An update on thrombolysis

perfusion mapDespite the recent upheaval in the emergency medicine community about the ACEP tPA-for-stroke guidelines, thrombolysis is one of the two foundations of modern stroke medicine. In a local stroke symposium, I gave a talk about new developments and folklore in tpa-ology. It also exposes our Augsburg data on thrombolysis with bleeding rate and all you could wish in a real life tpa setting. The talk introduced a new acronym for remembering the various causes of tpa-related ICH (I love acronyms). It reads CORTEX

  • C erebral amyloid angiopathy (extraischemic ICH)
  • O ld stroke (old meaning > 6h)
  • R ecanalization (recanalized vessels to dead tissue)
  • T rauma (bleeding into contusions)
  • E ndocarditis (rare but sometimes fatal)
  • X – coagulation (think of factor X, anticoagulants, ASS and the like)

If you can read German, you might want to give the presentation a try – here is the prezi link.


Tullio, Hennebert and other absurd eponyms

If vertigo patients make you vomit, this post is nothing for you.

It is always exciting to watch medicine develop new concepts. While Neurology is certainly full of examples with new diseases, acro- and eponyms popping up everywhere, HEENT people seem to be more conservative, perhaps because they are busy operating and healing people. Superior canal dehiscence syndrome is a very young disease that  probably owes it’s discovery more to highres CT than to puzzled (neuro-)otologists. But now that we have learned how to deal with it, even the posterior canal can erode and be operated on, so perhaps a thorough neurootologic exam and neurophysiological investigations are in order when your patient tells weird stories (as SCDS-patients seem to do).

We discuss an example we pulled out of our ER recently which then went on to surgery and successfully had his superior canal plugged (not before a repeated workup in a specialized vertigo clinic) and who now is symptom free.