Acute Cerebrovascular Conditions · Anaesthetic Agents · Ischaemic Stroke · Neuroanaesthesia · Sedation

AnStroke Trial: Anaesthesia vs. Sedation for Endovascular Treatment of Ischemic Stroke

Does choice of anaesthetic approach have an impact on neurological outcomes in stroke patients? This article, recently published in Stroke, examines outcomes in patients undergoing endovascular treatment for acute ischemic stroke, randomised to either conscious sedation or general anaesthesia. Retrospective material till now has suggested poorer outcomes in patients subjected to full anaesthesia when compared… Continue reading AnStroke Trial: Anaesthesia vs. Sedation for Endovascular Treatment of Ischemic Stroke

Acute Cerebrovascular Conditions · Subarachnoid Haemorrhage

SJTREM – Prehospital CT for Diagnosing SAH

Recently published in the Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine by Hov et al. This article relays two case reports on successful diagnosis of SAH in a prehospital setting using a mobile CT unit. As the article reveals, this could entail significantly shortened time to meaningful intervention at a neurosurgical center, especially in… Continue reading SJTREM – Prehospital CT for Diagnosing SAH

Acute Cerebrovascular Conditions · EEG · Neuromonitoring · Subarachnoid Haemorrhage

EEG and Oxygenation in Acute Brain Injury

Really interesting article in the latest issue of JAMA Neurology: Specific EEG changes, known as periodic discharges (PDs), seem to be of value in predicting brain tissue hypoxia in vulnerable patients with acute brain injury. In this investigation, Witsch and colleagues included 90 patients with high-grade subarachnoid haemorrhage and monitored them with continuous EEG in addition to… Continue reading EEG and Oxygenation in Acute Brain Injury

Acute Cerebrovascular Conditions · US Guidelines

AHA/ASA Guidelines on Ischemic Stroke

Published in 2015: American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment. Available here. It acknowledges that a stronger recommendation for the use of endovascular thrombectomy can now be made. This is based on a number of studies suggesting benefit with these… Continue reading AHA/ASA Guidelines on Ischemic Stroke

Acute Cerebrovascular Conditions · Haemodynamics · Neuromonitoring · Subarachnoid Haemorrhage

Cerebral Perfusion Pressure Thresholds for Brain Tissue Hypoxia and Metabolic Crisis After Poor-Grade Subarachnoid Hemorrhage

Published in 2011 by Schmidt et al (free full-text in Stroke), this article looks at CPP thresholds for cerebral hypoxia in SAH patients. They went through multimodal monitoring data for 30 patients with poor-grade SAH. Using microdialysis and brain tissue oxygenation as their main determinants of hypoxia, they found that patients with a CPP <70… Continue reading Cerebral Perfusion Pressure Thresholds for Brain Tissue Hypoxia and Metabolic Crisis After Poor-Grade Subarachnoid Hemorrhage

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · TBI General

To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin

There´s a paucity of guidelines and recommendations on diagnostic pathways in patients on warfarin who sustain head injuries. This article by Alrajhi et al from 2015 (J Emerg Med) looked at an historical cohort of patients on warfarin admitted for either minor (Glasgow Coma Score 13-15, with loss of consciousness, amnesia, or confusion) or minimal (Glasgow Coma Score… Continue reading To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · Haemodynamics · Intracerebral Haemorrhage

ATACH II Trial – No Benefit From Aggressive BP-lowering in ICH

Published in NEJM 2016, the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) trial compared two BP-management regimes in intracerebral haemorrhage patients with hypertension (SBP>180 mmHg): Intensive lowering to SBP 110-139 mm Hg. vs. standard treatment to within the 140-179 mm Hg range. The trial was discontinued early after an interim analysis showed no difference between the groups in… Continue reading ATACH II Trial – No Benefit From Aggressive BP-lowering in ICH

Acute Cerebrovascular Conditions · Coagulopathy and Bleeding · Intracerebral Haemorrhage

PATCH – Trial: Platelets in ICH Harmful

Transfusing thrombocytes to patients taking anti-platelet therapy who develop an intracerebral hemorrhage seems to confer harm, according to the authors of the PATCH trial (abstract). Published recently in the Lancet by Baharoglu et al, this multicentre RCT included 190 patients in order to determine whether platelet transfusion reduces extent of haemorrhage, thereby improving outcome, in ICH associated with… Continue reading PATCH – Trial: Platelets in ICH Harmful

Acute Cerebrovascular Conditions · Haemodynamics · ICP/CPP management · Intracerebral Haemorrhage

Best BETs – Safe to Lower BP in ICH?

A quick review published in BMJ´s Best Evidence Topic Reports series, April 2016 by Kapil Mohan Rajwani and Azlisham Mohd Nor. They address the issue of lowering elevated blood pressures in patients with an acute ICH. Is it safe and is there evidence to support active BP-management? And if yes, what´s our target? Targeted blood pressure management in… Continue reading Best BETs – Safe to Lower BP in ICH?