Journal of Emergency Medicine最新文献

{"title":"Prevalence and Clinical Relevance of Incidental Computed Tomography Findings in Pediatric Trauma: A Systematic Review and Meta-Analysis of 23,706 Patients","authors":"Amani N. Alansari MD ,&nbsp;Sandra Abusamaan MD ,&nbsp;Tahyia Alyafei MD ,&nbsp;Alaa Ahmed Elshanbary MD ,&nbsp;Mohamed Sayed Zaazouee MD","doi":"10.1016/j.jemermed.2025.09.022","DOIUrl":"10.1016/j.jemermed.2025.09.022","url":null,"abstract":"<div><h3>Background</h3><div>Radiological computed tomography (CT) reports often reveal incidental findings (IFs) unrelated to acute clinical concerns. These findings can range from clinically significant to benign variants, and their identification may have implications for follow-up care, resource utilization, and patient outcomes.</div></div><div><h3>Objective</h3><div>This study aims to estimate the pooled IFs on CT scans in pediatric trauma patients and to classify these findings into clinically meaningful categories.</div></div><div><h3>Methods</h3><div>PubMed, Web of Science, Scopus, and the Cochrane Library were searched from database inception up to April 2025 for studies reporting incidental findings on CT in pediatric trauma patients. Incidental findings were categorized as: category 1 (clinically significant requiring urgent follow-up), category 2 (indeterminate, requiring context-based evaluation), and category 3 (benign variants requiring no follow-up). Quantitative analyses were performed using Comprehensive Meta-Analysis (CMA) software, employing a random-effects model with 95% confidence intervals.</div></div><div><h3>Results</h3><div>Eleven studies were included in this meta-analysis. The overall pooled incidence of incidental findings on CT scans was 20.1% (95% CI: 9.6%–37.3%). Among incidental findings, 5.5% were classified as category 1, 36.7% as category 2, and 45.2% as category 3. Masses (tumors or nodules) were rare, constituting 0.8% (95% CI: 0.5%–1.3%), whereas cysts were more prevalent at 4.5% (95% CI: 2.8%–7.1%). Considerable heterogeneity was observed across studies (I² &gt; 90% for most categories), likely reflecting differences in study design, populations, and reporting practices.</div></div><div><h3>Conclusion</h3><div>Incidental findings are highly prevalent in pediatric trauma CT scans. This underscores the importance of standardized reporting and appropriate follow-up protocols. Categorization of these findings provides clinically useful insights, though the substantial heterogeneity observed suggests that clinical context plays an important role.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 152-164"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis of Late-Presenting Congenital Diaphragmatic Hernia by Point-of-Care Ultrasound","authors":"Abdullatif Alkhurayji MD ,&nbsp;Tasuku Takadera MD ,&nbsp;Maya Harel-Sterling MD, MScCH","doi":"10.1016/j.jemermed.2025.10.005","DOIUrl":"10.1016/j.jemermed.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Congenital diaphragmatic hernia (CDH) is a rare developmental anomaly, defined by a defect in the diaphragm that permits herniation of abdominal viscera into the thoracic cavity. While the majority of CDH cases are identified prenatally or present with severe respiratory distress in the immediate neonatal period, a minority are diagnosed beyond the first month of life, referred to as late-presenting or delayed-diagnosis CDH.</div></div><div><h3>Case Report</h3><div>Here we describe a previously well, full-term 2-month-old infant presenting with sudden onset of respiratory distress and cyanosis, initially raising concern for an acute pulmonary or cardiac event. Point-of-care ultrasound (POCUS) confirmed the diagnosis of CDH, demonstrating the presence of bowel loops with peristalsis in the left chest.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>POCUS can serve as a valuable diagnostic tool for infants with acute respiratory symptoms and can confirm the rare and life-threatening diagnosis of CDH when X-ray imaging is not readily available or is challenging to interpret.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 177-180"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145596686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stewardship of Intravenous Fluids During Shortage and Beyond","authors":"Andrew R. Moore MD ,&nbsp;Alexandra June Gordon MD ,&nbsp;James T. Marvel MD ,&nbsp;Manoj V. Maddali MD ,&nbsp;Jonathan H. Chen MD, PHD ,&nbsp;Alfredo Urdaneta MD ,&nbsp;Jennifer G. Wilson MD, MS","doi":"10.1016/j.jemermed.2025.09.027","DOIUrl":"10.1016/j.jemermed.2025.09.027","url":null,"abstract":"<div><h3>Background</h3><div>Recent supply chain issues caused by Hurricane Helene highlighted opportunities to improve stewardship of intravenous (IV) fluids.</div></div><div><h3>Objectives</h3><div>To quantify IV fluid bags saved by using “round down” strategies designed to limit use of partial bags of IV fluid in the emergency department (ED), and to estimate the associated environmental impact of this intervention.