BOOK
Neurologic Emergencies, An Issue of Emergency Medicine Clinics of North America, E-Book
Jonathan A. Edlow | Michael K. Abraham
(2016)
Additional Information
Book Details
Abstract
This issue of Emergency Medicine Clinics focuses on Neurologic Emergencies. Articles include: Headache; Back Pain; Dizziness; Generalized Weakness; Initial Diagnosis and Management of Coma; Neuro-ophthalmology; Diagnosis of Acute Ischemic Stroke; Treatment of Acute Ischemic Stroke; Acute Hemorrhagic Stroke; Status Epilepticus; Diagnosis and Emergency Management of Subarachnoid Hemorrhage and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Neurologic Emergencies | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Neurologic Emergencies\r | vii | ||
| Preface: Neurologic Emergencies—Making the Diagnosis and Treating the Life Threats\r | vii | ||
| Headache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes\r | vii | ||
| A New Approach to the Diagnosis of Acute Dizziness in Adult Patients\r | vii | ||
| Acute Nontraumatic Back Pain: Risk Stratification, Emergency Department Management, and Review of Serious Pathologies\r | vii | ||
| Status Epilepticus: What’s New?\r | viii | ||
| Initial Diagnosis and Management of Coma\r | viii | ||
| Acute Generalized Weakness\r | viii | ||
| Transient Ischemic Attacks: Advances in Diagnosis and Management in the Emergency Department\r | viii | ||
| Diagnosis of Acute Ischemic Stoke\r | viii | ||
| Treatment of Acute Ischemic Stroke\r | ix | ||
| Diagnosis and Management of Acute Intracerebral Hemorrhage\r | ix | ||
| Subarachnoid Hemorrhage\r | ix | ||
| Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department\r | ix | ||
| Diagnosis of Acute Neurologic Emergencies in Pregnant and Postpartum Women\r | x | ||
| Neuro-Ophthalmology in Emergency Medicine\r | x | ||
| EMERGENCY MEDICINE\rCLINICS OF NORTH AMERICA\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| February 2017 | xi | ||
| May 2017 | xi | ||
| August 2017 | xi | ||
| RECENT ISSUES | xi | ||
| August 2016 | xi | ||
| May 2016 | xi | ||
| February 2016 | xi | ||
| CME Accreditation Page | xiii | ||
| PROGRAM OBJECTIVE | xiii | ||
| LEARNING OBJECTIVES | xiii | ||
| ACCREDITATION | xiii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | xiii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | xiii | ||
| TO ENROLL | xiv | ||
| METHOD OF PARTICIPATION | xiv | ||
| CME INQUIRIES/SPECIAL NEEDS | xiv | ||
| Foreword:\rNeurologic Emergencies | xv | ||
| Preface:\rNeurologic Emergencies—Making the Diagnosis and Treating the Life Threats | xvii | ||
| Headache in the Emergency Department | 695 | ||
| Key points | 695 | ||
| NATURE OF THE PROBLEM/DEFINITION | 695 | ||
| GENERAL APPROACH TO THE PATIENT WITH HEADACHE | 696 | ||
| HIGH-RISK CLINICAL SCENARIOS | 696 | ||
| Scenario 1: Headache + Sudden/Severe Onset | 696 | ||
| Scenario 2: Headache + Focal Neurologic Deficits and Altered Mental Status | 697 | ||
| Scenario 3: Headache + Human Immunodeficiency Virus or Other Immunocompromised State | 701 | ||
| Scenario 4: Headache + Advanced Age | 702 | ||
| Scenario 5: Headache + Pregnancy | 702 | ||
| Scenario 6: Headache + Coagulopathy | 702 | ||
| Scenario 7: Headache + Malignancy | 703 | ||
| Scenario 8: Headache + Fever | 703 | ||
