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https://www.readbyqxmd.com/read/28336681/accuracy-and-reliability-of-stroke-diagnosis-in-the-pediatric-emergency-department
#1
Mark T Mackay, Adriana Yock-Corrales, Leonid Churilov, Paul Monagle, Geoffrey A Donnan, Franz E Babl
BACKGROUND AND PURPOSE: Access to acute stroke interventions in the emergency department (ED) relies on correct clinical diagnosis. Our aims were to determine the accuracy and reliability of pediatric ED physician diagnosis of childhood stroke and other conditions presenting with brain attack symptoms. METHODS: Prospective study of consecutive children aged 1 month to 18 years presenting to the ED from June 2009 to December 2010 with focal neurological deficits...
March 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28295242/an-update-on-non-pharmacological-neuromodulation-for-the-acute-and-preventive-treatment-of-migraine
#2
Francesca Puledda, Peter J Goadsby
OBJECTIVE: To review current neuromodulation treatments available for migraine therapy, both in the acute and preventive setting. METHODS: The published literature was reviewed for studies reporting the effects of different neuromodulation strategies in migraine with and without aura. The use of non-invasive: single pulse transcranial magnetic stimulation, non-invasive vagal nerve stimulation, supraorbital nerve stimulation, and transcranial direct current stimulation, as well as invasive methods such as occipital nerve stimulation and sphenopalatine ganglion stimulation, are assessed...
March 13, 2017: Headache
https://www.readbyqxmd.com/read/28271333/non-invasive-neuromodulation-in-primary-headaches
#3
REVIEW
Sarah Miller, Manjit Matharu
PURPOSE OF REVIEW: There is growing interest in neuromodulation for primary headache conditions. Invasive modalities such as occipital nerve stimulation, deep brain stimulation and sphenopalatine ganglion stimulation are reserved for the most severe and intractable patients. Non-invasive options such as vagal nerve stimulation (nVNS), supraorbital nerve stimulation (nSONS) and transcranial magnetic nerve stimulation (TMS) have all emerged as potentially useful headache treatments. This review examines the evidence base for non-invasive neuromodulation in trigeminal autonomic cephalalgias and migraine...
March 2017: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/28251391/a-multicenter-open-label-long-term-safety-and-tolerability-study-of-dfn-02-an-intranasal-spray-of-sumatriptan-10%C3%A2-mg-plus-permeation-enhancer-ddm-for-the-acute-treatment-of-episodic-migraine
#4
Sagar Munjal, Elimor Brand-Schieber, Kent Allenby, Egilius L H Spierings, Roger K Cady, Alan M Rapoport
BACKGROUND: DFN-02 is a novel intranasal spray formulation composed of sumatriptan 10 mg and a permeation-enhancing excipient comprised of 0.2% 1-O-n-Dodecyl-β-D-Maltopyranoside (DDM). This composition of DFN-02 allows sumatriptan to be rapidly absorbed into the systemic circulation and exhibit pharmacokinetics comparable to subcutaneously administered sumatriptan. Rapid rate of absorption is suggested to be important for optimal efficacy. The objective of this study was to evaluate the safety and tolerability of DFN-02 (10 mg) in the acute treatment of episodic migraine with and without aura over a 6-month period based on the incidence of treatment-emergent adverse events and the evaluation of results of clinical laboratory tests, vital signs, physical examination, and electrocardiograms...
December 2017: Journal of Headache and Pain
https://www.readbyqxmd.com/read/28041540/-basic-mechanisms-of-migraine-and-new-methods-of-treatment
#5
Jakob Møller Hansen, Messoud Ashina
Migraine is the most prevalent disabling neurological disorder. The management of patients with migraine has been hampered by lack of effective and well-tolerated acute and preventive therapies. Based on improved insights into the basic mechanisms of migraine, new and targeted treatments are currently undergoing large-scale testing. Among the most promising agents for migraine prevention are humanized antibodies against calcitonin gene-related peptide (CGRP) or the CGRP receptor. If proven effective, these new treatments may emerge to improve the lives of millions of individuals worldwide disabled by migraine...
