1/25. 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) |
2/25. stroke--a medical emergency.Acute ischaemic stroke as an urgent-to-treat condition has gained a more prominent role in the consciousness of emergency physicians and neurologists over the past decade. This is mainly due to an increasing insight into the pathophysiological mechanism of ischaemia, the definition of therapeutical goals, such as reperfusion or neuroprotection, and the recent application of respective treatment strategies in large multicentre studies. This review article will focus on the emergency assessment of stroke patients, on general treatment strategies, and particularly on specific measures of intensive care therapy of stroke including thrombolysis, decompressive surgery, hypothermia and treatment of brain oedema.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/25. Cerebrovascular events associated with infusion through arterially malpositioned triple-lumen catheter: report of three cases and review of literature.Analysis of 10 adult patients treated from January 1998 to November 2004 for arterial misplacement of triple-lumen catheter (TLC) during internal jugular vein cannulation was performed. Three cases that developed neurologic symptoms occurring in the context of infusion through a TLC that was arterially malpositioned are presented, along with the review of literature. In 7 patients, the diagnosis of arterial misplacement was suspected by the color or flow characteristics of blood and confirmed by a combination of blood gas analysis, connecting catheter to transducer, and/or chest film. In the remaining 3 patients, intraarterial misplacement was not suspected. In these patients, the initial review of chest films by qualified physicians prior to starting infusion failed to detect malposition of the catheter. Retrospectively, subtle clues suggestive of arterially placed TLCs were found. All 3 patients developed neurologic symptoms. Initiation of neurologic workup delayed a correct diagnosis by 6 to >48 hours. A volumetric pump was used for infusion in all patients. Of the 3 patients with neurologic symptoms, 1 recovered completely, 1 became comatose, and 1 partially improved.Based on our observations and review of literature, we conclude that cursory examination of chest films to verify proper positioning of central venous catheter attempted through the internal jugular vein may fail to detect arterial malposition. Infusion by volumetric pump precludes backflow of blood in the intravenous tubing as an indicator. Neurologic symptoms concurrent with the infusion of fluids and medication should raise suspicion of accidental arterial infusion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/25. Ethical issues in the management of cerebrovascular disease.Medical ethics, as a scholarly and applied discipline, is concerned with the morality of behavior in medical matters. The field of cerebrovascular disease is a worthy paradigm of medical ethical issue. Victims, whether they be patients or their families, are vulnerable, and the ethical virtues of kindness, understanding, compassion, mercy, and justice are badly needed. A variety of hypothetical ethical scenarios faced by the physician are discussed in this article in addition to four actual patient studies with commentary.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/25. stroke following oral trauma in children.stroke after oral trauma in children is a rare but catastrophic event. We describe two cases of stroke in children after each child fell with a writing instrument in the mouth. Both children had a latent period prior to the onset of neurologic symptoms. Ischemic infarction in the distribution of the middle cerebral artery was present in both cases. Both children were left with permanent hemiparesis. The case reports are reviewed and diagnosis and therapy are discussed. Emergency physicians should be aware of the risk of neurologic complications following apparently asymptomatic oral trauma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/25. Silent stroke associated with minor podiatric surgery.life-threatening intraoperative complications during minor podiatric surgery are rare. This paper presents a case of a "silent stroke," which occurred during total matrixectomies of hallux nails. The podiatric physician must be aware of the risk factors involved in each case and must be prepared to treat any complications that may arise.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/25. plasma concentrations of complement-activation complexes correlate with disease activity in patients diagnosed with isolated central nervous system vasculitis.Isolated central nervous system (CNS) vasculitis is rare medium- sized vessel disease limited to intracerebral vessels. The two most common symptoms of this inflammatory disorder observed at entry to a hospital are headaches and mild memory deficits. Further progression of this disease may result in focal neurologic alterations and seizures. Currently, the most common laboratory abnormality noted is an elevated erythrocyte sedimentation rate. The complement (C) system is known to play a role in many inflammatory processes; it may also be involved in CNS vasculitis. In this longitudinal study of patients with CNS vasculitis, we detected C activation by highly sensitive and specific assays that are capable of identifying breakdown products formed after C activation: C3a des arg, C4a des arg, C5a des arg, C1rC1s-C1-inhibitor complex, and terminal C complex (C5b-9). We present two cases of documented CNS vasculitis in which serial measurements of these C-activation products correlate with disease activity. Our results indicate that a temporal association exists between C activation and the clinical presentation of CNS vasculitis. We conclude that physicians should monitor C-activation by-products in plasma when they attempt to follow the clinical course of CNS vasculitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/25. 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) |
9/25. Trigeminal trophic syndrome.Trigeminal trophic syndrome is an unusual condition also known as trigeminal neurotrophic ulceration or trigeminal neuropathy with nasal ulceration. The diagnosis is suggested when ulceration of the face, especially of the ala nasi, occurs in a dermatome of the trigeminal nerve that has been rendered anesthetic by a surgical or other process involving the trigeminal nerve or its central sensory connections. A history of paresthesias and self-induced trauma to the area further support the diagnosis. Neurological deficits causing trigeminal trophic syndrome may result from surgical trigeminal ablation, vascular disorders and infarction of the brainstem, acoustic neuroma, postencephalitic parkinsonism, and syringobulbia. The following etiologies of nasal ulceration should be excluded: postsurgical herpetic reactivation and ulceration, syphilis, leishmaniasis, leprous trigeminal neuritis, yaws, blastomycosis, paracoccidioidomycosis, lethal midline granuloma, pyoderma gangrenosum, Wegener's granulomatosis, and basal cell carcinoma. In the case reported here, the diagnosis of TTS was made primarily as a result of previous experience with the syndrome, underscoring the importance of physician recognition of this unusual disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/25. Electronic stethoscope for detection of cerebral aneurysm, vasospasm and arterial disease.A specially designed acoustic stethoscope electronic-computer-analysis system has repeatedly detected and identified angiographically demonstrated anteriorly located intracranial aneurysms by their characteristic signals. The system has detected and measured clinically significant disease in the carotid siphon and bifurcation, even in cases with normal angiograms, and has recorded the onset and disappearance of cerebral vasospasm. Our data suggests that an aneurysm may act as a flexible Helmholtz resonator, possibly being driven by vortex shed or turbulence. Our goal is the development of a safe, non-invasive method by which the physician could investigate warning symptoms of aneurysms, cerebral vasospasm, and arterial disease in order to recommend preventive surgery or medical treatment early before the patient's condition might deteriorate. Individual cases, falsely positive and negative results are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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