| Scenario 9: Headache + Visual Deficits | 704 | ||
| Scenario 10: Headache + Loss of Consciousness | 705 | ||
| DANGEROUS CAUSES OF SECONDARY HEADACHE | 705 | ||
| Subarachnoid Hemorrhage | 705 | ||
| Carotid/Vertebral Artery Dissection | 705 | ||
| Giant Cell Arteritis | 706 | ||
| Cerebral Vein and Sinus Thrombosis | 707 | ||
| Idiopathic Intracranial Hypertension | 707 | ||
| Acute Angle Closure Glaucoma | 707 | ||
| Bacterial Meningitis | 708 | ||
| Preeclampsia | 708 | ||
| Pituitary Apoplexy | 708 | ||
| Carbon Monoxide Poisoning | 709 | ||
| REFERENCES | 709 | ||
| A New Approach to the Diagnosis of Acute Dizziness in Adult Patients | 717 | ||
| Key points | 717 | ||
| INTRODUCTION | 717 | ||
| DIFFERENTIAL DIAGNOSIS OF ACUTE DIZZINESS | 718 | ||
| ORIGIN OF THE SYMPTOM QUALITY APPROACH TO DIAGNOSING DIZZINESS | 721 | ||
| REASONS WHY THE SYMPTOM QUALITY APPROACH LACKS SCIENTIFIC VALIDITY | 722 | ||
| MISDIAGNOSIS OF PATIENTS WITH DIZZINESS AND RESOURCE UTILIZATION | 723 | ||
| A NEW PARADIGM TO DIAGNOSE PATIENTS WITH ACUTE DIZZINESS – ATTEST | 725 | ||
| ACUTE VESTIBULAR SYNDROME | 726 | ||
| TRIGGERED EPISODIC VESTIBULAR SYNDROME | 730 | ||
| SPONTANEOUS EPISODIC VESTIBULAR SYNDROME | 733 | ||
| PUTTING IT ALL TOGETHER — AN OVERARCHING ALGORITHM | 734 | ||
| SUMMARY | 736 | ||
| REFERENCES | 736 | ||
| Acute Nontraumatic Back Pain | 743 | ||
| Key points | 743 | ||
| INTRODUCTION | 743 | ||
| Scope of the Problem | 743 | ||
| Differential Diagnosis | 744 | ||
| RISK STRATIFICATION | 744 | ||
| DIAGNOSTIC EVALUATION | 747 | ||
| Biomarkers | 747 | ||
| Imaging | 747 | ||
| MANAGEMENT OF SIMPLE BACK PAIN | 748 | ||
| DIAGNOSIS AND EMERGENCY DEPARTMENT MANAGEMENT OF HIGH-RISK PATIENTS | 748 | ||
| Diagnosis of Serious Causes | 748 | ||
| Management | 749 | ||
| REVIEW OF SERIOUS ETIOLOGIES | 750 | ||
| Spinal Epidural Abscess | 750 | ||
| Metastatic Epidural Tumor | 751 | ||
| Spinal Epidural Hematoma | 752 | ||
| Giant Disk Herniation | 753 | ||
| SUMMARY | 754 | ||
| REFERENCES | 754 | ||
| Status Epilepticus | 759 | ||
| Key points | 759 | ||
| INTRODUCTION | 759 | ||
| PATHOPHYSIOLOGY | 760 | ||
| Physiologic Changes in Generalized Convulsive Status Epilepticus | 760 | ||
| Pharmacoresistance in Prolonged Seizures | 762 | ||
| Evaluation and Management | 762 | ||
| Airway management | 762 | ||
| History | 762 | ||
| Diagnostic testing | 763 | ||
| Management | 764 | ||
| Treatment of underlying conditions | 764 | ||
| First-line Agents | 765 | ||
| Benzodiazepines | 765 | ||
| Second-line Agents | 766 | ||
| Phenytoins | 767 | ||
| Valproic acid | 768 | ||
| Intubation | 768 | ||
| Third-line Agents (Second-line Adjuncts) | 769 | ||
| Levetiracetam | 769 | ||
| Lacosamide | 770 | ||
| Phenobarbital | 770 | ||
| Ketamine | 770 | ||
| Fourth-line Treatment | 771 | ||
| Midazolam infusion | 771 | ||
| Propofol infusion | 771 | ||
| Barbiturate infusion | 772 | ||
| Adjunctive therapies | 772 | ||
| MANAGEMENT OF SUBTLE STATUS EPILEPTICUS | 772 | ||
| FAILURES IN THE MANAGEMENT OF STATUS EPILEPTICUS | 772 | ||
| COMPLICATIONS | 773 | ||
| SUMMARY | 773 | ||
| REFERENCES | 773 | ||
| Initial Diagnosis and Management of Coma | 777 | ||
| Key points | 777 | ||
| INTRODUCTION | 777 | ||
| PATHOPHYSIOLOGY | 777 | ||
| CAUSES | 778 | ||
| STRUCTURAL CAUSES OF COMA | 779 | ||
