“Subtle” is the operative word in the session “Case Studies of Subtle Presentations of Devastating Neurological Conditions” by Andrew W. Asimos, MD, FACEP. The dizziness, nausea, vomiting, tingling, and back pain that may mean neurological trouble can also resemble other benign disorders seen on a daily basis.
“There may be some other presentation factor that should lead you to check for quality-of-life threatening conditions,” said Dr. Asimos, medical director of the Carolinas Stroke Network for the Carolinas Healthcare System in Charlotte, North Carolina. “We’ll look at real cases and talk about the most important components of the neurological exam, as well as the potential to inappropriately rely solely on imaging. The classic example is a CT brain scan, which is frequently done in the ED but which for some conditions is inadequate.”
Proper documentation is vital as well, said Dr. Asimos. “If you don’t document correctly, it may undermine the ability to understand what was done and, quite frankly, the ability of a physician to defend themselves when a patient has an unusual condition. Cognitive error is always possible, and documentation allows you to have stop points in your diagnostic momentum to consider certain things more carefully,” he said.
“The first 24 hours are often the most critical, and the right diagnosis can make a difference,” he added. “But it’s hard to remove a diagnosis label once it’s in place.”
Amy E. Hamaker is a Canyon Country, California-based freelance writer.
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