Acute neurocysticercosis presenting as suicidal ideation James F. Martin, Jessica Vidas, Ali Baday
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.070
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: May 1 2015
x This is a case of a 36-year-old Spanish-speaking Hispanic man who was brought to a busy suburban New Jersey emergency department (ED) by family members for altered mental status. By report, patient was noted by family to be “not acting normal” at home, when he went into his bathroom and locked the door. A brief time thereafter, he emerged smelling of bleach and with confused speech. The family surmised that he tried to commit suicide by drinking bleach and emergently brought the patient to the ED.
Paroxysmal sympathetic hyperactivity after near-hanging Atsushi Fujiwara, Hitoshi Kobata
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.033
The American Journal of Emergency Medicine , Vol. 33 , Issue 5 ,
Published online: October 21 2014
x Paroxysmal sympathetic hyperactivity (PSH) is a relatively common early complication after severe brain injury. It is characterized by episodic generalized sympathetic hyperactivity. We herein present a case of a 29-year-old woman who developed PSH after near-hanging with uncertainty of cardiac arrest. The patient attempted suicide by hanging herself. Her mother found her pulseless and in a deep coma and started chest compressions. Upon arrival at our hospital, spontaneous breathing was restored and her vital signs stabilized; however, she remained in a deep coma.
A rare entity in ED: posterior reversible encephalopathy syndrome Mehmet Fatih Yetkin, Omer Salt, Polat Durukan, Fusun Ferda Erdogan, Seda Ozkan
DOI: http://dx.doi.org/10.1016/j.ajem.2012.02.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 4 2012
x Posterior reversible encephalopathy syndrome is a cliniconeuroradiologic entity with typical symptoms and symmetric high-signal intensity lesions in the bilateral parietooccipital lobes on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging. In this presentation, we report a case of posterior reversible encephalopathy syndrome who was admitted to our emergency department because of seizure and deterioration of consciousness. The aim of this presentation is to alert the emergency physicians about one of the hypertensive emergencies with neurologic symptoms associated with hypertension.
Minor head injury in the elderly at very low risk: a retrospective study of 6 years in an Emergency Department (ED) Alessandro Riccardi, Flavio Frumento, Grazia Guiddo, Maria Beatrice Spinola, Luca Corti, Pierangela Minuto, Roberto Lerza
DOI: http://dx.doi.org/10.1016/j.ajem.2012.05.023
The American Journal of Emergency Medicine , Vol. 31 , Issue 1 ,
Published online: August 6 2012
x Mild head injury (MHI) is a common clinical problem in emergency departments (EDs). Long-standing debate is still going on about MHI in the elderly: current guidelines recommend to perform a CT scan on this group.
The locked-in syndrome: posterior stroke in the ED Corey Goldberg, Stephen Topp, Christopher Hopkins
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.015
The American Journal of Emergency Medicine , Vol. 31 , Issue 8 ,
Published online: May 22 2013
x A 42-year-old man presented to a tertiary care emergency department (ED) with a 5-hour history of abdominal pain, nausea, and vomiting. Over the course of several hours, symptoms progressed from nausea and vomiting to dysarthria and facial muscle weakness, ultimately resulting in complete bulbar paralysis requiring intubation and admission to the intensive care unit. The patient had no medical history to suggest a cause. The working differential initially focused on the patient's abdominal pain but quickly broadened to include myasthenia gravis, Miller Fisher variant Guillain-Barré syndrome, botulinum toxicity, and cerebrovascular event.
Table of Contents
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00880-3
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published in issue: November 2015
Rapid induction of hypothermia with a small volume aortic flush during cardiac arrest in pigs Wolfgang Weihs, Danica Krizanac, Fritz Sterz, Gerald Hlavin, Andreas Janata, Wolfgang Sipos, Michael Holzer, Udo M. Losert, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.002
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x The induction of deep cerebral hypothermia (15°C) via large-volume cold (4°C) saline aortic flush during cardiac arrest and resuscitation with cardiopulmonary bypass improves neurologic outcome in pigs. We hypothesized that induction of mild cerebral hypothermia (33°C) via smaller volume and resuscitation without bypass will improve survival and neurologic outcome after 15 minutes of cardiac arrest as compared with conventional resuscitation attempts.
