Neurology

Guidelines on the use of 14-3-3 protein for diagnosis of CJD

Sporadic CJD is rare and difficult to diagnose. The American Academy of Neurology just released guidelines on the use of CSF protein 14-3-3 to diagnose the disease. They found in suspected patients (rapidly progressive dementia), the assay had a sensitivity and specificity of 92% and 80% respectively, which can help improve the certainty of diagnosis is patients with suspected disease (abstract).

Cognitive function and delirium after cardiac surgery

In this cohort of 225 patients undergoing CABG or valve surgery, they were assessed with a mini-mental status exam (MMSE) and Confusion Assessment Method (CAM) preoperatively, daily from postoperative day 2 to discharge, and at 1, 6, and 12 months. Almost half (46%) developed delirium. At 6 months, the proportion of those that had not returned to baseline MMSE was significantly higher in those with delirium compared to those without (40% vs 24). Delirium prevention may improve long term cognitive function after cardiac surgery (abstract)

Effect of neurohospitalists

In this retrospective cohort of a neurohospitalist service at an academic medical, the service was associated with a reduced mean length of stay (4.6 days versus 6.3 days), reduced cost, and higher medical student satisfaction, without change in mortality, 30 day readmission rates, or patient satisfaction (abstract)

No benefit of clopidogrel added to ASA after lacunar infarct

In this large randomized trial of patients with a recent lacunar infarct, the addition of clopidogrel to ASA did not reduce the risk of recurrent stroke, but the risk of major bleeding was twice as high (2% vs 1% per year). There is no benefit, and there is harm, when clopidogrel is added to ASA after lacunar infarct (abstract)

Restenosis of CEA versus carotid stent

In this large randomized trial (CREST trial) of patients with carotid stenosis who underwent either CEA or carotid stenting, the rate of restenosis at 2 years was ~6% in both groups, indicating both procedures are reasonable in short and long term outcomes (abstract)
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