Bilateral Middle Cerebral Artery Occlusion: A Successful Case of Bilateral Thrombectomy.

Single-vessel occlusions often cause an acute ischemic stroke (AIS) but can rarely be caused by multi-vessel occlusions. Although bilateral AIS is rare, these patients often undergo mechanical thrombectomy as long as they are within the 24-hour window since symptom presentation. We present a case of a female in her 70s who presented to an outside facility with right-sided weakness in her upper and lower extremities, drooping of the right lower face, and aphasia. The patient developed bilateral symptoms on transfer to a tertiary center with neuro-interventional capabilities. Due to concern for a possible bilateral stroke, magnetic resonance imaging was ordered and was remarkable for bilateral middle cerebral artery occlusion. The patient underwent a successful bilateral mechanical thrombectomy within 24 hours of the last known normal. This case demonstrates that mechanical thrombectomy is an excellent treatment option for patients with bilateral occlusions that present within the recommended 24 hours from the last known normal.

Perceptions of Electronic Health Records Within Otolaryngology Residents Compared to Practicing Otolaryngologists.

OBJECTIVE: This study investigated the perceived impact of electronic health records (EHR) on otolaryngology residents with regard to education, patient care, and workflow, and then compared the trends with those of practicing otolaryngologists. METHODS: A descriptive, cross-sectional survey was developed for each core study group: the otolaryngology resident group (ORG) and the practicing otolaryngologist group (POG). In total, 536 surveys were submitted: 33 from the ORG survey and 510 from the POG survey. Response rates were 51.5% and 21.3%, respectively. RESULTS: Within the two study groups, ORG reported a predominately neutral response relating to the impact of EHR on experience compared with the POG, which reported far more negative responses. The most negative reported change in the ORG related to feeling more like a passive observer and scribe in terms of how EHR negatively impacted the role of resident. Within the POG group, the majority of negative responses were recorded on the impact of EHR on practice efficiency, practice overhead, and number of employees required to maintain practice function. CONCLUSION: With otolaryngologists making up 1.1% of the U.S. physician workforce in 2015, it is likely that software programing of EHR underrepresents the workflow needs of otolaryngologists at this time. Future studies investigating the impact of EHR on otolaryngology patient care and resident education are needed in the future. Laryngoscope, 128:2726-2731, 2018.