Neurology
Clinical Decision Making: Acute Ischemic Stroke with Large Vessel Occlusion
DOI: https://doi.org/10.5070/M5.60864By the end of this clinical decision-making case, learners will be able to: 1) demonstrate familiarity with the CDM case format and case play, 2) describe important historical information to obtain when suspecting an acute stroke, 3) outline key diagnostic tests to rule out other causes of acute neurologic deficits, 4) outline acute management strategies for acute ischemic stroke, 5) propose an appropriate disposition plan for patients with an acute ischemic stroke.
VP Shunt Malfunction Simulation Case for Emergency Medicine Residents
DOI: https://doi.org/10.5070/M5.52255The objective of this simulated case is to increase learner knowledge and develop the skills necessary to troubleshoot VP shunt malfunction. By the end of this simulation, learners should be able to: 1) review pertinent historical and physical exam points for a shunt patient, 2) recognize the signs and symptoms of VP shunt malfunction, 3) review an algorithm for diagnosing VP shunt malfunction, 4) discuss treatment for common complications of VP shunt dysfunction, and 5) recall the indications for an emergent VP shunt tap.
Computed Tomography Findings of Cerebral Venous Thrombosis: A Case Report
DOI: https://doi.org/10.5070/M5.52331The emergency physician ordered a non-contrast head CT and CT venogram of the head given worsening symptoms with disequilibrium and CVT risk factors of postpartum coagulopathy. The non-contrast head CT demonstrated a hyperdensity occlusion of the left transverse sinus (blue arrow). This serpiginous hyperdensity is called the “cord” or “string” sign, which is thrombosis within the vein. The CT venogram of the head demonstrated occlusion of the left transverse (red arrows) and sigmoid sinus (yellow arrow).
Blunt Cerebrovascular Injury: A Visual Case Report with Computed Tomography Angiography Findings Revealing Carotid and Vertebral Artery Dissection
DOI: https://doi.org/10.5070/M5.52229Computed tomography angiography of the neck showed worsening right ICA dissection with increased size of the pseudoaneurysm to 9 mm and worsening stenosis to greater than 70%. Computed tomography angiography of the neck also showed a new dissection of the V2 segment of the right vertebral artery with a 3 mm pseudoaneurysm and greater than 50% stenosis.
Escape Intern Orientation! — A Capstone and Team Building Activity for New EM Interns
DOI: https://doi.org/10.5070/M5.52158By the end of this small group exercise, learners will be able to: 1) identify first, second, and third-degree heart block on a 12-lead ECG; 2) recognize STEMI pattern on a 12-lead ECG; 3) categorize appropriate images that make up an EFAST exam for a trauma patient; 4) recall the proper management of a tension pneumothorax; 5) identify an organized approach to emergency department rapid-sequence intubation (RSI); 6) recognize acute otitis media (AOM); 7) locate the appropriate antibiotic and pediatric dose to treat acute otitis media via the Harriet Lane Handbook; 8) demonstrate how to apply evidence-based guidelines to a clinical case of neonatal pediatric fever; 9) recall common clinical findings of basilar skull fracture; 10) identify important concepts in the management of stroke syndromes; 11) recognize vital sign abnormalities that could indicate sepsis; and 12) review important concepts related to the management of septic patients.
Prioritization: Run This Board: Septic Shock, Acute Coronary Syndrome, Small Bowel Obstruction, and Penetrating Chest Trauma
DOI: https://doi.org/10.21980/J8.52355By the end of this case learners will be able to: 1) Become familiar with format of a prioritization case (a component of the ABEM Certifying Exam), 2) Practice their ability to prioritize multiple patients and provide stabilizing care, 3) Consider changes in status/patient acuity/new cases as presented, 4) Understand how to utilize team resources appropriately.
Prioritization: Intracranial Hemorrhage, Testicular Torsion, and Tricyclic Antidepressant Toxicity Presenting to a Community Emergency Department
DOI: https://doi.org/10.21980/J8.52346By the end of this case learners should: 1) Become familiar with the format of a prioritization case (a component of the ABEM Certifying Exam), 2) demonstrate their ability to prioritize multiple patients and provide stabilizing care, 3) consider changes in status/patient acuity/new cases as presented, 4) understand how to utilize team resources appropriately.
Case Report of a Patient Presenting with Nonketotic Hyperglycemia Hemichorea
DOI: https://doi.org/10.21980/J8.52115Laboratory tests indicated elevated blood glucose levels (198 mg/dL) with no urinary ketones, anion gap of 12, thyroid stimulating hormone (TSH) of 12 UIU/ml, and an increased glycated hemoglobin (HbA1c) of 14.9%. After initial stroke evaluation with neurology, imaging studies, including computed tomography (CT)/CT angiography (CTA) of the brain and neck, were unremarkable, ruling out structural lesions or acute stroke. Neurology recommended an MRI which showed T1 shortening within the left basal ganglia involving both the caudate nucleus and the lentiform nucleus. T1 shortening indicates changes in the tissue composition or structure that alters how the tissue responds to the MRI pulse, giving the tissue a brighter appearance on MRI (see white arrow).