Archive for category: Neurology

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. ┬áThere 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 […]

tPA-associated Angioedema

03 Apr
April 3, 2014

For the most part, the biggest concern with administering tPA is the bleeding complications, specifically intracranial hemorrhage. But there is another side effect that is being reported more frequently. I, myself, saw two cases in one week. This side effect is tPA-associated angioedema. Case: A 70-year-old female with a past medical history of hypertension and […]