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COMMENT
Jeffrey J Perry, Robert E Harbaugh
No abstract text is available yet for this article.
September 2016: Academic Emergency Medicine
#22
EDITORIAL
Theron S Williams, Rawle A Seupaul
No abstract text is available yet for this article.
September 2016: Annals of Emergency Medicine
#23
RANDOMIZED CONTROLLED TRIAL
Craig S Anderson, Thompson Robinson, Richard I Lindley, Hisatomi Arima, Pablo M Lavados, Tsong-Hai Lee, Joseph P Broderick, Xiaoying Chen, Guofang Chen, Vijay K Sharma, Jong S Kim, Nguyen H Thang, Yongjun Cao, Mark W Parsons, Christopher Levi, Yining Huang, Verónica V Olavarría, Andrew M Demchuk, Philip M Bath, Geoffrey A Donnan, Sheila Martins, Octavio M Pontes-Neto, Federico Silva, Stefano Ricci, Christine Roffe, Jeyaraj Pandian, Laurent Billot, Mark Woodward, Qiang Li, Xia Wang, Jiguang Wang, John Chalmers
BACKGROUND: Thrombolytic therapy for acute ischemic stroke with a lower-than-standard dose of intravenous alteplase may improve recovery along with a reduced risk of intracerebral hemorrhage. METHODS: Using a 2-by-2 quasi-factorial open-label design, we randomly assigned 3310 patients who were eligible for thrombolytic therapy (median age, 67 years; 63% Asian) to low-dose intravenous alteplase (0.6 mg per kilogram of body weight) or the standard dose (0.9 mg per kilogram); patients underwent randomization within 4...
June 16, 2016: New England Journal of Medicine
#24
REVIEW
Hugh J Willison, Bart C Jacobs, Pieter A van Doorn
Guillain-Barré syndrome is the most common and most severe acute paralytic neuropathy, with about 100,000 people developing the disorder every year worldwide. Under the umbrella term of Guillain-Barré syndrome are several recognisable variants with distinct clinical and pathological features. The severe, generalised manifestation of Guillain-Barré syndrome with respiratory failure affects 20-30% of cases. Treatment with intravenous immunoglobulin or plasma exchange is the optimal management approach, alongside supportive care...
August 13, 2016: Lancet
#25
REVIEW
Elyse Berger-Pelleiter, Marcel Émond, François Lauzier, Jean-François Shields, Alexis F Turgeon
OBJECTIVES: Hypertonic saline solutions are increasingly used to treat increased intracranial pressure following severe traumatic brain injury. However, whether hypertonic saline provides superior management of intracranial pressure and improves outcome is unclear. We thus conducted a systematic review to evaluate the effect of hypertonic saline in patients with severe traumatic brain injury. METHODS: Two researchers independently selected randomized controlled trials studying hypertonic saline in severe traumatic brain injury and collected data using a standardized abstraction form...
March 2016: CJEM
#26
JOURNAL ARTICLE
B Gregory Thompson, Robert D Brown, Sepideh Amin-Hanjani, Joseph P Broderick, Kevin M Cockroft, E Sander Connolly, Gary R Duckwiler, Catherine C Harris, Virginia J Howard, S Claiborne Clay Johnston, Philip M Meyers, Andrew Molyneux, Christopher S Ogilvy, Andrew J Ringer, James Torner
PURPOSE: The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. METHODS: Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria...
August 2015: Stroke; a Journal of Cerebral Circulation
#27
MULTICENTER STUDY
Daniel K Nishijima, Steven R Offerman, Dustin W Ballard, David R Vinson, Uli K Chettipally, Adina S Rauchwerger, Mary E Reed, James F Holmes
STUDY OBJECTIVE: Patients receiving warfarin or clopidogrel are considered at increased risk for traumatic intracranial hemorrhage after blunt head trauma. The prevalence of immediate traumatic intracranial hemorrhage and the cumulative incidence of delayed traumatic intracranial hemorrhage in these patients, however, are unknown. The objective of this study is to address these gaps in knowledge. METHODS: A prospective, observational study at 2 trauma centers and 4 community hospitals enrolled emergency department (ED) patients with blunt head trauma and preinjury warfarin or clopidogrel use from April 2009 through January 2011...
