International Journal of Emergency Medicine最新文献

{"title":"Impact of advanced trauma life support training on 30-day mortality in severely injured patients at a Kenyan tertiary center: a retrospective matched case-control study.","authors":"Charbel Kamau, Idris Chikophe, Abdulkarim Abdallah, Edwin Mogere","doi":"10.1186/s12245-024-00713-2","DOIUrl":"10.1186/s12245-024-00713-2","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma is a leading cause of mortality worldwide, particularly in low and middle-income countries (LMICs) like Kenya. This study evaluates the impact of Advanced Trauma Life Support (ATLS) training on 30-day mortality outcomes in severely injured patients at a tertiary care center in Kenya.</p><p><strong>Methods: </strong>A retrospective matched case-control study was conducted at Aga Khan University Hospital, Nairobi. The study included adult patients (≥ 18 years) with polytrauma (Injury Severity Score [ISS] > 15) from 2011 to 2022. Propensity score matching was used to pair 81 post-ATLS cases with 81 pre-ATLS controls based on age and ISS. Data analysis was performed using R Statistical language (version 4.3.0).</p><p><strong>Results: </strong>The 30-day mortality rate decreased significantly from 17% (95% CI: 9.4-27.4%) pre-ATLS to 6% (95% CI: 2.0-13.5%) post-ATLS (p = 0.028). No significant differences were found in baseline characteristics between the two groups. Road traffic accidents were the primary cause of trauma in both groups (72% pre-ATLS vs. 78% post-ATLS).</p><p><strong>Conclusion: </strong>ATLS training significantly reduced 30-day mortality in severely injured patients, demonstrating its effectiveness even in resource-limited settings. Further prospective randomized studies are recommended to confirm these findings and evaluate long-term outcomes.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual flagging failed to identify pseudohyperkalemia in acute myeloid leukemia: case report.","authors":"Yangming Cao","doi":"10.1186/s12245-024-00734-x","DOIUrl":"10.1186/s12245-024-00734-x","url":null,"abstract":"<p><strong>Background: </strong>Pseudohyperkalemia is well known in acute or chronic lymphocytic leukemia, but it is very rare in acute myeloid leukemia (AML). The lab flagging system for leukocytosis to prevent pseudohyperkalemia may not work.</p><p><strong>Case presentation: </strong>A 55 year-old white man with AML was sent to emergency department for transfusion due to severe anemia. Blood test showed severe leukocytosis and elevated potassium. Repeated blood test showed his potassium was even higher. Anti-hyperkalemic medical treatment was given. He was then diagnosed with pseudohyperkalema.</p><p><strong>Investigation: </strong>I was repeatedly reassured that the lab's manual flagging system for leukocytosis was the key in reaching the correct diagnosis. My persistent inquiries, however, revealed that the flagging system was not functioning in the care of this patient. It was clinicians' suspicion of pseudohyperkalema that led to the correct diagnosis, although the clinicians' recommendation of obtaining a heparinized plasma for test did not play a role because all blood samples were already heparinized. The cause of pseudohyperkalemia was pneumatic tube transport. After this incident, our laboratory is investigating the options of using the Laboratory Information System to automatically flag the results and Clinical Laboratory Scientists to make the chemistry team more aware of potentially erroneous potassium results due to pseudohyperkalemia.</p><p><strong>Conclusions: </strong>Pseudohyperkalemia associated with leukocytosis still occurs. This is the first case of pneumatic tube transport causing pseudohyperkalemia associated with AML. When significant leukocytosis, thrombocytosis, hyperproteinemia, or hyperlipidemia is present, whole blood should be utilized for potassium measurements and walked to the lab instead of sent by pneumatic tube transport. Even in a lab with a manual flagging system, there is still room to improve by implementing an automatic flagging system.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of cost-effectiveness of treating out of hospital cardiac arrest and the implications for resource-limited health systems.","authors":"Kalin Werner, Sarah Hirner, O Agatha Offorjebe, Edouard Hosten, Julian Gordon, Heike Geduld, Lee A Wallis, Nicholas Risko","doi":"10.1186/s12245-024-00727-w","DOIUrl":"10.1186/s12245-024-00727-w","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hospital cardiac arrest (OHCA) is a prevalent condition with high mortality and poor outcomes even in settings where extensive emergency care resources are available. Interventions to address OHCA have had limited success, with survival rates below 10% in national samples of high-income countries. In resource-limited settings, where scarcity requires careful priority setting, more data is needed to determine the optimal allocation of resources.</p><p><strong>Objective: </strong>To establish the cost-effectiveness of OHCA care and assess the affordability of interventions across income settings.