Neurogenic pulmonary edema after severe head injury: a transpulmonary thermodilution study Anis Chaari, Kamilia Chtara, Nozha Toumi, Mabrouk Bahloul, Mounir Bouaziz
DOI: http://dx.doi.org/10.1016/j.ajem.2014.12.009
The American Journal of Emergency Medicine , Vol. 33 , Issue 6 ,
Published online: December 18 2014
x Neurogenic pulmonary edema (NPE) is a possible complication of severe central nervous system insult. Its physiopathology is still debated. We report a fatal case of a 55-year-old man who was admitted because of severe head injury. The diagnosis of NPE was considered according to clinical and radiologic findings. Transpulmonary thermodilution study showed decreased stroke volume index and cardiac function index. Indexed extravascular lung water was increased as well as pulmonary vascular permeability index.
Therapeutic hypothermia: a state-of-the-art emergency medicine perspective Joseph Varon, Paul E. Marik, Sharon Einav
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.007
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x Therapeutic hypothermia (TH) has gained popularity as a brain-protective strategy for victims of sudden cardiac death in whom return of spontaneous circulation has been achieved but coma persists. Trials have also demonstrated some advantageous effects of lowering core body temperature after stroke and hypoxic-ischemic encephalopathy of the newborn. In a variety of clinical conditions, TH is still being studied (eg, hepatic encephalopathy and traumatic brain injury). This study describes the historical development of TH, its current applications in emergency medicine, and its potential future uses.
Is S100B protein level really not an indicator of brain damage due to carbon monoxide poisoning in children? Yusuf Emrah Eyi, Yakup Aksoy, Emre Zorlu, Abdullah Kaya, Kadir Ozturk, Kadir Colakoglu
DOI: http://dx.doi.org/10.1016/j.ajem.2013.07.015
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: August 19 2013
x We read with great interest the article “Neuron-specific enolase and S100B protein in children with carbon monoxide poisoning: children are not just small adults” written by Akelma et al [1]. The authors aimed in this study to evaluate the role of S100B protein and neuron-specific enolase (NSE) in children with carbon monoxide (CO) poisoning. They concluded that NSE levels increase in CO-associated hypoxic brain damage in accordance with clinical findings and contrary to the studies conducted on adults, S100B protein levels do not increase in response to hypoxic brain damage.
Intraparenchymal hemorrhage after heroin use Neha Kumar, Mary Colleen Bhalla, Jennifer A. Frey, Alison Southern
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.007
The American Journal of Emergency Medicine , Vol. 33 , Issue 8 ,
Published online: January 16 2015
x Heroin-associated stroke is a rare complication of use. Various proposed mechanisms of heroin-associated ischemic stroke have been proposed, including the following: cardioembolism in the setting of infective endocarditis, hypoxic ischemic brain injury in the setting of hypoxemia and hypotension, and infective arteritis or vasculitis from drug adulterants. A previously healthy 28-year-old woman presented to the emergency department with altered mental status and normal vitals after she was found wandering outside her apartment.
Significance of the vacuum phenomenon in patients with trauma evaluated by whole-body computed tomography Kazuhiko Omori, Kouhei Ishikawa, Mariko Obinata, Kentaro Mishima, Shin Fukusato, Hiromichi Ohsaka, Yasumasa Oode, Youichi Yanagawa
DOI: http://dx.doi.org/10.1016/j.ajem.2014.11.055
The American Journal of Emergency Medicine , Vol. 33 , Issue 2 ,
Published online: December 3 2014
x Severely traumatized patients undergo whole-body computed tomography (WCT) to detect lethal anatomical injuries. When checking the images, we have sometimes recognized minute gas (the vacuum phenomenon [VP]) near the traumatized lesions. Accordingly, we investigated the significance of the VP in patients with trauma.
Efficacy of concomitant use of dexmedetomidine and propofol in tetanus Ken Miya, Nobutake Shimojo, Yasuaki Koyama, Yuki Enomoto, Keiichi Hagiya, Yuichiro Yamasaki, Tomofumi Nishino, Satoru Kawano, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.04.069
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: April 30 2015
x Tetanus is an infectious disease caused by Clostridium tetani , which manifests systemic convulsion and autonomic instability associated with high case fatality. Despite proper medical intervention, management of those symptoms is often difficult. We report a case of 67-year-old man with tetanus in which a concomitant use of dexmedetomidine, an adrenaline α -2 receptor agonist, and propofol, a GABAA receptor binding agent, was successful in the management of systemic convulsion and autonomic instability without necessitating conventional anticonvulsant, neuromuscular blocking agents, or tracheostomy.
