation of the higher structures The result is complete paralysis with preserved cognitive function, hence the name Because of their location within the brainstem, ocular movements are sometimes preserved,…
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