M&M - Dr. Reyner

Case 1 - S/P Arrest w/ STEMI

• STEMI  - >1 mm STE at the J point in 2 contiguous leads or greater than 2 mm STE in 2 contiguous leads isolated to leads V2-V3; reciprocal depression makes diagnosis more likely but not necessary for diagnosis. 

• RBBB - causes = ischemia, functional, iatrogenic 
    > Definition - QRS >120 ms; RSR' pattern v1-v3, slurring of S wave in lateral leads
  
• Diagnosis of STEMI in the setting of RBBB does not require special diagnostic criteria.
• Consider RBBB as the result of an anterior MI (LAD lesion) rather than as a “benign bystander.”

• AHA recommends PCI for patients with aFMC-to-device time system goal of 120 minutes or less and fibrinolytics for patients > 120 minutes (FMC = first medical contact).
• Using a cutoff of 20 minutes from arrest to ROSC captures 96% of survivors and achieves a survival rate of 82%.

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Case 2 - Ear Pain and Facial Palsy

• Gradenigo’s Syndrome: Triad of otorrhea, retro-orbital pain, and CN VI palsy (diplopia).
• Consider Gradenigo’s in patients with a cranial nerve palsy in the setting of acute or chronic otitis media.

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Case 3 - Ataxia and Headache after Rollercoster Ride

• Wallenberg Syndrome- lateral medullary syndrome- is an acute infarct involving the lateral medulla oblongata
• It is the most common brainstem stroke
• Patients present with vertigo, facial numbness, dysarthria, dysphagia, ataxia, and cerebellar signs
• Consider CNS pathology in patients presenting with neurologic complaints after a roller-coaster ride