Emergency medicine clinics of North America
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Functional or psychogenic seizures have proved a diagnostic and therapeutic challenge for centuries. Functional seizures can look and feel similar to epileptic seizures but are instead a common and highly disabling form of functional neurologic disorder, or conversion disorder. ⋯ Functional seizures can be differentiated from epileptic seizures through the clinical history, features of the seizures themselves, and electroencephalography findings. Psychotherapy is effective in treating functional seizures.
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Using an algorithmic approach to acutely dizzy patients, physicians can often confidently make a specific diagnosis that leads to correct treatment and should reduce the misdiagnosis of cerebrovascular events. Emergency clinicians should try to become familiar with an approach that exploits timing and triggers as well as some basic "rules" of nystagmus. The gait should always be tested in all patients who might be discharged. Computed tomographic scans are unreliable to exclude posterior circulation stroke presenting as dizziness, and early MRI (within the first 72 hours) also misses 10% to 20% of these cases.
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Emerg. Med. Clin. North Am. · Feb 2021
ReviewDiagnosis and Initial Emergency Department Management of Subarachnoid Hemorrhage.
Atraumatic subarachnoid hemorrhage represents a small proportion of strokes, but is a true medical emergency that results in significant morbidity and mortality. Making the diagnosis can be challenging and misdiagnosis can result in devastating consequences. There are several time-dependent diagnostic and management considerations for emergency physicians and other frontline providers. This article reviews the most up-to-date literature on the diagnostic workup of subarachnoid hemorrhage, avoiding misdiagnosis, and initial emergency department management recommendations.
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Weakness has a broad differential diagnosis. A paradigm for organizing possibilities is to consider what part of the nervous system is involved, ranging from brain, spinal cord, nerve roots, and peripheral nerves to the neuromuscular junction. ⋯ It is helpful to consider whether an emergency department presentation of weakness is a new disease process or represents an exacerbation of an established condition. Emergency presentations of weakness are challenging, and one must carefully consider potential serious causes.