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Archive for January, 2013

Stroke mimic: an interesting case of repetitive conversion disorder

31 Jan, 13 | by Emma

Patients with non-organic or functional disorders do indeed present frequently to stroke services. The hazard for the patient is that they may receive IV thrombolysis – although limited available data.1

Chen et al 2 suggests as the authors here observe, that patients presenting with non-organic or functional disorders are at a relatively low risk of significant harm as a result of IV thombolysis.

The other risk for patients presenting with conversion disorders or associated non-organic symptoms is that they may be subject to inappropriate investigations. However, since the consequences of missing a stroke diagnosis may be non-trivial and the diagnosis of a conversion disorder is almost always made retrospectively, it is very hard to avoid a degree of investigation that may confer harm upon the patient (whether in terms of exposure to ionizing radiation, contrast media, or discovery of incidental abnormalities).

Use of the MDT can be very helpful in identifying as well as treating these patients. They respond well to occupational therapy and physiotherapy input.

It is worth spending some time with the patient to explain that they have not had a stroke and that the cause of the symptoms may not be physiological.

Reviewer
Dr James Scott MRCP MSc
Consultant Stroke Physician

References

1. Winkler DT, Fluri F, Fuhr P, et al. Thrombolysis in stroke mimics: frequency, clinical characteristics, and outcome. Stroke 2009;40:1522–5.

2. Chen Y, Bogosavljevic V, Leys D, et al. Intravenous thrombolytic therapy in patients with stroke mimics: baseline characteristics and safety profile. Eur J Neurol 2011;18:1246–50.

Stroke mimic: an interesting case of repetitive conversion disorder

Brain dead or not? CT angiogram yielding false-negative result on brain death confirmation

23 Jan, 13 | by Emma

In this article we are reminded how to confirm brain death and the pitfalls of using CT angiograms for the assessment of cerebral perfusion.

Seema Biswas
Editor-in-Chief

Brain dead or not? CT angiogram yielding false-negative result on brain death confirmation

Electrocautery-induced gangrene of the glans penis in a child following circumcision

10 Jan, 13 | by Emma

Circumcision is a routine procedure in some cultures. Different techniques are used as surgical methods. Unfortunately some of them cause tragic and irreversible complications. This article that includes distinct photographs highlights the undesirable consequences clearly and accurately. Because of pointing out the worrying cases in a certain way, I consider that publishing this article in BMJ will be educatory for medical society.

Professor Şamil Aktaş
Reviewer

Electrocautery-induced gangrene of the glans penis in a child following circumcision

Clinton’s ‘blood clot’ – an MRI and media challenge.

1 Jan, 13 | by Dr Dean Jenkins

So it turns out that Hillary Clinton, US Secretary of State – who has visited more countries in office than any other – developed a right transverse sinus venous thrombosis.

http://www.state.gov/r/pa/prs/ps/2012/12/202419.htm

Previously it was just called a ‘blood clot’ requiring ‘hospital’ and ‘blood thinners’. This followed a day of intense speculation in the media which included thousands of webpages, social media messages and, presumably many hours of broadcast TV and radio, talking over where the ‘blood clot’ was. If it were a DVT then why should she spend so much time in hospital? Some more unusual type of ‘blood clot’ was obviously the cause but no details were being released.

She had a routine MRI scan following ‘concussion’ and her doctors were keen to point out that “It did not result in a stroke, or neurological damage”.

For a potential future presidential candidate this must have caused quite a challenge. You need to quickly let people know that your health is assured and you are being cared for but telling the public that you have a clot near your brain is not what they may want to here. Transparency is important but communicating unusual medical conditions can be difficult.

Now everyone will be an expert in transverse sinus venous thrombosis.

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