Ultra-early computed tomography markers of haematoma expansion: Potential trial targets?

Introduction: The predictive value of CT markers of intracerebral haemorrhage (ICH) expansion is time-dependent, but data in the ultra-early period (<2 h from onset) are limited. We aimed to describe the frequency of these CT markers, their association with haematoma volume, haematoma expansion (HE) and functional outcome at 90-days. We also investigated the effect of tranexamic acid on HE in the presence of these markers.

Current perspectives on endovascular therapy for large core ischemic stroke.

Historically, patients with ischemic stroke and an extensive region of irreversibly injured ischemic core were excluded from endovascular thrombectomy trials due to concerns about limited benefit and high procedural risk. This has fundamentally changed with the publication of five strongly positive randomized controlled trials in this group of patients since 2022 and a sixth trial that showed consistent trends and was positive in per protocol analysis and long-term follow-up. This narrative review summarizes the key findings of these trials, including imaging selection criteria, functional and safety outcomes, and long-term benefits.

Developing and validating a prediction tool for cerebral amyloid angiopathy neuropathological severity.

Introduction: Cerebral amyloid angiopathy (CAA) is a cerebrovascular condition, the severity of which can only be determined post mortem. Here, we developed machine learning models, the Florey CAA Score (FCAAS), to predict CAA severity (none/mild/moderate/severe).

Methods: Building on an auto-score-ordinal algorithm, the FCAAS models were developed and validated using data collected by three cohort studies of aging and dementia.

Ultra-Early Hematoma Expansion Is Associated With Ongoing Hematoma Growth and Poor Functional Outcome.

Background: There are limited data on ultra-early hematoma growth dynamics and their clinical impact in primary intracerebral hemorrhage (ICH). We aimed to estimate the incidence of hematoma expansion within the hyperacute period of ICH, describe hematoma dynamics over time, investigate the associations between ultra-early hematoma expansion and clinical outcomes after ICH, and assess the effect of tranexamic acid on ultra-early hematoma expansion.

Methods: We performed a preplanned secondary analysis of the STOP-MSU trial (Stopping Intracerebral Hemorrhage With Tranexamic Acid for Hyperacute Onset Presentation Including Mobile Stroke Units), which compared tranexamic acid with placebo in 201 patients with primary ICH presenting within 2 hours of symptom onset.

Blood Pressure Management in Intracerebral Haemorrhage: when, how much, and for how long?

Purpose Of Review: When compared to ischaemic stroke, there have been limited advances in acute management of intracerebral haemorrhage. Blood pressure control in the acute period is an intervention commonly implemented and recommended in guidelines, as elevated systolic blood pressure is common and associated with haematoma expansion, poor functional outcomes, and mortality. This review addresses the uncertainty around the optimal blood pressure intervention, specifically timing and length of intervention, intensity of blood pressure reduction and agent used.

Cerebral Amyloid Angiopathy and the Fibrinolytic System: Is Plasmin a Therapeutic Target?

Cerebral amyloid angiopathy is a devastating cause of intracerebral hemorrhage for which there is no specific secondary stroke prevention treatment. Here we review the current literature regarding cerebral amyloid angiopathy pathophysiology and treatment, as well as what is known of the fibrinolytic pathway and its interaction with amyloid. We postulate that tranexamic acid is a potential secondary stroke prevention treatment agent in sporadic cerebral amyloid angiopathy, although further research is required.

Marking a surgical margin for excision of a keratinocyte cancer.

Background: The size of the measured margin for excision of a keratinocyte cancer is often discussed; however, a technique for marking the skin is rarely described.

Objective: The aim of this article is to describe a method for marking a lesion for excision.

Discussion: The key to surgical excision of a keratinocyte cancer is the assessment of the tumour border in good light under loupe magnification and delineation using a skin marker.