Neurologic emergencies: how to do a fast, focused evaluation of any neurologic complaint PDF
Preview Neurologic emergencies: how to do a fast, focused evaluation of any neurologic complaint
Neurologic Emergencies Latha Ganti • Joshua N. Goldstein Editors Neurologic Emergencies How to Do a Fast, Focused Evaluation of Any Neurologic Complaint Editors Latha Ganti Joshua N. Goldstein Orlando, Florida Boston, Massachusetts USA USA Disclaimer: The American College of Emergency Physicians (ACEP) makes every effort to ensure that contributors to its publications are knowledgeable subject matter experts. Readers are nevertheless advised that the statements and opinions expressed in this publication are provided as the contributors’ recommendations at the time of publication and should not be construed as official College policy. ACEP recognizes the complexity of emergency medicine and makes no representation that this publication serves as an authoritative resource for the prevention, diagnosis, treatment, or intervention for any medical condition, nor should it be the basis for the definition of, or standard of care that should be practiced by all health care providers at any particular time or place. To the fullest extent permitted by law, and without limitation, ACEP expressly disclaims all liability for errors or omissions contained within this publication, and for damages of any kind or nature, arising out of use, reference to, reliance on, or performance of such information. ISBN 978-3-319-64521-6 ISBN 978-3-319-64523-0 (eBook) https://doi.org/10.1007/978-3-319-64523-0 © Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland My co-faculty, residents, nurses, and paramedics at UCF/Osceola Regional Medical Center who lead by example, and make my job super fun. My dad Dr. Ganti L. Rao and late mother Prabha Ganti for always pushing me to pursue my dream of being a doctor and a writer. I wouldn’t have the amazing career I do without you. My children Thor, Tej, Trilok, Karthik & Vaishnavi for their patience, resilience and grace – I may have taught you to read and ace algebra, but you taught me how to live life. —LG My teachers, mentors, and colleagues at Massachusetts General Hospital for helping me build an academic career that is interesting, fulfilling, and fun. My parents, brother, sisters, friends, and so many family members that are immediate, extended, and “other” – they taught me, raised me, and gave my life meaning. My wife Erica for her love and support all these years (22 years so far!) even though I spent too many hours over the laptop. My children, Alexa and Lindsey, for filling my life with joy, love, and (of course) dance. And for just being awesome. —JNG This book was only possible thanks to the hard work of so many people. Our authors who put their time and effort into these chapters, and their families who helped them do it! Our team at Springer- Margaret, Gayathri & Rajeshwari for keeping us on track and seeing us through seamless production. Marta Foster at the American College of Emergency Physicians for encouraging us to co-publish this text with ACEP. —Latha Ganti & Joshua Goldstein Foreword Neurologic emergencies are not only some of the most common conditions seen in the emergency department, but are also among the most devastating conditions that we treat. The toll of severe neurological conditions not only involves life or death but also impacts the lives of its victims even more profoundly. The long- term sequelae from neurological emergencies include paralysis, loss of sensation, loss of intellectual capacity, and personality change, all of which can be often life changing. Between 5 and 8% of all patients seen in emergency departments across the United States will have neurological issues. These conditions range from neu- rotrauma such as traumatic brain and spinal cord injury to ischemic and hemor- rhagic stroke, status epilepticus, central nervous system infections, anoxic brain injury, headache, and others. These conditions have a very high burden of dis- ease. Acute ischemic stroke affects about 200/100,000 people in the United States and has a mortality of 15–17% at 30 days. Intracerebral hemorrhage affects about 15/100,000 people but has a mortality rate as high as 50% at 30 days. Status epilepticus affects 40/100,000 people in the United States with a mortality rate of 22% at 30 days and subarachnoid hemorrhage affects 6/100,000 people with a mortality of 50% at 30 days. Not only are these diseases devastat- ing in terms of death and disability, but the healthcare costs from these condi- tions are enormous. For many neurological emergencies, patient outcomes can be significantly affected by rapid recognition and appropriate treatment. Ischemic stroke outcomes have been profoundly affected by the use of intravenous thrombolytic agents and recently by the effective use of endovascular treatment for large vessel occlusions. Outcomes from status epilepticus are improved by rapid cessation of seizures with appropriate antiepileptic drugs. We also know that prompt recognition and effective treatment of hypoxia and hypotension can have profound impacts on the outcome of patients with traumatic brain and spinal cord injury. For these reasons, it is implicit that all emergency physicians have appropriate knowledge and training in recognition and treatment of neurological emergencies. Latha Ganti, M.D., M.S., M.B.A., and Josh Goldstein, M.D., Ph.D., have put together this outstanding book on Neurological Emergencies to address this need. The book has been structured to cover the broad landscape of neurological emer- gencies and provide the essential keys to rapid recognition and diagnosis. Drs. Ganti vii viii Foreword and Goldstein are notable experts in neurological emergencies and they have recruited an outstanding list of authors to put this book together. I am hopeful that this text will help emergency physicians to better recognize and treat neurological emergencies and lead to better patient outcomes. William Barsan MD, Professor of Emergency Medicine University of Michigan Ann Arbor, MI, USA Disclaimer The American College of Emergency Physicians (ACEP) makes every effort to ensure that contributors to its publications are knowledgeable subject matter experts. Readers are nevertheless advised that the statements and opinions expressed in this publication are provided as the contributors’ recommendations at the time of publi- cation and should not be construed as official College policy. ACEP recognizes the complexity of emergency medicine and makes no representation that this publica- tion serves as an authoritative resource for the prevention, diagnosis, treatment, or intervention for any medical condition, nor should it be the basis for the definition of, or standard of care that should be practiced by all health care providers at any particular time or place. To the fullest extent permitted by law, and without limita- tion, ACEP expressly disclaims all liability for errors or omissions contained within this publication, and for damages of any kind or nature, arising out of use, reference to, reliance on, or performance of such information. ix Contents 1 The Fast and Focused Neurological Examination . . . . . . . . . . . . . . . . 1 Matthew S. Siket 2 Rule Out Acute Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Aunali S. Khaku and Sayed K. Ali 3 Acute Head Injury: When to Image and When to Observe? . . . . . . . 39 Tracy MacIntosh and Adam Benzing 4 Seizure Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Claire S. Jacobs and Imoigele P. Aisiku 5 Syncope: Who Needs Imaging? Who Needs Admission? . . . . . . . . . . 85 Ellen Vollmers and Sean Kivlehan 6 Dizziness: An Evidence-Based Approach (Better than MRI?) . . . . . . 103 Jonathan A. Edlow 7 Acute Vision Loss and Diplopia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 David C. Lebowitz, Amninder Singh, and Amanda Webb 8 Headache: When to Image, When to Tap . . . . . . . . . . . . . . . . . . . . . . . 143 Perrin T. Considine, Levi Filler, and Murtaza Akhter 9 Atraumatic Acute Neck and Back Pain . . . . . . . . . . . . . . . . . . . . . . . . 175 John W. Martel and J. Brooks Motley 10 The Nonanatomic Exam: Psychogenic Syndromes and Malingering 195 Michael Hoffmann 11 Altered Mental Status in the Emergency Department . . . . . . . . . . . . 209 Austin T. Smith and Jin H. Han 12 Acute Generalized Weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 Latha Ganti and Vaibhav Rastogi xi
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