Take a moment to review part 1 and part 2. Now we’ll take a more in-depth look at the Circle of Willis. This is a type of anastomosis, or connection between vessels, which helps preserve blood flow in the brain. Let’s look at some images, first in context of how the Circle is situated in […]

This study regarding EMS determining last known normal is set to be published this month in ‘Stroke’. In the abstract the authors compared the Last Known Normal time of stroke patients as determined by EMS to the Last Known Normal time as determined by a neurologist. In 91% of cases the EMS-determined time was within 15 minutes […]

Recently we posted this case study. Highly suspicious for Bell’s Palsy (7th cranial, or facial, nerve paralysis). Let’s look at the photo below showing the facial nerve, the facial muscles it innervates, and some common signs/symptoms: Image credit   In the case study we saw right-sided paralysis and if you look at the patient’s photo […]

A 52 yof complains of chest and epigastric pain. Here is her 12 lead ECG: Image credit| Click here for larger image 50 minutes later she developed left-sided hemiplegia, facial asymmetry, deviated gaze, and left-sided neglect. (Which stroke syndrome is this indicative of?) A CT scan revealed a blockage in the R-MCA. The CT scan also indicated that the right insular cortex […]

10:10 in the AM. You respond to a 34 year-old-male c/o possible CVA. Upon arrival you find him seated in his apartment living room surrounded by two friends. He is alert and appears anxious. He tells you he was perfectly fine when he went to bed last night at around 11 PM. This is his […]

Recall from part 1 where we discussed how common it was to observe 12 lead ECG changes in stroke patients. Now let’s look at regions deep inside your head thought to be responsible. In each hemisphere of the brain there’s a part of the cerebral cortex which folds over on itself. It’s called theinsular cortex and it […]

Which image below is the biggest attention-getter? -OR- The Italian sports car vs. motorcycle collision or the middle-aged mother of two whose daughter noticed her crooked smile at dinner? How many ‘trauma junkies’ ride our ambulances and staff our Emergency Departments? Which motivated you to become an EMS/emergency medicine provider: facial droop or rollovers with […]

Last night we published this editorial and today received an email response from Dr. Bukata. His comments are reproduced in-part below: “[T]he purpose of the chart [Editor’s note: Dr. Bukata is referring to our concern that the imagery associated with his commentary appealed to emotion rather than reason] is to summary the facts — which are straightforward […]

You may have seen the above image circulating recently and/or you may have read this article by Rick Bukata, MD. FAST-MAG was a multicenter randomized, controlled clinical trial out of UCLA studying prehospital administration of magnesium sulfate to treat stroke. The results are in. It didn’t work. Not necessarily surprising. This paper states we’ve tested over 20 drugs in 270 preclinical trials with […]

15-30% of strokes are cardioembolic and 60-90% of stroke patients present with ECG abnormalities. (Source) So let me ask you some questions. Is it important to obtain a 12 lead ECG during a suspected acute stroke in the prehospital setting? Why? Why not? Does it really matter either way? Before we discuss the answer… Here’s the abnormalities you’re likely to […]