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FOAMED

Stroke Mimics: Pearls and Pitfalls

A stroke mimic is defined as a nonvascular disease that presents with stroke-like symptoms, often indistinguishable from an actual stroke. Why does it matter if a mimic is diagnosed as a stroke? Learn the pearls and pitfalls of stroke mimics.

practice updates

Neuro Intubation Highlights

You are working a busy shift when you receive a phone call from EMS that they are bringing in a “sick trauma patient.” As you prepare the trauma bay, the patient arrives. He is the victim of an assault and in clear need of intubation. He is unconscious with a GCS of 5, HR 125, BP 180/11, Sp02 88% on NRB 15 lpm, RR 22. As you prepare your medications, what are the best options for this scenario? Pre-treatment with lidocaine, fentantyl or esmolol? Is it okay to use ketamine in trauma patients in traumatic brain injury (TBI)?

clinical cases

Bounceback: An Unrelenting Headache

CC: Headache First visit HPI: 29 year old female with a prior history of headaches, presented with two days of gradual onset, atraumatic, right sided headache that is throbbing in nature. The patient reported heaviness about the eye but no visual changes or disturbances. No neck pain, fevers, chills. She described feeling slightly light-headed but no balance loss. She had a mechanical trip and fall yesterday without head trauma, and her headache had been present for a day prior to the fall. ROS: otherwise normal. PMH/PSH: headaches, depression, anxiety, asthma SH: no smoking, no etoh, no drugs Allergies: Penicillin (rash) Pertinent Exam Vitals: 98.6F, BP: 156/85 P: 101, RR: 16, O2: 98%RA Gen: A&Ox3, well-developed, well-nourished HEENT: normocephalic, atraumatic, conjunctiva wnl, EOM wnl, PERRL, normal fundoscopic exam, crisp optic discs, normal ROM neck/supple Chest: wnl Abd: wnl Musculoskeletal: wnl Neuro: CN2-12 intact, normal reflexes, normal muscle tone, normal coordination Labs: Serum HCG negative Imaging: None ordered ED Course: The patient was believed to be experiencing a migraine headache. She had no evidence of head trauma, no signs of infectious etiology, and had no clinical findings or hx for SAH. She was administered Toradol, IVF and Reglan, and discharged with instructions to follow up with neurology and possibly have an outpatient MRI. Discharge Dx: Headache [...]