Archive for category: Neurology

Sensitivity of Early Brain CT to Exclude Aneurysmal Subarachnoid Hemorrhage

11 Feb
February 11, 2016

Background: Headache accounts for approximately 2% of all ED visits. One of the most serious etiologies of headache is aneurysmal subarachnoid hemorrhage (SAH), which accounts for 4 – 12% of ED patients with thunderclap headache. There have been several studies in the past few years suggesting that in neurologically intact patients, the sensitivity of modern […]

Xanthochromia Detection: Visual Inspection vs. Spectrophotometry

25 Jan
January 25, 2016

Background: Although non-contrast head CT (NCHCT) has near perfect sensitivity (98-100%) in detecting aneurysmal subarachnoid hemorrhage (SAH) when performed within 6 hours of headache onset, sensitivity declines after 6 hours. As a result of declining sensitivity, lumbar puncture (LP) continues to be part of the workup in suspected SAH. An LP gives providers the ability […]

Clinical Decision Instruments in Minor Head Trauma – New Orleans + Canadian Decision Instruments

18 Jan
January 18, 2016

Background: CT scans are frequently done after minor head injury to evaluate for intracranial hemorrhage. While CT scans are an excellent tool for diagnosing or ruling out this disorder, they are not without harms including radiation exposure, cost and department delays. Much of the time, CTs are negative, or find injuries for which no intervention […]

Does a Normal Head CT Within 6 Hours of Onset of Headache Rule Out SAH?

07 Jan
January 7, 2016

Background: The traditional standard workup for ruling out subarachnoid hemorrhage (SAH) has been a non-contrast head CT and, if negative, a lumbar puncture. The thought behind this is that the sensitivity of head CT to rule out SAH is not 100% and declines over time and missing a SAH is potentially devastating. There has been […]

Ischemic Stroke Treatment Archive

09 Nov
November 9, 2015

I recently returned from the American College of Emergency Physicians (ACEP) Conference which took place from Oct. 26th – 29th, 2015 in Boston, MA.  There were really a lot of amazing talks by so many amazing speakers but one lecture in particular by David Newman, of SMART EM and The NNT fame, made me realize […]

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