Mixed Methods Survey to Identify Barriers to Accessing Deep Brain Stimulation for Movement Disorders in Canada.

Background: Movement disorders (Parkinson's disease, essential tremor, dystonia) are debilitating, progressive conditions that profoundly impact patients' quality of life. Surgical therapies, such as deep brain stimulation (DBS) can provide tremendous relief to patients but remain costly and, therefore, limited in availability. It is critical to understand regional barriers to accessing this service to improve access for all patients who may benefit from it.

The legal and socioeconomic considerations of spine telemedicine in Canada.

Telemedicine, or virtual care offers a platform for remote assessments, for either initial consultations or follow-up care. Telemedicine is a broad term and may refer to video conferences/assessments, telephone visits, messages through online platforms, and remote monitoring applications. The restrictions during the coronavirus disease 2019 (COVID-19) crisis had accelerated the use of telemedicine in Canadian healthcare.

A Canadian national survey of the medical management of acute traumatic spinal cord injury.

Background: The management of patients with acute traumatic spinal cord injury (SCI) remains a significant challenge, with ongoing debate surrounding the optimal targets for mean arterial pressure (MAP), spinal cord perfusion pressure (SCPP), and hemoglobin (Hb) transfusion thresholds. This study aimed to identify areas of consensus and discordance in the management strategies employed by Canadian healthcare providers caring for patients with acute SCI.

Methods: A comprehensive multi-stage survey was developed and administered to healthcare providers actively involved in the management of acute SCI, including neurosurgeons, orthopedic surgeons, intensive care specialists, trauma surgeons, and emergency medicine physicians.

Venous thromboembolism prophylaxis in traumatic brain injury after radiographic progression: a 6-year experience at a single Canadian Level 1 trauma Centre.

Background: Patients with traumatic brain injury are at high risk for venous thromboembolism. Therefore, pharmacological prophylaxis for venous thromboembolism has become critical in managing trauma patients. Unfortunately, the decision to initiate prophylaxis in patients with radiographic progression must be carefully weighed against the risk of further progression of intracranial haemorrhage, with little evidence to support decision-making.

Which adults aged 65 and older are at low-risk for cervical spine injuries after low-level falls?

Objectives: The population is aging and falls are a common reason for emergency department visits. Appropriate imaging in this population is important. The objectives of this study were to estimate the prevalence of cervical spine injury and identify factors associated with cervical spine injuries in adults ≥ 65 years after low-level falls.

A cost effectiveness analysis of two treatment strategies for trigeminal neuralgia in Ontario.

Background: Trigeminal neuralgia (TN) is a debilitating disease with an annual incidence of approximately 4-27/100,000. In Ontario, over 2000 patients receive interventions for profound pain, including medical and surgical therapies. The global expected cost of these approaches is unknown.

Therapeutic Hypothermia Compared with Normothermia in Adults with Traumatic Brain Injury; Functional Outcome, Mortality, and Adverse Effects: A Systematic Review and Meta-Analysis.

Background: The main focus of traumatic brain injury (TBI) management is prevention of secondary injury. Therapeutic hypothermia (TH), the induction of a targeted low core body temperature, has been explored as a potential neuroprotectant in TBI. The aim of this article is to synthesize the available clinical data comparing the use of TH with the use of normothermia in TBI.

Emergency physician gender and head computed tomography orders for older adults who have fallen.

Objective: Physicians vary in their computed tomography (CT) scan usage. It remains unclear how physician gender relates to clinical practice or patient outcomes. The aim of this study was to assess the association between physician gender and decision to order head CT scans for older emergency patients who had fallen.

Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study.

Background: Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke.

Objective: T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography.

Methods: We conducted a survey using 30 patients drawn from an institutional database of 3144 acute stroke cases.

Clinical Uncertainty in Large Vessel Occlusion ischemic stroke (CULVO): Does automated perfusion scanning make a difference? Protocol of an intrarater and interrater agreement study.

Background: Guidelines recommend the use of perfusion computed tomography (CT) to identify emergent large vessel ischemic stroke (ELVIS) patients who are likely to benefit from endovascular thrombectomy (EVT) if they present within 6-24 hour (late window) of stroke onset. We aim to determine if the interrater and intrarater reliability among physicians when recommending EVT is significantly different when perfusion CT or non-perfusion CT is reviewed.

Methods: A total of 30 non-consecutive patients will be selected from our institutional database comprising 3144 cranial CT scans performed for acute stroke symptoms January 2018 to August 2022.

Identification of clinically relevant patient endotypes in traumatic brain injury using latent class analysis.

Traumatic brain injury (TBI) is a complex condition where heterogeneity impedes the advancement of care. Understanding the diverse presentations of TBI is crucial for personalized medicine. Our study aimed to identify clinically relevant patient endotypes in TBI using latent class analysis based on comorbidity data.

Perfusion vs non-perfusion computed tomography imaging in the late window of emergent large vessel ischemic stroke: A systematic review and meta-analysis.