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of all 30 mL/kg IV fluid bolus orders placed in the EDs at Stanford Healthcare for adult patients from 2020 to 2023. We calculated the number of IV fluid bags that would be saved or reduced in size by rounding down to either the nearest 250 mL or the nearest 500 mL. Projected environmental impact was assessed using previously published estimates of CO₂ emissions and plastic waste generated by IV fluid use.</div></div><div><h3>Results</h3><div>Across 11,964 30 mL/kg IV fluid orders, rounding down would have saved up to 1567 bags of IV fluid, and reduced the size of IV fluid bag used for up to 3890 boluses. Depending on which “round down” strategy was used, the median reduction in fluid volume was 121 to 244 mL per patient. For each 1000 patients, this reduction was estimated to decrease CO₂ emissions by 112.8 kg and eliminate 14 kg of plastic waste.</div></div><div><h3>Conclusion</h3><div>Use of a “round down” strategy for IV fluid resuscitation in sepsis could substantially reduce the number of bags of IV fluid used, with associated reductions in CO₂ emissions and plastic waste.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 194-198"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexplained Back Pain in the Emergency Department May Require Referral to a Neurologist or Orthopedist","authors":"Josef Finsterer MD, PhD","doi":"10.1016/j.jemermed.2025.09.003","DOIUrl":"10.1016/j.jemermed.2025.09.003","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 319-320"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145972800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Value of the Clinical Frailty Scale in Critically Ill Older Adult Patients in the Emergency Department","authors":"Young Woo Um MD, MSC ,&nbsp;You Hwan Jo MD, PHD ,&nbsp;Jae Hyuk Lee MD, PHD ,&nbsp;Inwon Park MD, PHD ,&nbsp;Ji Eun Hwang MD, MSC ,&nbsp;Seung Hyun Kang MD ,&nbsp;Narae Kim MD","doi":"10.1016/j.jemermed.2025.10.025","DOIUrl":"10.1016/j.jemermed.2025.10.025","url":null,"abstract":"<div><h3>Background</h3><div>As populations age, emergency department (ED) visits by older patients are rising, many of whom present in critically ill state. This trend necessitates frailty assessment in clinical decision-making to guide appropriate goals of care.</div></div><div><h3>Objectives</h3><div>This study aims to evaluate the prognostic value of the Clinical Frailty Scale (CFS) among critically ill older ED patients.</div></div><div><h3>Methods</h3><div>In this prospective cohort study at a South Korean tertiary hospital, patients aged ≥65 years with Korean Triage and Acuity Scale levels 1 or 2 were included and grouped by CFS scores: nonfrail (1–3), mildly frail (4–5), moderately frail (6), severely frail (7), and very severely frail (8). The primary outcome was 3-month mortality. Data were analyzed using the Cox proportional hazards model and area under the receiver operating characteristic curve (AUROC).</div></div><div><h3>Results</h3><div>A cohort of 502 patients was analyzed (median age 78 years). The median CFS score was 5, with 73.8% classified as frail (CFS ≥ 4). The 3-month mortality rate was 29.0%. Hazard ratios (95% confidence intervals [CIs]) for 3-month mortality were 1.97 (1.14–3.39) for CFS 6, 2.56 (1.51–4.32) for CFS 7, and 3.99 (2.03–7.86) for CFS 8. Adding CFS categories significantly improved 3-month mortality prediction (AUROC [95% CI] with CFS: 0.74 [0.69–0.79], without CFS: 0.70 [0.65–0.75], <em>p</em> = 0.003), although the overall predictive performance remained similar.</div></div><div><h3>Conclusion</h3><div>Higher CFS scores were significantly associated with increased 3-month mortality among critically ill older ED patients, highlighting the prognostic value of the CFS.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 33-43"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pearls and Pitfalls: Severe Bradycardia","authors":"Mounir Contreras Cejin MD ,&nbsp;Alex Koyfman MD ,&nbsp;Brit Long MD","doi":"10.1016/j.jemermed.2025.11.002","DOIUrl":"10.1016/j.jemermed.2025.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Severe bradycardia is a serious condition that carries with it a high rate of morbidity and mortality.</div></div><div><h3>Objective of the Review</h3><div>This review highlights the pearls and pitfalls of severe bradycardia, including presentation, diagnosis, and management in the emergency department based on current evidence.