Matthew Bower

Neurointensivist at @SummaHealth via @UCIrvineHealth and @HopkinsMedicine

[Matthew Bower @MBowerMD]

Safety and efficacy of low-intensity versus standard monitoring following intravenous thrombolytic treatment in patients with acute ischaemic stroke (OPTIMISTmain) - The Lancet https://t.co/p3oxZkSIhD

[JAMA Neurology @JAMANeuro]

Among patients <70 years with acute #BasilarArteryOcclusion, endovascular thrombectomy doubled the rate of ambulatory and self-care capable outcomes at 3 years vs medical treatment.

https://t.co/Tlv2ftRPuu

[Stroke AHA/ASA @StrokeAHA_ASA]

#STROKE: In an economic analysis based on the ENRICH trial, minimally invasive trans-sulcal parafascicular surgery was more cost effective than medical management alone. #AHAJournals https://t.co/7iMIk9FuOK

[Chiara Robba @chiara_robba]

The Ventibrain study. Mechanical ventilation in acute brain injured patients. https://t.co/p8F59T2N22

[Chiara Robba @chiara_robba]

Protective MV is associated with improved mortality also in brain injured patients. 5 years of hard work. ❤️@yourICM

[Nicholas Morris @namorrismd]

Increasingly clear that pts with high grade #SAH can do well and that we should not limit or delay treatment. @NeurosurgeryCNS @neurocritical https://t.co/VExmyzjkAd

[JNIS @JNIS_BMJ]

In this meta-analysis, Guo et al. find that Endovascular treatment (EVT) may improve outcomes in acute ischemic stroke due to isolated posterior cerebral artery occlusion (iPCAO), offering higher chances of excellent recovery & early neurological improvement vs best medical treatment (BMT). #EVT #thrombectomy #stroke

[W David Freeman, MD, FRSM, FNCS, FAAN @freemanwd]

Summarizing Pensato et al Fast, Intermediate, vs Slow Progressors in Stroke:

1.Pathophysiology of Stroke 🧠
Infarct growth occurs due to critical blood flow reduction, leading to energy failure. Tissue in the ischemic penumbra can be salvaged with quick intervention but progresses variably based on factors like collateral flow.
2.Measurement Techniques 📊
Infarct Growth Rate (IGR) is assessed using imaging techniques such as CT and MRI. Methods include single- and double-snapshot approaches or perfusion estimates, with average IGR being 5.4 mL/h but highly variable.
3.Stroke Progressor Phenotypes 🚦
Patients are classified into fast progressors (IGR ≥10 mL/h) and slow progressors (<5 mL/h), aiding in predicting outcomes and planning treatments.
4.Research Gaps 🔍
A lack of standardization and understanding of complex infarct progression dynamics (e.g., nonlinear growth) highlights the need for better, continuous metrics and classifications.
5.Clinical Implications 🩺
Recognizing IGR can assist in predicting patient outcomes, optimizing transfer for thrombectomy, and selecting neuroprotective strategies, reinforcing the “time is brain” principle.

“You’re only as good as your collaterals”
#BayMazwi
#TimeIsBrain #1.9MillionNeuronsLostPerMinLVO
Pensato U, Demchuk AM, Menon BK, et al. Cerebral infarct growth: pathophysiology, pragmatic assessment, and clinical implications. Stroke. 2024;56:00-00. doi:10.1161/STROKEAHA.124.049013.

[Nicholas Morris @namorrismd]

Internal jugular vein catheters probably don't have any effect on ICP according to this study from @EmoryNeuroCrit : https://t.co/PPwIwDcrzq. Hard cosign on this one! @MDNeurocritcare @NeurocritCareJ

[Johns Hopkins Neurosciences Critical Care @HopkinsNCCU]

A @HopkinsMedicine-led team, helmed by Steve Keller and Sung-Min Cho @csmfisher have been awarded over $18M by @DARPA as part of multi-institution study to develop a portable, ECMO life support device. @HopkinsPCCM @HopkinsACCM @HopkinsNCCU

https://t.co/fB1ADZ4VWV

[Stroke AHA/ASA @StrokeAHA_ASA]

🧵This Controversies in #Stroke analysis by Bower et al. critically appraises the literature on imaging in intracerebral hemorrhage (ICH). #AHAJournals @LaurenHSansing

[Stroke AHA/ASA @StrokeAHA_ASA]

The advent of mobile stroke units, application of artificial intelligence for hemorrhage detection, and new data on timing and rationale for different imaging modalities are also reviewed.

https://t.co/9ROykQ4Xv8

[AshuJadhav @AshuPJadhav]

Intracerebral haemorrhage — mechanisms, diagnosis and prospects for treatment and prevention https://t.co/z15b3SzFDT

[Matthew Bower @MBowerMD]

@DGlaucomflecken Idk neurologist are very brain-centric.

[Stephan A Mayer @stephanamayer]

We still are overly pessimistic when assessing prognosis after #ICH

In the INTERACT-3 trial Of over 6000 ICH patients physicians (75% neurosurgeons) were very accurate in Identifying who was going to die…

…But massively underestimated the proportion of pts who went on to have a good recovery at six months.

Surprised?
#curingcoma

https://t.co/RoPIt7T4BR

[Stephan A Mayer @stephanamayer]

My latest with @JoshGoldsteinMD and friends:

Emergency Priorities in the Treatment of Cerebral Hemorrhage: #CodeICH keeps rolling

https://t.co/UtFfMHKmhw

[Matthew Bower @MBowerMD]

Tenecteplase versus alteplase for acute stroke within 4·5 h of onset (ATTEST-2): a randomised, parallel group, open-label trial - The Lancet Neurology https://t.co/exRKlqnp2N

[Matthew Bower @MBowerMD]

“TNK is superior to TPA regarding excellent functional outcome and reduced disability at 3 months.”
https://t.co/1cT2Qqb1Kd

[JAMA Neurology @JAMANeuro]

Among patients with basilar artery occlusion within 12 hours of onset, the benefits of endovascular thrombectomy at one year compared with 90 days were sustained for favorable outcome and enhanced for excellent outcome. https://t.co/Lu4ZKzIOCX

[Stephan A Mayer @stephanamayer]

The #CodeICH train is rolling!

I am ecstatic to share this great editorial by ⁦@Dr_Cit⁩ and ⁦@HemphillCl19865⁩

Making the case that INTENSIVISTS are best positioned to organize ICH treatment bundles at the local level

Couldn’t agree more! https://t.co/Mo0ItzgzjR