A 58-year-old man with a past medical history of seizures presented to the emergency department (ED) with acute onset of left gaze deviation, expressive aphasia, and right-sided hemiparesis. The patient was evaluated by the general neurology team in the ED, who suspected an acute ischemic stroke and requested an evaluation by the stroke neurology team but did not activate a stroke alert. The stroke team concluded that the patient had suffered a focal seizure prior to arrival and had postictal deficits. The stroke team did not order emergent CT angiography and perfusion imaging but recommended routine magnetic resonance imaging with angiography (MRI/MRA) for further evaluation, which showed extensive cerebral infarction in the distribution of an occluded left middle cerebral artery (MCA). Due to the delayed diagnosis of left MCA stroke, it was too late to perform any neurovascular intervention. The commentary highlights the importance of timely use of stroke alert protocols, challenges with CT angiography in early acute ischemic stroke, and the importance of communication and collaboration between ED and neurology teams.
- Provider:University of California, Davis, Health System
- Activity Link: https://psnet.ahrq.gov/web-mm/missing-large-vessel-occlusion-stroke-patient-history-seizures
- Start Date: 2022-05-25 05:00:00
- End Date: 2022-05-25 05:00:00
- Credit Details: AMA PRA Category 1 Credit™️: 1.0 hours
- MOC Credit Details: ABIM - 1.0 Point; Credit Type(s): Medical Knowledge (ABIM)
ABIM - 1.0 Point; Credit Type(s): Patient Safety (ABIM) - Commercial Support: No
- Activity Type: Enduring Material
- CME Finder Type: Online Learning
- Fee to Participate: No, it's free
- Measured Outcome: Learner Competence, Learner Knowledge
- Provider Ship: Jointly Provided
- Registration: Open to all
- Specialty: Internal Medicine
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