Cervical Artery Dissection: Early Recognition And Stroke Prevention (Stroke and Trauma CME) - $39.00
Publication Date: July 2016 (Volume 18, Number 7)
CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits.
Rhonda Cadena, MD
Assistant Professor, Departments of Neurology, Neurosurgery, and Emergency Medicine, University of North Carolina, Chapel Hill, NC
Christopher Lewandowski, MD
Vice Chair, Department of Emergency Medicine, Henry Ford Health System, Clinical Professor of Emergency Medicine, Wayne State University, Detroit, MI
Stephan A. Mayer, MD, FCCM
Director, Neurocritical Care, Mount Sinai Health System, Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
Cervical artery dissections involve the carotid or vertebral arteries. Although the overall incidence is low, they remain a common cause of stroke in children, young adults, and trauma patients. Symptoms such as headache, neck pain, and dizziness are commonly seen in the emergency department, but may not be apparent in the obtunded trauma patient. A missed diagnosis of cervical artery dissection can result in devastating neurological sequelae, so emergency clinicians must act quickly to recognize this event and begin treatment as soon as possible while neurological consultation is obtained. This issue reviews the evidence in applying advanced screening criteria and choosing imaging and antithrombotic treatment strategies for patients with cervical artery dissections to reduce the occurrence of ischemic stroke.
Excerpt From This Issue
You arrive for your shift in the ED on a busy Friday night. Your first patient is a 29-year-old man who was a restrained driver in a motor vehicle crash, where he ran off the road going 75 mph. He was intubated on the scene for airway protection. On examination, he has a GCS 6T score, a large scalp laceration, symmetric pupils, and he withdraws all extremities from painful stimulation. His cardiac, pulmonary, and abdominal examination is without significant findings, and his extremities have scattered abrasions. His initial trauma imaging included a portable chest x-ray, a noncontrast CT head and cervical spine, and a CT of the abdomen/pelvis with contrast. The CT head showed a diffuse axonal injury and a temporal bone fracture. The remainder of the imaging showed no significant traumatic injuries. You wonder: What else should be done at this point? What are his biggest risks right now? Should I be concerned about the temporal bone fracture?