Neurology
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Multicenter Study
CT within 6 hours of headache onset to rule out subarachnoid hemorrhage in nonacademic hospitals.
To investigate whether staff radiologists working in nonacademic hospitals can adequately rule out subarachnoid hemorrhage (SAH) on head CT <6 hours after headache onset. ⋯ Our results support a change of practice wherein a lumbar puncture can be withheld in patients with a head CT scan performed <6 hours after headache onset and reported negative for the presence of SAH by a staff radiologist in the described nonacademic setting.
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Randomized Controlled Trial Multicenter Study Comparative Study
Reduced efficacy of sumatriptan in migraine with aura vs without aura.
To determine whether acute migraine treatment outcome is different in migraine with aura compared with migraine without aura. ⋯ This post hoc analysis of pooled data from multiple randomized trials indicates that sumatriptan is less effective as acute therapy for migraine attacks with aura compared with attacks without aura. In the single study of inhaled DHE, the treatment had similar efficacy for migraine attacks with and without aura. Different responses of migraine with vs without aura to acute therapies may provide insight into underlying migraine mechanisms and influence the choice of acute therapies for different types of migraine attacks.
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Multicenter Study Observational Study
Full medical support for intracerebral hemorrhage.
This study tested the hypothesis that patients without placement of new do-not-resuscitate (DNR) orders during the first 5 days after intracerebral hemorrhage (ICH) have lower 30-day mortality than predicted by the ICH Score without an increase in severe disability at 90 days. ⋯ Avoidance of early DNR orders along with guideline concordant ICH care results in substantially lower mortality than predicted. The observed functional outcomes in this study provide clinicians and families with data to determine the appropriate goals of treatment based on patients' wishes.
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Randomized Controlled Trial Multicenter Study Comparative Study
Cluster randomized controlled trial of TIA electronic decision support in primary care.
To test if TIA/stroke electronic decision support in primary care improves management. ⋯ This study provides Class II evidence that a primary care electronic decision support tool improves guideline adherence and might reduce 90-day stroke risk.
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Multicenter Study Observational Study
Initial use of a novel noninvasive vagus nerve stimulator for cluster headache treatment.
To report our initial experience with a novel device, designed to provide portable, noninvasive, transcutaneous stimulation of the vagus nerve, both acutely and preventively, as a treatment for cluster headache. ⋯ This study provides Class IV evidence that for patients with cluster headache, transcutaneous stimulation of the vagus nerve aborts acute attacks and reduces the frequency of attacks.