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The SWITCH trial found that decompressive craniectomy plus best medical treatment may improve outcomes in patients with severe intracerebral hemorrhage involving the basal ganglia or thalamus.

Source
Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage: a randomised controlled clinical trial. Lancet. 2024 Jun 1;403(10442):2395-2404. doi: 10.1016/S0140-6736(24)00702-5. Epub 2024 May 15. PMID: 38761811.

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Diagnosing patients with a posterior circulation TIA who are experiencing  isolated episodic dizziness can be challenging, especially when considering the difficulty in assessing individual symptoms and the small absolute number of these patients. The authors lay out a pragmatic approach for assessment and diagnosis, but the data to support a reliable clinical decision-making tool is weak.

Source
Recognizing Posterior Circulation Transient Ischemic Attacks Presenting as Episodic Isolated Dizziness. Ann Emerg Med. 2024 May 23:S0196-0644(24)00214-2. doi: 10.1016/j.annemergmed.2024.04.006. Epub ahead of print. PMID: 38795083.

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This new review summarizes the current evidence regarding diagnosis and management of mild TBI in children.

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Contemporary diagnosis and management of mild TBI (concussions): What you need to know. J Trauma Acute Care Surg. 2024 Jun 1;96(6):865-869. doi: 10.1097/TA.0000000000004297. Epub 2024 May 2. PMID: 38696496.

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This retrospective cohort study of Kaiser NorCal EDs found increasing use of CT cerebral angiography for spontaneous subarachnoid hemorrhage diagnosis to be associated with fewer lumbar punctures and higher detection of unruptured intracranial aneurysms, with no significant change in the miss rate for SAH or bacterial meningitis.

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Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021. JAMA Netw Open. 2024 Apr 1;7(4):e247373. doi: 10.1001/jamanetworkopen.2024.7373. PMID: 38639937; PMCID: PMC11031686.

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This retrospective validation study at a single site in Hong Kong found the TriAGe+ score for vertigo or dizziness would have performed reasonably well for risk-stratifying patients who presented to their ED for dizziness or vertigo when evaluating for acute stroke or TIA.

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The TriAGe + score for vertigo or dizziness: A validation study in a university hospital emergency department in Hong Kong. Am J Emerg Med. 2024 Mar;77:39-45. doi: 10.1016/j.ajem.2023.10.055. Epub 2023 Nov 10. PMID: 38096638.

Exciting news! JournalFeed and Dr. Amal Mattu's Top Picks Video Series is set to GO LIVE this week! It's free for Gold Spoon members or you can just get the video series. Watch this trailer and get excited!

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In this retrospective cohort study, there was no increased risk of intracranial hemorrhage, major bleeding, or in-hospital mortality in patients taking non-vitamin K antagonist oral anticoagulants compared to those not taking anticoagulants, but read the fine print.

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Is Guillain-Barre Syndrome (GBS) on your differential for neurologic symptoms? Let’s review this high morbidity/mortality disease.

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This is a review of the diagnosis and management of non-convulsive status epilepticus (NCSE) in the emergency department. Nonspecific signs and symptoms at presentation make it challenging to identify, which can lead to under-diagnosis and delay in treatment.

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Nonconvulsive Status Epilepticus: A Review for Emergency Clinicians. J Emerg Med. 2023 Oct;65(4):e259-e271. doi: 10.1016/j.jemermed.2023.05.012. Epub 2023 Jun 5.

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This RCT found no differences between high dose (16 mg) and low dose (4 mg) IV dexamethasone in patients who presented to EDs with migraine headaches. 

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Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine. Neurology vol. 101,14 (2023): e1448-e1454. doi:10.1212/WNL.0000000000207648

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Encephalitis can be cryptic – here are the latest updates for diagnosis and treatment.

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State of the Art: Acute Encephalitis. Clin Infect Dis. 2023 Sep 11;77(5):e14-e33. doi: 10.1093/cid/ciad306.