Emergency medicine clinics of North America
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This article reviews the various imaging modalities available for the evaluation of patients presenting with a potential stroke syndrome, specifically acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. It reviews the various computed tomography (CT) modalities, including noncontrast brain CT (NCCT), CT angiography, and CT perfusion. It discusses multimodal magnetic resonance imaging in the evaluation of patients with acute stroke, including diffusion-weighted imaging, T2-weighted sequences/fluid-attenuated inversion recovery, magnetic resonance angiography, perfusion-weighted imaging, and gradient-recalled echo. At the end of this article, a brief review on how to read an NCCT geared toward the emergency physician is included.
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Stroke is rare in children but leads to significant morbidity and mortality. Emergency department physicians are likely to be the first to evaluate children suffering strokes and it is, therefore, important for them to recognize common presenting features and risk factors for pediatric stroke. This review describes the epidemiology, clinical presentations, stroke types, associated risk factors, evaluation, treatment, and prognosis of pediatric stroke. Further research is needed on the acute and preventative treatments of pediatric stroke because merely applying our knowledge of stroke in adults to children is insufficient.
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Intracranial hemorrhage refers to any bleeding within the intracranial vault, including the brain parenchyma and surrounding meningeal spaces. This article focuses on the acute diagnosis and management of primary nontraumatic intracerebral hemorrhage and subarachnoid hemorrhage in the emergency department.
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Stroke mimics are an important consideration for emergency physicians and physician extenders working in emergency departments. The emergency medicine physician must determine whether the acute neurologic deficits represent a transient event or a potential stroke. This article describes the common stroke mimic presentations by cause, including toxic-metabolic pathologies, seizure disorders, degenerative neurologic conditions, and peripheral neuropathies.
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Emerg. Med. Clin. North Am. · Aug 2012
ReviewRecognition and initial management of acute ischemic stroke.
This article addresses the recognition and management of acute ischemic stroke. It includes a discussion of cerebrovascular anatomy, common ischemic stroke syndromes, and central venous thrombosis. Extensive attention is paid to the initial emergency department management of stroke, addressing medical and systems issues, and treatment of ischemic stroke by thrombolysis.