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Öğe Acute coronary syndrome mimicked by acute cholecystitis: Case report(2010) Aksay E.; Ersel M.; Kiyan S.; Musalar E.; Gungor H.Various aetiologies have been reported that cause severe trauma segment and T-wave abnormalities that are not related to acute coronary syndromes. However, the reports of transient ECG abnormalities associated with acute cholecystitis are limited in the literature. We describe a 42-year-old man presented with abdominal pain and hypertensive episode that developed dynamic ECG changes mimicking acute coronary syndrome and was diagnosed acute cholecystitis eventually. Emergency physicians should keep in mind dynamic T-wave changes mimicking acute myocardial ischaemia in patients with acute cholecystitis. © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.Öğe Can D-dimer testing help emergency department physicians to detect acute aortic dissections? [D-dimer testi akut aort disseksiyonlari{dotless}ni{dotless} belirlemede acil servis hekimlerine yardi{dotless}mci{dotless} olabilir mi?](2010) Ersel M.; Aksay E.; Kiyan S.; Bayraktaroglu S.; Yürüktümen A.; Özsaraç M.; Çalkavur T.Objective: To determine the diagnostic accuracy of D-dimer testing for detection of acute aortic dissection. Methods: This study is a retrospective chart review of patients who had been evaluated with suspicion of acute aortic dissection. All patients' D-dimer levels were determined prior to their further work up in the emergency department. The study was conducted in a tertiary care center between February 2006-August 2008. The D-dimer assay used was the immunoturbidimetric assay, with a normal range up to 0.246 µg/ml. Statistical analysis was accomplished using Chi-square test, Student's t-test and a receiver-operating characteristics (ROC) curve analysis. Results: Ninety-nine patients were included in the study, 30 patients were diagnosed as having acute aortic dissection and 69 patients were evaluated in non-acute aortic dissection group. In comparison of the two groups, positive D-dimer results were found to be significantly higher in acute aortic dissection group than in non-acute aortic dissection group (p<0.001). Sensitivity of the D-dimer test in detection of acute aortic dissection was found as 96.6% and the negative predictive value of the test was 97.3%. Specificity and positive predictive value of the D-dimer test were 52.2% and 46.8%, respectively. The area under the ROC curve yielded an acceptable certainty for excluding acute aortic dissection on base of negative results (AUC: 0.764; CI 95%: 0.674-0.855; p<0.001). Conclusion: D-dimer testing is helpful for emergency physicians in detection of patients with suspected acute aortic dissection in the emergency department. © 2010 by AVES Yayi{dotless}li{dotless}k Ltd.Öğe Can elevated troponin I levels predict complicated clinical course and inhospital mortality in patients with acute pulmonary embolism?(2007) Aksay E.; Yanturali S.; Kiyan S.Objective: The purpose of this study was to evaluate the value of elevated cardiac troponin I (cTnI) for prediction of complicated clinical course and in-hospital mortality in patients with confirmed acute pulmonary embolism (PE). Methods and Results: This study was a retrospective chart review of patients diagnosed as having PE, in whom cTnI testing was obtained at emergency department (ED) presentation between January 2002 and April 2006. Clinical characteristics; echocardiographic right ventricular dysfunction; inhospital mortality; and adverse clinical events including need for inotropic support, mechanical ventilation, and thrombolysis were compared in patients with elevated cTnI levels vs patients with normal cTnI levels. One hundred sixteen patients with PE were identified, and 77 of them (66%) were included in the study. Thirty-three patients (42%) had elevated cTnI levels. Elevated cTnI levels were associated with inhospital mortality (P = .02), complicated clinical course (P < .001), and right ventricular dysfunction (P < .001). In patients with elevated cTnI levels, inhospital mortality (odds ratio [OR], 3.31; 95% confidence interval [CI], 1.82-9.29), hypotension (OR, 7.37; 95% CI, 2.31-23.28), thrombolysis (OR, 5.71; 95% CI, 1.63-19.92), need for mechanical ventilation (OR, 5.00; 95% CI, 1.42-17.57), and need for inotropic support (OR, 3.02; 95% CI, 1.03-8.85) were more prevalent. The patients with elevated cTnI levels had more serious vital parameters (systolic blood pressure, pulse, and oxygen saturation) at ED presentation. Conclusion: Our results indicate that elevated cTnI levels are associated with higher risk for inhospital mortality and complicated clinical course. Troponin I may play an important role for the risk assessment of patients with PE. The idea that an elevation in cTnI levels is a valuable parameter for the risk stratification of patients with PE needs to be examined in larger prospective studies. © 2007 Elsevier Inc. All rights reserved.