scholarly journals Differentiating stroke, transient ischemic attack, or hemiplegic migraine in a teenager: a case report

2021 ◽  
Vol 15 (2) ◽  
pp. 1-5
Author(s):  
Monika Ciechanowska ◽  
Jan Stachurski
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Transient Ischemic Attack ◽  
Pediatric Population ◽  
Young Patients ◽  
Diagnostic Process ◽  
First Episode ◽  
Hemiplegic Migraine ◽  
Ischemic Attack ◽  
The Right

Background: The symptoms of stroke in the pediatric population are less evaluated than in adults. Although certain indicators are characteristic of stroke – acute drooping of the mouth corners, hemiparesis, and headache – they are not pathognomonic. Other diseases may manifest with similar symptoms, such as the first episode of hemiplegic migraine, and should be differentiated from stroke at an emergency department. Aim of the study: We present the differential diagnosis between stroke, transient ischemic attack, and first episode of hemiplegic migraine in a teenager with alarming focal symptoms. Case report: We present a case of 15-year-old patient with acute headache, drooping of the right mouth corners, and hemiparesis of the right upper and lower limb. He was brought by ambulance to the emergency department under suspicion of a stroke. A series of diagnostic tests performed at the Emergency Department did not reveal any vascular incident. Further diagnosis was performed at the Neurology Department. The patient was discharged from the hospital with a suspicion of first attack of hemiplegic migraine or transient ischemic attack. Conclusions: Differentiating stroke from other conditions in young patients is a significant challenge. The stroke diagnostic process in children requires further research to support accurate diagnosis and, if necessary, treatment as rapidly as possible.

scholarly journals Ipsilateral Ophthalmic Artery Stenosis in Amaurosis Fugax: A Case Report

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Referano Agustiawan ◽  
Ferdy Iskandar ◽  
Muhammad Ikhsan Mokoagow ◽  
Kanisius Kanovnegara ◽  
Firman Hendrik
Keyword(s):  
Case Report ◽  
Ophthalmic Artery ◽  
Retinal Ischemia ◽  
Artery Stenosis ◽  
First Episode ◽  
Amaurosis Fugax ◽  
Transient Visual Loss ◽  
Ischemic Attack ◽  
The Right ◽  
Untreated Hypertension

Introduction: Amaurosis fugax is caused by an abrupt reduction of blood flow to the retina. Determining the etiology of amaurosis fugax should ensure proper management. Case Report: A 47-year-old female patient who had the first episode of amaurosis fugax in her right eye was referred to our hospital. The amaurosis fugax resolved spontaneously, however, we found a 3 mm long stenosis at her right ophthalmic artery during magnetic resonance angiography. She had clinical histories of untreated hypertension and dyslipidemia. Transient ischemic attack (TIA) was suspected and unfractionated heparin, aspirin, antihypertensive agent, and statin were given. Treatments were maintained, the symptoms had not recurred in the following 6 months after the event. Discussion: Stenosis of the ophthalmic artery is very rare. It occurs in approximately 2% of patient suffering from amaurosis fugax. In our case, stenosis of the right ophthalmic artery due to thromboembolism might cause retinal ischemia leading to a transient visual loss. Conclusion: This case suggests stenosis of ophthalmic artery as the cause of amaurosis fugax. Keywords: amaurosis fugax, ipsilateral, ophthalmic artery, stenosis

scholarly journals Complete Superior and Inferior Sagittal Sinus Thromboses With Multiple Cranial Nerve Pareses and Transient Ischemic Attack. Case Report.

2002 ◽  
Vol 42 (9) ◽  
pp. 383-386 ◽  
Author(s):  
Cahide TOPSAKAL ◽  
Mutlu CIHANGIROGLU ◽  
Metin KAPLAN ◽  
Ismail AKDEMIR ◽  
Murat TIFTIKCI
Keyword(s):  
Case Report ◽  
Transient Ischemic Attack ◽  
Cranial Nerve ◽  
Sagittal Sinus ◽  
Ischemic Attack ◽  
Multiple Cranial Nerve

scholarly journals Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

2018 ◽  
Vol 13 (9) ◽  
pp. 949-984 ◽  
Author(s):  
JM Boulanger ◽  
MP Lindsay ◽  
G Gubitz ◽  
EE Smith ◽  
G Stotts ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Best Practice ◽  
Stroke Care ◽  
Stroke Management ◽  
Practice Recommendations ◽  
Prehospital Emergency ◽  
Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

scholarly journals Aurea diagnosis of pneumomediastinum. A case report

2020 ◽  
Vol 14 (3) ◽  
pp. 179-183
Author(s):  
Lucio Brugioni ◽  
Francesca De Niederhausern ◽  
Chiara Gozzi ◽  
Pietro Martella ◽  
Elisa Romagnoli ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Chest Pain ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Diagnostic Process ◽  
Acute Aortic Syndrome ◽  
X Ray ◽  
Chest X Ray

Pericarditis and spontaneous pneumomediastinum are among the pathologies that are in differential diagnoses when a patient describes dorsal irradiated chest pain: if the patient is young, male, and long-limbed, it is necessary to exclude an acute aortic syndrome firstly. We present the case of a young man who arrived at the Emergency Department for chest pain: an echocardiogram performed an immediate diagnosis of pericarditis. However, if the patient had performed a chest X-ray, this would have enabled the observation of pneumomediastinum, allowing a correct diagnosis of pneumomediastinum and treatment. The purpose of this report is to highlight the importance of the diagnostic process.