</p><p><strong>Methods: </strong>The authors conducted a systematic review of economic evaluations on interventions to address OHCA. Six databases (PubMed, EMBASE, Global Health, Cochrane, Global Index Medicus, and Tuft's Cost-Effectiveness Registry) were searched in September 2023. Included studies were (1) economic evaluations (beyond a simple costing exercise); and (2) assessed an intervention in the chain of survival for OHCA. Article quality was assessed using the CHEERs checklist and data summarised. Findings were reported by major themes identified by the reviewers. Based upon the results of the cost-effectiveness analyses we then conduct an analysis for the progressive realization of the OHCA chain of survival from the perspective of decision-makers facing resource constraints.</p><p><strong>Results: </strong>Four hundred and sixty-eight unique articles were screened, and 46 articles were included for final data abstraction. Studies predominantly used a healthcare sector perspective, modeled for all patients experiencing non-traumatic cardiac OHCA, were based in the US, and presented results in US Dollars. No studies reported results or used model inputs from low-income settings. Progressive realization of the chain of survival could likely begin with investments in termination of resuscitation protocols, professional prehospital defibrillator use, and CPR training followed by the distribution of AEDs in high-density public locations. Finally, other interventions such as indiscriminate defibrillator placement or adrenaline use, would be the lowest priority for early investment.</p><p><strong>Conclusion: </strong>Our review found no high-quality evidence on the cost-effectiveness of treating OHCA in low-resource settings. Existing evidence can be utilized to develop a roadmap for the development of a cost-effective approach to OHCA care, however further economic evaluations using context-specific data are crucial to accurately inform prioritization of scarce resources within emergency care in these settings.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of early death in heat stroke and the challenges of emergency care in Hungary - a case series study.","authors":"Kornél Ádám, Tamás Berényi, Dóra Melicher, Bánk G Fenyves, Szabolcs Gaál, Csaba Varga","doi":"10.1186/s12245-024-00743-w","DOIUrl":"10.1186/s12245-024-00743-w","url":null,"abstract":"<p><strong>Background and aim: </strong>The increasing frequency of heat waves worldwide is a major challenge for emergency care providers worldwide. The aim of this study was to analyze the clinical features, treatment options, and early outcomes of heat stroke patients presenting to a large academic emergency department (ED) in Hungary and to provide guidance in management for other emergency professionals.</p><p><strong>Methods: </strong>Patients presenting to the ED between June 1, 2024, and July 31, 2024, with a body temperature above 40 °C were analyzed in a retrospective cohort study. Data collection included demographic, clinical and laboratory parameters. Predictors of mortality were analyzed with Mann-Whitney U test.</p><p><strong>Results: </strong>Eight patients were included in our analysis. Three patients died in the ED (37.5%). Patients who died had significantly lower pH (7.07 vs. 7.4, p = 0.036), higher potassium (7.3 vs. 3.2 mmol/L, p = 0.036), higher calcium (1.19 vs. 0.97 mmol/L, p = 0.036), higher lactate (10.9 vs. 3.5 mmol/L, p = 0.036) and higher PaCO2 (57.2 vs. 28 mmHg, p = 0.036) at admission compared to those who did not die.</p><p><strong>Conclusions: </strong>The risk of heat stroke due to climate change-induced heat stress and the consequent thermoregulatory disruption may now be significant in temperate climate zones where it was not previously present. Standardization of differential diagnostic and therapeutic procedures could reduce mortality. pH, potassium, lactate and calcium levels may play an important role in predicting the outcome of heat stroke.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive approach to managing brachiocephalic trunk cannulation complicating central venous catheterization: a case report.","authors":"Haihui Deng, Bin Chen, Deti Peng, Fuwen Pang","doi":"10.1186/s12245-024-00744-9","DOIUrl":"10.1186/s12245-024-00744-9","url":null,"abstract":"<p><strong>Background: </strong>Central venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment.</p><p><strong>Case presentation: </strong>A 74-year-old woman in the recovery phase of cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography (CT) and digital subtraction angiography (DSA). With the high surgical risk and the complexity of endovascular treatment, catheter replacement was chosen. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was retracted without complications. Follow-up CT and DSA revealed no leakage, with the patient's vitals remaining stable. A three-month post-discharge phone follow-up confirmed the patient's continued stability.</p><p><strong>Conclusion: </strong>This case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure's accuracy and safety.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute mesenteric ischemia secondary to complete AV block and acute systolic heart failure: a case report.","authors":"Jian Cui","doi":"10.1186/s12245-024-00737-8","DOIUrl":"10.1186/s12245-024-00737-8","url":null,"abstract":"<p><strong>Background: </strong>Acute mesenteric ischemia (AMI) usually presents with abrupt and severe abdominal pain associated with nausea and vomiting. This case is notable due to the occurrence of AMI secondary to acute systolic heart failure caused by new onset complete heart block.