The NIH Stroke Scale Isn’t So Scary: Pearls and Pitfalls
The NIH Stroke Scale can be intimidating. This post provides what you need to know.
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Neurology
emDOCs Podcast – Episode 99: Multiple Sclerosis in the ED
Davis Sugar, Jess Pelletier, and Brit Long cover multiple sclerosis in the ED.
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emDOCs Podcast – Episode 97: Spontaneous Cervical Artery Dissection
The emDOCs cast with Jess Pelletier and Brit Long covers the challenging diagnosis of spontaneous cervical artery dissection.
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EM@3AM: Pneumocephalus
A 58-year-old female presents with severe headache and nausea. Her symptoms started shortly after leaving the office of her pain management doctor, where she had an epidural steroid injection to alleviate her chronic back pain approximately 30 minutes before she arrived in the ED. The patient denies any trauma to the head, fevers, nuchal rigidity, changes in vision, focal weakness, paresthesia, or anticoagulation use. On arrival, she is awake and alert and in obvious distress. Her vitals signs include temperature of 98.8F, HR of 64, BP 133/78, and O2 saturation of 98% on room air with a respiratory rate of 18. Her exam, including a complete neurological exam, is grossly benign. Given her acute complaint and recent history, labs and CT of the head are obtained. The clinician orders analgesics. The CT shows intracranial air.
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Blood Pressure Management in Neurologic Emergencies: What Does the Evidence Say?
How should you manage blood pressure in the patient with acute ischemic stroke or intracerebral hemorrhage?
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EM@3AM: Oculomotor Nerve Palsy
A 50-year-old female with no past medical history presents to the ED with a diffuse, constant headache onset a few weeks. The patient describes droopiness of the left eye and double vision associated with specific directional movements of the eye. On exam, you note ptosis of the left eye with findings as indicated in the photograph below (inability to adduct, ability to abduct). The left pupil is dilated at 5mm and minimally reactive to light; the right pupil is 3mm and reactive. The remaining cranial nerve testing and components of the neurological exam are normal.
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EM@3AM: Basilar Artery Occlusion
A 68-year-old male with a past medical history of hypertension, diabetes mellitus, and CAD with a drug eluting stent placed 2 months ago presents with dizziness and vomiting that began 3 hours ago. He has been having “issues with [his] eyes” today and “not feeling quite right.” Vital signs include BP 165/83, HR 81, RR 18, SpO2 96%. On exam, you notice he has dysarthric speech, limb ataxia, and vertical gaze palsy, which he reports is new. You perform a NIHSS which scores a 3 for mild dysarthria and ataxia in two limbs.
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Subarachnoid hemorrhage: ED presentation, evaluation, and management
This post looks at subarachnoid hemorrhage, including evaluation and management.
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52 in 52 – #38: Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke
Welcome back to the “52 in 52” series. This week we cover the EXTEND trial looking at thrombolysis up to 9 hours after stroke onset.
EM@3AM: Cerebellar Stroke
A 53-year-old female with a history of hypertension presents to the ED with headache and dizziness. Her symptoms have been constant over the last two weeks. Triage vital signs (VS) include BP 163/89, HR 78, T 98.4, RR 14, SpO2 98% on room air. On exam, no nystagmus is noted. Her extraocular movements and cranial nerves II-XII are intact, strength of all four extremities is 5/5 without any focal weakness, and there are no appreciable sensory deficits. There is, however, dysmetria of the right upper extremity. What should you consider?
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