Diagnosing frontal lobe epilepsy in the ED Lara Phillips, Michele Walsh
DOI: http://dx.doi.org/10.1016/j.ajem.2014.03.025
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: March 31 2014
x Frontal lobe seizures are a common form of epilepsy. It has a variable presentation and can often be missed in the emergency department (ED). Missing this diagnosis can lead to a delay in treatment and poor outcome for cognitive function. We hereby present a case of a 14-year-old girl who presented to our ED after the development of abnormal movements. Knowledge of the anatomy behind the development of partial seizures and the best testing modality can aid in the diagnosis. In this review, we attempt to discuss the pathophysiology of frontal lobe epilepsy and what physical examination findings and testing will best lead to a diagnosis.
Simultaneous event of brachial artery occlusion and acute embolic stroke Soo Hoon Lee, Nack-Cheon Choi, In Seok Jang, Tae-Sin Kang, Changwoo Kang, Jin Hee Jeong, Dong Seob Kim
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.049
The American Journal of Emergency Medicine , Vol. 33 , Issue 3 ,
Published online: August 26 2014
x Although the rapid and accurate diagnosis of both acute ischemic stroke and extremity ischemia is essential to the timely and appropriate treatment, it is not always easy to differentiate between true stroke and stroke mimics. Although in general, limb ischemia due to extremity embolism is not included in stroke mimics or misdiagnosis, limb arterial embolism should be considered in the differential diagnosis of acute monoparesis because the diagnosis may be missed if the other typical manifestations of this presentation (pain, pallor, pulselessness, sensory loss, and coolness of the arm) are overlooked.
Transient ischemic attack (TIA): the initial diagnostic and therapeutic dilemma Peter D. Panagos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.004
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x Many patients with transient ischemic attacks (TIA) are at high risk of stroke within the first few days of onset of symptoms. Emergency physicians and primary care physicians need to assess these patients quickly and initiate appropriate secondary stroke prevention strategies. Recent refinements in diagnostic imaging have produced valuable insight into risk stratification of patients with TIA. Clinical data regarding urgent initiation of antiplatelet therapy specifically in this patient population with non-cardioembolic TIA are limited but promising.
The orthopedic literature 2009 Michael C. Bond, Daniel L. Lemkin, William Brady
DOI: http://dx.doi.org/10.1016/j.ajem.2010.06.028
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: October 11 2010
x Green DW, Mogekwu N, Scher DM, et al. A modification of Klein's Line to improve sensitivity of the anterior-posterior radiograph in slipped capital femoral epiphysis. J Pediatr Orthop 2009;29:449-453.
Posterior reversible encephalopathy syndrome as the first presentation of chronic kidney disease Mohammadmahdi Forouzanfar, Pauline Haroutunian, Alireza Baratloo, Behrooz Hashemi
DOI: http://dx.doi.org/10.1016/j.ajem.2013.11.013
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: November 18 2013
x Posterior reversible encephalopathy syndrome is a clinicoradiologic syndrome characterized by seizure, headache, nausea, vomiting, altered mental status, visual disturbance, or visual loss, together with radiologic findings.
Acute pediatric stroke—what’s the hurry? A case for emergency physician-performed echocardiography Christopher D. Thom, Scott E. Sparks
DOI: http://dx.doi.org/10.1016/j.ajem.2014.04.023
The American Journal of Emergency Medicine , Vol. 32 , Issue 11 ,
Published online: April 18 2014
x Acute ischemic stroke in a pediatric population is uncommon and has a different etiology from the adult population. We describe a case of acute ischemic stroke for which emergent, physician-sonographer–performed transthoracic echocardiography (TTE) changed his outcome. The patient in this case presented with left-sided hemiparesis, with subsequent CT Angiography (CTA) imaging and follow-on neurosurgical embolectomy for a proximal middle cerebral artery occlusion after which showed early recovery of muscular deficit.
Syncopal storm caused by glossopharyngeal neuralgia Babak Kazemi, Fariborz Akbarzadeh
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x We report a rare case presenting with up to 50 episodes of syncopes per day in a 54-year-old man with the ultimate diagnosis of idiopathic glossopharyngeal neuralgia. All episodes were started with a severe pain sensation in the right side of the throat followed by asystole and then very slow ventricular escape beats. The patient was successfully treated with the combination of carbamazepine, gabapentin, and dual-chamber pacemaker implantation.