June 2012: Annals of Emergency Medicine
#28
REVIEW
K D Kurz, G Ringstad, A Odland, R Advani, E Farbu, M W Kurz
Patients who suffer acute ischaemic stroke can be treated with thrombolysis if therapy is initiated early. Radiological evaluation of the intracranial tissue before such therapy can be given is mandatory. In this review current radiological diagnostic strategies are discussed for this patient group. Beyond non-enhanced computed tomography (CT), the standard imaging method for many years, more sophisticated CT stroke protocols including CT angiography and CT perfusion have been developed, and additionally an increasing number of patients are examined with magnetic resonance imaging as the first imaging method used...
January 2016: European Journal of Neurology
#29
JOURNAL ARTICLE
Omar Batal, Jacob Jentzer, Bhavna Balaney, Nadeem Kolia, Gavin Hickey, Zeina Dardari, Vivek Reddy, Tudor Jovin, Maxim Hammer, John Gorcsan, Mark Schmidhofer
BACKGROUND: The significance of cardiac troponin I (TnI) levels in patients with acute ischemic stroke remains unclear. METHODS: Data were prospectively collected on 1718 patients with acute ischemic stroke (2009-2010). Patients with positive TnI (peak TnI ≥0.1 μg/L) were assigned to the myocardial infarction (MI) group if they met diagnostic criteria. The remaining patients with positive TnI were assigned to the no-MI group. Patients were followed up for 1.4 ± 1...
February 2016: Journal of Critical Care
#30
JOURNAL ARTICLE
Jetan H Badhiwala, Farshad Nassiri, Waleed Alhazzani, Magdy H Selim, Forough Farrokhyar, Julian Spears, Abhaya V Kulkarni, Sheila Singh, Abdulrahman Alqahtani, Bram Rochwerg, Mohammad Alshahrani, Naresh K Murty, Adel Alhazzani, Blake Yarascavitch, Kesava Reddy, Osama O Zaidat, Saleh A Almenawer
IMPORTANCE: Endovascular intervention for acute ischemic stroke improves revascularization. But trials examining endovascular therapy yielded variable functional outcomes, and the effect of endovascular intervention among subgroups needs better definition. OBJECTIVE: To examine the association between endovascular mechanical thrombectomy and clinical outcomes among patients with acute ischemic stroke. DATA SOURCES: We systematically searched MEDLINE, EMBASE, CINAHL, Google Scholar, and the Cochrane Library without language restriction through August 2015...
November 3, 2015: JAMA
#31
EDITORIAL
Michael Gottlieb, Benton Hunter
No abstract text is available yet for this article.
December 2015: Annals of Emergency Medicine
#32
RANDOMIZED CONTROLLED TRIAL
Benjamin W Friedman, Lisa Cabral, Victoria Adewunmi, Clemencia Solorzano, David Esses, Polly E Bijur, E John Gallagher
STUDY OBJECTIVE: More than 1 million patients present to US emergency departments (EDs) annually seeking care for acute migraine. Parenteral antihistamines have long been used in combination with antidopaminergics such as metoclopramide to treat acute migraine in the ED. High-quality data supporting this practice do not exist. We determine whether administration of diphenhydramine 50 mg intravenously+metoclopramide 10 mg intravenously results in greater rates of sustained headache relief than placebo+metoclopramide 10 mg intravenously...
January 2016: Annals of Emergency Medicine
#33
EDITORIAL
Brit J Long, Alex Koyfman
No abstract text is available yet for this article.
December 2015: Annals of Emergency Medicine
#34
JOURNAL ARTICLE
M Fernanda Bellolio, Erik P Hess, Waqas I Gilani, Tyler J VanDyck, Stuart A Ostby, Jessica A Schwarz, Christine M Lohse, Alejandro A Rabinstein
We aim to externally validate the Ottawa subarachnoid hemorrhage (OSAH) clinical decision rule. This rule identifies patients with acute nontraumatic headache who require further investigation. We conducted a medical record review of all patients presenting to the emergency department (ED) with headache from January 2011 to November 2013. Per the OSAH rule, patients with any of the following predictors require further investigation: age 40 years or older, neck pain, stiffness or limited flexion, loss of consciousness, onset during exertion, or thunderclap...
February 2015: American Journal of Emergency Medicine
#35
COMMENT
Michael Gottlieb, John Bailitz
No abstract text is available yet for this article.
