Top Neurology Journal Insights for Clinicians

Emergency Medicine Neurology Stroke

OPTION RCT – TNK for Stroke at 4.5-24 Hours – Better Again
March 13, 2026April 6, 2026

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Tenecteplase (TNK) vs. usual care in non-large vessel occlusion (non-LVO) stroke patients 4.5–24 hours from onset, with perfusion mismatch, had better outcome but slightly more intracranial hemorrhage.

Source
OPTION Investigators. Tenecteplase for Acute Non-Large Vessel Occlusion 4.5 to 24 Hours After Ischemic Stroke: The OPTION Randomized Clinical Trial. JAMA. 2026 Feb 5:e260210. doi: 10.1001/jama.2026.0210. Epub ahead of print. PMID: 41642827; PMCID: PMC12878635.

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Emergency Medicine Neurology Pharmacy/Pharmacology Stroke

TNK Up to 24 Hours for Basilar Artery Stroke
March 12, 2026March 9, 2026

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Tenecteplase administration up to 24 hours after onset of ischemic basilar artery stroke showed improved disability scores compared to standard medical treatment without an increase in adverse events.

Source
Tenecteplase versus standard medical treatment for basilar artery occlusion within 24 h (TRACE-5): a multicentre, prospective, randomised, open-label, blinded-endpoint, superiority, phase 3 trial. Lancet. 2026 Feb 21;407(10530):763-772. doi: 10.1016/S0140-6736(25)02633-9. Epub 2026 Feb 5. PMID: 41655588.

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Emergency Medicine Neurology Pharmacy/Pharmacology Stroke

EMPHASIS RCT – Minocycline in Acute Ischemic Stroke
March 11, 2026March 9, 2026

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This multicenter RCT demonstrated that a short course of minocycline in patients with acute ischemic stroke (AIS) resulted in improved functional neurologic outcomes at 90 days.

Source
Efficacy and safety of minocycline in patients with acute ischaemic stroke (EMPHASIS): a multicentre, double-blind, randomised controlled trial. Lancet. 2026 Feb 14;407(10529):679-688. doi: 10.1016/S0140-6736(25)01862-8. Epub 2026 Jan 30. PMID: 41628627.

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Critical Care Emergency Medicine Neurology Pediatric Emergency Stroke

New 2026 Stroke Guidelines and Updates
March 9, 2026March 12, 2026

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These guidelines for acute ischemic stroke (AIS) are a doozy, but we’ve covered the highlights.

Source
2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2026 Jan 26. doi: 10.1161/STR.0000000000000513. Epub ahead of print. PMID: 41582814.

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Emergency Medicine Neurology

Fluids Might Not Help Your Headache
March 5, 2026March 12, 2026

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In this randomized controlled trial, adding 1 liter of IV normal saline to intramuscular diclofenac for acute migraine in the ED did not significantly improve pain relief at 2 hours compared with diclofenac alone.

Source
Efficacy of Adding Intravenous Saline Solution to Nonsteroidal Anti-Inflammatory Drug-Based Treatment of Acute Migraine in the Emergency Department. Ann Emerg Med. 2026 Feb;87(2):157-166. doi: 10.1016/j.annemergmed.2025.09.013. Epub 2025 Oct 10. PMID: 41071134.

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Critical Care Emergency Medicine Neurology Pharmacy/Pharmacology Stroke

Slow and Steady – Be Careful with ICH BP Control
January 15, 2026January 17, 2026

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In this retrospective multicenter study, both early, overly rapid systolic blood pressure (SBP) reduction after intracerebral hemorrhage (ICH) and overshooting SBP targets (<120 mmHg) were linked with worse functional outcomes at discharge.

Source
Early Intensive Blood Pressure Reduction After Intracerebral Hemorrhage Is Associated With Worse Functional Outcome: The Risk of Overshooting Blood Pressure Goals. Ann Emerg Med. 2025 Dec 9:S0196-0644(25)01303-4. doi: 10.1016/j.annemergmed.2025.10.009. Epub ahead of print. PMID: 41369631; PMCID: PMC12757810.

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Emergency Medicine Medicine/Geriatrics Neurology Psychiatry | Substance Use

Discharging Delirium Is Dangerous
January 7, 2026January 10, 2026

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Older adults discharged from the ED with delirium had almost 3 times the risk of 30-day mortality compared to those discharged without delirium.

Source
Outcomes of Older Adults With Delirium Discharged From the Emergency Department. Ann Emerg Med. 2025 Nov;86(5):484-495. doi: 10.1016/j.annemergmed.2025.02.003. Epub 2025 Mar 12. PMID: 40072382; PMCID: PMC12353625.

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Emergency Medicine EMS Neurology Stroke

What Are the Best LVO Stroke Predictors for EMS?
December 5, 2025December 6, 2025

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The prehospital screening tools for large vessel occlusion (LVO) with the best accuracy were: FAST-ED, RACE, and LAMS. Cincinnati Prehospital Stroke Scale (CPSS) was the worst.

Source
Accuracy of Published Screening Tools for Large Vessel Occlusion in Patients With Suspected Acute Ischemic Stroke: A Prospective Cohort Study. Ann Emerg Med. 2025 Sep 19:S0196-0644(25)01092-3. doi: 10.1016/j.annemergmed.2025.07.030. Epub ahead of print. PMID: 40974366.

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Emergency Medicine Neurology Pharmacy/Pharmacology Stroke

TNK 4.5 to 24 Hours After Stroke – Better Late Than Never?
December 4, 2025December 6, 2025

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Patients with delayed presentation, 4.5 to 24 hours after onset of ischemic stroke, still had significant benefit from tenecteplase (TNK): NNT = 17, NNH = 72.

Source
Tenecteplase for Acute Ischemic Stroke at 4.5 to 24 Hours: A Meta-Analysis of Randomized Controlled Trials. Stroke. 2025 Oct 13. doi: 10.1161/STROKEAHA.125.053256. Epub ahead of print. PMID: 41078125.

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Emergency Medicine Neurology Neurosurgery

Idiopathic Intracranial Hypertension—Spoon Feed Version
November 28, 2025December 4, 2025

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Idiopathic intracranial hypertension is an obesity-associated disorder, most often seen in young women, which causes elevated intracranial pressure and papilledema, leading to headaches and potential vision loss. Diagnosis relies on neuroimaging and lumbar puncture, while treatment focuses on weight reduction, acetazolamide, and emerging GLP-1 agonists, with surgery reserved for vision-threatening cases.

Source
Idiopathic Intracranial Hypertension. N Engl J Med. 2025 Oct 9;393(14):1409-1419. doi: 10.1056/NEJMra2404929. PMID: 41061234.

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