| Tumors | 779 | ||
| Acute Hydrocephalus | 779 | ||
| Intracranial Hemorrhage | 779 | ||
| Spontaneous subarachnoid hemorrhage | 779 | ||
| Subdural hemorrhage | 779 | ||
| Epidural hemorrhage | 779 | ||
| Intraparenchymal hemorrhage | 780 | ||
| Vascular Occlusion | 780 | ||
| DIFFUSE NEURONAL DYSFUNCTION CAUSES OF COMA: METABOLIC | 780 | ||
| Respiratory Insufficiency | 780 | ||
| Dysthermia | 780 | ||
| Hypertension | 780 | ||
| Dysglycemia | 780 | ||
| Electrolyte Disorders | 781 | ||
| Infection | 781 | ||
| Thyroid Disorders | 781 | ||
| Renal Failure | 781 | ||
| Hepatic Failure | 781 | ||
| Hyperammonemia | 781 | ||
| Thiamine Deficiency | 781 | ||
| Nonconvulsive Status Epilepticus | 782 | ||
| DIFFUSE NEURONAL DYSFUNCTION CAUSES OF COMA: TOXINS | 782 | ||
| Sedative-Hypnotic Agents | 782 | ||
| Opioids | 782 | ||
| Dissociative Agents | 782 | ||
| Carbon Monoxide | 782 | ||
| Serotonin Syndrome and Neuroleptic Malignant Syndrome | 782 | ||
| Miscellaneous Toxins | 783 | ||
| Coma Mimics | 783 | ||
| INITIAL STABILIZATION | 783 | ||
| HISTORY | 784 | ||
| PHYSICAL EXAMINATION | 784 | ||
| VITAL SIGNS | 784 | ||
| Pulse | 784 | ||
| Blood Pressure | 784 | ||
| Respiratory Rate | 785 | ||
| Temperature | 785 | ||
| Physical Examination | 785 | ||
| Head, eyes, ears, nose, and throat | 785 | ||
| Head | 785 | ||
| Eyes | 785 | ||
| Ears | 785 | ||
| Throat | 785 | ||
| Skin | 785 | ||
| Bowel Sounds | 786 | ||
| The Toxidrome-Oriented Physical Examination | 786 | ||
| IMAGING AND LABORATORY TESTING | 786 | ||
| GRADING SYSTEMS | 787 | ||
| TREATMENT | 788 | ||
| SUMMARY | 789 | ||
| REFERENCES | 789 | ||
| Acute Generalized Weakness | 795 | ||
| Key points | 795 | ||
| INTRODUCTION | 795 | ||
| HISTORY | 796 | ||
| Onset | 796 | ||
| Description of Weakness | 796 | ||
| Comorbidities | 796 | ||
| Family History | 796 | ||
| Medications | 797 | ||
| PHYSICAL EXAMINATION | 797 | ||
| Motor Nervous System | 797 | ||
| Elements of the Motor Examination | 799 | ||
| Bulk | 799 | ||
| Tone | 800 | ||
| Assessment of muscle strength | 800 | ||
| Stretch reflexes | 800 | ||
| EMERGENCY DEPARTMENT MANAGEMENT | 800 | ||
| GUILLAIN-BARRÉ SYNDROME | 801 | ||
| MYASTHENIA GRAVIS | 803 | ||
| BOTULISM | 804 | ||
| FAMILIAL PERIODIC PARALYSES | 804 | ||
| POLIOMYELITIS | 805 | ||
| ORGANOPHOSPHATE AND CARBAMATE POISONING | 805 | ||
| TRANSVERSE MYELITIS | 806 | ||
| TICK PARALYSIS | 806 | ||
| AMYOTROPHIC LATERAL SCLEROSIS | 807 | ||
| REFERENCES | 807 | ||
| Transient Ischemic Attacks | 811 | ||
| Key points | 811 | ||
| INTRODUCTION | 811 | ||
| DEFINITION | 812 | ||
| EPIDEMIOLOGY | 812 | ||
| ETIOLOGY AND PATHOPHYSIOLOGY | 813 | ||
| DIAGNOSIS | 814 | ||
| History | 816 | ||
| Physical Examination | 817 | ||
| Laboratory Tests | 817 | ||
| Electrocardiogram and Cardiac Monitoring | 817 | ||
| Cardiac Echocardiography | 818 | ||
| Brain Imaging | 818 | ||
| Cervical Vessel Imaging | 819 | ||
| RISK STRATIFICATION | 819 | ||
| TREATMENT | 821 | ||
| Immediate Treatment | 821 | ||
| Anticoagulant Therapy | 821 | ||
| Antiplatelet Therapy | 824 | ||
| Carotid Endarterectomy and Carotid Stenting | 824 | ||
| Treatment of Risk Factors | 824 | ||
| DISPOSITION | 828 | ||
| REFERENCES | 829 | ||
| Diagnosis of Acute Ischemic Stoke | 837 | ||
