Trials for Patients on Neuro-Intensive Care: Removing the Headache IA Anderson, CJ McMahon, J Timothy _ Department of Neurosurgery, Leeds General Infirmary,

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Presentation transcript:

Trials for Patients on Neuro-Intensive Care: Removing the Headache IA Anderson, CJ McMahon, J Timothy _ Department of Neurosurgery, Leeds General Infirmary, UK Details: Phase III, double-blinded, RCT. Does simvastatin reduce incidence and duration of delayed ischaemic deficits following SAH Inclusion: Age | Confirmed aneurismal SAH (any grade) on CTA, MRA or DSA | Commence trial <96hrs of ictus | Patient independent prior to the SAH | Exclusion: F&D pupils post resuscitation | Devastating scan | Already taking a statin, verapamil, amiodarone or CYP3A4 inhibitors | Pregnancy | Significant renal or hepatic impairment | Life-threatening co morbidities | Significant drug or alcohol abuse Details: RCT comparing early surgery vs initial conservative Rx in Rx of patients with traumatic intracerebral haemorrhage (TICH) Inclusion: Age ≥14 | Evidence of TICH >10mls volume on CT (as per AxBxC/2 method) | <48hrs of injury | Clinical equipoise Exclusion: Significant EDH/SDH | Cerebellar contusion/bleed | ≥3 discrete haematomas >10mls | Surgery cannot be performed <12hrs of randomisation | Severe co morbidities making good outcome unrealistic Details: RCT comparing early surgery vs conservative Rx for haematomas in selected patients with spontaneous lobar ICH will improve outcome Inclusion: Spontaneous lobar ICH on CT scan (≤1cm from cortex) | < 48hrs of ictus | GCS has motor ≥5 and eyes ≥2 | Haematoma volume of mls (as per AxBxC/2) Exclusion: Evidence of cause: aneurysm, tumour, trauma or AVM | IVH or HCP | Brainstem/cerebellar/basal ganglia/thalamic bleed | Surgery >12hrs of randomisation | Severe co morbidities making good outcome unrealistic | Coagulopathy Details: RCT comparing decompressive craniectomy vs medical Rx for treatment of refractory intracranial HTN following trauma Inclusion: Age | Abnormal CT head | ↑ICP (>25mmHg for 1-12hrs), refractory to initial medical Rx | Patients who have undergone an prior operation still eligible Exclusion: Bilateral F&D pupils | Bleeding diathesis | Not expected to survive >24hrs Unable to monitor ICP | Patients treated on the Lund protocol | Given barbiturates pre-randomisation | Brainstem involvement Details: RCT comparing titrated therapeutic hypothermia (32-35°C) conventional Rx for ↑ICP after TBI Inclusion: Age to consent | Primary TBI | Abnormal CT head | ↑ICP (>20mmHg for ≥ 5mins) after first line Rx |No obvious reversible cause for ↑ICP | ≤10 days from initial injury | temp randomisation Exclusion: Already receiving hypothermia Rx treatment | Already given barbiturates | Not expected to survive >24hrs | Temp ≤34°C on admission | Pregnancy Details: RCT comparing intravenous progesterone vs standard medical Rx for treating severe TBI Inclusion: Age | Wt Kg | Closed head injury | Randomisation <8hrs of injury | GCS 4-8, ≥1 reactive pupil | Abnormal CT head | ICP monitoring indicated Exclusion: Not expected to survive >24hrs | Prolonged or uncorrectable hypoxia or hypotension | Spinal cord injury | Pregnancy | ↓GCS due to other causes | EDH alone | Severe co morbidities making good outcome unrealistic Download this poster in.ppt or.pdf format plus links to all above trials from: