0:00

Okay.

0:01

One of the most common scenarios that

0:03

you'll have in the emergency department is

0:07

a patient who has a new neurologic deficit.

0:10

And these may be secondary to transient ischemic

0:13

attacks or TIAs, or it may be secondary to

0:16

strokes, and that's gonna be the first scenario

0:19

that we're gonna deal with in this course.

0:22

What other clinical scenarios might

0:24

you see this under the same category?

0:27

Well, for example, new aphasia.

0:29

For most patients when you have new aphasia,

0:32

we're talking about a left middle cerebral artery

0:35

distribution infarction that we're concerned about.

0:38

So it's stroke.

0:39

Same thing with new-onset hemiparesis.

0:41

Now that might be left or right side, and that would

0:44

involve obviously the motor strip, which again is

0:47

within the middle cerebral artery distribution,

0:49

and we're concerned about a stroke facial droop.

0:53

Maybe a manifestation of a large vessel

0:56

occlusion, LVO, large vessel occlusion.

1:00

But it may also be found in patients who have

1:03

brainstem strokes, or it may even be found in patients

1:07

who have Bell's palsy, which is not a stroke,

1:11

but a viral illness affecting the facial nerve,

1:15

vertigo and dizziness, another neurologic deficit.

1:18

These patients, there's just so

1:19

many causes of patients to be dizzy.

1:22

But one of them is a vertebral

1:24

basilar artery infarction or ischemia.

1:27

And therefore, we do see those patients in the new

1:31

neurologic deficit, visual field loss, a lot less common.

1:36

That's usually a posterior cerebral artery

1:39

distribution infarction affecting the occipital lobes.

1:42

Or it could be something that's compressing, for

1:44

example, the optic chiasm, but sometimes it's just,

1:48

you know, my elderly father who is in the nursing home.

1:52

Or my elderly mother who is in the assisted

1:54

care facility is just not acting right.

1:57

And this is a new neurologic finding.

2:00

So these are the scenarios that you will see.

2:03

The other thing that you will see this

2:04

under is something called BAT.

2:08

Which is the brain attack team.

2:11

So this is a patient who has a suspected

2:15

acute stroke for which everything is very rushed.

2:17

You have to go and, and, and image the patient

2:20

as quickly as possible because they may be

2:22

having an acute or hyperacute stroke, the

2:25

so-called BAT team, brain attack team evaluation.

2:29

So what we're going to do now is I'm going to

2:31

ask you to review some of the unknown cases.

2:36

That are full DICOM series and then afterwards I will

2:41

review them and we can compare your interpretation

2:44

of the studies from my interpretation of the studies.

2:47

We'll see who gets it right.

Clinical Scenario 1: New Neurologic Deficit Introduction

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