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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.

Source
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. 

Source
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.

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

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At least in the initial period, there appears to be no clinically meaningful difference in IQ scores in pediatric patients after a concussion. 

Source
IQ After Pediatric Concussion. Pediatrics. 2023. 152(2);e2022060515. https://doi.org/10.1542/peds.2022-060515.

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Aneurysmal subarachnoid hemorrhage (aSAH) is a deadly condition. Here’s a quick summary of the 40-page AHA/ASA evidence-based guidelines for diagnosis and management.

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Post-concussion return to functional baseline occurs early for symptoms, balance, and mental status along with partial neurocognitive functioning. Visual-memory and reaction-time recovery, however, lag behind the other groups post-concussion.

Source
Time to Recovery as Measured on Clinical Assessments after Sport-Related Concussion. N Engl J Med. 2023 May 4;388(18):1717-1719. doi: 10.1056/NEJMc2301706.

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The GRACE-3 group (SAEM) provides us with a guideline based on their review we covered previously with the evidence for evaluating and managing adult patients presenting to emergency departments for acute dizziness. Emergency clinicians need additional training in physical exam techniques related to acute dizziness in order to perform them effectively, which should be a specialty-wide goal for the future. 

Source
Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. Acad Emerg Med. 2023 May;30(5):442-486. doi: 10.1111/acem.14728.

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Tenecteplase was non-inferior to alteplase in patients with acute ischemic stroke who were eligible for intravenous thrombolytic therapy but ineligible or refused endovascular thrombectomy.

Source
Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial. Lancet. 2023 Feb 8;S0140-6736(22)02600-9. doi: 10.1016/S0140-6736(22)02600-9. Online ahead of print.

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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.