Neurology Flashcards
Can my patient with dementia refuse treatment?
Medical decision-making capacity refers to the patient’s ability to make informed decisions regarding their care, and emergency physicians are frequently required to assess whether a patient possess this capacity. Patients with acute or chronic neurological diseases (such as dementia) may lack this capacity, and this should be identified, especially in life-threatening situations. The patient must have the ability to: communicate a consistent choice understand (and express) the risks, benefits, alternatives and consequences appreciate how the information applies to the particular situation reason through the choices to make a decision There are numerous tools that may help with this assessment, but none has been validated in the ED. Be careful of determining that the patient lacks capacity just because of the diagnosis they carry. Capacity is a fluid concept; a patient may have the capacity to make simple decisions but not more complex ones. Capacity may also change over time Psychiatry consultation to determine capacity is not obligatory but may be utilized for a second opinion.
Stroke studies bottom line
- DAWN Trial bottom line — In a higly selected patient population presenting with large vessel occlusion stroke within 6-24 hours and a mismatch of severity of stroke symptoms and infarct on neuroimaging, endovascular thrombectomy + standard therapy resulted in better functional outcomes at 90 days compared to those receving standard medical therapy alone. - DEFUSE 3 Trial bottom line — In patients with a large vessel occlusion stroke presenting within 6-16 hours and neuroimaging showing ischemic (but not yet infarcted) tissue, endovascular thrombectomy + standard therapy resulted in better functional outcomes at 90 days compared to those receving standard medical therapy alone. - WAKE UP Trial bottom line — In patients presenting with stroke with an unknown time of onset and signs on MRI that the stroke occurred within the last 4.5 hours, IV alteplase resulted in a small but significant improvement in functional outcome at 90 days when compared with placebo.
Diplopia, what does it mean?
