emergency medicine neurology

Best Case Ever 11: Cauda Equina Syndrome

As a bonus to Episode 26 on Low Back Pain Emergencies with Dr. Brian Steinhart & Dr. Walter Himmel, we have Dr. Walter Himmel's own personal incredible case of Cauda Equina Syndrome. In the related Episode we will cover the most serious spinal and vascular causes that present with low back pain including Cauda Equina Syndrome, Spinal Epidural Abscess, Spinal Epidural Hematoma, Metastases to the spine, Abdominal Aortic Aneurysm and Retroperitoneal Hematoma. [wpfilebase tag=file id=394 tpl=emc-play /] [wpfilebase tag=file id=395 tpl=emc-mp3 /]

By Anton Helman|2022-01-04T19:51:07-05:00September 6th, 2012|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology|Tags: abdominal aortic aneurysm, Brian Steinhart, cauda equina syndrome, disc herniation, inflammatory markers, lumbosacral sprain, mechanical low back pain, metastatic cancer, pain managment, retroperitoneal bleed, siatica, spinal cord compression, spinal epidural hematoma, Walter HImmel|2 Comments

Episode 17 Part 2: Stroke, Dabigatran and Intracranial Hemorrhage

In the 2nd part of this episode on Stroke, Dabigitran & Intracranial Hemorrhage Dr. Walter Himmel & Dr. Dan Selchen tell us everything the ED doc needs to know about the oral direct thrombin inhibitor Dabigatran and how to reverse a Dabigatran ICH. The ED treatment of stroke is reviewed including best medications and a simple way to remember BP goals. They review the management of ICH including BP goals, indications for neurosurgery, the role of recombinant Factor Vlla, and how best to reverse Warfarin-associated and platelet-associated ICH.

By Anton Helman|2024-08-18T18:51:11-04:00September 7th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: anticoagulants, dabigitran, intracranial hemorrhage, recombinant factor 7, stroke, Walter HImmel, Warfarin|0 Comments

Episode 17 Part 1: Emergency Stroke Controversies

Ep17 P1 StrokeDr. Walter Himmel, "the walking encyclopedia of Emergency Medicine" & Dr. Dan Selchen, the head of the stroke program at St. Micheal's Hospital in Toronto with 30+ years of experience as a stroke neurologist, update us on the literature regarding Emergency Stroke Controversies including the ABCD2 Score to predict Stroke after TIA, as well as the current thinking around the best carotid imaging for patients who have had a TIA. They then review the important findings of the key thrombolysis stroke trials & how we could incorporate these findings into our daily practice. Dr. Selchen reviews the key CT findings we should look for in stroke, & Dr. Himmel takes us through how to manage the dreaded complication of ICH post thrombolysis. This episode is super controversial - so please 'speak your mind' at the bottom of the page.

By Anton Helman|2024-08-18T18:51:10-04:00September 7th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: ABCD2 Score, anti-platelet, atrial fibrillation, clinical decision rules, clopidogrel, CT head, intracranial hemorrhage, ischemic stroke, thrombolysis, TIA, transient ishemic attack, Walter HImmel|1 Comment

Best Case Ever 3: Emergency Headache – Importance of Opening Pressure

In association with Episode 14, 'Headache Pearls & Pitfalls' with Dr. Anil Chopra and Dr. Stella Yiu, we present here, the third of our new 5 minute 'Best Case Ever' series. In Episode 14: Headache Pearls & Pitfalls, which has just been released, Dr. Chopra and Dr. Yiu answer questions like: With the ever improving resolution of CT, should we still be doing LP after negative plain CT head for all our thunderclap headache patients? How can we best minimize the chance of post-LP headache? What evidenced-based treatments can we initiate in the ED for our SAH patients that will improve outcomes? [wpfilebase tag=file id=375 tpl=emc-play /] [wpfilebase tag=file id=374 tpl=emc-mp3 /]

By Anton Helman|2016-10-20T13:26:59-04:00May 10th, 2011|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology|Tags: Anil Chopra, IIH, lumbar puncture, pseudotumor cerebri, thunderclap headache|1 Comment

Episode 14 Part 2: Thunderclap Headache – Cerebral Venous Thrombosis and Cervical Artery Dissection

emergency headacheIn Part 2 of this episode on Thunderclap Headache - Cerebral Venous Thrombosis & Cervical Artery Dissction, Dr. Stella Yiu and Dr. Anil Chopra review the presentation, work-up and management of some of the less common but very serious causes of headache including Cervical Artery Dissection (CAD), Cerebral Venous Thrombosis (CVT) and Idopathic Intracranial Hypertension (IIH). They tell us the most effective ways in which we can minimize the chance of the common Post-LP Headache. They answer questions such as: How does a carotid artery dissection present compared to a vertebral artery dissection? What is the evidence for chiropractic neck manipulation as a cause for Cervical Artery Dissection? How do antiplatelets compare to heparin for the treatment of Cervical Artery Dissection? What is Spontaneous Intracranial Hypotension? What is the differential diagnosis for headache in the peri-partum patient? Does D-dimer have a role in ruling out Cerebral Venous Thrombosis in the low risk patient? What is the imaging modality of choice for suspected Cerebral Venous Thrombosis? What is the value of opening pressure when performing an LP? What are the key headache diagnoses that can be missed on plain CT of the head and would warrant further investigation? and many more.....

