Patients beyond the 6-hour invasive stroke treatment window benefitted from endovascular treatment of proximal MCA or ICA occlusion up to 16 hours from onset if there was a large ischemic penumbra on perfusion imaging that had not yet infarcted.

Patients with acute stroke from occluded intracranial internal carotid artery (ICA) or proximal middle cerebral artery (MCA) presenting from 6-24 hours from onset benefitted from endovascular thrombectomy when clinical deficits of stroke were greater than expected based on infarct volume on diffusion-weighted MRI or perfusion CT.

The Canadian CT Head Rule was 100% sensitive for ruling out clinically important brain injury.  It had higher specificity than the New Orleans Criteria, which meant fewer people would need a CT scan by using the Canadian rule.

Compared with vitamin K antagonist (VKA)-related non-traumatic intracerebral hemorrhage (ICH), direct oral anticoagulant (DOAC)-related ICH had less disability, smaller bleeds, and the meta-analysis showed lower in-hospital mortality rates.

A negative c-spine CT had 99.9% NPV for clinically significant c-spine injury in intoxicated patients.  The Western Trauma Association recommends c-spine clearance, even in intoxicated patients, if gross motor function is normal, no neurologic complaints, and negative c-spine CT per experienced radiologist.  Be careful out there, and get institutional buy-in if you plan to put this into practice.

Prior studies have shown that sentinel bleeds lead to worse outcomes if missed and subsequent aneurysmal subarachnoid hemorrhage (SAH) occurs, but this Kaiser Permanente case-control study suggests this may be a myth.

As CTA use increases, so does detection of small UIAs.  Most are unlikely to grow, and rupture rates are low but may be up to 1% per year in larger, 7mm aneurysms.