tPA 4.5 to 9h or Wake-Up Stroke - New Meta-analysis

tPA 4.5 to 9h or Wake-Up Stroke - New Meta-analysis

Compared to the placebo group, patients who presented with ischemic stroke (4.5-9h from onset or wake-up stroke) with salvageable brain tissue identified on perfusion imaging and received tPA, had a slight improvement in functional outcome (mRS of 0-1) at 3 months (36% vs 29%) with higher rates of symptomatic intracerebral hemorrhage (5% vs <1%).

EcLiPSE - Should Levetiracetam Replace Phenytoin for Pediatric Status Epilepticus?

EcLiPSE - Should Levetiracetam Replace Phenytoin for Pediatric Status Epilepticus?

There was no difference in levetiracetam vs phenytoin as second-line agents after benzodiazepines for pediatric status epilepticus in median time to seizure cessation. Levetiracetam may have other advantages, as it is able to be given over 5 minutes (vs 20 minutes for phenytoin) and causes fewer adverse effects.

How Often Do We Miss Serious Causes of Headache and Back Pain?

How Often Do We Miss Serious Causes of Headache and Back Pain?

In patients presenting to the ED with headache or back pain, very few return with serious, missed diagnoses after the initial evaluation. Patient who are elderly, immunocompromised, or have preexisting neurologic disease were at greater risk of missing serious conditions.

Ottawa Rule for SAH

Ottawa Rule for SAH

The application of the Ottawa SAH rule in this relatively small sample of patients had a 100% sensitivity for identifying SAH in the ED but a lower 95% confidence interval of 78.2. The 100% negative predictive value, with a promising 95% CI of 98.6-100%, may have been driven by the lower prevalence of SAH in this study population compared to a previous validation study.

Migraine - A Better Steroid than Dexamethasone?

Migraine - A Better Steroid than Dexamethasone?

Methylprednisolone acetate 160mg IM was not better than dexamethasone 10mg IM (both given with metoclopramide 10mg IM) for reducing headache days in the week following the ED visit in migraine patients.

Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage

Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage

The table below summarizes the recommendations for adult patients on anti-thrombotic agents with intracranial hemorrhage (both spontaneous and traumatic). This will be focused on ED management.

Forget the Blood Patch? A Medical Option That Works

Forget the Blood Patch? A Medical Option That Works

Administration of neostigmine and atropine vs placebo, in addition to usual care for post-dural puncture headache (PDPH), was highly effective in this RCT involving healthy postpartum women.

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