December 19, 2016: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/27955971/utility-of-point-of-care-assessment-of-platelet-reactivity-using-the-pfa-100%C3%A2-to-aid-in-diagnosis-of-stroke
#6
Claire Pearson, Karin Przyklenk, Valerie H Mika, Syed Imran Ayaz, Morgan Ellis, Preet Varade, Rosa Tolomello, Robert D Welch
BACKGROUND: Rapid and accurate diagnosis of patients presenting with symptoms of stroke is needed to facilitate the timely delivery of proven effective treatment for patients with acute ischemic stroke (AIS). The aim of this study was to determine whether early assessment of platelet reactivity in patients presenting with symptoms of AIS was associated with a diagnosis of AIS, transient ischemic attack (TIA), or stroke mimic. METHODS: This prospective study included patients with symptoms of AIS treated at an inner-city emergency department (ED)...
November 15, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27902848/topiramate-in-migraine-prevention-a-2016-perspective
#7
Stephen D Silberstein
BACKGROUND: In evidence-based guidelines published in 2000, topiramate was a third-tier migraine preventive with no scientific evidence of efficacy; recommendation for its use reflected consensus opinion and clinical experience. Its neurostabilizing activity, coupled with its favorable weight profile, made topiramate an attractive alternative to other migraine preventives that caused weight gain. When guidelines for migraine prevention in episodic migraine were published in 2012, topiramate was included as a first-line option based on double-blind, randomized controlled trials involving nearly 3000 patients...
January 2017: Headache
https://www.readbyqxmd.com/read/27889366/intranasal-lidocaine-in-acute-treatment-of-migraine-a-randomized-controlled-trial
#8
Nazire Avcu, Nurettin Özgür Doğan, Murat Pekdemir, Elif Yaka, Serkan Yılmaz, Cansu Alyeşil, Latif Erdem Akalın
STUDY OBJECTIVE: The study aims to evaluate the efficacy and safety of intranasal lidocaine administration for migraine treatment. METHODS: This single-center, double-blind, randomized, controlled trial was conducted in a tertiary care emergency department. Included patients met the migraine criteria of the International Headache Society. Patients were randomized to intranasal lidocaine or saline solution; all participants received 10 mg of intravenous metoclopramide...
November 23, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27861834/an-algorithm-for-opioid-and-barbiturate-reduction-in-the-acute-management-of-headache-in-the-emergency-department
#9
Zubair A Ahmed, Dimitrios A Nacopoulos, Seby John, Nancy Papesh, David Levine, Cynthia C Bamford
OBJECTIVE: To develop and implement an algorithm for the management of headaches presenting to the emergency department (ED) in order to decrease the frequency of opioid and barbiturate treatment both acutely as well as on discharge. BACKGROUND: Headache is the fifth leading cause of ED visits in the United States. In the case of primary headache, particularly migraine, treatment in the ED can be highly variable. Patients with migraine continue to be treated with opioids more commonly than nonopioid, migraine specific medications...
January 2017: Headache
https://www.readbyqxmd.com/read/27797837/phaeochromocytoma-presenting-as-an-acute-coronary-syndrome
#10
Towhid Imam, Philip Finny, Alan Choo-Kang, Rehman Khan
A 44-year-old Caucasian man presented to the emergency department in acute cardiogenic shock, with pulmonary oedema, secondary to an acute myocardial infarction and in a hyperosmolar hyperglycaemic state. The previous day he had undergone a colonoscopy, which revealed features of colitis, and was started on prednisolone. He had been previously diagnosed with type 2 diabetes, migraine and anxiety attacks. While awaiting a coronary angiogram he developed abdominal pain and a CT scan was performed and found a large right adrenal mass...