By Anton Helman|2024-08-18T18:53:59-04:00May 9th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: Anil Chopra, CVT, D-dimer, IIH, opening pressure, post-LP headache, pseudotumor cerebri, spontaneous intracrnial hypotension, Stella Yiu|4 Comments

Episode 14 Part 1: Migraine Headache and Subarachnoid Hemorrhage

In Part 1 of this episode on Headache Pearls & Pitfalls - Migraine Headache & Subarachnoid Hemorrhage, Dr. Anil Chopra and Dr. Stella Yiu discuss the best evidenced-based management of migraine headache in the ED including the use of dexamethasone, dopamine antagonists, the problems with narcotics and the efficacy of 'triptans'. An easy way to remember the worrisome symptoms of headache indicating a serious cause is reviewed followed by a detailed discussion of the pearls, pitfalls and controversies around the work-up of Subarachnoid Hemorrhage (SAH) in light of some exciting recent literature, including the basis for a new Canadian decision rule for SAH.

By Anton Helman|2024-08-18T18:53:57-04:00May 9th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: Anil Chopra, clinical decision rules, lumbar puncture, migraine, Stella Yiu, subarchnoid hemorrhage|1 Comment

Episode 13 Part 2: Killer Coma Cases – The Intoxicated Patient

In part 2 of this episode Dr. Helman presents two more cases to Dr. Carr and Dr. Steinhart, who give us their insights into the common conundrums when it comes to the intoxicated ED patient, and some key clues to the not-so-common life threatening toxicological emergencies that we need to be on the look out for.

By Anton Helman|2021-03-31T13:28:03-04:00April 12th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology, Toxicology|Tags: altered mental status, Brian Steinhart, coma cocktail, David Carr, naloxone|2 Comments

Episode 13 Part 1: Killer Coma Cases – The Found Down Patient

In Part 1 of Killer Coma Cases - The Found Down Pateint, Dr. Helman presents two challenging cases to Dr. Brian Steinhart and Dr. David Carr, who tell us loads of key clinical pearls in their approaches to the 'found down' patient. They discuss the important components of the neurological exam in the comatose patient, the differential diagnosis of altered mental status and hyperthermia, the controversies around when to get a CT head before performing a lumbar puncture, and much more in this Killer Coma Cases episode. In Part 1 of this episode, we discuss the limitations of plain CT, the interpretation of CSF and the many faces of seizures. Any more information would be giving away the cases.....

By Anton Helman|2024-08-18T18:55:50-04:00April 12th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: altered mental status, Brian Steinhart, coma cocktail, CSF analysis, David Carr, found down, lumbar puncture, meningitis, seizure, status epilepticus|5 Comments

Best Case Ever 2 The Found Down Patient

In relation to Episode 13 on The Found Down Patient with Dr. Brian Steinhart and Dr. David Carr, we present here, the second of our new 5 minute 'Best Case Ever' series. Dr. Steinhart's found down patient In Episode 13 The Found Down Patient, Dr. Helman presents 4 challenging cases of patients who present with altered mental status to Dr. Carr and Dr. Steinhart, who give us loads of key pearls and intriguing controversy in the evaluation and treatment of these difficult patients. [wpfilebase tag=file id=370 tpl=emc-play /] [wpfilebase tag=file id=371 tpl=emc-mp3 /]

By Anton Helman|2016-10-20T13:27:39-04:00March 31st, 2011|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology|Tags: aortic dissection, Brian Steinhart, coma, found down|0 Comments

Episode 6: Transient Ischemic Attack

Transient Ischemic Attack (TIA) can be difficult to diagnose. It's unclear who to work up. It's challenging if the patient is already taking blood thinners. Dr. Walter Himmel and Dr. Daniel Selchen discuss the key historical and physical examination maneuvers to determine whether patients with neurologic complaints have had a TIA or whether they have had a TIA mimic. They review the 3 best risk stratification rules including the ABCD2 Score to help us determine who needs to be admitted and who needs timely investigations to reduce vascular morbidity and mortality. The reasoning behind which patients require urgent carotid imaging, echocardiograms and advanced imaging such as CT Angiogram is explained, and the best medication choices are reviewed, as well as the indications for Clopidogrel, Aggrenox, Warfarin, Heparin and carotid endarterectomy in the managment of Transient Ischemic Attack. In the second part of the episode, a simple and practical approach to the patient with dizziness is presented, and a discussion on which patients with dizziness need urgent work-up and treatment for vertebrobasilar TIA.

By Anton Helman|2021-03-31T13:38:54-04:00July 1st, 2010|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Neurology|Tags: ABCD2 Score, anti-platelet, anticoagulants, anticoagulation, clinical decision rule, clopidogrel, CT angiogram, TIA, vertigo, Walter HImmel, Warfarin|1 Comment