Time is Brain, Time is Testicle, Time is…Spine?

A 56 year-old right hand dominant male presented to the emergency department with weakness in his bilateral hands, worse on the left. For the last several months, he had been having daily neck pain and frequent occipital headaches. He had been dropping things more frequently, but noticed over the previous week that he had increasing difficulty getting dressed in the morning. He used to be very active, but began using a walker last year because of frequent falls from what he described as always “feeling off-balance”. He also endorsed intermittent tingling in all fingers of his left hand.

Neurology, OrthopedicsMeredith HortonNovember 27, 2020cervical myelopathy, cervical stenosis, orthopedics, spinal cord injuryComment

Errors in Emergency Medicine Radiology

An elderly man reported to the emergency room after a fall down 15 stairs at home. He was more confused than his baseline but otherwise did not have any specific complaints. Vitals and labs were within normal limits. A non-contrast CT of the brain and C-spine was performed and read as normal…

Neurology, Radiology, TraumaAustin QuinnNovember 16, 2020Emergency Radiology, Medical Error, Clinical Images

The Febrile Seizure

Despite how frequently emergency physicians encounter children who have had a febrile seizure, there tends to be great variation in the diagnostic evaluation of these patients. The algorithm below was created to provide a more simplified approach to the patient presenting with a febrile seizure. The algorithm draws from the 2011 American Academy of Pediatrics (AAP) Clinical Practice Guideline for the Febrile Seizure as well as the clinical pathways published by Seattle Children’s Hospital…

Pediatrics, NeurologyAlexander DaytonOctober 2, 2020Febrile Seizure, pediatrics, seizure, algorithm, best practiceComment

Herpes Encephalitis

A 70 year-old male, with a past medical history of hypertension, gastroesophageal reflux disease, chronic lymphocytic leukemia on Ibrutinib, and coronary artery disease, presented with right hand weakness since waking that morning. He reported that he felt the strength of his grip was not at baseline, and his wife also noted that, while eating breakfast, the patient dropped his bagel, a dish towel, and his utensils. His last known well was 10:00 PM the night before, although he also endorsed two weeks of persistent right hand numbness and burning paresthesias in his right hand. He denied headache, fever/chills, chest/back/abdominal pain, nausea/vomiting, urinary symptoms, or diarrhea, as well as any visual symptoms, speech changes, or gait problems…

Community EM, Infectious Disease, NeurologyKelly WongSeptember 21, 2020herpes, herpes simplex virus, encephalopathy, seizure, Infectious DiseaseComment

A Case of Abnormal Movements in an Infant

Austin Quinn, MD, and Meghan Beucher, MD

CASE:

The patient is a 4 month-old ex-full term fully vaccinated otherwise healthy male who presented to the ED with one week of abnormal movements. The patient's mother stated that over the past week he had had increasingly frequent clusters of 5 or 6 episodes of flexing his hips and arms in toward his trunk, accompanied by abnormal eye movements with upward deviation and head drop. She sent videos to the PCP who felt it was from gas pain and started the patient on simethicone, without improvement in symptoms. Mother commented that they appeared to happen more often before sleep, but could happen when the patient was wide awake. He appeared to remain conscious throughout the episodes and would often cry afterwards.

Pediatrics, NeurologyAustin QuinnSeptember 4, 2020pediatrics, pediatric neurology, neurology, seizure, abnormal movement, spasmsComment

CASE:

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