Rabia Handan Günsay

Neurogenic Stunned Myocardium (NSM) is a clinical condition in which neurological events lead to cardiac abnormalities. Studies in the literature show that neurological events such as stroke and seizures cause autonomic dysregulation and sympathetic discharge, leading to myocardial damage. It is difficult to differentiate NSM from acute coronary syndrome based solely on the clinical picture. Elevated troponin, left ventricular dysfunction, and electrocardiographic (ECG) changes may be seen in the clinical picture. Here, computed tomography images of a case diagnosed with NSM, a rare clinical condition, are presented.

Acil servis başvurularının en yaygın nedenlerinden biri olan karın ağrısı şikâyetinde, dalak kaynaklı patolojiler nadir görülmekle birlikte yüksek morbidite ve mortalite potansiyelleri nedeniyle kritik öneme sahiptir. Bu bölüm, acil tıp pratiğinde karşılaşılan temel dalak patolojilerini; anatomik ve fizyolojik temellerden başlayarak güncel tanı ve tedavi algoritmaları ışığında ele almaktadır. Dalağın yüksek vaskülarizasyonu, özellikle travmatik ve spontan rüptür durumlarında masif intraperitoneal kanamalara yol açarak acil cerrahi müdahale ihtiyacını doğurmaktadır. Travmatik yaralanmaların yanı sıra, bu çalışmada vasküler patolojiler özel bir başlık altında incelenmiştir. Splenik arter anevrizmaları, özellikle gebelik ve portal hipertansiyon gibi risk faktörleri varlığında rüptür riski taşıyan sinsi seyirli klinik antitelerdir. Benzer şekilde, pankreatit veya cerrahi müdahaleler sonrası gelişebilen splenik ven trombozu, sinistral portal hipertansiyon ve gastrik varis kanamaları gibi ciddi komplikasyonlara zemin hazırlamaktadır. Bölüm boyunca, bu patolojilerin acil servisteki yönetimi, radyolojik görüntüleme bulguları ve antikoagülasyon gerekliliği gibi tartışmalı konular literatürdeki en güncel verilerle (StatPearls, vaka serileri ve meta-analizler) sentezlenerek sunulmaktadır. Amaç, acil tıp hekimine bu nadir fakat hayati tabloları tanıma ve yönetme konusunda kapsamlı bir rehber sağlamaktır. Abdominal pain is a predominant complaint in emergency department visits, where splenic pathologies represent a rare but life-threatening spectrum due to the organ's high vascularity and potential for massive hemorrhage. This chapter explores the primary splenic disorders encountered in emergency medicine, integrating anatomical and physiological foundations with contemporary diagnostic and therapeutic algorithms.Special emphasis is placed on vascular pathologies, including splenic artery aneurysms and splenic vein thrombosis. Splenic artery aneurysms, often linked to multiparity and portal hypertension, carry a significant risk of catastrophic rupture requiring immediate multidisciplinary intervention. Splenic vein thrombosis, frequently secondary to pancreatitis or post-splenectomy complications, is characterized as the leading cause of sinistral portal hypertension, posing a risk for isolated gastric variceal bleeding. Through a synthesis of recent literature, including case reports and clinical investigations, this section details emergency management strategies, the role of radiological imaging, and the nuances of anticoagulation therapy. This comprehensive review aims to equip emergency physicians with the necessary clinical insights to effectively diagnose and manage complex splenic emergencies.

Objectives: Syncope is a common cause of emergency department admissions and poses challenges in patient management due to its broad etiology and risk of short-term adverse events. This study aimed to comparatively evaluate the ability of the San Francisco Syncope Rule, Canadian Syncope Risk Score and Anatolian Syncope Rule to predict short-term (1-week and 1-month) adverse events in patients presenting to the emergency department with syncope. Methods: This multicenter, prospective, observational study included 108 patients who presented to the emergency departments of two tertiary-level hospitals with syncope. Patients aged <18 years, pregnant women, those with non-syncopal causes of transient loss of consciousness, and those requiring hospitalization at presentation were excluded. Patients were contacted by phone on the 7th and 30th days after discharge to assess adverse events, including death, life-threatening arrhythmias, myocardial infarction, aortic dissection, pulmonary embolism, major bleeding, and subarachnoid hemorrhage. Results: The mean age was 45.9±18.9 years, and 57.4% were female. The most common comorbidity was hypertension (34.3%), and vasovagal syncope (47.2%) was the leading etiology. Within 1 week, 8 (7.4%) patients experienced adverse events; none occurred at 1 month. Median scores were 0 for the San Francisco Syncope Rule, 1 for the Anatolian Syncope Rule, and 0 for the Canadian Syncope Risk Score; among those with events: 0.5, 2, 3, respectively. Conclusions: The San Francisco Syncope Rule showed limited early discrimination, the Canadian Syncope Risk Score identified high-risk patients, and the Anatolian Syncope Rule better stratified low–moderate risk groups. Risk scores should complement, not replace, clinical judgment.

Background/Objectives: This study investigated whether serum salusin-α and salusin-β levels could support the diagnosis and prognosis of confirmed acute pulmonary embolism (APE) cases. Methods: A prospective observational study was conducted including 57 patients diagnosed with APE using computed tomography pulmonary angiography (CTPA) and 30 control participants without any acute or chronic disease. APE patients were categorized based on the Pulmonary Artery Obstruction Index (PAOI) into low (≤20) and high (>20) thrombus burden groups. Serum salusin-α and salusin-β levels were measured at diagnosis using an enzyme-linked immunosorbent assay. Associations with PAOI and Pulmonary Embolism Severity Index (PESI) scores were analyzed. Results: Salusin-α and salusin-β levels were markedly reduced in APE patients versus controls (p < 0.001). In multivariate analysis, salusin-α remained independently associated with APE (p = 0.042), whereas salusin-β was not significant. A receiver operating characteristic analysis showed good diagnostic performance for salusin-α (AUC = 0.799; sensitivity = 89.5%; specificity = 46.7%). Neither peptide correlated with PAOI or PESI. At a 305.85 pg/mL cut-off, salusin-α yielded a positive predictive value of 76.1% and a negative predictive value of 70% in this cohort. Conclusions: The findings suggest that salusin-α has high sensitivity in detecting acute pulmonary embolism and may serve as a supportive diagnostic marker in emergency settings. Although its specificity is limited, it could contribute to guiding additional testing. While salusin-β showed no significant diagnostic value, the potential role of salusin peptides in prognostic evaluation requires further exploration.