913: INADVERTENT INTRATHECAL CEFEPIME ADMINISTRATION: A NEUROLOGIC EMERGENCY

Intracerebral hemorrhage can be classified as either secondary (due to trauma, vascular malformations, aneurysms, tumors, or hemorrhagic transformation of ischemic stroke) or primary (without a clear secondary cause). Intracerebral hemorrhage is a neurologic emergency, and leads to significant death and disability each year; care should be expedited and emergency departments should be equipped to appropriately care for and manage these patients. This review covers the risk factors, natural history, pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for patients with intracerebral hemorrhage. Figures show head computed tomographic scans demonstrating a left basal ganglia intracerebral hemorrhage, and an algorithm of management of intracerebral hemorrhage in the emergency department. Tables list some common causes of intracerebral hemorrhage, Boston criteria for diagnosis of cerebral amyloid angiopathy, mechanism of action of common anticoagulants, and suggested reversal agents. This review contains 2 highly rendered figures, 4 tables, and 79 references.

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Incidence, Presentation, and Outcome of Spinal Cord Disease in Children With Systemic Cancer

PEDIATRICS ◽

10.1542/peds.78.3.438 ◽

1986 ◽

Vol 78 (3) ◽

pp. 438-443

Author(s):

Donald W. Lewis ◽

Roger J. Packer ◽

Beverly Raney ◽

Ihor W. Rak ◽

Jean Belasco ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Delayed Diagnosis ◽

Cord Compression ◽

High Dose ◽

Spinal Cord Disease ◽

Satisfactory Outcome ◽

First Relapse ◽

Age Range ◽

Neurologic Emergency

During a 40-month period, in 24 of 643 (4%) newly diagnosed patients with systemic cancer younger than 18 years of age (range: 3 months to 17 years) spinal cord disease developed. Patients with spinal cord disease included 21 children with metastatic spinal cord compression, two with treatment-related transverse myelopathies, and one with an anterior spinal artery stroke. Spinal cord disease occurred in 13 of 102 children (12%) with sarcomas, six of 82 (7%) with neuroblastomas, and four of 94 (4%) with lymphomas. Spinal cord compression occurred as the presenting sign of malignancy in six children (four with sarcomas and two with lymphomas). In the remaining 15 patients, cord compression occurred a median of 13 months after initial diagnosis, and in four patients it occurred at the time of first relapse. Symptoms of metastatic cord compression included back pain in 17 patients (80%), weakness in 14 (67%), sphincter dysfunction in 12 (57%), and sensory abnormalities in three (14%). Findings on plain radiographs of the spine were abnormal in only seven of 20 patients with cord compression, and myelography was needed to differentiate compression from other causes of spinal cord disease. Treatment included high-dose corticosteroids followed by operation (seven patients) or radiotherapy (14 patients). After treatment, nine of 15 nonambulatory patients became ambulatory, and five of 10 incontinent patients regained sphincter control. None of the patients with nonmetastatic spinal cord disease had a satisfactory outcome. Incorrect and delayed diagnosis was frequent in children with spinal cord disease (median time from onset of symptoms to diagnosis, 2 weeks) and 12 children were paraplegic and ten had loss of sphincter control at diagnosis. Spinal cord disease is a relatively common neurologic emergency in children with cancer, especially in those with sarcoma, and requires immediate investigation and intervention.

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Intraparenchymal Cerebral Hemorrhage

10.1093/med/9780197512166.003.0052 ◽

2021 ◽

pp. 422-428

Author(s):

Maria I. Aguilar

Keyword(s):

General Population ◽

Arteriovenous Malformation ◽

Cerebral Aneurysm ◽

Cerebral Hemorrhage ◽

Brain Parenchyma ◽

Severe Morbidity ◽

The Us ◽

Neurologic Emergency ◽

The Brain

Intraparenchymal cerebral hemorrhage (ICH) is the presence of blood in the brain parenchyma. It is a neurologic emergency and may carry severe morbidity and death. This chapter focuses mainly on spontaneous, nontraumatic ICH (ie, hemorrhage not related to trauma, arteriovenous malformation, cerebral aneurysm, or tumor). ICH accounts for 15% to 20% of all new strokes annually. Among the US general population, the incidence is 15 cases per 100,000 person-years.

