WAKE-UP Time for Thrombolysis in Acute Stroke?

By Martina McGrath, MD
October 30, 2018

MRI thrombolysis for stroke of unknown time of onset

Current clinical guidelines recommend thrombolysis in acute stroke where patients present within 4.5 hours of onset of symptoms. However, for up to a quarter of patients, the time of symptom onset is unknown as they wake from sleep with neurological deficits.1 Such patients frequently do not meet criteria for therapies such as thrombolysis or mechanical thrombectomy.

Prior studies have suggested a particular pattern may be seen on an MRI of the brain in the early hours following stroke onset; a visible ischemic lesion on diffusion-weighted imaging along with the lack of a hyperintense signal in the same area on fluid-attenuated inversion recovery (FLAIR). The benefit of aggressive stroke intervention in patients with the combination of unknown time of symptom onset and this particular signal mismatch on MRI brain scans is unknown. Continue reading “WAKE-UP Time for Thrombolysis in Acute Stroke?”

Cefepime-Induced Neurotoxicity

By Martina McGrath, MD
February 20, 2018

Cefepime is a fourth generation cephalosporin with extended spectrum of coverage, including gram-positive and gram-negative organisms, such as Klebsiella pneumoniae, Pseudomonas aeruginosa, Citrobacter and Serratia.1 It has activity against many multidrug-resistant gram negatives and is resistant to beta lactamases. Given its broad range of activity, it is a widely used and highly effective choice for hospitalized patients with a range of infections.

However, at elevated concentrations, cefepime can cross the blood-brain barrier Continue reading “Cefepime-Induced Neurotoxicity”