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Novel Treatments in Neuroprotection for Aneurysmal Subarachnoid Hemorrhage
Opinion statement New neuroprotective treatments aimed at preventing or minimizing “delayed brain injury” are attractive areas of investigation and hold the potential to have substantial beneficial effects on aneurysmal subarachnoid hemorrhage (aSAH) survivors. The underlying mechanisms for this “delayed brain injury” are multi-factorial and not fully understood. The most ideal treatment strategies would have the potential for a pleotropic effect positively modulating multiple implicated pathophysiological mechanisms at once. My personal management (RFJ) of patients with aneurysmal subarachnoid hemorrhage...
Source: Current Treatment Options in Neurology - June 19, 2016 Category: Neurology Source Type: research

French Intensive Care Society, International congress - Réanimation 2016.
C, Sauneuf B, Verrier P, Pottier V, Orabona M, Samba D, Viquesnel G, Lermuzeaux M, Hazera P, Hanouz JL, Parienti JJ, Du Cheyron D, Demoule A, Clavel M, Rolland-Debord C, Perbet S, Terzi N, Kouatchet A, Wallet F, Roze H, Vargas F, Guérin C, Dellamonica J, Jaber S, Similowski T, Quenot JP, Binquet C, Vinsonneau C, Barbar SD, Vinault S, Deckert V, Lemaire S, Hssain AA, Bruyère R, Souweine B, Lagrost L, Adrie C, Jung B, Daurat A, De Jong A, Chanques G, Mahul M, Monnin M, Molinari N, Lheureux O, Trepo E, Hites M, Cotton F, Wolff F, Surin R, Créteur J, Vincent JL, Gustot T, Jacobs F, Taccone FS, Neuville M, Timsit JF, El-Hel...
Source: Australian Family Physician - May 31, 2016 Category: Primary Care Authors: Jaillette E, Girault C, Brunin G, Zerimech F, Chiche A, Broucqsault-Dedrie C, Fayolle C, Minacori F, Alves I, Barrailler S, Robriquet L, Delaporte E, Thellier D, Delcourte C, Duhamel A, Nseir S, Valette X, Desmeulles I, Savary B, Masson R, Seguin A, Daubi Tags: Ann Intensive Care Source Type: research

Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke.
CONCLUSIONS: At the moment, evidence of very low to moderate quality is available on the effectiveness of tDCS (anodal/cathodal/dual) versus control (sham/any other intervention) for improving ADL performance after stroke. However, there are many ongoing randomised trials that could change the quality of evidence in the future. Future studies should particularly engage those who may benefit most from tDCS after stroke and in the effects of tDCS on upper and lower limb function, muscle strength and cognitive abilities (including spatial neglect). Dropouts and adverse events should be routinely monitored and presented as sec...
Source: Cochrane Database of Systematic Reviews - March 20, 2016 Category: Journals (General) Authors: Elsner B, Kugler J, Pohl M, Mehrholz J Tags: Cochrane Database Syst Rev Source Type: research

News from the International Stroke Conference: Using tPA and Draining Blood from Patients with Intraventricular Hemorrhage Did Not Lead to Better Outcomes at Six Months, New Study Finds
No abstract available
Source: Neurology Today - March 17, 2016 Category: Neurology Tags: Features Source Type: research

Medtronic touts Solitaire stent retriever meta-analysis
The Solitare stent retriever Medtronic (NYSE:MDT) acquired for $50 billion last year when it bought Covidien is safe and highly effective when combined with standard care using the thrombolysis drug alteplase, according to a meta-analysis of 4 previous trials of the device. The transcatheter Solitaire device uses a stent-like device to trap and retrieve a blood clot in the brain in cases of ischemic stroke. Researchers from the 4 trials – Swift Prime, Revascat, Extend-IA and Escape – pooled their data to examine the results from 787 patients, randomized to either thrombectomy with the Solitaire device (401) or stan...
Source: Mass Device - February 18, 2016 Category: Medical Equipment Authors: Brad Perriello Tags: Clinical Trials Neurological Vascular Medtronic Stroke Source Type: news

Recommendations for Reducing Death and Disability Among Stroke Victims
To reduce death and disability among stroke victims - and help healthcare providers lower rates of life-threatening venous thromboembolism (VTE) in ischemic and hemorrhagic stroke patients – leading neurological health and patient safety experts will release Stroke VTE Safety Recommendations during the International Stroke Conference (ISC) 2015, February 11-13 in Nashville.
Source: Disabled World - February 10, 2015 Category: Disability Tags: Events Source Type: news

Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.
CONCLUSIONS: Although we have not found conclusive evidence that etomidate increases mortality or healthcare resource utilization in critically ill patients, it does seem to increase the risk of adrenal gland dysfunction and multi-organ system dysfunction by a small amount. The clinical significance of this finding is unknown. This evidence is judged to be of moderate quality, owing mainly to significant attrition bias in some of the smaller studies, and new research may influence the outcomes of our review. The applicability of these data may be limited by the fact that 42% of the patients in our review were intubated for...
Source: Cochrane Database of Systematic Reviews - January 8, 2015 Category: Journals (General) Authors: Bruder EA, Ball IM, Ridi S, Pickett W, Hohl C Tags: Cochrane Database Syst Rev Source Type: research

