Research and Reviews in the Fastlane 148

Welcome to the 148th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the full list of R&R contributors This Edition’s R&R Hall of Famer Emergency Medicine Taylor RA et al. Determination of a Testing Threshold for Lumbar Puncture in the Diagnosis of Subarachnoid Hemorrhage after a Negative Head CT: A Decision Analysis. Academic emergency medicine. 2016. PMID: 27378053 Test thresholds are an essential concept in emergency medicine, but have really only taken hold in PE workups so far. This group attempts to weigh the harms and benefits of LP after negative CT for subarachnoid haemorrhage and come up with a test threshold of 4.3%. This means that we are doing more harm than good by testing anyone with a pre-LP likelihood of disease less than 4.3% – which is almost everyone after a negative CT. (Look at figure 3 in the paper for more detail.) That being said, there are a lot of assumptions that...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Education Emergency Medicine Infectious Disease Neurosurgery R&R in the FASTLANE EBM literature recommendations research and reviews Source Type: blogs

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Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient. Introduction Decompressive craniectomy (DC) may effectively decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in traumatic brain injury (TBI) patients with refracto...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusion: In ischemic stroke or TIA patients with platelet count within normal range, platelet count may be a qualified predictor for long-term recurrent stroke, mortality, and poor functional outcome. Introduction Platelets exert a critical role in the pathogenesis of atherosclerotic complications of cardio-cerebrovascular disease, contributing to thrombus formation, and embolism (1, 2). Previous literature reported that platelets of various size and density are produced by megakaryocytes of different size and stages of maturation in different clinical conditions, suggesting various platelet patterns in differen...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient. Introduction Decompressive craniectomy (DC) may effectively decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in traumatic brain injury (TBI) patients with refracto...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
ConclusionsThis analysis of nationally representative US data suggests that although readmission after RS for MMD is not uncommon, cerebral hemorrhagic events during the 90-day postoperative period are rare.
Source: Journal of Neurology - Category: Neurology Source Type: research
We describe the case of an 18-year-old female affected by HbSS genotype SCD presenting with reversible cerebral vasoconstriction syndrome (RCVS) as well as features of posterior reversible encephalopathy syndrome and convexity subarachnoid hemorrhage (SAH) after transfusion of red blood cells. We reviewed the existing literature dealing with SCD, blood transfusion, and hemorrhagic strokes. To our knowledge, this case presentation is unique with convexity SAH predominantly attributable to a RCVS spectrum disorder occurring in the setting of a recent blood transfusion in an adolescent female with SCD. As this case illustrate...
Source: The Neurologist - Category: Neurology Tags: Case Report/Case Series Source Type: research
ConclusionsWe demonstrated that this novel agent can improve regional CBF and may improve oxygen supply –demand balance. Clinical studies (likely with repeat dosing) are required to evaluate whether this effect can prevent DCI or cerebral infarction.
Source: Neurocritical Care - Category: Neurology Source Type: research
Conclusions:Our preliminary findings are that RBC SNO-Hb and overall NO levels are reduced in patients with SAH. We are actively enrolling additional subjects and determining if these decrease are prognostic of outcome. Future studies may include therapeutic interventions to restore SNO-Hb levels and to study the clinical outcomes of this intervention.Disclosure: Dr. M. Alkhachroum has nothing to disclose. Dr. Nazemian Yazdi has nothing to disclose. Dr. Aldamouk has nothing to disclose. Dr. Hausladen has nothing to disclose. Dr. Stamler has nothing to disclose. Dr. Reynolds has received research support from Roche Organ Tr...
Source: Neurology - Category: Neurology Authors: Tags: Neurocritical Care: Subarachnoid Hemorrhage Source Type: research
A 15-year-old boy with sickle cell disease became unresponsive after sudden-onset headache. There was no antecedent trauma. A head CT scan demonstrated subarachnoid hemorrhage at the medulla (figure). Magnetic resonance angiography of the head and neck identified the patient's known bilateral internal carotid artery stenosis (a moyamoya-like arteriopathy associated with stroke in sickle cell disease) and a new right vertebral artery dissection, which was confirmed on conventional angiography (figure). Prior MRI performed as part of routine cerebral monitoring did not reveal any preexisting abnormality of the vertebral artery.
Source: Neurology - Category: Neurology Authors: Tags: Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke RESIDENT AND FELLOW SECTION Source Type: research
We present the role of TCD in acute cerebrovascular ischemia, sonothrombolysis, and intracranial stenosis.
Source: Neurology India - Category: Neurology Authors: Source Type: research
Conclusions— Intracranial aneurysms are common in HbSS SCD. There was also a trend toward more common occurrence of aneurysmal subarachnoid hemorrhage in HbSS; women in the age group 30 to 39 years were most at risk. There was no correlation between the occurrence of intracranial aneurysms and moyamoya syndrome.
Source: Stroke - Category: Neurology Authors: Tags: Epidemiology, Genetics, Imaging, Cerebral Aneurysm, Moyamoya Clinical Sciences Source Type: research
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