Neurology
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To test the hypothesis that the effect of antithrombotic medications on the risk of intracerebral hemorrhage (ICH) varies according to the location of the hematoma. ⋯ OACs, as opposed to antiplatelets, predispose to lobar location of brain hematomas according to a dose-response relationship.
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To obtain quantitative neurometabolite measurements, specifically myoinositol (mI) and glutamate plus glutamine (Glx), markers of glial and neuronal excitation, in deep gray matter structures after mild traumatic brain injury (mTBI) using proton magnetic resonance spectroscopy ((1)H-MRS) and to compare these measurements against normal healthy control subjects. ⋯ Increased putaminal mI, mI/Cr, and Glx/Cr in patients after mTBI compared with control subjects supports the notion of a complex glial and excitatory response to injury without concomitant neuronal loss, evidenced by preserved N-acetylaspartate levels in this region.
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Case Reports
Clinical reasoning: a 76-year-old man remaining comatose after cardiopulmonary resuscitation.
A 76-year-old man was admitted to the hospital after having a "cardiac arrest" while riding his bicycle and subsequently falling into a canal. Thirty minutes after the accident, he was resuscitated by an ambulance crew. They detected a ventricular tachycardia, which responded to defibrillation. ⋯ Neurologic examination during hypothermia and under sedation showed a deeply comatose patient with intact pupillary reaction to light bilaterally and present oculocephalic reflex. He had multifocal random twitching movements involving the face, arms, and legs. These shock-like movements were found to increase by external stimuli.
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Randomized Controlled Trial Multicenter Study
ASA failure: does the combination ASA/clopidogrel confer better long-term vascular protection?
To assess whether adding clopidogrel to acetylsalicylic acid (ASA) has a long-term protective vascular effect in patients with lacunar stroke while taking ASA. ⋯ This study provides Class I evidence that for patients with recent lacunar stroke while taking ASA, adding clopidogrel as compared to continuing ASA alone does not reduce the risk of recurrent stroke.