October 26, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27775762/association-of-persistent-postconcussion-symptoms-with-pediatric-quality-of-life
#11
Zuzana Novak, Mary Aglipay, Nick Barrowman, Keith O Yeates, Miriam H Beauchamp, Jocelyn Gravel, Stephen B Freedman, Isabelle Gagnon, Gerard Gioia, Kathy Boutis, Emma Burns, Andrée-Anne Ledoux, Martin H Osmond, Roger L Zemek
Importance: Persistent postconcussion symptoms (PPCS) pose long-term challenges and can negatively affect patients' health-related quality of life (HRQoL). To date, no large comprehensive study has addressed the association between PPCS and HRQoL. Objectives: To determine the association between HRQoL and PPCS at 4 weeks after concussion and assess the degree of impairment of HRQoL in the subsequent 12 weeks. Design, Setting, and Participants: In a prospective, multicenter cohort study (Predicting Persistent Postconcussive Problems in Pediatrics [5P]) from August 14, 2013, to September 30, 2014, children aged 5 to 18 years who presented to the emergency department within 48 hours after head injury and were considered to have an acute concussion were enrolled across 9 pediatric emergency departments within the Pediatric Emergency Research Canada Network...
December 5, 2016: JAMA Pediatrics
https://www.readbyqxmd.com/read/27758813/tuberculous-meningitis-in-an-immunocompetent-male-complicated-by-hydrocephalus
#12
Louise Dunphy, Prashanth Shetty, Rabinder Randhawa, Kharil Amir Rani, Yaw Duodu
A 39-year-old man, born in India but resident in the UK for 10 years, was travelling in America when he became feverish with an altered mentation. He reported a 10-day history of fever, photophobia, headache and fatigue. His medical history included hypothyroidism and migraine. He was a non-smoker, did not consume alcohol and denied a history of drug use. He was transferred to the emergency department. Laboratory investigations confirmed hyponatraemia (sodium 128 mmol/L). A chest radiograph confirmed no focal consolidation...
October 7, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27754180/ed-08-4-diagnosis-and-treatment-of-hypertensive-emergency-in-children
#13
Lin Shi
According to the seventh report of Joint National Committee (JNC 7), hypertensive emergency (HE), a kind of hypertensive crisis, is defined as a sudden and abrupt elevation in blood pressure so as to cause acute target organ dysfunctions, including central nervous system, cardiovascular system or kidneys. Patients with HE require immediate reduction in markedly elevated blood pressure. Currently, there are no international guidelines for children HE, so the JNC definition is commonly used. Hypertensive emergency in children is rare but a life-threatening emergency...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27651281/combined-early-treatment-in-hemiplegic-attacks-related-to-cacna1a-encephalopathy-with-brain-oedema-blocking-the-cascade
#14
Francesca Camia, Livia Pisciotta, Giovanni Morana, Maria Cristina Schiaffino, Salvatore Renna, Paola Carrera, Maurizio Ferrari, Maria Giuseppina Baglietto, Edvige Veneselli, Laura Siri, Maria Margherita Mancardi
INTRODUCTION: Variants in the CACNA1A gene on chromosome 19p13 result in a spectrum of neurological phenotypes ranging from familial or sporadic hemiplegic migraine to congenital or progressive encephalopathies. Patients with CACNA1A variants often show acute attacks with ataxia or hemiplegia till coma, sometimes related to unilateral brain oedema. No guidelines for the medical management of these attacks are available since treatment is empiric, and many cases do not respond to common antimigraine drugs...