</div></div><div><h3>Discussion</h3><div>Severe bradycardias are critical conditions that can cause hemodynamic instability, necessitating emergent evaluation and management. Common causes include intrinsic conduction system disease, acute coronary syndrome, and acute myocardial infarction, pharmacologic agents (e.g., beta-blockers, calcium channel blockers, digitalis), and metabolic disturbances (e.g., hyperkalemia, decompensated hypothyroidism, hypothermia), among others. A focused history and physical examination are necessary to narrow the differential diagnosis. An electrocardiogram is essential and may establish a definitive diagnosis. Laboratory studies directed toward a specific, identifiable diagnosis can be useful, such as elevated serum troponin or potassium values. Initial management aims to increase the heart rate and thus stabilize cardiac output via initiation of transcutaneous pacing and administration of chronotropic agents while addressing the underlying cause. In cases of severe bradycardia with accompanying hypotension despite initial therapy, transvenous pacing may be required. Early recognition and prompt management of severe bradycardia are vital to preventing hemodynamic collapse. By combining a systematic diagnostic approach with tailored interventions, clinicians can effectively address underlying causes and improve patient outcomes, even in the most critical scenarios.</div></div><div><h3>Conclusion</h3><div>An understanding of severe bradycardia can assist emergency clinicians in diagnosing and managing this potentially deadly condition.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"80 ","pages":"Pages 297-316"},"PeriodicalIF":1.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145786579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Torsion of Undescended Testis in Children Detected By Point-of-Care Ultrasound","authors":"Takaaki Mori MD, MRCPCH, MSc,&nbsp;Sung Shin Teng MBBS, MRCPCH, FAMS","doi":"10.1016/j.jemermed.2025.08.030","DOIUrl":"10.1016/j.jemermed.2025.08.030","url":null,"abstract":"<div><h3>Background</h3><div>Torsion of undescended testis (UDT) is a rare urological emergency requiring immediate intervention to salvage the affected testis. Ultrasonography is used for identifying torsion of UDT, but it is mostly performed by radiologists or urologists. Point-of-care ultrasound (POCUS) is currently used in pediatric emergency care but reports of its use for diagnosing torsion of UDT are scarce.</div></div><div><h3>Case Report</h3><div>A previously healthy 11-year-old male patient presented to our emergency department (ED) complaining of swelling of his left inguinal area with mild pain. He denied having any fever, vomiting, or diarrhea. Vital signs were appropriate for his age. Physical examination revealed an approximately 3 cm, hard, and tender mass over his left inguinal area without erythema or fluctuation. No mass was palpated over the right inguinal area. POCUS showed an empty left scrotal sac, and an oval-shaped, homogeneous, hypoechoic structure suggestive of a testis in the left inguinal area. POCUS also detected a hyperechoic structure posterior to the left testis with a whirlpool sign, indicating a twisted spermatic cord. Based on the POCUS findings, the patient was referred to the pediatric surgeon for concern of torsion of UDT. Radiology department ultrasonography also suggested torsion of UDT, and urgent surgical exploration was performed. Torsion of UDT was confirmed and orchidopexy done. The patient was discharged without any complications on the second post-operative day.</div></div><div><h3>Why Should an Emergency Physician Be Aware of tThis?</h3><div>Torsion of UDT is often challenging to diagnose due to its atypical presentation. POCUS can directly visualize structures in the inguinal canal to differentiate potential causes, empowering physicians to diagnose torsion of UDT promptly and optimize patient care.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"79 ","pages":"Pages 323-326"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triage Pediatric Age-Adjusted Shock Index as a Predictor of Hospital Admission","authors":"Mishuka Adhikary MD ,&nbsp;Ellen J. Silver PhD ,&nbsp;Daniel M. Fein MD","doi":"10.1016/j.jemermed.2025.05.003","DOIUrl":"10.1016/j.jemermed.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Shock index (SI), the ratio of heart rate to systolic blood pressure, is a valuable prognostic tool for assessing shock severity and predicting morbidity and mortality in trauma. Emergency department (ED) triage SI shows promise as an alternative prognostic tool for predicting hospital admission and inpatient mortality in adults. Pediatric age-adjusted shock index (SIPA) has been validated for identification of mortality in children with blunt trauma.</div></div><div><h3>Objective</h3><div>To determine whether ED triage SIPA can be used to predict disposition.</div></div><div><h3>Methods</h3><div>Retrospective chart review of patients aged 4–20 years who were either admitted or discharged from a quaternary care pediatric ED in 2019. Initial SIPA values were characterized as high or low based on established age-based cutoffs. Association between high SIPA and inpatient admission was evaluated.</div></div><div><h3>Results</h3><div>There were 29,064 eligible ED encounters in the study period. High triage SIPA was associated with female sex, age less than 12 years old, emergency severity index 1–2, and clinical conditions involving fever, sepsis, dehydration and respiratory distress. Overall, those with high triage SIPA were 2.4 (95% CI 2.21–2.60) times more likely to be admitted. Among admitted patients, high triage SIPA was associated with higher odds of intensive care unit admission (OR 3.2; 95% CI 2.5–4.2) and higher odds of rapid response (OR 3.9; 95% CI 1.8–8.7) within the first 24 hours on the inpatient unit.