Neurology

Can newer CT scanners reliably exclude subarachnoid haemorrhage beyond six hours? This 2021 appraisal examines a retrospective study, focusing on patient selection, uncertain symptom timings and why cumulative sensitivity figures may not answer the emergency clinician's question.

An April 2021 discussion of post-vaccination headache as evidence about vaccine-induced thrombosis and thrombocytopenia was emerging. It explores VITT, cerebral venous sinus thrombosis and the role of clinical probability, targeted investigation and specialist input, reflecting the uncertainties and guidance available at that time.

A 2021 appraisal of the Canadian TIA score's prospective validation and comparison with ABCD scores. It explores seven-day stroke risk, the need for validation in other settings and why better prediction only helps when local services can act on the result.

Does tranexamic acid improve recovery after spontaneous intracerebral haemorrhage? This 2018 appraisal of TICH-2 examines death and dependence, haematoma expansion and the uncertainty around the results. It explores why a possible effect on bleeding does not necessarily establish a meaningful improvement in patients’ longer-term outcomes.

Can the Ottawa subarachnoid haemorrhage rule reduce unnecessary investigation without missing serious disease? This 2017 appraisal examines its prospective validation, patient selection and the tradeoff between sensitivity and specificity. Natalie May considers testing burden, clinician interpretation and why careful documentation of headache onset matters.

When might an early CT scan change the need for lumbar puncture in suspected subarachnoid haemorrhage? This 2016 discussion reviews the evidence available then, scanner and reporting requirements, and conversations with patients about uncertainty, further investigation and the risks of testing.