Time to Acute Treatment in Intracerebral Hemorrhage Lags Significantly Behind Ischemic Stroke: A Multicenter, Observational Retrospective Study.

Background: Time-to-treatment goals for acute ischemic stroke (AIS) have substantially improved outcomes, yet similar metrics have not been studied in patients with intracerebral hemorrhage (ICH), where mortality rates are much higher.

Methods: Multicenter, observational retrospective study of patients with ICH and AIS between January 1, 2017, and December 31, 2022, in 11 comprehensive stroke centers across the United States participating in Get With The Guidelines. We included patients with ICH who received antihypertensive therapy and anticoagulation reversal, and patients with AIS requiring intravenous thrombolytic and mechanical thrombectomy.

Impact of acute alcohol intoxication and alcohol dependence on outcomes after subarachnoid hemorrhage.

Background: Non-traumatic subarachnoid hemorrhage (SAH) is most commonly caused by a ruptured aneurysm. Risk factors for rupture include hypertension, smoking, and substance use, but the relationship between alcohol use and clinical outcomes after SAH is poorly understood. The objective of this population-based, longitudinal, study is to characterize the relationships between alcohol use, alcohol dependence, and adverse clinical outcomes following SAH.

Publication Race: The Battle for Residency in a Competitive Landscape.

Research plays a significant role in the residency match, particularly after the United States Medical Licensing Examination Step 1 changed from a score-based exam to pass/fail scoring. This study shows the impact of research on the match between 2009 and 2024, categorized by specialties and residency competitiveness. Residency specialties were categorized according to competitiveness (high, medium, and low), according to the Association of American Medical Colleges.

Enhancing Outcomes in Subdural Hematoma: The Role of Middle Meningeal Artery Embolization.

Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition with increasing incidence, especially among the elderly. The pathophysiology of cSDH is multifactorial, involving inflammation, fibrinolysis, and angiogenesis, with fragile neovascularization contributing to recurrent microbleeding and hematoma persistence. While burr-hole evacuation remains a standard surgical approach, recurrence rates remain high, necessitating adjunctive strategies such as subdural drain placement, subdural-peritoneal shunting, and pharmacologic interventions.

StrokeNet Thrombectomy Endovascular Platform (STEP): A Catalyst for Stroke Research.

Endovascular thrombectomy is a critical treatment for acute ischemic stroke. Challenges remain in extending treatment windows, refining patient selection, optimizing posttreatment interventions, and expanding endovascular thrombectomy indications. Traditional stroke trials have played a pivotal role in advancing care but are hindered by inefficiencies, rigid designs, high costs, long timelines, and slow enrollment.

Prediction of Mortality After Convulsive Status Epilepticus: The Status Epilepticus MASH Score.

PurposeThis study aimed to investigate in-patient mortality and predictors of death associated with convulsive status epilepticus (CSE) in a large nationwide cohort and create a simplified predictive score for in-hospital mortality.MethodsRetrospective data from the National Inpatient Sample (NIS) database between 2007 and 2014 were analyzed, including 123,082 adults with CSE. Univariate logistic testing identified admission variables, neurological and medical complications associated with mortality.

ICU-acquired weakness: Critical illness myopathy and polyneuropathy.

Critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) are significant complications in intensive care unit (ICU) patients, first identified in the late 20th century. These conditions often present as flaccid paralysis and respiratory muscle weakness, making it challenging for patients to wean off ventilatory support. The incidence of ICU-acquired weakness, which includes CIM and CIP, ranges from 25 % to 84 % among long-term ventilated patients, with higher rates observed in those with sepsis or systemic inflammatory response syndrome.

Silencing the Noise: State-of-the-Art Neuroendovascular and Cardiology Management of Pulsatile Tinnitus.

Pulsatile tinnitus (PT) is a unique clinical condition often attributed to various vascular anomalies, making it of increasing interest to specialists outside the traditional realms of otolaryngology and neurology. Endovascular treatment has recently emerged as a key management tool for patients suffering from PT, particularly in cases associated with venous sinus stenosis or arteriovenous shunting. Understanding the indications, procedural risks, and long-term outcomes associated with endovascular treatment is important to ensure timely referral and comprehensive care for patients presenting with PT.

Code-ICH: time is brain.

Purpose Of Review: Intracerebral hemorrhage (ICH) is the most devastating type of stroke resulting in severe disability and mortality. This review summarizes the emerging body of evidence supporting a new paradigm for care of patients called Code-ICH. It highlights the need for the adoption of time-based care bundles based on recent evidence, akin to those used in the management of acute ischemic stroke.

Impact of prior antiplatelet therapy on safety and efficacy of alteplase in acute ischemic stroke: a systematic review and meta-analysis.

