1/23. Emergency department presentations of cerebrovascular disease in children.Five cases of children with cerebrovascular disease presentations to the emergency department (ED) were selected as a series to illustrate the variety of presentation of cerebrovascular disease in children. This series shows that although cerebrovascular disease in children is uncommon, it is likely that cases will occasionally present acutely to an ED. The emergency physician's role in the management of suspected acute strokes in children is that of immediate stabilization, imaging to rule out hemorrhage, other studies to rule out emergent acute disease, and timely consultation for further management. Computed tomography (CT) is useful to detect an acute hemorrhage or old ischemic lesion. magnetic resonance imaging has superior image resolution over CT, but CT may be more practical initially. magnetic resonance angiography is a useful part of the stroke workup in children.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/23. Suspected conversion disorder: foreseeable risks and avoidable errors.The authors reviewed the occurrence in their emergency department of cases of serious neurologic problems initially thought to be conversion disorders or similar psychogenic conditions. Their aim is to indicate the significance of this issue for emergency physicians (EPs) because of its contribution to the incidence of medical errors. Although there are no national statistics, the authors estimate by extrapolation that thousands of such cases probably have occurred and large numbers may still occur each year in the united states, sometimes resulting in patient injury. They have identified ways of anticipating and attempting to prevent such occurrences. Proposed interventions focus on education regarding the difficulty of diagnosis, patient-based risk factors, and physician-based attitudes and thought processes. The authors also include suggestions for systemic "safety nets" that will help to ensure quality of care, such as appropriate imaging and consultation. review of texts and journals readily accessible to EPs revealed little attention to this subject.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/23. Craniofacial trauma in children.Craniofacial trauma is relatively uncommon in children, but the potential involvement of the structures at the base of the skull and the intracranial space makes it important for physicians to understand the potential dangers presented by such injuries. This report delineates the different types of injury that can damage the upper facial skeleton and the brain of a child. The author reviews initial management and diagnosis of such injuries and examines the approach to definitive reconstructive surgery using three case studies as examples for discussion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/23. Pontine hemorrhage after frontal craniotomy. Report of a case.This report describes the complication of pontine hemorrhage in a patient who had undergone supratentorial craniotomy for treatment of a frontal intracerebral hematoma. A literature review revealed no previous cases of pontine hemorrhage in this clinical scenario. Abnormal findings on neurological examination in the early postoperative period should alert the physician to the possibility of this complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/23. Emergency department presentation of pediatric stroke.Pediatric stroke is not a common occurrence. When compared with adults, the pediatric population has a much more diverse group of risk factors, and while numerous rare congenital disorders are possible, most known etiologies are cardiac, vascular, or hematologic. The emergency department (ED) presentation of pediatric stroke does not differ greatly from that of adults, although posterior circulation ischemia is less common, and neurologic findings may be more difficult to recognize. ED treatment is also largely the same, with an attention to resuscitation and avoidance of hypoxia, hypotension, hyperthermia, and changes in blood sugar. Use of specialized agents such as aspirin and heparin should be considered in certain cases. It is important for the emergency physician to recognize acute neurologic events in pediatric patients to minimize complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/23. neurology case studies: cerebrovascular disease.Data from randomized therapeutic trials often provide little relevant evidence for therapeutic decisions physicians make daily. By illustrating the nuances of these four complex cases involving cerebrovascular disease, the authors stress the importance of more time spent by specialists at the bed-side, exploring patients' symptoms and learning their thoughts, fears, biases, and wishes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/23. phenylpropanolamine: an over-the-counter drug causing central nervous system vasculitis and intracerebral hemorrhage. Case report and review.phenylpropanolamine (PPA) is the major ingredient in more than 70 over-the-counter preparations including diet pills, nasal decongestants, and the legal "look-alike" stimulants. Structurally and functionally similar to amphetamine and ephedrine, PPA has recently been associated with several neurological manifestations including psychosis, stroke, severe headache, seizures, and intracerebral hematoma. We report a case of intracerebral hematoma and subarachnoid hemorrhage in a young woman with angiographic and biopsy-proven vasculitis of the central nervous system (CNS) induced by PPA in her diet pills. From review of the literature, we distinguish drug-induced vasculitis as a separate entity from primary CNS vasculitis, both clinically and pathologically. This report should alert physicians, in general, to this potentially fatal side effect of PPA, a commonly used over-the-counter drug. Also, neurosurgeons in particular should consider the possibility of drug-induced vasculitis when faced with cases of intracerebral or subarachnoid hemorrhage without apparent cause.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/23. Intracranial hemorrhage and cerebral angiopathic changes in a suicidal phenylpropanolamine poisoning.A 27-year-old man had an intracerebral hemorrhage and angiographic evidence of cerebral vasculitis after suicidal ingestion of 13 nasal decongestant tablets containing phenylpropanolamine (PPA). toxicology screen and gas chromatography demonstrated PPA in the urine. phenylpropanolamine is found in many over-the-counter preparations, but physicians should be aware of PPA's side effects and should be cautious about prescribing this potentially hazardous drug to suicidal patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/23. prazosin-induced first-dose phenomenon possibly associated with hemorrhagic stroke: a report of three cases.A small initial dose of prazosin ranging from 0.5 to 1 mg has been recommended to avoid the first-dose phenomenon characterized by a sudden and severe drop in blood pressure after the administration of the first dose of prazosin. However, even with an initial dose of 0.5 mg, hypotension with consciousness disturbance developed in three hypertensive patients with recent cerebral hemorrhage. We present this report to alert physicians and pharmacists about the potential risk of the first-dose phenomenon even at the recommended initial doses of prazosin in hypertensive patients who have suffered a recent stroke.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/23. Treatment of impending carotid rupture with detachable balloon embolization.Acute carotid artery rupture is frequently heralded by prodromal arterial bleeding. This warning signal provides the physician with a brief interval in which to hemodynamically stabilize a patient, electively occlude the carotid, and consequently improve the patient's chance of survival. For three years, we have employed an initial nonoperative approach to patients with impending carotid rupture. A trial of endovascular balloon occlusion followed by detachable balloon embolization of the carotid artery has been utilized. patients unable to tolerate temporary occlusion underwent a vascular bypass procedure followed by embolization. Six patients have undergone this approach, and all had permanent cessation of bleeding. None died as a result of the procedures. One patient developed permanent neurologic deficits. Balloon embolization offers improved results over elective ligation and should be considered as an alternative treatment for patients in this dire predicament.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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