</div></div><div><h3>Conclusion</h3><div>Elevated triage SIPA is associated with higher odds of admission, intensive care unit admission and rapid response in first 24 hours of admission.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"79 ","pages":"Pages 399-409"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145444966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartwatch-Based Detection of Ventricular Dysrhythmias: A Systematic Review of Literature","authors":"Yuval Avidan MD,&nbsp;Razi Khoury MD,&nbsp;Ibrahim Naoum MD,&nbsp;Asaf Danon MD, MSc,&nbsp;Amir Aker MD","doi":"10.1016/j.jemermed.2025.10.007","DOIUrl":"10.1016/j.jemermed.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>The rise of smartwatches introduces a novel technology for detecting dysrhythmias. However, the diagnosis of ventricular dysrhythmias (VDs) usually requires automatic recording modes. There is a scarcity of literature on smartwatch-based VDs detection.</div></div><div><h3>Objectives</h3><div>We conducted a literature review to synthesize current evidence on the clinical profiles of smartwatch-detected VDs and to highlight their detectability in real-world settings.</div></div><div><h3>Methods</h3><div>PubMed, Embase, Scopus, and the Cochrane Library were searched from inception to May 2025 for studies reporting smartwatch-based detection of VDs, with availability of participant-level data. Two investigators independently extracted study data and quality.</div></div><div><h3>Results</h3><div>A total of 20 patients from 18 articles were included, with a mean age of 48 years; 35% were over 60 years of age, and 35% had a documented history of structural heart disease. Primary complaints were palpitations (70%) and syncope (20%). Sustained monomorphic ventricular tachycardia was the most common dysrhythmia (60%), followed by polymorphic ventricular tachycardia (25%). Vasospastic angina and idiopathic ventricular tachycardia were the leading diagnoses. Interventions included coronary angiography (25%), electrophysiology studies (35%), catheter ablation (35%), and implantable cardioverter defibrillators (45%). The rest received medical therapy.</div></div><div><h3>Conclusions</h3><div>Smartwatches may provide valuable outpatient data that support timely diagnosis and appropriate therapy across diverse clinical scenarios. As exemplified in this review, the detectability of VDs through smartwatches in real-world settings is feasible. Emergency department interrogation of smartwatch data may provide valuable information.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"79 ","pages":"Pages 610-618"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case Report of Headache and Weakness Diagnosed as Functional Neurological Disorder","authors":"Drew Castleberry MD ,&nbsp;Michael P. Wilson MD, PhD ,&nbsp;Kimberly Nordstrom MD, JD","doi":"10.1016/j.jemermed.2025.04.012","DOIUrl":"10.1016/j.jemermed.2025.04.012","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral venous sinus thrombosis (CVST) is a rare diagnosis and is estimated at 1.32-1.57 per 100,000 cases. Patients with CVST often present with headache, seizures, focal motor deficits, encephalopathy, or aphasia, and can be fatal in 3%-15% of cases. Newer diagnostic criteria indicate functional neurological disorder (previously known as conversion disorder) as a “rule in” diagnosis that should be given only if patients meet strict criteria.</div></div><div><h3>Case Report</h3><div>A 26-year-old woman with a past medical history of depression during pregnancy, anxiety, and migraines, presented to a large emergency department in the United States with headache, unilateral weakness, spastic movement, numbness, and “feeling off.” At the time of presentation, she had a Glasgow Coma Scale score of 14 and was approximately 7 weeks postpartum and had resumed oral contraceptives 11 days prior. After a normal head computed tomography scan, she was discharged with a diagnosis of anxiety reaction and headache, with question of possible conversion disorder. The patient returned the next morning with worsening weakness and inability to walk. Given that she was only intermittently following commands, she was admitted for seizure monitoring, with particular concern for psychogenic nonepileptic seizures. A magnetic resonance imaging scan ordered by the admitting hospitalist indicated left thalamic infarct secondary to cerebral venous thrombosis.</div></div><div><h3>Why Should an Emergency Physician Be Aware of This?</h3><div>CVST should be considered on the differential for premenopausal women presenting with headache, altered mental status, and focal neurological deficits. The diagnosis of functional neurological disorder was previously thought of as a diagnosis of exclusion, however, it is now a diagnosis of inclusion using specific positive findings.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"79 ","pages":"Pages 639-645"},"PeriodicalIF":1.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}