University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas.
Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
J Emerg Med. 2021 Oct;61(4):e60-e63. doi: 10.1016/j.jemermed.2021.05.010. Epub 2021 Jun 28.
Acute-onset, unilateral weakness is an alarming presentation due to the possibility of a cerebrovascular accident. When considering cerebrovascular accidents in patients younger than 35 years, emergency physicians should evaluate embolic sources.
A 28-year-old man with no reported past medical history presented to the Emergency Department with a complaint of acute-onset left-sided hemiparesis and facial droop that started a day prior to arrival. He was stable, had unilateral weakness, hyperreflexia, and slightly slurred speech. He reported no sensory deficits. A computed tomography scan of the head demonstrated areas of ischemia. Patient demographics suggested an embolic source, so point-of-care-ultrasound (POCUS) was performed by emergency practitioners, leading to the discovery of a large, mobile, left atrial mass. After admission and confirmatory imaging, the mass was surgically removed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In young, otherwise healthy individuals, heart masses should be considered as a cause of unexplained stroke-like symptoms. POCUS can identify these masses and expedite care.
突发性、单侧无力是一种令人警惕的表现，因为可能是脑血管意外。当考虑 35 岁以下患者的脑血管意外时，急诊医生应评估栓子来源。
一名 28 岁的男性，无既往病史，因突发左侧偏瘫和面部下垂于就诊前一天就诊于急诊科。他病情稳定，表现为单侧无力、反射亢进和言语含糊。他报告无感觉缺失。头部计算机断层扫描显示有缺血区域。患者的人口统计学数据提示栓子来源，因此急诊医生进行了即时护理超声检查（POCUS），发现了一个大而移动的左心房肿块。入院并进行确认性成像后，该肿块被手术切除。
为什么急诊医生应该注意这一点？：在年轻、健康的个体中，心脏肿块应被视为不明原因的类似中风症状的原因。POCUS 可以识别这些肿块并加快治疗。
