A 52 yof complains of chest and epigastric pain. Here is her 12 lead ECG: Image credit| Click here for larger image 50 minutes later she developed left-sided hemiplegia, facial asymmetry, deviated gaze, and left-sided neglect. (Which stroke syndrome is this indicative of?) A CT scan revealed a blockage in the R-MCA. The CT scan also indicated that the right insular cortex […]

10:10 in the AM. You respond to a 34 year-old-male c/o possible CVA. Upon arrival you find him seated in his apartment living room surrounded by two friends. He is alert and appears anxious. He tells you he was perfectly fine when he went to bed last night at around 11 PM. This is his […]

Recall from part 1 where we discussed how common it was to observe 12 lead ECG changes in stroke patients. Now let’s look at regions deep inside your head thought to be responsible. In each hemisphere of the brain there’s a part of the cerebral cortex which folds over on itself. It’s called theinsular cortex and it […]

Which image below is the biggest attention-getter? -OR- The Italian sports car vs. motorcycle collision or the middle-aged mother of two whose daughter noticed her crooked smile at dinner? How many ‘trauma junkies’ ride our ambulances and staff our Emergency Departments? Which motivated you to become an EMS/emergency medicine provider: facial droop or rollovers with […]

Last night we published this editorial and today received an email response from Dr. Bukata. His comments are reproduced in-part below: “[T]he purpose of the chart [Editor’s note: Dr. Bukata is referring to our concern that the imagery associated with his commentary appealed to emotion rather than reason] is to summary the facts — which are straightforward […]

You may have seen the above image circulating recently and/or you may have read this article by Rick Bukata, MD. FAST-MAG was a multicenter randomized, controlled clinical trial out of UCLA studying prehospital administration of magnesium sulfate to treat stroke. The results are in. It didn’t work. Not necessarily surprising. This paper states we’ve tested over 20 drugs in 270 preclinical trials with […]

15-30% of strokes are cardioembolic and 60-90% of stroke patients present with ECG abnormalities. (Source) So let me ask you some questions. Is it important to obtain a 12 lead ECG during a suspected acute stroke in the prehospital setting? Why? Why not? Does it really matter either way? Before we discuss the answer… Here’s the abnormalities you’re likely to […]

View Incognito: The Secret Lives of the Brain on Amazon.com “Three pounds of the most complex materials we’ve discovered in the universe…is built of cells called neurons and glia-hundreds of billion of them…[that] are connected to one another in a network of such staggering complexity that it bankrupts human language and necessitates a new kinds […]

Depending on what statistic you’re looking at anywhere from 30-40% of strokes result from an unknown cause. That’s right. A full work-up of these patients reveals no cardioembolic causes, no large-artery occlusive disease, and typically an absence of risk factors. It’s a diagnosis of exclusion and it’s called cryptogenic. So what actually causes these strokes to […]

Let’s get a little more familiar (and look at a cool image) with the path blood takes as it leaves the heart and travels up to the brain. If you don’t recall what we covered in Blood Flow Through the Brain Part 1, take a moment to review. Remember the above picture? Now let’s take a […]