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A new DAWN for stroke treatment

Last week we looked at a case study involving a patient who awoke with stroke symptoms. In these cases there has been little to offer patients. Thrombolysis has no application here, given its 3-4 hour window. Endovascular mechanical thrombectomy has been hailed as the new treatment. Until January of 2018, trials in this area demonstrated…

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Neuro Exam Pearls: Upper limb

I don’t know about you, but I’ve always wanted to be able to perform a neurological exam and pick the lesion and look good doing it. Over the years I’ve tried to get better at it. What I have put together is a series of ‘PEARLS’ that sometimes help me decipher the cryptic world of…

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Status Epilepticus

Convulsive Status Epilepticus accounts for up to 75% of all status epilepticus(1). We recognise it in patients where they have a depressed conscious state accompanied by tonic clonic movements of the extremities. The length of status epilepticus is important in terms of patient survival. About 5% of adults and up to 25% of children with epilepsy…

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Carotid Artery Dissection

Patients can present to us with a sudden severe headache, also known as a thunderclap headache. Although there are several potential causes of sudden headache(shown below), the main aetiology we try to exclude in the emergency department, is aneurysmal rupture. When we do rule this out, we still need to consider the other possible causes…

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Cerebral Venous Thrombosis

You’ve just seen a patient with sudden onset of headache. They have presented within 6 hours and your super-sliced scanner spits out a normal CT brain. Are you done? You apply shared decision making with your patient and decide against a lumbar puncture. Are you done? Beware the mimics; amongst them cerebral venous thrombosis and…

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Should We Lower BP in Inra-Cerebral Haemorrhage- ATACH-2

Introduction Two days after speaking at the EMCORE Conference on blood pressure control in intra-cerebral bleeds the ATACH-2 trial (Antihypertensive Treatment of Acute Cerebral Haemorrhage II) has been published. We know that intra-cerebral bleeds are dynamic, with up to 40% of patients having growth in haemorrhage volume, in the first 3 hours(Stroke 1997:28:1-5). We also…

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