Tranexamic acid for acute intracerebral haemorrhage growth based on imaging assessment (TRAIGE): a multicentre, randomised, placebo-controlled trial.

BACKGROUND: Studies show tranexamic acid can reduce the risk of death and early neurological deterioration after intracranial haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in intracerebral haemorrhage patients susceptible to haemorrhage expansion. METHODS: We did a prospective, double-blind, randomised, placebo-controlled trial at 10 stroke centres in China. Acute supratentorial intracerebral haemorrhage patients were eligible if they had indication of haemorrhage expansion on admission imaging (eg, spot sign, black hole sign or blend sign), and were treatable within 8 hours of symptom onset. Patients were randomly assigned (1:1) to receive either tranexamic acid or a matching placebo. The primary outcome was intracerebral haematoma growth (>33% relative or >6 mL absolute) at 24 hours. Clinical outcomes were assessed at 90 days. RESULTS: Of the 171 included patients, 124 (72.5%) were male, and the mean age was 55.9±11.6 years. 89 patients received tranexamic acid and 82 received placebo. The primary outcome did not differ significantly between the groups: 36 (40.4%) patients in the tranexamic acid group and 34 (41.5%) patients in the placebo group had intracranial haemorrhage growth (OR 0.96, 95% CI 0.52 to 1.77, p=0.89). The proportion of death was lower in the tranexamic acid treatment group than placebo group (8.1% vs 10.0%), but there were no significant differences in secondary outcomes including absolute intracranial haemorrhage growth, death and dependency. CONCLUSIONS: Among patients susceptible to haemorrhage expansion treated within 8 hours of stroke onset, tranexamic acid did not significantly prevent intracerebral haemorrhage growth. Larger studies are needed to assess safety and efficacy of tranexamic acid in intracerebral haemorrhage patients.

Low dose concomitant treatment with chlorpromazine and promethazine is safe in acute ischemic stroke.

BACKGROUND: Acute ischemic stroke (AIS) is associated with significant morbidity and mortality and has a very narrow window of treatment with fibrinolytics. We investigated the safety and efficacy of combined chlorpromazine and promethazine (C+P) treatment in AIS. METHODS: A total of 64 consecutive patients diagnosed with AIS were selected and were randomly (double-blind) assigned into either the control group (standard of care [SOC] treatment) or the treatment group (SOC+C+P [12.5+12.5 mg BID or 25+25 mg BID]) which were treated for 2 weeks. The National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were computed prior to and after treatment to evaluate neurological deficits and daily functional status. RESULTS: In our study, 64 patients (males=81.3%) were divided into either the control (34 patients, 83.3% males, mean age=58.8±11.7 years) or the study group (30 patients, 79.4% males, mean age=62.3±9.1 years). While the NIHSS scores were not different between the control and treatment group at admission (P>0.05), a greater proportion of the cohort in both the groups (control group low NIHSS=79.4%, high NIHSS=20.6%, P<0.01) had a lower NIHSS at admission and (treatment group low NIHSS=83.3%, high NIHSS=16.7%, P<0.01). Interestingly, while both the control and treatment group had lower NIHSS and mRS scores at 90d post treatment compared to those at baseline, there were no significant differences in those scores between the two group (P>0.05) suggesting no improved benefit with C+P. Moreover, using C+P did not lead to any serious adverse effects when compared to the treatment group. CONCLUSIONS: While the addition of low dose chlorpromazine and promethazine to standard of care for acute ischemic stroke did not have any significant improvement in functional outcomes, there were no serious adverse effects. Thus, the use of chlorpromazine and promethazine in the acute ischemic stroke setting and future studies using higher doses of C+P are justified.

Brain ultrasound for diagnosis and prognosis in the neurological intensive care unit: a mini review for current development.

Objective: Transcranial doppler ultrasonography (TCD) is one of the few tools in the Neurological Intensive Care Unit (NICU) that allows for real-time monitoring of cerebral blood flow while also being non-invasive. This review examines the current use of TCD monitoring in the NICU. Method: We completed a literature review using Google Scholar and Pubmed. Relevant articles were included in this review. Results: The role of TCD in the NICU continues to evolve since its infancy in the 1980s. TCD use is now standard of care of for some neurological maladies. The significant advantages of TCD include convenience of use, non-invasive nature, bedside operation, high accuracy, and absence of interference from external factors such as temperature and sedatives. Conclusion: This review examines the current use of TCD monitoring in the NICU. Through review and continued development of similar non invasive technologies NICU care continues to innovate and evolve. Abbreviation: TCD: Transcranial Doppler.

Efficacy of neuromuscular electrical stimulation in improving the negative psychological state in patients with cerebral infarction and dysphagia.

Objective To observe the improvement of negative affect disorders in patients with cerebral infarction and dysphagia by neuromuscular electrical stimulation. Methods One hundred and twelve patients with cerebral infarction and dysphagia were selected and randomized into treatment (n = 59) and control (n = 53) groups. Similar swallowing function was found in both groups before treatment: (1) Water-drinking test in the treatment group proved swallowing function Level III in 24 cases, Level IV in 22 cases and Level V in 13 cases; (2) in the control group, swallowing function was Level III in 21 cases, Level IV in 20 cases and Level V in 12 cases. Both groups received conventional drug therapy and swallowing training. The treatment group additionally received neuromuscular electrical stimulation. Both groups underwent water-drinking test evaluation, Hamilton Anxiety Scale test, and Hamilton Depression Scale test before and after treatment. Results After two courses of treatment, the rate of improvement in swallowing function was 88.1% in the treatment group while 69.8% in the control group. Somatic anxiety, psychogenic anxiety and total scores in the Hamilton Anxiety Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.01). Anxiety, cognitive disorder, psychomotor retardation and total scores in the Hamilton Depression Scale in the treatment group were improved to varying degrees compared to the control group (P < 0.05). Conclusion Patients with cerebral infarction and dysphagia have varying degrees of anxiety, depression, and other negative affect disorders, which could be minimized by neuromuscular electrical stimulation in conjunction with conventional therapy.