MRI-Guided Alteplase for Wake-Up Stroke

MRI-Guided Alteplase for Wake-Up Stroke

For patients with unknown time of stroke onset, MRI characteristics may be able to discern the timing of the stroke and allow for thrombolytic therapy.  Overall, outcomes were better with thrombolysis but at the possible cost of higher mortality and risk of intracranial bleed.

Atraumatic Needles Drastically Reduce Post-LP Headache

Atraumatic Needles Drastically Reduce Post-LP Headache

In this large meta-analysis of 110 RCTs, the incidence of post-dural puncture headache (PDPH) was only 4.2% compared to conventional LP needles at 11%; NNT = 14.  This is a game-changer.

Does Diphenhydramine Help EPS with Prochlorperazine?

Does Diphenhydramine Help EPS with Prochlorperazine?

Prophylactic diphenhydramine reduces extrapyramidal symptoms in patients receiving bolus anti-emetic therapy (given over 2 minutes), but not when the anti-emetic is given as an infusion over 15 minutes.

Delayed Endovascular Stroke Treatment - Beyond the 6-hour Window

Delayed Endovascular Stroke Treatment - Beyond the 6-hour Window

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.

IV Prochlorperazine + Diphenhydramine vs Hydromorphone for Migraines

IV Prochlorperazine + Diphenhydramine vs Hydromorphone for Migraines

The primary outcome (quick and sustained headache relief) was achieved in 60% of the IV prochlorperazine + diphenhydramine group vs 31% in the IV hydromorphone group with a NNT of 4. As a result, the study was stopped early.

DOAC vs Warfarin Related Non-Traumatic ICH

DOAC vs Warfarin Related Non-Traumatic ICH

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.

Should We Give Delayed Lytics for Stroke Over Age 80?

Should We Give Delayed Lytics for Stroke Over Age 80?

Elderly stroke patients over age 80 who received tPA >3 - 4.5 hours from time of onset were more likely to have symptomatic intracranial hemorrhage (SICH), 10% vs 8% in the <3-hour group, but overall mortality and percentage with good neurological outcome was the same in the delayed group as patients who received it in under 3 hours.

Is Analgesic Rebound Headache a Myth?

Is Analgesic Rebound Headache a Myth?

Medication overuse headache (MOH), also known as rebound headache or drug-induced headache, may be the stuff of legend.  The evidence for it is sketchy. The authors say, "Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication."

Video on How to Tell Stroke vs. Mimic on Exam

Video on How to Tell Stroke vs. Mimic on Exam

The "upgoing thumb sign" can be used as part of a comprehensive neurological evaluation to help distinguish stroke mimic from actual stroke.  It won't replace MRI, but it can be part of the neurological exam, just like we use the Babinski sign.  One editorial from 1993 suggested calling it the Hachinski-Babinski, after the discover.  Here's how to do it.

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