scholarly journals Systolic blood pressure as a predictor of transient ischemic attack/minor stroke in emergency department patients under age 80: a prospective cohort study

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrew M. Penn ◽  
Nicole S. Croteau ◽  
Kristine Votova ◽  
Colin Sedgwick ◽  
Robert F. Balshaw ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Transient Ischemic Attack ◽  
Final Diagnosis ◽  
Conditional Inference ◽  
Minor Stroke ◽  
Logistic Regression Models ◽  
Stroke Mimics ◽  
Stroke Mimic ◽  
Ischemic Attack

Abstract Background Elevated blood pressure (BP) at emergency department (ED) presentation and advancing age have been associated with risk of ischemic stroke; however, the relationship between BP, age, and transient ischemic attack/minor stroke (TIA/MS) is not clear. Methods A multi-site, prospective, observational study of 1084 ED patients screened for suspected TIA/MS (symptom onset < 24 h, NIHSS< 4) between December 2013 and April 2016. Systolic and diastolic BP measurements (SBP, DBP) were taken at ED presentation. Final diagnosis was consensus adjudication by stroke neurologists; patients were diagnosed as either TIA/MS or stroke-mimic (non-cerebrovascular conditions). Conditional inference trees were used to define age cut-points for predicting binary diagnosis (TIA/MS or stroke-mimic). Logistic regression models were used to estimate the effect of BP, age, sex, and the age-BP interaction on predicting TIA/MS diagnosis. Results Over a 28-month period, 768 (71%) patients were diagnosed with TIA/MS: these patients were older (mean 71.6 years) and more likely to be male (58%) than stroke-mimics (61.4 years, 41%; each p < 0.001). TIA/MS patients had higher SBP than stroke-mimics (p < 0.001). DBP did not differ between the two groups (p = 0.191). SBP was predictive of TIA/MS diagnosis in younger patients, after accounting for age and sex; an increase of 10 mmHg systolic increased the odds of TIA/MS 18% (odds ratio [OR] 1.18, 95% CI 1.00–1.39) in patients < 60 years, and 23% (OR 1.23, 95% CI 11.12–1.35) in those 60–79 years, while not affecting the odds of TIA/MS in patients ≥80 years (OR 0.99, 95% CI 0.89–1.07). Conclusions Raised SBP in patients younger than 80 with suspected TIA/MS may be a useful clinical indicator upon initial presentation to help increase clinicians’ suspicion of TIA/MS. Trial registration ClinicalTrials.gov NCT03050099 (10-Feb-2017) and NCT03070067 (3-Mar-2017). Retrospectively registered.

scholarly journals Compliance With Imaging Guidelines for Workup of Transient Ischemic Attack

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2563-2567
Author(s):  
Vincent M. Timpone ◽  
Alexandria Jensen ◽  
Sharon N. Poisson ◽  
Premal S. Trivedi
Keyword(s):  
Emergency Department ◽  
Trend Analysis ◽  
Transient Ischemic Attack ◽  
Emergency Departments ◽  
Odds Ratio ◽  
International Classification Of Diseases ◽  
Multivariable Logistic Regression Analysis ◽  
Primary Analysis ◽  
Ischemic Attack ◽  
Neurovascular Imaging

Background and Purpose: Multiple societal guidelines recommend urgent brain and neurovascular imaging in patients with transient ischemic attack (TIA) to identify and treat risk factors that may lead to future stroke. The purpose of this study was to evaluate whether national imaging utilization for workup of TIA complies with society guidelines. Methods: Analysis utilized the Nationwide Emergency Department Sample. Primary analysis was performed on a 2017 cohort, and secondary trend analysis was performed on cohorts from 2006 to2017. Patients diagnosed and discharged from emergency departments with TIA were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. Demographics, health insurance, patient income, and hospital-type covariates were analyzed using a hierarchical multivariable logistic regression analysis to identify predictors of obtaining neurovascular imaging during an emergency department encounter. Results: In 2017, there were 167 999 patients evaluated and discharged from emergency departments with TIA. The percentage of patients receiving brain and neurovascular imaging was 78.5% and 43.2%, respectively. The most common imaging workup utilized was a solitary computed tomography–brain without any neurovascular imaging (30.9% of encounters). Decreased odds of obtaining neurovascular imaging was observed in Medicaid patients (odds ratio, 0.65 [95% CI, 0.58–0.74]), rural hospitals (odds ratio, 0.26 [95% CI, 0.17–0.41]), nontrauma centers (odds ratio, 0.40 [95% CI, 0.21–0.74]), and weekend encounters (odds ratio, 0.91 [95% CI, 0.85–0.96]). Trend analysis demonstrated a steady rise in brain and neurovascular imaging in 2006 from 34.9% and 6.8% of encounters, respectively, to 78.5% and 43.2% of encounters in 2017. Conclusions: Compliance with imaging guidelines is improving; however, the majority of TIA patients discharged from the emergency department do not receive recommended neurovascular imaging during their encounter. Follow-up studies are needed to determine whether delayed or incomplete vascular screening increases the risk of future stroke.

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