Last week we looked at a case study involving a patient who awoke with stroke symptoms. In these cases there has been little to offer patients. Thrombolysis has no application here, given its 3-4 hour window. Endovascular mechanical thrombectomy has been hailed as the new treatment. Until January of 2018, trials in this area demonstrated…
Dealing with acute major vessel occlusion stroke in a peripheral hospital setting is not what it used to be. Nor should it be! This is a recent case from one of the team. This is a case of a 55 year old chef who woke up at 6am unable to speak or move the right…
How to Diagnose the Patient with Vertigo in 5 steps This week it’s all about the ‘dizzy’ patient, or that patient with vertigo. I recently spoke at EMCORE Melbourne and went through my step by step approach of sorting, in my mind at least, the potential causes of the ‘dizzy’ patient. Below is a summary…
I don’t know about you, but I’ve always wanted to be able to perform a neurological exam and pick the lesion and look good doing it. Over the years I’ve tried to get better at it. What I have put together is a series of ‘PEARLS’ that sometimes help me decipher the cryptic world of…
Temporal Arteritis also known as Giant Cell Arteritis, affects the medium and large arteries and is a vasculopathy. The greatest risk, if not treated, is irreversible loss of vision. It is a medical emergency. CASE A 79 year old woman has been sent in by her GP, complaining of unbearable, intractable headache for the past…
Convulsive Status Epilepticus accounts for up to 75% of all status epilepticus(1). We recognise it in patients where they have a depressed conscious state accompanied by tonic clonic movements of the extremities. The length of status epilepticus is important in terms of patient survival. About 5% of adults and up to 25% of children with epilepsy…
Patients can present to us with a sudden severe headache, also known as a thunderclap headache. Although there are several potential causes of sudden headache(shown below), the main aetiology we try to exclude in the emergency department, is aneurysmal rupture. When we do rule this out, we still need to consider the other possible causes…
You’ve just seen a patient with sudden onset of headache. They have presented within 6 hours and your super-sliced scanner spits out a normal CT brain. Are you done? You apply shared decision making with your patient and decide against a lumbar puncture. Are you done? Beware the mimics; amongst them cerebral venous thrombosis and…
Introduction A 38 year old woman presents to the emergency department, with sudden onset severe headache, which she describes as being “hit on the head with a shovel’. She is not a headache sufferer and has no other past medical history. Her conscious state is normal and the headache has subsided. We suspect a sentinel…
Introduction Two days after speaking at the EMCORE Conference on blood pressure control in intra-cerebral bleeds the ATACH-2 trial (Antihypertensive Treatment of Acute Cerebral Haemorrhage II) has been published. We know that intra-cerebral bleeds are dynamic, with up to 40% of patients having growth in haemorrhage volume, in the first 3 hours(Stroke 1997:28:1-5). We also…
How to Control Blood Pressure in Intracranial Haemorrhage The scenario is this: A 62 year old male is brought in to your emergency department by ambulance. He has had a sudden onset of headache and has decreased use of left side. His vitals are: GCS 14, HR 92, BP 210/100, Sats 95% on room air. A CT…
Here I am, in front of a 43 year old female patient who tells me that she had a sudden headache 4 hours ago. It’s like someone hit her on the back of the head. She is not distraught, nor upset, but texting hurriedly on her smartphone. The headache occurred whilst she was at her…