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The Presenting Neurologic Emergency

The Practice of Emergency and Critical Care Neurology ◽

10.1093/med/9780190259556.003.0001 ◽

2016 ◽

pp. 3-8

Author(s):

Eelco F. M. Wijdicks

Keyword(s):

Neurologic Emergency

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Improving stroke alert response time: Applying quality improvement methodology to the inpatient neurologic emergency

Journal of Hospital Medicine ◽

10.1002/jhm.984 ◽

2011 ◽

Vol 7 (2) ◽

pp. 137-141 ◽

Cited By ~ 13

Author(s):

Ethan Cumbler ◽

Rebekah Zaemisch ◽

Alexandra Graves ◽

Kerry Brega ◽

William Jones

Keyword(s):

Quality Improvement ◽

Response Time ◽

Neurologic Emergency

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723: Thoracic Spinal Lesions: A Rare Cause of Pediatric Neurologic Emergency in Marfan Syndrome

Critical Care Medicine ◽

10.1097/01.ccm.0000728780.55635.56 ◽

2020 ◽

Vol 49 (1) ◽

pp. 357-357

Author(s):

Jack Green ◽

Tiffany Perry

Keyword(s):

Marfan Syndrome ◽

Spinal Lesions ◽

Thoracic Spinal ◽

Neurologic Emergency

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Novel Approach to Neurologic Emergency Research Yields Results

Annals of Neurology ◽

10.1002/ana.23751 ◽

2012 ◽

Vol 72 (4) ◽

pp. A8-A10

Author(s):

Andrew Schwartz

Keyword(s):

Emergency Research ◽

Novel Approach ◽

Neurologic Emergency

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Standard operating procedures improve acute neurologic care in a sub-Saharan African setting

Neurology ◽

10.1212/wnl.0000000000004080 ◽

2017 ◽

Vol 89 (2) ◽

pp. 144-152 ◽

Cited By ~ 4

Author(s):

Lamin E.S. Jaiteh ◽

Stefan A. Helwig ◽

Abubacarr Jagne ◽

Andreas Ragoschke-Schumm ◽

Catherine Sarr ◽

...

Keyword(s):

Emergency Management ◽

Low Cost ◽

Intervention Group ◽

Vital Signs ◽

Standard Operating Procedures ◽

Sub Saharan Africa ◽

Standard Operating ◽

Sub Saharan ◽

Neurologic Emergency

Objective:Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs).Methods:Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, performance of key procedures was assessed at baseline and in the first and second implementation years.Results:At Banjul, 100 patients of the first-year intervention group exhibited higher rates of general procedures of emergency management than 105 control patients, such as neurologic examination (99.0% vs 91.4%; p < 0.05) and assessments of respiratory rate (98.0% vs 81.9%, p < 0.001), temperature (60.0% vs 36.2%; p < 0.001), and glucose levels (73.0% vs 58.1%; p < 0.05), in addition to written directives by physicians (96.0% vs 88.6%, p < 0.05), whereas assessments of other vital signs remained unchanged. In stroke patients, rates of stroke-related procedures increased: early CT scanning (24.3% vs 9.9%; p < 0.05), blood count (73.0% vs 49.3%; p < 0.01), renal and liver function tests (50.0% vs 5.6%, p < 0.001), aspirin prophylaxis (47.3% vs 9.9%; p < 0.001), and physiotherapy (41.9% vs 4.2%; p < 0.001). Most effects persisted until the second-year evaluation. SOP implementation was similarly feasible and beneficial at the Brikama hospital. However, outcomes did not significantly differ in the hospitals.Conclusions:Implementing SOPs is a realistic, low-cost option for improving process quality of neurologic emergency management in under-resourced settings.Classification of evidence:This study provides Class IV evidence that, for patients with suspected neurologic emergencies in sub-Saharan Africa, neurologic SOPs increase the rate of performance of guideline-recommended procedures.

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