Neurology
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Review Meta Analysis
Subtherapeutic warfarin therapy entails an increased bleeding risk after stroke thrombolysis.
To quantify the risk for bleeding complications after thrombolysis for ischemic stroke in patients on warfarin (international normalized ratio [INR] ≤ 1.7) and to put these data into perspective with previous studies. ⋯ Our data suggest a statistically significant and clinically meaningful increase in the risk for symptomatic intracranial and major systemic bleedings among patients with stroke thrombolysis receiving warfarin up to the day of or day before stroke.
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Meta Analysis
Accuracy of clinical signs, SEP, and EEG in predicting outcome of hypoxic coma: a meta-analysis.
Accurate prediction of neurologic outcome after hypoxic coma is important. Previous systematic reviews have not used summary statistics to summarize and formally compare the accuracy of different prognostic tests. We therefore used summary receiver operating characteristic curve (SROC) and cluster regression methods to compare motor and pupillary responses with sensory evoked potential (SEP) and EEG in predicting outcome after hypoxic coma. ⋯ This study demonstrated that sensory evoked potential (SEP) is marginally better than M1 at predicting outcome after hypoxic coma. However, the superiority of SEP diminishes after day 1 and when M < or = 3 is used. The findings therefore caution against the tendency to generalize that SEP is a better marker than clinical signs.
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Review Meta Analysis
Recurrent cerebral ischemia in medically treated patent foramen ovale: a meta-analysis.
Among patients with a patent foramen ovale (PFO) and a prior cryptogenic ischemic stroke or TIA, the absolute and relative risk of recurrent events is unclear. ⋯ In medically treated patients with prior cryptogenic stroke, while the absolute rate of recurrent events is variable, available evidence does not support an increased relative risk of recurrent ischemic events in those with vs without a patent foramen ovale. Patent foramen ovale closure in these patients cannot be recommended until the results of ongoing clinical trials are reported.
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Meta Analysis Comparative Study
Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a meta-analysis.
Impact of cardiac complications after aneurysmal subarachnoid hemorrhage (SAH) remains controversial. We performed a meta-analysis to assess whether EKG changes, myocardial damage, or echocardiographic wall motion abnormalities (WMAs) are related to death, poor outcome (death or dependency), or delayed cerebral ischemia (DCI) after SAH. ⋯ Markers for cardiac damage and dysfunction are associated with an increased risk of death, poor outcome, and delayed cerebral ischemia after subarachnoid hemorrhage. Future research should establish whether these cardiac abnormalities are independent prognosticators and should be directed toward pathophysiologic mechanisms and potential treatment options.
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Review Meta Analysis
Motor cortex stimulation for chronic pain: systematic review and meta-analysis of the literature.
To conduct a systematic review and meta-analysis to quantify the efficacy of invasive and noninvasive brain stimulation for the treatment of chronic pain. ⋯ This meta-analysis shows that two different techniques of brain stimulation of motor cortex--invasive and noninvasive--can exert a significant effect on pain in patients with chronic pain. We discuss potential reasons that invasive brain stimulation showed a larger effect in this meta-analysis. Our findings encourage continuation of research in this area and highlight the need for well-designed clinical trials to define the role of brain stimulation in pain management.