Background: Intravenous thrombolysis (IVT), utilizing the clot-dissolving medications alteplase (rt-PA) or tenecteplase (TNK), is the cornerstone in acute ischemic stroke (AIS) emergency intervention. However, the impact of prior antiplatelet therapy (APT) on post-IVT outcomes when utilizing alteplase remains controversial. We conducted a systematic review and meta-analysis to evaluate the effect of prior APT on the outcomes after using alteplase in AIS patients.

Nursing Initiation of Rapid Electroencephalography Point-of-Care Monitoring: Lessons From the Pioneer Summit.

BACKGROUND: Status epilepticus is an emergency, and applying electroencephalography (EEG) monitoring is an important part of diagnosing and treating seizure. The use of rapidly applied limited array continuous EEG (rapid EEG) has become technologically feasible in recent years. Nurse-led protocols using rapid EEG as a point-of-care monitor are increasingly being adopted.

Exploring the Obesity Paradox in All Subtypes of Intracranial Hemorrhage: A Retrospective Cohort Analysis of 13,000 Patients.

Background/objectives: Recent studies reveal an "obesity paradox", suggesting better clinical outcomes after intracranial hemorrhage for obese patients compared to patients with a healthy BMI. While this paradox indicates improved survival rates for obese individuals in stroke cases, it is unknown whether this trend remains true across all forms of intracranial hemorrhage. Therefore, the objective of our study was to investigate the incidence, characteristics, and outcomes of hospitalized obese patients with intracranial hemorrhage.

Surrogates may not accurately estimate resilience and spirituality in neurologically critically ill patients.

Background: Surrogates often provide substituted judgement for neurologically critically ill patients. Resilience and spirituality are understudied constructs in this patient population. In this study we examine how accurately surrogates estimate measures of resilience and spirituality for neurologically critically ill patients.

Emergency Priorities in the Treatment of Cerebral Hemorrhage: Code-Intracerebral Hemorrhage.

The focus of acute treatment of intracerebral hemorrhage (ICH) includes acute blood pressure management, prevention of secondary hematoma expansion through anticoagulation reversal, and neurosurgical interventions for select patients. Recent evidence points to ultra-early acute ICH bundles, implementing multiple therapies in parallel, as the most impactful therapy in reducing morbidity and mortality. It is time for widespread implementation of formalized care bundles in ICH, including specific metrics for time to treatment and criteria for neurosurgical therapy.

Inpatient Outcomes of Cerebral Venous Thrombosis in Patients With Malignancy Throughout the United States.

Background And Purpose: Cerebral venous thrombosis (CVT) is associated with a high degree of morbidity and mortality. Our objective is to elucidate characteristics, treatments, and outcomes of patients with cancer and CVT (CA-CVT).

Methods: The 2016-2019 National Inpatient Sample (NIS) database was queried for patients with a primary diagnosis of CVT.

REACT: a randomized trial to assess the efficacy and safety of clazosentan for preventing clinical deterioration due to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

Objective: Ischemic complications account for significant patient morbidity following aneurysmal subarachnoid hemorrhage (aSAH). The Prevention and Treatment of Vasospasm with Clazosentan (REACT) study was designed to assess the safety and efficacy of clazosentan, an endothelin receptor antagonist, in preventing clinical deterioration due to delayed cerebral ischemia (DCI) in patients with aSAH.

Methods: REACT was a prospective, multicenter, randomized, double-blind, phase 3 study.

Code-ICH: A New Paradigm for Emergency Intervention.

Purpose Of Review: Intracerebral hemorrhage (ICH) is the most devastating type of stroke, causing widespread disability and mortality. Unfortunately, the acute care of ICH has lagged behind that of ischemic stroke. There is an increasing body of evidence supporting the importance of early interventions including aggressive control of blood pressure and reversal of anticoagulation in the initial minutes to hours of presentation.

Glucose Control and Risk of Symptomatic Intracerebral Hemorrhage Following Thrombolysis for Acute Ischemic Stroke: A SHINE Trial Analysis.

Background And Objectives: Baseline hyperglycemia is associated with worse outcomes in acute ischemic stroke (AIS), including higher risk of symptomatic intracerebral hemorrhage (sICH) following treatment with thrombolysis. Prospective data are lacking to inform management of post-thrombolysis hyperglycemia. In a prespecified analysis from the Stroke Hyperglycemia Insulin Network Effort (SHINE) trial of hyperglycemic stroke management, we hypothesized that post-thrombolysis hyperglycemia is associated with a higher risk of sICH.

Ultra-Early Hemostatic Therapy for Acute Intracerebral Hemorrhage: An Updated Review.

Intracerebral hemorrhage (ICH) is the second most common type of stroke, accounting for approximately 10-20% of all strokes, and is linked to severe neurological disability and death. Since the most accurate predictor of outcome in patients with ICH is hematoma volume, there is a great need for pharmacologic therapy that can reduce hematoma expansion and resultant mass effect and edema. This is especially critical within the ultra-early window of 3-4 hours after the presentation.