Background: Guidelines recommend the treatment of emergent large vessel ischemic stroke (ELVIS) patients presenting beyond 6 hours of last known well time with endovascular thrombectomy (EVT) based on perfusion computed tomography (CT) neuroimaging. We compared the outcomes (long-term good clinical outcomes, symptomatic intracranial hemorrhage (sICH), and mortality) of ELVIS patients according to the type of CT neuroimaging they underwent.

Methods: We searched the following databases: Medline, Embase, CENTRAL, and Scopus from January 1, 2015, to June 14, 2023.

Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen.

Background: Ground-level falls are common among older adults and are the most frequent cause of traumatic intracranial bleeding. The aim of this study was to derive a clinical decision rule that safely excludes clinically important intracranial bleeding in older adults who present to the emergency department after a fall, without the need for a computed tomography (CT) scan of the head.

Methods: This prospective cohort study in 11 emergency departments in Canada and the United States enrolled patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed.

Economic Evaluations Comparing Deep Brain Stimulation to Best Medical Therapy for Movement Disorders: A Meta-Analysis.

Background: Movement disorders (Parkinson's disease, essential tremor, primary dystonia) are a debilitating group of conditions that are progressive in nature. The mainstay of treatment is best medical therapy; however, a number of surgical therapies are available, including deep brain stimulation. Economic evaluations are an important aspect of evidence to inform decision makers regarding funding allocated to these therapies.

Surgical Management of Meningiomas Involving the Torcula, Transverse Sinus, and Jugular Bulb: A Technical Note and Review of the Literature.

Meningiomas that invade the confluens sinuum are rare and require extensive preoperative planning. Here, we describe the surgical and radio-oncological management of an aggressive large occipital meningioma invading the superior sagittal sinus, torcula, right and left transverse sinus down to the level of the jugular bulb in a 21-year-old female patient. Details of the surgical approach are presented to highlight the planned staged resection of this tumor at the level of the torcula to initially debulk the lesion while preserving venous outflow through the patent's sinus.

Intracranial hemorrhage in patients treated for SARS-CoV-2 with extracorporeal membrane oxygenation: A systematic review and meta-analysis.

Background: Extracorporeal membrane oxygenation (ECMO) is routinely used in patients with severe respiratory failure and has been increasingly needed during the COVID-19 pandemic. In patients treated with ECMO, significant intracranial hemorrhage (ICH) risk exists due to circuit characteristics, anticoagulation, and disease characteristics. ICH risk may be substantially higher in COVID-19 patients than patients treated with ECMO for other indications.

Rates of cerebrospinal fluid leak and pseudomeningocele formation after posterior fossa craniotomy versus craniectomy: A systematic review and meta-analysis.

Background: Postoperative cerebrospinal fluid (CSF) leak is a major concern after posterior fossa surgery with significant clinical implications. It has been postulated that replacing the bone flap, performing a craniotomy, would reinforce the surgical closure and decrease rates of CSF leak. This systematic review and meta-analysis compared the rate of CSF leak after posterior fossa craniotomies versus craniectomies.

Beta blockers in traumatic brain injury: a systematic review and meta-analysis.

Background: Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Beta blockers have shown promise in improving mortality and functional outcomes after TBI. The aim of this article is to synthesize the available clinical data on the use of beta blockers in acute TBI.

Systematic Review and Meta-Analysis of Randomized Controlled Trials for Scalp Block in Craniotomy.

Background: Scalp block is regional anesthetic injection along nerves innervating the cranium. Scalp blocks for craniotomy may decrease postoperative pain and opioid consumption. Benefits may extend beyond the anesthetic period.

Computed Tomography Angiography Compared with Computed Tomography Perfusion in the Diagnosis of Cerebral Vasospasm: A Systematic Review and Meta-Analysis.

Introduction: Cerebral vasospasm (CV) is a serious complication after subarachnoid hemorrhage; however, swift identification can be challenging. Computed tomography perfusion (CTP) directly measures tissue perfusion and may better screen for CV compared with other modalities. This systematic review summarizes studies assessing the diagnostic performance of computed tomography angiography (CTA) and CTP in identifying CV.

Delayed intracranial hemorrhage after head injury among elderly patients on anticoagulation seen in the emergency department.

Introduction: Elderly patients on oral anticoagulation are commonly seen in emergency departments (EDs). Oral anticoagulation, particularly warfarin, is associated with an increased risk of intracranial hemorrhage after head trauma. Data on delayed bleeds in anticoagulated patients are limited.

Intravenous milrinone for delayed cerebral ischaemia in aneurysmal subarachnoid haemorrhage: a systematic review.

Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a major contributor to mortality worldwide, with delayed cerebral ischaemia (DCI) contributing significantly to morbidity in these patients. There are limited evidence-based therapies for DCI. A 2012 case series first recommended the use of intravenous (IV) milrinone in this patient population, stating the need for formal prospective trials.