Neurology

ATTENTION RCT – Thrombectomy Benefits Basilar Artery Occlusion Stroke?

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Endovascular thrombectomy was associated with improved functional neurologic outcomes compared to best medical care for patients with basilar-artery occlusion who presented within 12 hours of stroke onset. However, thrombectomy was also associated with significant procedural complications and an increased risk of intracranial hemorrhage.

Source
Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion. N Engl J Med. 2022 Oct 13;387(15):1361-1372. doi: 10.1056/NEJMoa2206317.

Should We Use Steroids for Pediatric Bell’s Palsy?

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There was no statistical difference in 1, 3, or 6 month facial recovery with prednisolone vs placebo for children with Bell’s palsy in this underpowered RCT. I plan to keep using steroids, though opinions on this will differ.

Source
Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Neurology. 2022 Aug 25;10.1212/WNL.0000000000201164. doi: 10.1212/WNL.0000000000201164. Online ahead of print.

Does Ketorolac Improve Your Migraine Cocktail?

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This systematic review found IM or IV ketorolac had similar efficacy in treating acute migraine headache as phenothiazines and metoclopramide but was unable to draw significant conclusions about ketorolac in comparison to other therapies or as part of a multi-drug cocktail due to paucity of evidence.

Source
Efficacy of ketorolac in the treatment of acute migraine attack: A systematic review and meta-analysis. Acad Emerg Med. 2022 Sep;29(9):1118-1131. doi: 10.1111/acem.14457. Epub 2022 Mar 10.

Should Benadryl Be in Your Migraine Cocktail?

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There is still no strong evidence to suggest that an anticholinergic agent should be administered prophylactically to prevent extrapyramidal symptoms when treating migraine.

Source
Adjuvant anticholinergic therapy for the prevention of akathisia in patients with primary headache in the emergency department: a systematic review. Acad Emerg Med. 2022 Aug 13. doi: 10.1111/acem.14581. Online ahead of print.

NOR-TEST 2 – What’s the Right Dose of Tenecteplase for Stroke?

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Tenecteplase, at a dose of 0.4 mg/kg, is not safe for patients with moderate to severe ischemic stroke.

Source
Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial. Lancet Neurol. 2022 Jun;21(6):511-519. doi: 10.1016/S1474-4422(22)00124-7. Epub 2022 May 4.

How to Use Nerve Blocks for Acute Headache

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Peripheral nerve blocks may help achieve symptomatic improvement in our primary headache patients, but we are still far off with research supporting it as a first line intervention.

Source
Effectiveness of Peripheral Nerve Blocks for the Treatment of Primary Headache Disorders: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2022 Mar;79(3):251-261. doi: 10.1016/j.annemergmed.2021.08.007. Epub 2021 Oct 28.

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