Oral Anticoagulants and the Risk of Intracranial Hemorrhage
Conclusions and Relevance Novel oral anticoagulants are uniformly associated with an overall reduced risk of ICH when used for stroke prevention in atrial fibrillation. Any of the currently available NOACs can be considered first line for patients at high risk for ICH.JAMA Neurol. 2013;70(12):1486-1490. doi:10.1001/jamaneurol.2013.4021.
Source: JAMA - December 17, 2014 Category: Journals (General) Source Type: research

Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease.
Abstract Cerebrovascular neurologic emergencies including ischemic and hemorrhagic stroke, subarachnoid hemorrhage (SAH), and migraine are leading causes of death and disability that are frequently diagnosed and treated in the emergency department (ED). Although sex and gender differences in neurologic emergencies are beginning to become clearer, there are many unanswered questions about how emergency physicians should incorporate sex and gender into their research initiatives, patient evaluations, and overall management plans for these conditions. After evaluating the existing gaps in the literature, a core group...
Source: Accident and Emergency Nursing - November 24, 2014 Category: Emergency Medicine Authors: Madsen TE, Seigel TA, Mackenzie RS, Marcolini EG, Wira CR, Healy ME, Wright DW, Gentile NT Tags: Acad Emerg Med Source Type: research

Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease
Abstract Cerebrovascular neurologic emergencies including ischemic and hemorrhagic stroke, subarachnoid hemorrhage (SAH), and migraine are leading causes of death and disability that are frequently diagnosed and treated in the emergency department (ED). Although sex and gender differences in neurologic emergencies are beginning to become clearer, there are many unanswered questions about how emergency physicians should incorporate sex and gender into their research initiatives, patient evaluations, and overall management plans for these conditions. After evaluating the existing gaps in the literature, a core group of ED re...
Source: Academic Emergency Medicine - November 24, 2014 Category: Emergency Medicine Authors: Tracy E. Madsen, Todd A. Seigel, Richard S. Mackenzie, Evie G. Marcolini, Charles R. Wira, Megan E. Healy, David W. Wright, Nina T. Gentile Tags: Proceedings Breakout Session Source Type: research

Gamma aminobutyric acid (GABA) receptor agonists for acute stroke.
CONCLUSIONS: This review does not provide the evidence to support the use of GABA receptor agonists (chlormethiazole or diazepam) for the treatment of patients with acute ischemic or hemorrhagic stroke. Chlormethiazole appeared to be beneficial in improving functional independence in patients with TACS according to the subgroup analysis, but this result must be interpreted with great caution. More well-designed RCTs with large samples of TACS would be required for further confirmation. However, somnolence and rhinitis are frequent adverse events related to chlormethiazole. PMID: 25097101 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 6, 2014 Category: Journals (General) Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Thrombolysis for acute ischaemic stroke.
CONCLUSIONS: Thrombolytic therapy given up to six hours after stroke reduces the proportion of dead or dependent people. Those treated within the first three hours derive substantially more benefit than with later treatment. This overall benefit was apparent despite an increase in symptomatic intracranial haemorrhage, deaths at seven to 10 days, and deaths at final follow-up (except for trials testing rt-PA, which had no effect on death at final follow-up). Further trials are needed to identify the latest time window, whether people with mild stroke benefit from thrombolysis, to find ways of reducing symptomatic intracrani...
Source: Cochrane Database of Systematic Reviews - August 3, 2014 Category: Journals (General) Authors: Wardlaw JM, Murray V, Berge E, Del Zoppo GJ Tags: Cochrane Database Syst Rev Source Type: research

Hypoxia, haemorrhage and hypotension: the interface between emergency medicine and intensive care medicine
This subjective review is based on a presentation made at the College of Emergency Medicine Scientific Conference in September 2013. My theme was that there are certain features of the critically ill which cause understandable anxiety, namely hypoxia, haemorrhage and hypotension. So, I have selected papers relevant to the management of these frightening situations.
Source: Emergency Medicine Journal - May 16, 2014 Category: Emergency Medicine Authors: Foex, B. A. Tags: Editor's choice, Stroke, Adult intensive care Review Source Type: research

The Impact on Radiology Utilization of Disseminating an Analysis on the Value of Neuroimaging Studies in Intracerebral Hemorrhage: The University Hospitals Case Medical Center Comprehensive Stroke Center Experience (P5.145)
CONCLUSIONS: Disseminating the findings of our prior analysis regarding the use of neuroimaging studies for patients with ICH at our institution led to a significant reduction in resource case use for CT and MRI. Neuroimaging resource utilization, fostered by the availability of sophisticated neuroimaging, EMR standard order sets, and clinical trials protocols is an important area for research on the value of our health care. Healthcare value analyses should be driven by medical decision making, patient outcomes and risk then extend to resource utilization and cost.Study Supported by:NADisclosure: Dr. Shams has nothing to ...
Source: Neurology - April 9, 2014 Category: Neurology Authors: Shams, T., McCartney, L., Polly, W., Sila, C. Tags: Cerebrovascular Disease and Interventional Neurology: Intracerebral Hemorrhage Source Type: research

Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation.
CONCLUSIONS: DTIs were as efficacious as VKAs for the composite outcome of vascular death and ischaemic events and only the dose of dabigatran 150 mg twice daily was found to be superior to warfarin. DTIs were associated with fewer major haemorrhagic events, including haemorrhagic strokes. Adverse events that led to discontinuation of treatment occurred more frequently with the DTIs. We detected no difference in death from all causes. PMID: 24677203 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 27, 2014 Category: Journals (General) Authors: Salazar CA, Del Aguila D, Cordova EG Tags: Cochrane Database Syst Rev Source Type: research

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