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Background: Despite the association of statin use and lowered recurrent stroke and mortality, some studies suggest young stroke patients do not receive the same intense targeted treatment medical therapies for secondary stroke prevention as older patients. Our specific objective was to determine if there were differences in statin medication discharge practices provided to young ischemic stroke patients within a Stroke Clinical Network. The Stroke Clinical Network consists of nine stroke centers located in rural, suburban and urban geographical regions. Methods: The GWTG registry was queried (FY 2017-2021) to identify ischemic stroke patients to determine statin discharge practices using the following criteria: sex, race, age groups ≥18-39 and ≥40-49, LDL levels < 100, 101-129 and > 130, diabetes, HTN, and smoking status. Chi squared tests of proportions were used to evaluate significant relationships between subgroups. Results: Among 1,294 young ischemic stroke patients: 53% (682/1294) were Black and 38% (493/1294) White; mean age 40.9 years (SD +/-7.21years). Men, blacks, patients older than 40 and diabetics were more likely to be discharged on a statin. There was a direct correlation between sex, race, age, LDL level and diabetes with statin discharge practices. There was no difference in statin discharge practices between smokers and nonsmokers. Conclusions: Opportunities to improve compliance with obtaining LDL levels upon admission and prescribing statins at discharge exist. Increasing statin administration in the young stroke patient population reflects best practice and will decrease mortality and morbidity.

Spontaneous intracerebral hemorrhage (ICH), the most devastating and debilitating form of stroke, remains a major healthcare concern all over the world. Intracerebral hemorrhage is frequently managed in critical care settings where intensive monitoring and treatment are employed to prevent and address primary and secondary brain injury as well as other medical complications that may arise. Although there has been increasing data guiding the management of ICH in the past decade, prognosis remains dismal. In this article, the authors discuss the risk factors for ICH, the role of imaging, the major targets of neurocritical care management, the etiology and management of raised intracranial pressure, as well as prevention of and prompt response to the emergence of medical complications. They also discuss the effect of early withdrawal of life-sustaining therapy on prognosis. Finally, we outline several clinical trials that hold promise in improving our management of ICH in the near future.

Purpose The reliability of somatosensory evoked potentials (SSEPs) in predicting outcome in comatose survivors of cardiac arrest treated with therapeutic hypothermia (TH) has been questioned. We investigated whether the absence of cortical (N20) responses was a reliable predictor of a nonawakening in the setting of TH. Methods A retrospective review was conducted in cardiac arrest survivors treated with TH admitted to a single tertiary care hospital from April, 2010 to March, 2013 who underwent SSEP testing at various time points after cardiac arrest. N20 responses were categorized as normal, present but abnormal, bilaterally absent, or inadequate for interpretation. Neurologic outcome was assessed at discharge by the Cerebral Performance Category Scale (CPC). Results Ninety-three SSEP studies were performed in 73 patients. Fourteen patients had absent N20 responses; all had poor outcome (CPC 4-5). Eleven patients had absent N20 s during hypothermia, three of whom had follow-up SSEPs after rewarming and cortical responses remained absent. Fifty-seven patients had N20 peaks identified and had variable outcomes. Evaluation of 1 or more N20 peaks was limited or inadequate in 11.4% of SSEPs performed during the cooling because of artifact. Conclusions Somatosensory evoked potentials remain a reliable prognostic indicator in patients undergoing TH. The limited sample size of patients who had SSEP performed during TH and repeated after normothermia added to the effect of self-fulfilling prophecy limit the interpretation of the reliability of this testing when performed during cooling. Further prospective, multicenter, large scale studies correlating cortical responses in SSEPs during and after TH are warranted. Technical challenges are commonplace during TH and caution is advised in the interpretation of suboptimal recordings.