@UMDNeurosurgery's Dr. Aldrich post hoc analysis shows thick (≥ 4mm) and diffuse (≥ 3 basal cisterns) SAH independently predicts vasospasm-related morbidity and poor 12-wk outcomes. thejns.org/view/journals/…
@claassen_jan used Hijdra grade 3 (completely fills a cistern) to define "thick blood" in Fisher scale revisited paper + showed additive effect of b/l IVH. ahajournals.org/doi/10.1161/hs…
Dr. Jen Frontera, using data from tirilazad RCTs, showed that thick blood and IVH predict symptomatic vasospasm, but did not have explicit definitions for thin/thick and scored IVH as simply present/absent.pubmed.ncbi.nlm.nih.gov/16823296/
We found that there is confusion around these scales as many neuro-intensivists operationalize these variables differently. link.springer.com/article/10.100… Image
No one has thought more about this than @stephanamayer (who was author on papers by Aldrich, Claassen, and Frontera). How do we move forward? Dichotomize thick/diffuse vs. others? Include IVH (which was not included in Aldrich's model)? Important for enriched study design...

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More from @namorrismd

12 Mar
1/ A trainee approached me re: a "hypothetical" case. A patient p/w acute weakness 90 min after onset of R arm/leg without other neuro deficits. The neurology consultant advised IV tPA after CT/CTA head and neck showed no hemorrhage (and also no LVO). The ED attending balked.
2/ Trainee's ?: Can you have a stroke with only motor involvement? Can you have a stroke that causes weakness of the arm and leg, but not the face?... a short tweetorial
3/ C. Miller Fisher described several lacunar stroke syndromes, including pure motor hemiparesis (PMH). He found the most common anatomical locations responsible for PMH (based on autopsy studies) to be the internal capsule and basis pontis. jamanetwork.com/journals/jaman… ImageImage
Read 13 tweets
11 Feb
Nice study on Thrombocytopenia and Clinical Outcomes in Intracerebral Hemorrhage. Helps further delineate risks for poor outcome after ICH among patients on antiplatelet agents. ahajournals.org/doi/full/10.11…
Over 1/2 of U.S. adults over 45 take antiplatelet agents (APA). ajpmonline.org/article/S0749-…. Studies show disparate results when investigating effect of APA on outcome. doi:10.1161/01.STR.0000231842.32153.74
doi:10.1161/01.STR.0000196991.03618.31
Plt transfusion is common for APA associated ICH, but not show to improve outcomes. PATCH study actually showed worse outcomes in patients who received platelets.
Read 12 tweets
5 Feb
We recently published our first paper sharing validity evidence for the development of neurological emergency simulations for assessment. Are you familiar with forms of validity evidence? If you are an educator, you should be! A thread… rdcu.be/ceMm3
Steven Downing wrote a fantastic review on validity as it pertains to assessment in medical education. Let’s review the highlights! pubmed.ncbi.nlm.nih.gov/14506816/
As Downing states, validity is the sine qua non of assessment. It is approached as a hypothesis. No assessment is “valid” or “invalid” -> assessments have scores with more or less validity evidence to support interpretations.
Read 17 tweets
29 Jan
IV glibenclamide shows promise for reducing cerebral edema and appears to be safe. PO glyburide leads to more hypoglycemia, especially if abnl renal fxn. Smaller, more frequent dosing may help. Kudos to @MikeA_42 for pushing this through to publication. sciencedirect.com/science/articl…
@jessestokum performed work in Dr. Marc Simard's lab demonstrating how SUR1-TRPM4 and AQP4 form a complex that amplifies ion/water osmotic coupling and drives astrocyte swelling after brain injury. @UMDNeurosurgery . onlinelibrary.wiley.com/doi/full/10.10…
The role of Sur1-TRPM4 and AQP4 in the milieu that drives cerebral edema was recently summarized nicely by @MDNeurocritcare fellow Melissa Pergakis.tandfonline.com/doi/abs/10.108…
Read 15 tweets

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