Thanks to Dr Paul Page for his summary
Edited by Dr David Lewis
Top tips from this month’s rounds:
Vertebral Artery Dissection – a tricky diagnosis and potentially catastrophic if missed…
Consider dissection in vertigo patients even without history of significant or mild trauma.
Headache and/or neck pain followed by vertigo or unilateral facial paresthesia is an important warning sign that may precede onset of stroke by several days. Dizziness, vertigo, double vision, ataxia, and dysarthria are common clinical features. Lateral medullary (Wallenberg syndrome) and cerebellar infarctions are the most common types of strokes.
Diagnosis – CT Angiography
Treatment – Antiplatelet or Anticoagulation (unless contraindications – see article below)
Cervical Artery Dissection in Stroke Study (CADISS) trial, RCT – antiplatelets versus anticoagulants in the treatment of extracranial carotid and vertebral artery dissections (VADs) = no difference found in outcomes between groups receiving antiplatelets vs anticoagulants. CADISS
Vertebral Artery Dissection: Natural History, Clinical Features and Therapeutic Considerations – (full text)
Rounds Presentation by Dr Kavish Chandra (R2 iFMEM)
Limping Kids – inability to weight bear is always significant…
Need for thorough investigation of non traumatic hip pain in child unable to weight bear. Don’t get biased with previous diagnosis even if by specialists.
Don’t miss – Septic Arthritis or SCFE
From – Orthobullets.com – Hip Septic Arthritis – Pediatric – Deborah Allen
See this SJRHEM ED Rounds on Limping Kids
Take home pearls:
- A limping/NWB child that can crawl is likely to have pathology below the knee
- Examine least likely source of symptoms first.
- Flex, Adduct and Int Rot hip most likely manoeuvre to elicit pain in hip pathology
- Children >8yrs – X-ray hip first
- If fever (>38°) or > 24hrs then bloods (incl CRP)
- CRP < 12 is very reassuring (and a high CRP mandates further Ix to rule out septic arthritis)
- Positive ultrasound is most likely to be irritable hip
- Negative ultrasound – X-ray leg