A 34 yo female with a history of trigeminal neuralgia presented to the Emergency Department with a chief complaint of 5 days of severe, worsening paroxysms of pain in the left trigeminal nerve distribution. The pain was refractory to carbamazepine and gabapentin. Neurology was consulted and an unconventional therapy was recommended.
A 4 year old boy, otherwise healthy, is rushed into the emergency room by his mom because she thinks he had a seizure. His mom states he was sitting on the ground playing a game on his iPad when he suddenly started having jerking movements of his entire body that eventually self resolved after around 2 minutes. He has never had a seizure before. He is up to date on vaccines and had an unremarkable birth history.
On exam, the child is not actively seizing at this time, he just seems slightly drowsy and confused. It is noted that he is febrile to 38.2 C, otherwise vitals are stable. The rest of the exam is nonfocal.
What should you be thinking about? What are your next steps?
How do we manage a first time seizure? Let's review the basics here
Working up a patient for visual loss? Concerned they have optic neuritis and not sure what to do next? Let's review some basics of optic neuritis
Your patient is seizing, your benzo didn't work, what's next?
Knowing your action plan for a patient in status epilepticus is crucial. Preparation = success! Review this chart until you've got a 1st, 2nd & 3rd line medication, with doses, always ready in your mind. If you've got this down already, how about for pediatrics?
Autonomic dysreflexia is a potentially dangerous and lethal syndrome that develops in spinal cord injury (SCI) patients resulting in acute, uncontrolled, life-threatening hypertension.
Your Myasthenia Gravis patient looks quite short of breath. You know that there are some tests which can help guide your management, but can't quite remember the name....
Subarachnoid Hemorrhage Management Pearls
1. SAH requiring intubation:
Mr. Clean, Escape, Extend IA. So many trials...just tell me the bottom line! Here are some of the most critical neuro-interventional trials and their take home points.
Ever wonder where the the current American Heart Association and American Stroke Association (AHA/ASA) guidelines for thrombolysis in acute ischemic stroke come from? Included is a summary of the landmark studies that have contributed to these recommendations (NINDS& ECASS III) as well as a review of IST-3.
