What a headache: Updates on Migraine Management

Migraine headaches are not a benign disease – they have a significant impact on quality of life, ability to function, and pose a considerable economic and societal burden. Prevalence tends to peak during peoples’ period of highest productivity.  According to the World Health Organization’s (WHO) update on Global Burden of Disease (2004), a severe migraine is considered to be as disabling […]

Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Methodology: 4/5 Usefulness: 4/5 Lyttle MD, et al. Lancet. 2019 May 25;393(10186):2125-2134. Question and Methods: Eclipse was an open label RCT that evaluated time to seizure cessation in pediatric SE between Keppra and Dilantin Findings: They found that Keppra was not superior (HR 1.2, 95%CI 0.91-1.60, p= 0.20) to Dilantin for the treatment of SE Limitations: Limited somewhat by study […]

Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial.

Journal Club Methodology Score: 4/5 Usefulness Score: 3/5 Sprigg N, et al. Lancet. 2018 May 26;391(10135):2107-2115 Question and Methods: Multicenter, double-blinded, randomized, placebo-controlled trial comparing if IV TXA vs placebo, given within 8h of spontaneous (non-traumatic) ICH onset, decreased death or dependence at 90 days. Findings: No difference in 90d dependence or death [Ordinal OR 0·88 (0·76 to 1·03) p=0.11]. […]

Identifying stroke mimics in the ED

In this post, we will aim to review the literature looking at identifying clinical and historical features that can help differentiate stroke mimics from strokes. We will also discuss the safety of the administration of IV tPA to misdiagnosed stroke mimics. This post will not focus on the recent developments in endovascular therapy for stroke and the implications of this. […]

Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA

Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 4/5 Johnston SC, et al. N Engl J Med. 2018 Jul 19;379(3):215-225 Editorial:  Antiplatelet Therapy after Ischemic Stroke or TIA. Question and Methods: This randomized, double-blind trial evaluated ASA + Clopidogrel (DAPT) against ASA alone for preventing ischemic events after a minor stroke/high-risk TIA. Findings: Although there was a significant reduction in DAPT group ischemic […]

Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis

Journal Club Summary Methodology Score: 4/5 Usefulness Score: 5/5 Nath S, et al. Lancet. 2018 Mar 24;391(10126):1197-1204 Question and Methods: This meta-analysis sought to determine, in lumbar punctures, whether atraumatic or conventional (traumatic) spinal needles were superior in terms of their complication rates. Findings: Atraumatic spinal needles were superior to conventional needles in every outcome assessed, including decreased postdural-puncture headache (RR 0.4) […]