Archive for category: Neurology

The PATCH Trial: Hold the Platelets in Spontaneous Intracerebral Hemorrhage?

15 Jun
June 15, 2016

Background: Hemorrhagic stroke accounts for 11 – 22% of strokes, half of all stroke deaths, and a significant amount of disability in many of the remaining survivors. Spontaneous, non-traumatic, intracerebral hemorrhage (ICH) accounts for 2/3 of hemorrhagic strokes; estimated at > 2 million ICHs each year. To date several studies have suggested that antiplatelet therapy […]

The ENCHANTED Trial: Is Low-Dose the Right Dose for Intravenous tPA in Acute Ischemic Stroke?

26 May
May 26, 2016

Background: Despite continued debate on the efficacy of alteplase (tPA), it currently remains one of the major interventions directed at patients presenting with acute ischemic stroke. The current standard dose of the drug is 0.9 mg/kg given over 1 hour. It is unclear whether lower doses would be equally effective in increasing good neurologic outcomes […]

Sensitivity of Early Brain CT to Exclude Aneurysmal Subarachnoid Hemorrhage

11 Feb
February 11, 2016

Background: Headache accounts for approximately 2% of all ED visits. One of the most serious etiologies of headache is aneurysmal subarachnoid hemorrhage (SAH), which accounts for 4 – 12% of ED patients with thunderclap headache. There have been several studies in the past few years suggesting that in neurologically intact patients, the sensitivity of modern […]

Xanthochromia Detection: Visual Inspection vs. Spectrophotometry

25 Jan
January 25, 2016

Background: Although non-contrast head CT (NCHCT) has near perfect sensitivity (98-100%) in detecting aneurysmal subarachnoid hemorrhage (SAH) when performed within 6 hours of headache onset, sensitivity declines after 6 hours. As a result of declining sensitivity, lumbar puncture (LP) continues to be part of the workup in suspected SAH. An LP gives providers the ability […]

Clinical Decision Instruments in Minor Head Trauma – New Orleans + Canadian Decision Instruments

18 Jan
January 18, 2016

Background: CT scans are frequently done after minor head injury to evaluate for intracranial hemorrhage. While CT scans are an excellent tool for diagnosing or ruling out this disorder, they are not without harms including radiation exposure, cost and department delays. Much of the time, CTs are negative, or find injuries for which no intervention […]