Rationale:Diffusion-weighted imaging(DWI)is a cardinal tool for detecting acute brain ischemia;however,recent studies have shown that DWI may not show the ischemic lesion during the hyperacute period.Patient concerns:...Rationale:Diffusion-weighted imaging(DWI)is a cardinal tool for detecting acute brain ischemia;however,recent studies have shown that DWI may not show the ischemic lesion during the hyperacute period.Patient concerns:A 76-year old male patient was admitted due to an acute onset of dysarthria and right lower paresis which progressed on the second day of admission.Diagnosis:The preliminary diagnosis was an ischemic stroke and the final diagnosis was left medullary stroke.Interventions:Antiaggregant and anticoagulant therapies were initiated after excluding hemorrhagic stroke by cranial computed tomography.However,DWIs,which were recorded on the 6th hour and 19th hour after the symptom onset,were in normal ranges.Hence,the patient was referred to a senior hospital for further etiological investigations.Outcome:The patient was discharged after treatments with aspirin and atorvastatin,and the neurological examination showed mild-moderate dysarthria and moderate right-sided paralysis(3/5).Lessons:Clinicians should pay more attention to stroke patients with negative DWI and perform DWI several times when the diagnostic is unclear.展开更多
Distinguishing stroke mimics constitutes a considerable challenge for clinicians in emergency department. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally rece...Distinguishing stroke mimics constitutes a considerable challenge for clinicians in emergency department. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally received diagnosis of tardive phenomenon associated with betahistine. Through the presentation of this case, we point out tardive phenomenon as an alternative differential diagnosis of stroke. Furthermore, this case adds substantial data presenting an interesting manifestation of isolated dysarthria as a tardive phenomenon, occurring due to betahistine usage which is extremely rare in literature.展开更多
Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who v...Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.展开更多
Dear Editor, A-72-year-old male with medical history of hypertension admitted with acute onset double vision.On neurological examination,right eye could not adduct whereas nystagmus occurs on the left eye abduction.Cr...Dear Editor, A-72-year-old male with medical history of hypertension admitted with acute onset double vision.On neurological examination,right eye could not adduct whereas nystagmus occurs on the left eye abduction.Cranial diffusion weighted imaging (DWI) was in normal ranges.Based on the negative DWI result and atypical clinical presentation for stroke,third nerve paly was considered in the forefront and the patient was planned to be discharged with suggestion of ophthalmology outpatient visit.However,following neurology evaluation,the diagnosis of left internuclear ophthalmoplegia (INO) was favored.展开更多
A 67-year-old male with a medical history of hypertension,diabetes mellitus,and previous ischemic stroke applied to the neurology outpatient clinic due to acute onset double vision which had abruptly started 2 days ag...A 67-year-old male with a medical history of hypertension,diabetes mellitus,and previous ischemic stroke applied to the neurology outpatient clinic due to acute onset double vision which had abruptly started 2 days ago.On neurological examination,the right eye could not adduct whereas nystagmus occurs on the left eye abduction(Figure 1).Upon history interrogation,it was learned that the patient had applied to the emergency department two days ago and cranial diffusion-weighted imaging(DWI)was performed which resulted in normal ranges(Figure 2).展开更多
文摘Rationale:Diffusion-weighted imaging(DWI)is a cardinal tool for detecting acute brain ischemia;however,recent studies have shown that DWI may not show the ischemic lesion during the hyperacute period.Patient concerns:A 76-year old male patient was admitted due to an acute onset of dysarthria and right lower paresis which progressed on the second day of admission.Diagnosis:The preliminary diagnosis was an ischemic stroke and the final diagnosis was left medullary stroke.Interventions:Antiaggregant and anticoagulant therapies were initiated after excluding hemorrhagic stroke by cranial computed tomography.However,DWIs,which were recorded on the 6th hour and 19th hour after the symptom onset,were in normal ranges.Hence,the patient was referred to a senior hospital for further etiological investigations.Outcome:The patient was discharged after treatments with aspirin and atorvastatin,and the neurological examination showed mild-moderate dysarthria and moderate right-sided paralysis(3/5).Lessons:Clinicians should pay more attention to stroke patients with negative DWI and perform DWI several times when the diagnostic is unclear.
文摘Distinguishing stroke mimics constitutes a considerable challenge for clinicians in emergency department. Here, we illustrate an extremely rare patient presenting with acute onset isolated dysarthria, who finally received diagnosis of tardive phenomenon associated with betahistine. Through the presentation of this case, we point out tardive phenomenon as an alternative differential diagnosis of stroke. Furthermore, this case adds substantial data presenting an interesting manifestation of isolated dysarthria as a tardive phenomenon, occurring due to betahistine usage which is extremely rare in literature.
文摘Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.
文摘Dear Editor, A-72-year-old male with medical history of hypertension admitted with acute onset double vision.On neurological examination,right eye could not adduct whereas nystagmus occurs on the left eye abduction.Cranial diffusion weighted imaging (DWI) was in normal ranges.Based on the negative DWI result and atypical clinical presentation for stroke,third nerve paly was considered in the forefront and the patient was planned to be discharged with suggestion of ophthalmology outpatient visit.However,following neurology evaluation,the diagnosis of left internuclear ophthalmoplegia (INO) was favored.
文摘A 67-year-old male with a medical history of hypertension,diabetes mellitus,and previous ischemic stroke applied to the neurology outpatient clinic due to acute onset double vision which had abruptly started 2 days ago.On neurological examination,the right eye could not adduct whereas nystagmus occurs on the left eye abduction(Figure 1).Upon history interrogation,it was learned that the patient had applied to the emergency department two days ago and cranial diffusion-weighted imaging(DWI)was performed which resulted in normal ranges(Figure 2).
