We focus a lot on acute stroke patients. Rapid response. Rapid assessment. Rapid transport. Dispatch, Delivery, Door, and Drug. But what about the other D’s associated with stroke such as Discharge? And Disability? And Depression? Stroke is the chief culprit of serious long term disability in the US. Below is the Modified Rankin Scale (MRS), a […]

Published in JAMA last month the Prehospital Acute Neurological Treatment and Optimization of Medical care in Stroke Study (PHANTOM-S; conducted in Berlin, Germany) studied 6182 patients randomized to 1) receiving the standard prehospital care (stroke alert and rapid transport only) versus 2) receiving care via a STEMO (Stroke Emergency Mobile). Let’s skip to the results: […]

In this study out of UCSF, patients were surveyed as to see if they would prefer treatment with fibrinolytic (TPA) therapy in the event of a stroke. Adults over 50 years of age read a scenario where they suffered a stroke and were brought to the emergency department by paramedics. The risks and benefits of TPA therapy […]

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 […]

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 […]

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 […]

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 […]

We all remember blood flow through the heart being pounded into our heads in school. Knowing the blood flow through the brain is every bit as important and proficiency in the basics of cerebral vasculature can quickly improve your assessment of stroke patients. There is a concept in stroke diagnosis known as localization. This refers to […]