BOSTON—BAO and PRES and colloid cysts, oh my.
Explore This IssueACEP15 Tuesday Daily News
Matthew Siket, MD, co-director of the stroke centers at Rhode Island and The Miriam hospitals in Providence, didn’t want to sound like a fear monger when he delivered “Case Studies of Subtle Presentations of Devastating Neurological Conditions” at ACEP15 on Monday afternoon.
But he most assuredly wanted the emergency physicians who gathered—and those reading this now—to view the session as a clarion call that taking an extra minute to be vigilant for worst-case scenarios is important.
“It’s increasing awareness that these entities exist, that they can be emergent, and having it in your diagnostic armamentarium can help you be a better clinician,” said Dr. Siket, assistant professor of emergency medicine at The Warren Alpert Medical School of Brown University in Providence.
Via a series of case studies, Dr. Siket introduced less common medical conditions such as BAO (basilar artery occlusion), PRES (posterior reversible encephalopathy syndrome), and CADASIL (cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy). He doesn’t expect emergency physicians to become neurologists, but rather to be aware of the conditions and be prepared should one present.
In fact, Dr. Siket believes that ACEP15 and other large-scale educational opportunities are a perfect place to learn about concepts, conditions, and care normally outside doctors’ proverbial comfort zones.
“We need to use forums like this to discuss the things we don’t see as often,” he said. “Maybe identify the areas that we’re a little less comfortable clinically. Our perceived weaknesses. The patients we’re not excited to see. For a lot of us, the subtle or obscure neurological condition is entirely the opposite of emergency medicine. It’s the field we chose not to go in. But it’s very relevant.”
Kerin Howe, ARNP, agrees. “I’m not well educated on subtle neurological conditions,” said Ms. Howe, who works for Florida Emergency Physicians in Orlando. “You hear this and it’s an eye opener.”
Ms. Howe will now add the presentations to her differential as she sees neurological cases back home. So will Robert Butler, MD, a fourth-year medical student at Brown University in Providence.
“A lot of times…you have someone who you just have a extra sense about,” said Dr. Butler, who has worked under Dr. Siket as an attending. “This talk, it moves your discussion to a higher level. You think, ‘What about PRES? What about something else?’ It might just push [you] a little bit farther to get the MRI or do another test. I’m more comfortable thinking about it after seeing this and [more comfortable] having that discussion with neurologists and neurosurgeons.”