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This study supports the notion that an early return to school (RTS), results in faster recovery from concussion symptoms versus prolonged absences.
Source
Association Between Early Return to School Following Acute Concussion and Symptom Burden at 2 Weeks Postinjury. JAMA Netw Open. 2023 Jan 3;6(1):e2251839. doi: 10.1001/jamanetworkopen.2022.51839.
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After a training session, both interns and senior emergency providers (EPs) could accurately distinguish between central and peripheral vertigo using the 4-step STANDING algorithm.
Source
Effectiveness and reliability of the 4-step STANDING algorithm performed by emergency interns and seniors for predicting central causes of vertigo. Acad Emerg Med. 2023 Jan 11. doi: 10.1111/acem.14659. Online ahead of print.
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A general neurological exam has low sensitivity but high specificity for stroke in acute dizziness or vertigo. No modality is more sensitive than a HINTS exam by a trained provider.
Source
Diagnostic accuracy of the physical exam in emergency department patients with acute vertigo or dizziness: Systematic review and meta-analysis for GRACE-3. Acad Emerg Med. 2022 Dec 1. doi: 10.1111/acem.14630. Online ahead of print.
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Non-contrasted multislice CT (MSCT) is known to be highly sensitive in detecting subarachnoid hemorrhage (SAH) when performed within 6 hours of headache onset. Now, with modern MSCT, it looks like we can safely extend the timeframe even more.
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Vestibular suppressant medications in peripheral vertigo were not associated with symptom resolution, decrease in repeat ED visits, patient satisfaction, or increased quality of life. The authors suggest that positional maneuvers, such as the Epley maneuver, should be the primary treatment for BPPV.
Source
Vestibular suppressants for benign paroxysmal positional vertigo: A systematic review and meta-analysis of randomized controlled trials. Acad Emerg Med. 2022 Oct 21. doi: 10.1111/acem.14608. Online ahead of print.
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Among patients ≥65 years who presented to the ED with delirium, confusion, or altered mental status, 15.6% had an abnormal head CT. Presence of neurologic deficit was a significant predictor for abnormal CT, but anticoagulation was not.
Source
Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review. Acad Emerg Med. 2022 Nov 4. doi: 10.1111/acem.14622. Online ahead of print.
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Inconsistency and incongruence are two keys to diagnosing a functional neurological disorder. The video demonstration really helps sort this out.
Source
Inconsistency and incongruence: the two diagnostic pillars of functional movement disorder. Lancet. 2022 Jul 23;400(10348):328. doi: 10.1016/S0140-6736(22)01184-9.
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In children with refractory status epilepticus, around 3/4 of patients who were started on a ketamine infusion had seizure termination or improvement.
Source
Ketamine for Management of Neonatal and Pediatric Refractory Status Epilepticus. Neurology. 2022 Sep 20. Doi:10.1212/WNL.0000000000200889
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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.
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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.