Lemierre syndrome complicated by cerebral abscess Water Valesky, Konstantinos Agoritsas
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.004
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published in issue: February 2013
x Often referred to as the “forgotten disease,” the incidence of Lemierre syndrome has seen a resurgence over the last 20 to 30 years. Cerebral abscesses are a rare complication of Lemierre syndrome, with only a few cases reported in the medical literature. We describe a case of Lemierre syndrome diagnosed in an 18-year-old man with complications of cerebral abscess and disseminated intravascular coagulation with a complicated course. Discussion will include causes for the resurgence of this disease and its initial management.
Carboplatin: a new cause of severe type B lactic acidosis secondary to mitochondrial DNA damage François Gilles Brivet, Abdelhamid Slama, Dominique Prat, Frédéric Marc Jacobs
DOI: http://dx.doi.org/10.1016/j.ajem.2010.07.005
The American Journal of Emergency Medicine , Vol. 29 , Issue 7 ,
Published online: October 11 2010
x In adults, type B lactic acidosis is rare and generally associated with a toxin, particularly metformin or antiretroviral nucleosides analogues. We report a case of lactic acidosis caused by carboplatin in a 50-year-old woman suffering from primary peritoneal carcinoma. She was admitted for severe lactic acidosis (pH 6.77, lactate 19 mmol/L) associated with multiple organ failure (PaO2 /FiO2 96, creatinine 231 μ mol/L, aspartate aminotransferase >25 000 UI, factor V 13%) occurring during the sixth carboplatin cycle.
Synthetic drugs: a new trend and the hidden danger Getaw Worku Hassen, Farzaneh Ghobadi, Hossein Kalantari
DOI: http://dx.doi.org/10.1016/j.ajem.2013.05.047
The American Journal of Emergency Medicine , Vol. 31 , Issue 9 ,
Published online: July 26 2013
x Designer or synthetic drugs and other recreational type use have increased among young people. The synthetic drugs present difficulty for law enforcement agents as the chemical structure is minimally altered to create a new and almost identical “legal” drug that can be sold as herbal incense or aromatic products. The symptoms of intoxication from these substances include euphoria, palpitations, confusion, anxiety, muscle cramps, depression, blurred vision, paranoia, insomnia, and altered mental status in extreme cases.
Metabolic vs structural coma in the ED—an observational study Sune Forsberg, Jonas Höjer, Ulf Ludwigs, Harriet Nyström
DOI: http://dx.doi.org/10.1016/j.ajem.2012.04.032
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: July 16 2012
x Patients presenting unconscious may reasonably be categorized as suffering from a metabolic or structural condition.
Mortality after discharge in clinically stable infants admitted with a first-time apparent life-threatening event Shruti Kant, Jay D. Fisher, David G. Nelson, Shehma Khan
DOI: http://dx.doi.org/10.1016/j.ajem.2013.01.002
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 11 2013
x The objective of this study is to review the mortality after discharge in clinically stable infants admitted with a first apparent life-threatening event.
On the pathways of an imperfect chameleon: posterior reversible encephalopathy syndrome Catarina Félix, Nádia Nunes, André Florêncio, Pablo Grande, Beatriz Gozabez, Miguel Milheiro, Luis Soleiro, Motassen Shamasha, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.11.012
The American Journal of Emergency Medicine , Vol. 34 , Issue 2 ,
Published online: November 9 2015
x Posterior reversible encephalopathy (PRES) is a rare clinicoradiological syndrome characterized by a variety of neurological manifestations such as acute encephalopathy, headache, seizures, visual loss, and focal neurologic signs in association with a reversible and predominantly posterior leukoencephalopathy [1,2]. Although precipitated by severe hypertension in most cases, other conditions such as eclampsia, autoimmune disorders, renal failure, and drugs, for example, are now recognized to cause PRES [3].
The association between ketamine given for prehospital chemical restraint with intubation and hospital admission Aaron M. Burnett, Bjorn K. Peterson, Samuel J. Stellpflug, Kristin M. Engebretsen, Katherine J. Glasrud, Jordan Marks, Ralph J. Frascone
DOI: http://dx.doi.org/10.1016/j.ajem.2014.10.016
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 20 2014
x Intramuscular ketamine has become increasingly popular for prehospital chemical restraint of severely agitated or violent patients because of its favorable adverse effect profile, rapid onset, and wide therapeutic window. However, there is currently no literature quantifying the need for intubation or hospital admission for these patients once they reach the emergency department.