September 19, 2016: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/27643137/ed-08-4-diagnosis-and-treatment-of-hypertensive-emergency-in-children
#15
Lin Shi
According to the seventh report of Joint National Committee (JNC 7), hypertensive emergency (HE), a kind of hypertensive crisis, is defined as a sudden and abrupt elevation in blood pressure so as to cause acute target organ dysfunctions, including central nervous system, cardiovascular system or kidneys. Patients with HE require immediate reduction in markedly elevated blood pressure. Currently, there are no international guidelines for children HE, so the JNC definition is commonly used. Hypertensive emergency in children is rare but a life-threatening emergency...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27638080/vestibular-migraine
#16
REVIEW
M von Brevern, T Lempert
During the last decades a new vestibular syndrome has emerged that is now termed vestibular migraine (VM). The main body of evidence for VM is provided by epidemiologic data demonstrating a strong association between migraine and vestibular symptoms. Today, VM is recognized as one of the most common causes of episodic vertigo. The clinical presentation of VM is heterogeneous in terms of vestibular symptoms, duration of episodes, and association with migrainous accompaniments. Similar to migraine, there is no clinical or laboratory confirmation for VM and the diagnosis relies on the history and the exclusion of other disorders...
2016: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/27629088/aprepitant-for-the-management-of-nausea-with-inpatient-iv-dihydroergotamine
#17
Denise E Chou, Amy R Tso, Peter J Goadsby
OBJECTIVE: To assess the efficacy and tolerability of oral aprepitant, a substance P/neurokinin A receptor antagonist, in controlling nausea associated with IV dihydroergotamine (DHE) administered for medically refractory migrainous headache in patients not responding to standard antiemetics or with a history of uncontrolled nausea with DHE. METHODS: This was a retrospective chart review of prospectively collected hourly diary data and clinical notes of patients hospitalized between 2011 and 2015 for inpatient treatment with DHE...
October 11, 2016: Neurology
https://www.readbyqxmd.com/read/27606340/metabotropic-glutamate-receptor-5-a-target-for-migraine-therapy
#18
Maggie W Waung, Simon Akerman, Mark Wakefield, Charlotte Keywood, Peter J Goadsby
INTRODUCTION: Many patients suffering from migraine gain little relief from existing treatments partly because many existing acute and preventive therapies used in migraine have been adopted from other neurologic conditions such as depression or epilepsy. Here, we present data supporting a new migraine-specific target, the mGlu5 receptor. METHODS: We studied the effect of mGlu5 blockade using ADX10059, on neuronal firing in the trigeminocervical complex (TCC) and durovascular effects of nociceptive trigeminovascular activation in the anesthetized rat...
August 2016: Annals of Clinical and Translational Neurology
https://www.readbyqxmd.com/read/27551404/the-change-of-neutrophils-lymphocytes-ratio-in-migraine-attacks-a-case-controlled-study
#19
Keziban Ucar Karabulut, Tomris Ugur Egercioglu, Mehmet Uyar, Yildiz Ucar
OBJECTIVE: As commonly seen symptoms, headaches are among the most frequently encountered health challenges in emergency rooms by healthcare professionals. Among one of the most commonly seen and primary headaches is migraine. Migraines are mostly accompanied by functional deficits. AIMS: To observe the changes of neutrophil/lymphocyte ratio occurring during migraine attacks. METHOD: This is a retrospective study where hospital records of patients previously diagnosed with migraine and admitted to the emergency with the complaints of attacks between May 2014 and January 2015 were investigated...
September 2016: Annals of Medicine and Surgery
https://www.readbyqxmd.com/read/27473746/acute-headache-presentations-to-the-emergency-department-a-statewide-cross-sectional-study
#20
Kevin H Chu, Tegwen E Howell, Gerben Keijzers, Jeremy S Furyk, Robert M Eley, Frances B Kinnear, Ogilvie Thom, Ibrahim Mahmoud, Anthony F T Brown
OBJECTIVES: The objective of this study was to describe demographic and clinical characteristics including features that were consistent with subarachnoid hemorrhage (SAH), use of diagnostic tests, emergency department (ED) discharge diagnoses, and disposition of adult patients presenting with an acute headache to EDs statewide across Queensland, Australia. In addition, potential variations in the presentation and diagnostic workup between principal-referral and city-regional hospitals were examined...
January 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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