January 2016: Annals of Emergency Medicine
#36
REVIEW
John P Betjemann, Daniel H Lowenstein
Status epilepticus is a common neurological emergency with considerable associated health-care costs, morbidity, and mortality. The definition of status epilepticus as a prolonged seizure or a series of seizures with incomplete return to baseline is under reconsideration in an effort to establish a more practical definition to guide management. Clinical research has focused on early seizure termination in the prehospital setting. The approach of early escalation to anaesthetic agents for refractory generalised convulsive status epilepticus, rather than additional trials of second-line anti-epileptic drugs, to avoid neuronal injury and pharmaco-resistance associated with prolonged seizures is gaining momentum...
June 2015: Lancet Neurology
#37
RANDOMIZED CONTROLLED TRIAL
Jeffrey L Saver, Mayank Goyal, Alain Bonafe, Hans-Christoph Diener, Elad I Levy, Vitor M Pereira, Gregory W Albers, Christophe Cognard, David J Cohen, Werner Hacke, Olav Jansen, Tudor G Jovin, Heinrich P Mattle, Raul G Nogueira, Adnan H Siddiqui, Dileep R Yavagal, Blaise W Baxter, Thomas G Devlin, Demetrius K Lopes, Vivek K Reddy, Richard du Mesnil de Rochemont, Oliver C Singer, Reza Jahan
BACKGROUND: Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome. METHODS: We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group)...
June 11, 2015: New England Journal of Medicine
#38
RANDOMIZED CONTROLLED TRIAL
Olvert A Berkhemer, Puck S S Fransen, Debbie Beumer, Lucie A van den Berg, Hester F Lingsma, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke J H Wermer, Marianne A A van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A van Oostayen, Geert J Lycklama à Nijeholt, Jelis Boiten, Patrick A Brouwer, Bart J Emmer, Sebastiaan F de Bruijn, Lukas C van Dijk, L Jaap Kappelle, Rob H Lo, Ewoud J van Dijk, Joost de Vries, Paul L M de Kort, Willem Jan J van Rooij, Jan S P van den Berg, Boudewijn A A M van Hasselt, Leo A M Aerden, René J Dallinga, Marieke C Visser, Joseph C J Bot, Patrick C Vroomen, Omid Eshghi, Tobien H C M L Schreuder, Roel J J Heijboer, Koos Keizer, Alexander V Tielbeek, Heleen M den Hertog, Dick G Gerrits, Renske M van den Berg-Vos, Giorgos B Karas, Ewout W Steyerberg, H Zwenneke Flach, Henk A Marquering, Marieke E S Sprengers, Sjoerd F M Jenniskens, Ludo F M Beenen, René van den Berg, Peter J Koudstaal, Wim H van Zwam, Yvo B W E M Roos, Aad van der Lugt, Robert J van Oostenbrugge, Charles B L M Majoie, Diederik W J Dippel
BACKGROUND: In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a beneficial effect on functional outcome is lacking. METHODS: We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset...
January 1, 2015: New England Journal of Medicine
#39
REVIEW
A C Rickard, J E Smith, P Newell, A Bailey, A Kehoe, C Mann
BACKGROUND: Rising intracranial pressure (ICP) is a poor prognostic indicator in traumatic brain injury (TBI). Both mannitol and hypertonic sodium solutions are used to treat raised ICP in patients with TBI. OBJECTIVE: This meta-analysis compares the use of mannitol versus hypertonic sodium solutions for ICP control in patients with TBI. DATA SOURCES AND STUDY ELIGIBILITY: Randomised clinical trials in adults with TBI and evidence of raised ICP, which compare the effect on ICP of hypertonic sodium solutions and mannitol...
August 2014: Emergency Medicine Journal: EMJ
#40
REVIEW
Joanna M Wardlaw, Veronica Murray, Eivind Berge, Gregory del Zoppo, Peter Sandercock, Richard L Lindley, Geoff Cohen
BACKGROUND: Recombinant tissue plasminogen activator (rt-PA, alteplase) improved functional outcome in patients treated soon after acute ischaemic stroke in randomised trials, but licensing is restrictive and use varies widely. The IST-3 trial adds substantial new data. We therefore assessed all the evidence from randomised trials for rt-PA in acute ischaemic stroke in an updated systematic review and meta-analysis. METHODS: We searched for randomised trials of intravenous rt-PA versus control given within 6 h of onset of acute ischaemic stroke up to March 30, 2012...
June 23, 2012: Lancet
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