</p><p><strong>Case presentation: </strong>A 65-year-old male presented with sudden onset epigastric pain. ECG showed complete AV block and acute ischemia, and a subsequent CTA revealed complete occlusion of the mid superior mesenteric artery. His emergent left heart catheterization showed non-occlusive coronary artery disease. The patient underwent emergent laparotomy and SMA thrombectomy. Postoperative complications included worsening congestive heart failure and persistent bradycardia, requiring a permanent pacemaker. The patient was discharged to a skilled nursing facility in stable condition.</p><p><strong>Conclusions: </strong>This case highlights the diagnostic challenges of AMI in the setting of acute heart failure and new onset AV block mimicking acute cardiac events and emphasizes the importance of a multidisciplinary approach in managing such complex cases.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11463034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of smart watch in expediting diagnosis of cold drink-triggered atrial fibrillation: a case report.","authors":"Grace V Heringer, David R Vinson","doi":"10.1186/s12245-024-00716-z","DOIUrl":"10.1186/s12245-024-00716-z","url":null,"abstract":"<p><strong>Background: </strong>Patients presenting to the emergency department with recent palpitations are a diagnostic challenge when the arrhythmia and its symptoms have resolved prior to arrival. Newer smart watch technology, adept at detecting atrial fibrillation, can assist in the diagnostic evaluation of transitory palpitations. We report a case of cold drink-triggered atrial fibrillation whose diagnosis would not have been possible without the assistance of the patient's smart watch.</p><p><strong>Case presentation: </strong>A middle-aged man without cardiac history developed sudden rapid, irregular palpitations with shortness of breath while drinking a glass of cold juice. He activated his smart watch with 1-lead electrocardiography technology which detected rapid atrial fibrillation. He sought medical care, but while waiting, his symptoms-then 90 min in duration-spontaneously resolved. His initial diagnostic evaluation documented only sinus rhythm, as did several follow-up evaluations with cardiology the next several weeks. Had it not been for his smart watch, the etiology of his transitory palpitations would have remained undiagnosed. His physicians encouraged trigger avoidance. In the following months, he avoided rapid ingestion of cold drink, taking instead small sips. The atrial fibrillation has not recurred.</p><p><strong>Conclusions: </strong>The case illustrates the valuable contribution of smart watch technology in the diagnostic evaluation of patients with short-lived palpitations. The case also educates clinicians about cold drink and food as a trigger of paroxysmal atrial fibrillation. This trigger, like alcohol, can be modified. Cold drink trigger avoidance has been reported by patients to reduce atrial fibrillation recurrence and is a low-risk, cost-effective strategy that is often successful.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The polk county screening tool screening for detecting subarachnoid hemorrhage.","authors":"Krish Patel, Sanjana Konda, Latha Ganti, Anjali Banerjee, Paul Banerjee","doi":"10.1186/s12245-024-00722-1","DOIUrl":"10.1186/s12245-024-00722-1","url":null,"abstract":"<p><strong>Introduction: </strong>The subarachnoid space in the brain contains crucial blood vessels and cerebrospinal fluid. Aneurysms in these vessels can lead to subarachnoid hemorrhage (SAH), a serious stroke subtype with high morbidity and mortality rates. SAH treatment includes procedures like coiling and clipping, but these are available only at comprehensive stroke centers (CSCs), necessitating urgent diagnosis and transfer to specialized facilities.</p><p><strong>Methods: </strong>This IRB-approved study was conducted by Polk County Fire Rescue (PCFR) in Florida. PCFR, serving an 850,000-person population, implemented a three-step SAH protocol. The protocol uses both Ottawa SAH criteria and recurring symptoms, such as new-onset seizures and high systolic blood pressure, that were identified by EMS. Acute management included administering labetalol, levetiracetam, and ondansetron.</p><p><strong>Results: </strong>Of 2175 stroke patients, 80 screened positive for SAH and were eligible for transfer. Patients had a median age of 66, and 33% had an initial systolic BP over 220 mmHg. The interfacility transfer rate dropped from 12.9 to 3.6% after implementing the protocol.</p><p><strong>Conclusion: </strong>The PCFR protocol's effectiveness suggests its potential for nationwide implementation. Early SAH recognition and prompt transfer to CSCs reduce complications and improve outcomes. Accurate field diagnosis by EMTs can prevent unnecessary transfers and enhance patient care. Future improvements may include portable diagnostic tools and enhanced EMT training to further improve SAH patients' pre-hospital care.