Neurology

Endovascular treatment for acute stroke

In this randomized trial of patients with acute stroke s/p t-PA, they were randomized to further endovascular treatment or no treatment; the trial was stopped early, as the 90 day Rankin and NIHSS scores were no different between the groups, nor was mortality. Currently, the use of endovascular treatment after t-PA has unproven benefit (abstract).

Stroke guidelines updated

The AHA/ASA has updated their guidelines for the management of acute stroke; they stress the need for early thrombolytics, early transfer to a stroke center or use of telemedicine consultation when feasible. The full guidelines are at (AHA/ASA)

SSRIs post-stroke

This large meta-analysis of 52 trials found that SSRIs significantly reduced the risk of neurological deficit, dependence, disability, depression, and anxiety post stroke, compared to controls (abstract).

Trends in in-hospital cardiac arrest

In this analysis from 2000-2009 from the Get with the Guidelines registry of patients with in-hospital cardiac arrest, 80% had asystole or PEA, and 20% Vfib/Vtach. Survival to discharge increased from 14% to 22% over the time period. Neurological disability also decreased from 33% to 28% over the time period. Advances in in-hospital arrest have improved survival and reduced neurological disability rates (abstract).

Guidelines for steroids in Bell’s palsy

The American Academy of Neurology (AAN) has issued updated guidelines on the treatment of Bell's palsy; they concluded that steroids are "probably effective" and antivirals are "possibly effective". The steroids should be continued for 10 days, and best outcomes were noted in those started within 3 days of onset (guidelines)
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