At the beginning of 2020, I would like to make sure you didn't miss the top three "must-read" emergency medicine articles of the past year. They were practice-changing, reminding or teaching us about critically important, potentially life-saving clinical pearls.
All three articles are excellent reads with take-home points. Following are my summaries; I hope all acute care physicians take time to read the articles in full.
Avoiding Misdiagnosis in Patients With Posterior Circulation Ischemia
Posterior circulation strokes represent approximately 20% of all ischemic strokes and can be associated with devastating complications, especially when delays in diagnosis or misdiagnoses occur. Unfortunately,
These delays and misdiagnoses happen much more frequently with posterior than anterior circulation strokes and are attributed to the nonspecific symptoms with which they present: nausea and vomiting, dizziness, blurry vision, headaches or neck pain, and vague sensory symptoms. Many other, more classic stroke symptoms manifest early as well, such as ataxia or focal weakness, though these are less likely to result in misdiagnosis.
In a paper published in Academic Emergency MedicineGurley and Edlow review the presenting symptoms and focus the reader's attention on those nonspecific symptoms that are often associated with misdiagnosis. They provide a framework for evaluating patients with these symptoms and also provide some clues that help to distinguish posterior stroke from benign conditions.