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated high-sensitive cardiac troponin T in emergency department patients: insights from a retrospective descriptive cohort study.","authors":"Finn Syryca, Bernhard Haller, Lisa Schmid, Christiane Kallweit, Philipp Nicol, Teresa Trenkwalder, Karl-Georg Kanz, Anja Haas, Michael Dommasch","doi":"10.1186/s12245-024-00735-w","DOIUrl":"https://doi.org/10.1186/s12245-024-00735-w","url":null,"abstract":"<p><strong>Background: </strong>High-sensitive cardiac troponin T (hs-cTnT) assessments are routinely conducted in German emergency departments (EDs). However, data describing a large number of ED patients with pathological hs-cTnT levels and subsequent clinical outcomes are limited.</p><p><strong>Methods: </strong>This retrospective descriptive analysis included 141.892 patients who presented to the interdisciplinary ED at Klinikum rechts der Isar in Munich, Germany, between January 2019 and December 2021. Patients with trauma diagnoses were excluded, focusing on those with elevated hs-cTnT levels. These patients were categorized into three groups based on the International Classification of Procedures in Medicine (ICPM): those with elevated hs-cTnT who received no coronary angiography (NCA), those who underwent diagnostic coronary angiography (DCA), and those who received percutaneous coronary intervention (PCI). The objective of this study was to characterize a large emergency department patient cohort and assess their subsequent clinical outcomes.</p><p><strong>Results: </strong>After initial Manchester Triage Sytem (MTS) categorization, 32.6% (46.307/141.892) of patients were identified as non-trauma cases. Of these, 9.9% (4.587/46.307) had hs-cTnT levels exceeding 14 ng/L. Within this subset, 70.4% (3.230/4.587) did not undergo coronary angiography, 15.4% (705/4.587) underwent DCA and 14.2% (652/4.587) received PCI. Chest pain occurred more frequently in the PCI group (28.0%, 160/652) compared to the DCA group (18.3%, 113/705) or NCA group (5.7%, 159/3230), p < 0.001. However, breathing problems occurred more frequently in the NCA group (23.2%, 647/3230) compared to the PCI group (17.7%, 101/652) or DCA group (21.8%, 135/705), p < 0.001. Also, collapse was more frequent in patients in the NCA group (4.0%, 112/3230) compared to the DCA group (3.4%, 21/705) or PCI group (3.5%, 20/652), p < 0.001. Overall, in-hospital mortality was significantly higher in the NCA group (7.9%, 256/3230) compared to the DCA group (2.3%, 16/705) or PCI group (4.1%, 27/652), p < 0.001.</p><p><strong>Conclusion: </strong>Emergency patients with elevated hs-cTnT who did not undergo coronary angiography faced a higher risk of in-hospital mortality in our retrospective descriptive study. Given the heterogeneous nature of presenting complaints in emergency departments, identifying at-risk patients can pose challenges for treating physicians.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11457446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A diagnosis that's hard to swallow: case report of delayed onset lateral medullary syndrome presenting with only dysphagia.","authors":"Jose Ernesto Gomez, Eric Justin Ho","doi":"10.1186/s12245-024-00709-y","DOIUrl":"https://doi.org/10.1186/s12245-024-00709-y","url":null,"abstract":"<p><strong>Background: </strong>Lateral Medullary Syndrome (LMS) is a posterior circulation stroke (PCS) that has a broad array of manifestations but most classically presents with Horner's syndrome, ipsilateral ataxia, and ipsilateral hyperalgesia. Although dysphagia is also common, isolated and single presentation of this alone is rare and there are only a few case reports of this in the literature. This presentation can bias a clinician's differential diagnosis and delay diagnosis.</p><p><strong>Case presentation: </strong>A previously healthy 53-year-old-male presented with a complaint of dysphagia. He had no PCS symptoms, a National Institute of Health Stroke Scale (NIHSS) of zero, and an otherwise unremarkable neurological exam. Stroke imaging including non-contrast computed tomography (NCCT) scan of his head and computed tomography angiography (CTA) scan of his head and neck revealed no acute abnormalities. He was found to be positive for Influenza A, but otherwise all other etiologies for his dysphagia were worked up, including consultation with other specialty services, without resolve. Two days later, the patient subsequently developed new right sided sensory deficits and left sided Horner's syndrome, in which a magnetic resonance imaging (MRI) scan of his head revealed an acute infarct of the left lateral medulla with likely thrombus in the left posterior inferior cerebellar artery (PICA).</p><p><strong>Conclusions: </strong>PCS is frequently missed due to the often-vague symptoms and reassuring negative imaging. This case highlights the variability of presentations that ED physicians may encounter. Nonetheless, a high index of suspicion for PCS should be maintained even in young patients without risk factors. Lastly, dysphagia is never normal, and this case demonstrates the need to reconsider neurogenic origin when other causes have been ruled out.</p>","PeriodicalId":13967,"journal":{"name":"International Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}