Acute Ischemic Stroke with Devastating Consequences Can Occur Due to Posterior Sternoclavicular Joint Dislocation.

Posterior sternoclavicular joint dislocation is a rare injury requiring prompt diagnosis as it has been associated with the compression of the subclavian and brachiocephalic arteries. We report the case of a 27-year-old male presenting with altered mental status and left hemiparesis found to have life-altering neurologic damage caused by severe orthopedic injury after a fall while intoxicated. Imaging revealed a posteriorly displaced right medial clavicle with surrounding hematoma compressing the brachiocephalic artery causing local thrombus formation and distal embolization, ultimately resulting in malignant cerebral infarction. His hospital course was complicated by cerebral edema requiring decompressive craniectomy, hemorrhagic transformations, brachiocephalic pseudoaneurysm, and the development of remote embolic ischemic infarctions.

Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology, Epidemiology, Prevention and Treatment.

BACKGROUND: Air embolism is an extremely rare complication that can follow gastrointestinal endoscopy. The most accepted treatment of cerebral air embolism (CAE) is hyperbaric oxygen (HBO). Limited evidence suggests that lidocaine may have a neuroprotective effect. The exact mechanism does not appear to be well elucidated. METHODS: We conducted a literature search using multiple combinations of keywords from PubMed and Ovid Medline databases according to the PRISMA guidelines. We included articles with cases of air embolism caused by an esophagogastroduodenoscopy (EGD). We excluded cases related to other procedures e.g. colonoscopy, endoscopic retrograde cholangiopancreatography, cholangioscopy, Kasai procedure, bronchoscopy, laparoscopy or thoracoscopy. We were able to identify 30 cases of CAE associated with EGD. We included our experience in treating one patient with CAE after elective EGD. RESULTS: Given the results of our literature search and this patient's characteristics, we chose to treat our patient with HBO and lidocaine infusion. Our case series consists of 31 patients of post EGD CAE, the mean age was 63.7 ± 11.14 years, 38.7% of the patients were women (n = 12). 38.7% of the cases underwent esophageal dilatation (n = 12), while 19.35% had EGD biopsy (n = 6), 9.6% had variceal ligation (n = 3), and 3.22% had variceal banding (n = 1). In 20 out of 31 cases, echocardiography has been documented, 20% of those patients (n = 4) had patent foramen ovale. HBO was used in treatment of 48% of cases (n = 15), among the included patients, 61% survived (n = 19). Our patient showed significant neurological improvement. CONCLUSIONS: Despite the rare incidence of CAE during or after EGD, physicians should be aware of this potential complication. In patients who develop sudden acute neurological symptoms, early diagnosis and intervention may prevent devastating neurological injury and death. The most accepted emergent treatment for CAE includes HBO, consideration of lidocaine, and work-up of source of the air embolism.

Acute Neuromuscular Respiratory Weakness Due to Acute Inflammatory Demyelinating Polyneuropathy (AIDP): A Simulation Scenario for Neurology Providers.

Introduction: Acute neuromuscular respiratory failure is a source of morbidity and mortality in neurological diseases, including acute inflammatory demyelinating polyneuropathy (AIDP), also known as Guillain-Barré syndrome. It is important for health care providers to recognize this condition and provide early ventilatory support. In this simulation, learners must assess and treat a standardized patient with acute respiratory complications related to AIDP. Methods: This is a single-session simulation that can be run in a standard simulation center using a live standardized patient. The simulation scenario is followed by a facilitated debriefing session. Details about the simulation scenario, critical action checklist, environment preparation, actors/roles, and debriefing session are outlined. Results: A total of 14 neurology residents participated in this simulation. A postsimulation survey revealed that participants thought the simulation achieved its stated objectives, was useful, and would impact their future practice. Discussion: We designed this simulation to assess a learner's ability to identify acute neuromuscular respiratory weakness in a patient with AIDP and initiate treatment with ventilatory support. This simulation can easily be incorporated into an existing curriculum for neurology residents or for trainees in other specialties.