Öğe De novo cerebral arteriovenous malformation: Pink Floyd's song "brick in the Wall" as a warning sign(2012) Ozsarac M.; Aksay E.; Kiyan S.; Unek O.; Gulec F.F.Background: Arteriovenous malformations are shunts between an artery and the venous system that lie within a nidus without an intervening capillary bed. These lesions are thought to be congenital, but recent reports have challenged this assumption. Case Report: A 50-year-old man presented to the emergency department with a generalized tonic-clonic seizure. Before the onset of his seizure, he experienced a vivid auditory hallucination of his favorite song by the band Pink Floyd, "A Brick in the Wall." He had been diagnosed with epilepsy 25 years previously. On presentation, his neurological examination was normal, but a computed tomography scan of the brain revealed a large arteriovenous malformation (AVM) occupying the left temporal lobe. Upon more detailed questioning, he recalled that a brain angiogram had been performed 25 years before and was reported to be normal. Neurosurgery was not performed in view of the size of the malformation. The patient is being followed-up as an outpatient. Conclusion: AVMs may arise de novo and then spontaneously become symptomatic. Cerebral de novo AVM should be considered in the differential diagnosis in patients with complex auditory musical hallucinations or any new neuropsychiatric symptoms. © 2012 Elsevier Inc.Öğe Prospective, multicenter, Turkish out-of-hospital cardiac arrest study: TROHCA(Wolters Kluwer Medknow Publications, 2024) Şener A.; Pekdemir M.; İslam M.M.; Aksay E.; Karahan S.; Aksel G.; Doğan N.Ö.OBJECTIVES: There is no sufficient data to provide a clear picture of out-of-hospital cardiac arrest (OHCA) across Türkiye. This study is the first to present the prognostic outcomes of OHCA cases and the factors associated with these outcomes. MATERIALS AND METHODS: The study was conducted in a prospective, observational, multicenter design under the leadership of the Emergency Medicine Association of Turkey Resuscitation Study Group. OHCA cases aged 18 years and over who were admitted to 28 centers from Türkiye were included in the study. Survived event, return of spontaneous circulation (ROSC), survival to hospital discharge, and neurological outcome at discharge were investigated as primary outcomes. RESULTS: One thousand and three patients were included in the final analysis. 61.1% of the patients were male, and the average age was 67.0 ± 15.2. Cardiopulmonary resuscitation (CPR) was performed on 86.5% of the patients in the prehospital period by emergency medical service, and bystander CPR was performed on only 2.9% by nonhealth-care providers. As a result, the survived event rate was found to be 6.9%. The survival rate upon hospital discharge was 4.4%, with 2.7% of patients achieving a good neurological outcome upon discharge. In addition, the overall ROSC and sustained ROSC rates were 45.2% and 33.4%, respectively. In the multiple logistic regression analysis, male gender, initial shockable rhythm, a shorter prehospital duration of CPR, and the lack of CPR requirement in the emergency department were determined to be independent predictors for the survival to hospital discharge. CONCLUSION: Compared to global data, survival to hospital discharge and good neurological outcome rates appear to be lower in our study. We conclude that this result is related to low bystander CPR rates. Although not the focus of this study, inadequate postresuscitative care and intensive care support should also be discussed in this regard. It is obvious that this issue should be carefully addressed through political moves in the health and social fields. © 2024 Turkish Journal of Emergency Medicine | Published by Wolters Kluwer - Medknow.Öğe A rare diagnosis in emergency department. Spontaneous spinal epidural hematoma(W.B. Saunders, 2008) Aksay E.; Kiyan S.; Kitis O.; Yuruktumen A.We report a case of a 32-year-old man who presented to the emergency department (ED) with a sudden onset of paraplegia due to spontaneous spinal epidural hematoma. Although the patient had a poor neurological condition on presentation, he was successfully operated and discharged without any neurological sequel. Spontaneous spinal epidural hematoma is a rarely seen clinical entity, especially in the ED. Magnetic resonance imaging is the best choice for early diagnosis, and urgent surgical decompression is essential to prevent serious neurological deficits. A 32-year-old previously healthy man presented to the emergency department with a complaint of sudden onset of numbness and weakness of the lower extremity. He had been having back pain during 1 week before presentation, and it was gradually worsening. There was no medical history of any recent trauma or illness, and he was on no medication. On presentation, his vital signs were stable. He was in apparent distress because of back pain. Physical examination revealed paraplegia and bilateral lower extremity anesthesia below the T3 dermatome. Deep tendon reflexes were absent on both lower extremities. The rest of physical examination including peripheral pulses and anal sphincter tone was normal. Complete blood count, electrolytes, coagulation, and kidney and liver function tests were normal except that white blood cell count was 13 500/µL, creatine kinase was 447 U/L (range, 24-195 U/L), and myoglobin was 128 ng/mL (range, <70 ng/mL). Thoracic and abdominal contrast-enhanced computed tomography was performed with a suspicion of aortic dissection, and it revealed normal aortic anatomy. Afterward, he underwent spinal magnetic resonance imaging (MRI). Magnetic resonance imaging demonstrated spinal epidural hematoma at the level of C7-T3 causing spinal cord compression (Fig. 1). Intravenous pulse prednisolone (bolus of 30 mg/kg and maintenance of 5.4 mg/kg per hour) therapy was initiated, and he was admitted to the neurosurgery ward. He was successfully operated the following day and discharged without any neurological sequel after 5 days of admission. Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but important neurological emergency. The incidence is 0.1 patients per 100 000 populations [1]. It presents in all ages, and most cases occur after the fourth or fifth decade [2]. The common symptom is preceding neck or back pain, followed by sudden onset of neurological deficits [3]. The initial neck or back pain is sometimes vague and cannot be early diagnosed until the following cord compression and neurological deficits present. Although sensory and motor deficits are usually bilateral (paraplegia or quadriplegia), unilateral involvement (hemiparesis or hemiplegia) or Brown-Sequard syndrome is also reported [4-6]. Urine retention or loss of sphincter tone frequently accompanies. If the hematoma extends above the upper cervical vertebra, respiratory failure may be observed [6]. The etiopathogenesis of spinal epidural hematoma is not clear, although many predisposing factors including abnormality of coagulation (hemophilia), vascular malformation (eg, spinal dural arteriovenous fistula and hemangioma), some drugs (eg, anticoagulant therapy, therapeutic thrombolysis, aspirin, clopidogrel, and cocaine abuse), trauma (vertebral fractures, postsurgical bleeding, and missile injuries), and iatrogenic manipulations (spinal/epidural injections) are suggested [3,7-11]. The duration between onset of symptoms and inciting event varies from minutes to months [11,12]. Spontaneous spinal epidural hematoma is defined as spontaneous collection of blood in spinal epidural space without any obvious causes. Idiopathic cases account for approximately 40% to 60% of all spinal epidural hematoma [3,13]. Straining-associated events such as bending, dancing, swimming, sneezing, coughing, vomiting, micturition, or heavy lifting may play a role in the development of SSEH [3,14]. Liu and colleagues [3] reported that SSEH is generally located (96%) in the dorsal aspect of the spinal epidural space in cervical (30%), thoracic (35%), and cervicothoracic (22%) levels. They also demonstrated a worse prognosis associated with the bigger size of hematoma, shorter progressive intervals between the initial onset and emergence of the obviously neurological deficits (<12 hours), and a poor neurological condition on presentation [3]. Epidural venous plexus have been considered the source of hemorrhage for SSEH by many authors. The bleeding from rupture of valveless venous plexus in the epidural spaces is possibly secondary to abrupt change in venous pressure after blunt trauma or straining. In addition, the rapidly deteriorating neurological deficits after initial back pain and quick formation of the hematoma also suggested the arterial origin of SSEH [15,16]. Acute or progressive painful paraparesis and/or paraparesis with sphincter dysfunction is a well-known indication for an emergency MRI. Magnetic resonance imaging is the most useful method for diagnosis of SSEH. Magnetic resonance imaging can evaluate the location, extent, and compressive effects of hemorrhage. The hematomas usually appear as a shuttle-shaped image on sagittal section and a crescent-shaped image on transverse section dorsal to the spinal cord on MRI. In the hyperacute phase, MRI demonstrates an isointense lesion on T1-weighted images and hyperintense lesion on T2-weighted images. In the late or subacute phase, the hemorrhage demonstrates a hyperintense lesion on T1- and T2-weighted images [17]. Although some cases of spontaneous recovery have been reported, the most appropriate treatment of SSEH is surgical decompression [18]. Laminectomy and evacuation of the hematoma is the most effective method for rapid decompression of the spinal cord. The best favorable outcome can be achieved if surgical decompression is performed within 12 hours of symptom onset [19]. Therefore, operation should be considered as soon as possible, unless the neurological deficits resolve in the earlier period. Our patient had no history of any trauma, recent medication, or iatrogenic manipulations. His coagulation tests including prothrombin time, activated partial thromboplastin time, and platelet counts were normal. Therefore, in our case, spontaneous spinal epidural hematoma was considered. Spontaneous spinal epidural hematoma was diagnosed using MRI, and he was operated on immediately. Early diagnosis and treatment were the major factors that contributed to the complete recovery of our patient. Spinal epidural hematomas can cause dramatic neurological deficits, which can be successfully reversed if diagnosed and treated without delay. Emergency physicians should be aware of spinal epidural hematoma in patients presenting with back pain and new-onset neurological deficits, and MRI as an appropriate diagnostic modality should be performed immediately. © 2008 Elsevier Inc. All rights reserved.Öğe Thrombotic thrombocytopenic purpura mimicking acute ischemic stroke.(2006) Aksay E.; Kiyan S.; Ersel M.; Hudaverdi O.Thrombotic thrombocytopenic purpura (TTP) is an autoimmune disorder characterised by thrombocytopenia, haemolytic anemia, fluctuating neurological deficits, fever, and renal impairment. This case report is about a young man who presented with acute onset right sided paralysis, dysarthria, and central facial paralysis, suggestive of cerebrovascular accident, but eventually diagnosed as TTP. In addition, the clinical presentation of TTP is discussed and some teaching points for the emergency physicians are emphasised.
