1/ So now it's the cataclysmic TTM -2 trial, just published in @NEJM. How can a world changing trial like HACA published in 2002 now be effectively reversed almost 20 years later? I will explain.

Do you have serial CTP studies when you transfer in LVO pts?. Interesting study looking at the rate of core volume growth, then estimating WHEN core = penumbra . Thrombectomy prior to this tissue clock helps. After this time, hurts (no benefit, more bleeds).

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Very cool study of cardiac arrest patients with status epilepticus. 9% good outcome overall. Predictors of good outcome:. No burst-suppression.Higher Sz discharge frequency (>2 Hz).Earlier Sz termination.Higher ASM doses.Higher discharge frequency.

The Upshot: When a patient with AF has a stroke on a DOAC, don’t switch to warfarin. The result will be a higher risk of recurrent stroke and ICH down the road . Anticoagulation Strategies Following Breakthrough Ischemic Stroke While on DOACs.

Early Tirofiban Infusion after IV Thrombolysis for #AIS. This RCT of 400+ pts showed a ~10% absolute increase in good outcome compared to lytic therapy alone. A trial of 800-1000 pts might give us a new standard — GP 2B3A inhibition + lytics for AIS .

To learn more check out my MasterClass #NCS Podcast with her on the concept of brain protective ventilation.

A nice succinct review of how pCO2 manipulation can modulate ICP and CBF in #SABI by the Chiara Robba group .

Fascinating study of the origins of #SUDEP. 70 pts with 400 Szs in the EMU. 16% of Szs had interictal apnea. In half of those (7% overall) there was post-ictal apnea, which lasted a mean of >2 minutes before organized breathing resumed. #curingcoma.

Soon we will ALL be giving IV TNK to stroke patients on DOACS. The drumbeats are pounding. Here is yet another comparative effectiveness study showing lower ICH and better mRS outcomes among DOAC pts given lytics compared to those who did not.

The SEDS score: a daily severity score for monitoring pts with refractory status epileptics. This is an interesting idea from a strong group: trend the score daily over the first week, and incorporate response to therapy, trend in EEG, and markers of systemic illness to get a.

Check out this comprehensive and authoritative review of Covert Consciousness by Daniel Zondziella in Current Neural Neuroscience Reports!. #curingcoma.

Asymptomatic Hemorrhagic Transformation After Thrombectomy .Is associated with substantially worse clinical outcomes.

in this large observation study 12% of pts with a ruptured AVM developed vasospasm. Three risk factors. 1. Younger age.2. Female.3. Intraventricular hemorrhage. This met analysis is primarily;y rep[resented by a paper by our group at @WMCHealth @nymedcollege.

Transfusion Strategies in Neuroanaesthesia and Neurocritical Care: A Review..You have a poor grade SAH patient with asymptomatic vasospasm. What's your transfusion trigger (mg/dl)?.

70% of patients with autoimmune encephalitis experience seizures during their hospitalization. The biggest risk factor is periodic epileptiform discharges.

Minimally invasive surgical evacuation confers a mortality benefit in patients with moderate-sized putaminal hemorrhages . A retrospective single center propensity matched analysis of only 66 patients, but provocative given the negative findings for MIS for deep bleeds in ENRICH.

The Large-Core Paradox explained here. How can MCA stroke patients presenting with large lucencies and low CBV regions benefit from thrombectomy? . Here’s a thoughtful review.

An important feature of early brain injury after poor grade SAH is global cerebral edema. Dynamic Contrast–Enhanced MRI can quantify blood brain barrier disruption in this entity.

Nice review of the role of MMA embolization in the management of chronic subdural hematoma.

This is fabulous. It takes over 1800 overnight vital sign assessments among Neurology floor inpatients to generate one clinical actionable finding. Let your patients sleep!.

Greater Postthrombectomy contrast staining on CT calculated using the ASPECTS score correlates with worst functional outcome. Not a shocker, but this might be useful for prognostication.