Stroke thrombolysis given by emergency physicians: The time is here.

Emergency Medicine core clinical privileges include administration of thrombolytic therapy for myocardial infarction and stroke. However, emergency medicine providers have created their own paradigm to rely on neurology specialty consultation to treat acute stroke patients. A 2013 study supported by the American Academy of Neurology showed an 11% shortage of neurologists at that time and projected a 19% shortage by 2025.

Endovascular Coil Embolization of a Posterior Communicating Artery Aneurysm: 2-Dimensional Operative Video.

Since the International Subarachnoid Aneurysm Trial,1 endovascular treatment has been the favored treatment for appropriate ruptured intracranial aneurysms. While our endovascular technology has advanced to allow us to treat the majority of intracranial aneurysms, simple coil embolization is still the most common modality. This video demonstrates the fundamentals of aneurysm catheterization and coiling for safe treatment.

Tofacitinib-Associated Cerebral Venous Sinus Thrombosis.

Tofacitinib is a Janus kinase inhibitor indicated to treat adult patients with moderately to severely active ulcerative colitis (UC). Although thrombosis is a known adverse event of tofacitinib, there are no reports specific to cerebral venous sinus thrombosis (CVST). We present a report of a patient presenting with a CVST several months after starting tofacitinib.

Case report: vertebral osteomyelitis secondary to a dental abscess.

Background: Vertebral osteomyelitis can be attributed to many factors including immunosuppression, diabetes, malignancy, collagen disease, periodontal disease, open fractures, and endoscopic procedures. Anaerobic bacteria, such as Veillonella species, are found in the oral cavity and are rarely implicated in the infection. This report describes vertebral osteomyelitis secondary to a dental abscess with positive Veillonella cultures.

Carotid Stenosis: Utility of Diagnostic Angiography.

Objective: Carotid artery stenosis is frequently diagnosed through screening tests with noninvasive imaging. Because of differences noted between the various modalities, we sought to investigate our experience comparing noninvasive imaging (ultrasound, computed tomography angiography, magnetic resonance angiography) with invasive imaging (digital subtraction angiography).

Methods: In a multicenter retrospective analysis, 249 carotid vessels were reviewed based on angiography with the associated noninvasive imaging.

Carotid Artery Angioplasty and Stenting Without Distal Embolic Protection Devices.

Background: Embolic protection devices are used during carotid artery stenting procedures to reduce risk of distal embolization. Although this is a standard procedural recommendation, no studies have shown superiority of these devices over unprotected stenting procedures.

Objective: To assess the periprocedural outcome and durability of carotid artery stenting without embolic protection devices and poststent angioplasty.

An Analysis of Transient Ischemic Attack Practices: Does Hospital Admission Improve Patient Outcomes?

Introduction: Immediate treatment has been shown to decrease the recurrence of cerebrovascular accidents following transient ischemic attacks (TIA), prompting the use of a specialized neurologic emergency department (Neuro ED) to triage patients. Despite these findings, there is little evidence supporting the notion that hospital admission improves post-TIA outcomes. Through the lens of a Neuro ED, this retrospective chart review of TIA patients examines whether hospital admission improves 90-day outcomes.

Resistance to rocuronium and cisatracurium in a patient with a spinal injury and acute respiratory distress syndrome.

Purpose: A case of resistance to rocuronium and cisatracurium in a patient with a spinal injury who developed acute respiratory distress syndrome (ARDS) is reported.

Summary: A 34-year-old, 88-kg Caucasian man with a history of polysubstance abuse fell from a bridge approximately 30-ft high, landing head first in about 2-3 ft of water. The patient sustained anterior subluxation at cervical spine levels C5-C6 and severe spinal canal compromise with cord compression and edema from C5 to C7, resulting in quadriplegia.

Early postmarket experience after US Food and Drug Administration approval with the Trevo device for thrombectomy for acute ischemic stroke.

Background: TREVO 2 showed the Trevo stent retriever to be more successful for revascularization than Merci for acute stroke intervention in patients treated within 8 hours of symptom onset. These results led to US Food and Drug Administration approval of Trevo.

Objective: To report the first postmarket experience with Trevo since US Food and Drug Administration approval at a single high-volume comprehensive stroke center in the United States.

Retrospective study of Heparin Administration for Ischemic Stroke when there is an IV-tPA Contraindication.

Background: The majority of patients presenting with an ischemic stroke arrive after the 3-4.5 h time window allowed for intravenous tissue plasminogen activator (IV tPA) administration. Most of the literature on heparin use in acute ischemic stroke does not describe dose-adjusted intravenous unfractionated heparin (IV UFH) without bolus, a common method of administration.

Endovascular coil embolization of unruptured posterior communicating artery aneurysm.

The patient is a 60-year-old woman who presented to her primary care physician with new onset of headache. She was neurologically intact without cranial nerve deficit. An outpatient CT angiogram (CTA) revealed no subarachnoid hemorrhage, but showed a right-sided posterior communicating artery aneurysm measuring 11 mm by 10 mm.

Diffusion tensor imaging and fiber-tracking in Marchiafava-Bignami disease.

Marchiafava-Bignami disease, a rare disorder most commonly seen in patients with a history of alcohol consumption, involves demyelination and subsequent necrosis of the corpus callosum. Diffusion tensor imaging demonstrates regional abnormalities in the corpus callosum that are not evident by conventional magnetic resonance imaging (MRI). Furthermore, fiber-tracking demonstrates significant disruption of axonal fiber bundles within the corpus callosum, most marked within the body, corresponding to the clinical finding of interhemispheric disconnection, which is characteristic of the disease.