The FOUR score (Full Outline of UnResponsiveness), is a new coma scale (range 0-16) with 4 components (eye response, motor response, brainstem reflex, and respiration pattern) which was validated against the Glascow coma scale (GCS) in 100 medical ICU patients. The FOUR score and GCS were almost identical in their ability to predict poor neurologic outcome, and the FOUR score was able to be performed reliably (with excellent interrater reliability). It is also able to be performed in intubated patients. The FOUR score may become a popular coma scale in critically ill medical patients (abstract).
In this large multicenter trial, patients with minor stroke or TIA were randomized to clopidogrel+ASA or ASA alone; 90-day stroke occurred in 8% vs 12% respectively, and rates of hemorrhage or hemorrhagic stroke were the same (abstract).
These guidelines provide an evidence based for the use of periprocedural antithrombotics in patients with cerebrovascular disease. They recommend continuing ASA-warfarin for dental procedures, and most other minor procedures. There is little evidence to support the use of procedural bridging with heparin, and it does increase the risk of bleeding. Cessation of therapy for 7 […]
A large analysis from a stroke registry found better outcomes with earlier thrombolytics for acute ischemic stroke; every 15 minutes earlier was associated with an odds ratio of 0.96 for in-hospital death or intracranial hemorrhage, and an odds ratio of 1.03 for being discharged home and 1.04 for walking independently at discharge (abstract).