Paralytic rabies or postvaccination myelitis: a diagnostic dilemma Rajendra Singh Jain, Pankaj Kumar Gupta, Rahul Handa, Shankar Tejwani, Swayam Prakash, Sunil Kumar, Rakesh Agrawal, Mahendra S. Sisodiya
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.026
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: September 26 2014
x Rabies is a serious health hazard in developing countries like India. Paralytic rabies is difficult to diagnose due to lack of classic manifestations. It poses diagnostic dilemma in patients who have received postexposure prophylaxis, as it is difficult to differentiate it from vaccine-induced Guillain-Barre syndrome, postvaccination myelitis, and acute disseminated encephalomyelitis. Early diagnosis of rabies in such cases is very important for adequate infection control and for institution of public health measures.
Tramadol-induced apnea Hossein Hassanian-Moghaddam, Hoorvash Farajidana, Saeedeh Sarjami, Hamid Owliaey
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.013
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: July 18 2012
x In contrast with other opioids, there are few cases of tramadol-related respiratory depression described in the literature, and renal impairment is a proposed risk factor. The aim of this study is to determine the prevalence of and predisposing factors for tramadol-related apnea in patients referred to our center.
Recurrent hypoglycemia in a toddler Marissa Cohen, Sean Zwiebel, Rebecca Jeanmonod
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.074
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: April 30 2015
x Idiopathic ketotic hypoglycemia is the most common cause of hypoglycemia in toddlers. This diagnosis should be considered in any hypoglycemic toddler with no prior history of abnormal growth who is developmentally normal when toxic ingestions and sepsis are inconsistent with the clinical picture. Diagnosis is important in preventing serious long-term sequelae and is made in the setting of hypoglycemia, ketonuria, and ketonemia. Therefore, checking urine and blood ketones is an essential part of the evaluation in any hypoglycemic toddler.
Mimics of subacute subdural hematoma in the ED Marlijn H. de Beer, Ad P. van Gils, Hille Koppen
DOI: http://dx.doi.org/10.1016/j.ajem.2012.10.019
The American Journal of Emergency Medicine , Vol. 31 , Issue 3 ,
Published online: February 4 2013
x Diagnosing the true etiology of a subdural fluid collection is challenging in the acute setting of an emergency department (ED). In case of a subdural fluid collection at computed tomographic imaging, the possibility of a subdural hematoma will be considered at once. However, other causes such as subdural empyema and dural metastases with pachymeningitis hemorrhagica must be kept in mind. Especially when there is a medical history of recent sinusitis or malignancy. We describe 3 patients who presented to the ED with a history of progressive headache, aphasia, and a right-sided hemiparesis in whom a isodense subdural fluid collection was demonstrated with computed tomographic imaging.
Automated electroencephalogram identifies abnormalities in the ED Rosanne S. Naunheim, Matthew Treaster, Joy English, Teya Casner
DOI: http://dx.doi.org/10.1016/j.ajem.2010.03.010
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: May 3 2010
x Advances in analysis of electrical signals have now made it possible to create a handheld electroencephalogram (EEG).
A near-fatal case of exercise-associated hyponatremia Mathilde Severac, Jean-Christophe Orban, Thibaut Leplatois, Carole Ichai
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.041
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: December 30 2013
x A 42-year-old woman presented to our emergency department with headache, nausea, and confusion after completing an Ironman triathlon. She performed the race at a slow pace, in hot and dry weather. The first medical examination reported confusion with a Glasgow Coma Scale score of 13. A few minutes later, she presented with seizures. A cerebral computed tomographic (CT) scan showed major cerebral edema. Blood analysis showed severe acute hyponatremia (123 mEq/L) with hypotonicity (255 mEq/L). Her clinical condition quickly worsened, leading to a Glasgow Coma Scale score of 3 with fixed dilated pupils.
Atrial fibrillation related to carbon monoxide poisoning in a female patient Hızır Ufuk Akdemir, Bülent Güngörer, Fatih Çalışkan, Şahin Çolak, Murat Güzel
DOI: http://dx.doi.org/10.1016/j.ajem.2014.02.050
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: March 11 2014
x The clinical findings related to carbon monoxide (CO) poisoning, which is one of the most mortal types of poisoning in the world, are associated with different tissues that are more sensitive to hypoxia such as the central nervous system and cardiovascular system. Carbon monoxide causes myocardial damage and arrhythmias by impairing the transport of oxygen. However, there have been few reported cases of CO poisoning–induced atrial fibrillation in the literature. In this article, a case of CO poisoning–induced atrial fibrillation and myocardial damage is presented.