| Key points | 837 | ||
| INTRODUCTION | 837 | ||
| Community Awareness and Education | 838 | ||
| PREHOSPITAL IDENTIFICATION AND DIAGNOSIS | 839 | ||
| Prehospital Identification of Stroke | 840 | ||
| Prehospital Assessment of Stroke Severity | 841 | ||
| EMERGENCY DEPARTMENT EVALUATION | 844 | ||
| Patient History | 846 | ||
| Physical Examination | 848 | ||
| Primary assessment | 848 | ||
| Secondary assessment | 848 | ||
| Diagnostic Tests | 849 | ||
| Neuroimaging | 850 | ||
| Computed tomography | 850 | ||
| MRI | 852 | ||
| DIAGNOSIS AND DISPOSITION | 854 | ||
| REFERENCES | 855 | ||
| Treatment of Acute Ischemic Stroke | 861 | ||
| Key points | 861 | ||
| INTRODUCTION | 861 | ||
| PATIENT EVALUATION OVERVIEW | 862 | ||
| EMERGENT AND SUPPORTIVE CARE | 863 | ||
| REPERFUSION WITH INTRAVENOUS THROMBOLYSIS | 864 | ||
| THE ISSUE OF INFORMED CONSENT AND INFORMED REFUSAL | 866 | ||
| SAFETY OF TISSUE PLASMINOGEN ACTIVATOR IN STROKE MIMICS | 867 | ||
| ALTERNATIVE AND EMERGING THROMBOLYTIC AGENTS | 867 | ||
| INTERVENTIONAL STROKE TREATMENT | 868 | ||
| TREATMENT OF POSTERIOR CIRCULATION STROKE | 870 | ||
| APPROACH TO ILL-DEFINED STROKE ONSET | 871 | ||
| TREATMENT OF MINOR, ISOLATED, AND IMPROVING SYMPTOMS | 872 | ||
| NEUROPROTECTION | 872 | ||
| SONOTHROMBOLYSIS | 872 | ||
| MANAGEMENT OF HEMORRHAGIC TRANSFORMATION AND TISSUE PLASMINOGEN ACTIVATOR–RELATED BLEEDING | 873 | ||
| MANAGEMENT OF CEREBRAL EDEMA | 873 | ||
| SECONDARY PREVENTION | 873 | ||
| SUMMARY | 874 | ||
| REFERENCES | 874 | ||
| Diagnosis and Management of Acute Intracerebral Hemorrhage | 883 | ||
| Key points | 883 | ||
| INTRODUCTION AND EPIDEMIOLOGY | 883 | ||
| PATHOPHYSIOLOGY | 883 | ||
| CLINICAL PRESENTATION AND DIAGNOSIS | 884 | ||
| Clinical Assessment | 884 | ||
| Blood Tests | 884 | ||
| Neuroimaging | 885 | ||
| Noncontrast computed tomography | 885 | ||
| Computed tomography angiography | 885 | ||
| MRI | 885 | ||
| Natural History and Clinical Evolution | 886 | ||
| ACUTE MANAGEMENT | 886 | ||
| Prehospital Care | 886 | ||
| Airway Protection | 886 | ||
| Blood Pressure Management | 887 | ||
| Hemostatic Treatment | 887 | ||
| Platelet function | 887 | ||
| Warfarin-associated coagulopathy | 887 | ||
| Heparin-associated coagulopathy | 888 | ||
| Direct oral anticoagulants | 888 | ||
| Recombinant tissue plasminogen activator–associated coagulopathy | 890 | ||
| Intracranial Pressure Management | 890 | ||
| Seizures and Antiepileptic Treatment | 890 | ||
| Blood Glucose Management | 891 | ||
| Temperature Management | 891 | ||
| Surgical Treatment | 891 | ||
| Intraventricular hemorrhage management | 891 | ||
| Surgical hematoma evacuation | 891 | ||
| Decompressive craniotomy with or without hematoma evacuation | 892 | ||
| Minimally invasive surgery | 892 | ||
| ADMISSION TO STROKE UNIT OR NEUROSCIENCE INTENSIVE CARE UNIT | 892 | ||
| PROGNOSIS PREDICTION | 892 | ||
| FUTURE PERSPECTIVES | 892 | ||
| REFERENCES | 894 | ||
| Subarachnoid Hemorrhage | 901 | ||
| Key points | 901 | ||
| INTRODUCTION | 901 | ||
| Causes and Incidence | 902 | ||
| Symptoms and Clinical Presentation | 903 | ||
| Clinical Decision Rules and Differential Diagnosis | 903 | ||
| Clinical Severity Grading Scales | 904 | ||
| DIAGNOSTIC EVALUATION | 905 | ||
| Neuroimaging | 905 | ||