Improved door-to-needle times and neurologic outcomes when IV tissue plasminogen activator is administered by emergency physicians with advanced neuroscience training Karen Greenberg, Christina R. Maxwell, Keisha D. Moore, Michael D’Ambrosio, Kenneth Liebman, Erol Veznedaroglu, Geri Sanfillippo, Cynthia Diaz, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.025
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: November 28 2014
x The neurologic emergency department (neuro ED) at our medical center is staffed by emergency medicine physicians who have specialized neuroscience training and give intravenous (IV) tissue plasminogen activator (tPA) independently for acute ischemic stroke patients. Door-to-needle (DTN) times, discharge location, and discharge National Institute of Health Stroke Scale (NIHSS) scores were studied between the neuro ED and main emergency department (ED) with the hypothesis that all measures would be better in the neuro ED group.
Traumatic posterior shoulder dislocation with a large engaging Hill-Sachs lesion: splinting technique Sultan Aldebeyan, Ahmed Aoude, Hans Van Lancker
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.061
The American Journal of Emergency Medicine , Vol. 34 , Issue 3 ,
Published online: June 25 2015
x Posterior shoulder dislocations are rare and are often associated with seizures, electrocution, and high-energy trauma. They can be missed and, therefore, left untreated. Early diagnosis and treatment can help avoid future complications and surgical intervention.
Hyperthermia and severe rhabdomyolysis from synthetic cannabinoids Brett Sweeney, Soheila Talebi, David Toro, Kristhiam Gonzalez, Jean-Paul Menoscal, Ronald Shaw, Getaw Worku Hassen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.05.052
The American Journal of Emergency Medicine , Vol. 34 , Issue 1 ,
Published online: June 13 2015
x Synthetic cannabinoids (SC) have exploded on to the scene. With this rise in SC use, the number of complications and potential adverse effects are also well documented in the literature and is on the rise. The most frequently cited side effects are behavioral in nature and range for severe agitation to psychosis and delirium. We report a case of hyperthermia with severe rhabdomyolysis from SC use.
The associative factors of delayed-onset rhabdomyolysis in patients with doxylamine overdose Han Joon Kim, Sang Hoon Oh, Chun Song Youn, Jung Hee Wee, Ji Hoon Kim, Won Jung Jeong, Soo Hyun Kim, Seung Hee Jeong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2010.10.032
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: December 15 2010
x The aim of this study was to investigate the associative factors of rhabdomyolysis in patients with doxylamine overdose who had normal creatine phosphokinase levels at admission.
Purple glove syndrome occurring after oral administration of phenytoin in therapeutic doses: mechanism still a dilemma Rajendra Singh Jain, Kadam Nagpal, Sunil Kumar, Swayam Prakash, Rahul Handa
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.039
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: May 31 2014
x Purple glove syndrome is a rare and poorly understood complication of phenytoin use, occurring almost always with its intravenous formulation. This syndrome comprises of pain, purple discoloration, and edema distal to the site of intravenous administration of phenytoin. We hereby report an unusual case, wherein purple glove syndrome was seen on oral formulation of phenytoin in its therapeutic dose.
Pralidoxime inhibits paraoxon-induced depression of rocuronium-neuromuscular block in a time-dependent fashion Eichi Narimatsu, Tomohisa Niiya, Kazunobu Takahashi, Masanori Yamauchi, Michiaki Yamakage
DOI: http://dx.doi.org/10.1016/j.ajem.2011.06.013
The American Journal of Emergency Medicine , Vol. 30 , Issue 6 ,
Published online: August 26 2011
x The composite effects of organophosphorus (OP)–cholinesterase (ChE) inhibitors and oximes on the actions of nondepolarizing neuromuscular blockers in acute OP-ChE inhibitor intoxication have not been evaluated in detail. We investigated the effects of paraoxon (Pox) (an OP-ChE inhibitor) and pralidoxime (PAM) (an oxime) on the nondepolarizing neuromuscular blocking action of rocuronium.