| Lumbar Puncture | 907 | ||
| MANAGEMENT | 908 | ||
| Pharmacologic Treatments | 908 | ||
| Antiepileptic drugs | 908 | ||
| Nimodipine | 908 | ||
| Blood pressure management | 909 | ||
| Antifibrinolytics | 909 | ||
| Nonpharmacologic Treatments | 909 | ||
| Fever management | 909 | ||
| Surgical and Endovascular Treatments | 910 | ||
| External ventricular drainage | 910 | ||
| Microsurgical clipping versus endovascular coiling | 910 | ||
| COMPLICATIONS | 910 | ||
| Rebleeding | 910 | ||
| Cerebral Edema | 910 | ||
| Vasospasm and Cerebral Ischemia | 911 | ||
| SUMMARY | 911 | ||
| REFERENCES | 911 | ||
| Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department | 917 | ||
| Key points | 917 | ||
| INTRODUCTION | 918 | ||
| MENINGITIS | 918 | ||
| Clinical Presentation | 919 | ||
| Diagnostic Workup | 921 | ||
| Treatment | 923 | ||
| Bacterial meningitis | 923 | ||
| Viral meningitis | 924 | ||
| Fungal meningitis | 924 | ||
| ENCEPHALITIS | 924 | ||
| Clinical Presentation | 925 | ||
| Diagnosis | 925 | ||
| Treatment | 929 | ||
| BRAIN ABSCESS | 930 | ||
| Clinical Presentation | 930 | ||
| Diagnosis | 930 | ||
| Treatment | 931 | ||
| SPECIAL SITUATIONS | 931 | ||
| The Febrile Neonate | 931 | ||
| The Elderly Patient | 932 | ||
| Patients with Exposure to Arthropod Vectors | 933 | ||
| Human Immunodeficiency Virus and Other Immunocompromised States | 933 | ||
| Cerebrospinal Fluid Shunt Infections | 937 | ||
| SUMMARY | 937 | ||
| REFERENCES | 937 | ||
| Diagnosis of Acute Neurologic Emergencies in Pregnant and Postpartum Women | 943 | ||
| Key points | 943 | ||
| INTRODUCTION | 943 | ||
| HEADACHE | 945 | ||
| ACUTE NEUROLOGIC SYMPTOMS AND DEFICITS | 947 | ||
| SEIZURES | 950 | ||
| INDIVIDUAL CONDITIONS | 950 | ||
| CEREBRAL VENOUS SINUS THROMBOSIS | 951 | ||
| REVERSIBLE CEREBRAL VASOCONSTRICTION SYNDROME | 951 | ||
| POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME | 953 | ||
| NEUROLOGIC COMPLICATIONS OF ECLAMPSIA | 955 | ||
| RARE CONDITIONS CAUSING ACUTE NEUROLOGIC SYMPTOMS IN PREGNANT AND POSTPARTUM WOMEN | 956 | ||
| NEUROIMAGING AND MULTIDISCIPLINARY COORDINATION OF CARE | 957 | ||
| SUMMARY | 958 | ||
| REFERENCES | 958 | ||
| Neuro-Ophthalmology in Emergency Medicine | 967 | ||
| Key points | 967 | ||
| INTRODUCTION | 967 | ||
| ANATOMY AND PHYSIOLOGY | 968 | ||
| CLINICAL FINDINGS/PHYSICAL EXAMINATION TECHNIQUES | 969 | ||
| Inspection of the Pupils and Pupillary Reactivity | 970 | ||
| Extraocular Movements | 971 | ||
| Vestibular-Ocular and Caloric Testing | 972 | ||
| Corneal Reflex | 973 | ||
| Visual Fields | 973 | ||
| Patients with Altered Mental Status or Coma | 974 | ||
| SPECIFIC CLINICAL ISSUES | 975 | ||
| Visual Loss | 975 | ||
| Visual Field Loss | 975 | ||
| Unequal Pupils — Anisocoria | 976 | ||
| Diplopia, Cranial Nerve Palsies | 978 | ||
| Ptosis | 980 | ||
| Nystagmus | 981 | ||
| Increased Intracranial Pressure | 981 | ||
| Coma and Altered Mental Status | 982 | ||
| Toxins | 982 | ||
| Seizures | 982 | ||
| Carotid Cavernous Fistula | 983 | ||
| Nutritional Deficiency | 983 | ||
| Myasthenia Gravis | 984 | ||
| Stroke | 984 | ||
| Functional Neuro-Ophthalmologic Problems | 984 | ||
| SUMMARY | 985 | ||
| ACKNOWLEDGMENTS | 985 | ||
| REFERENCES | 985 | ||
| FURTHER READINGS | 985 | ||
| Index | 987 |