Lowering pressure hard after thrombectomy is where outcomes were lost

The edition in brief

A Bayesian network meta-analysis of eight randomised trials compared systolic blood pressure targets after successful endovascular thrombectomy. A target below 180 mmHg ranked highest for functional independence (SUCRA 87.3%), while targets below 140 mmHg (OR 1.65, 95% CI 1.03-2.54) and below 120 mmHg (OR 1.75, 1.14-2.71) were associated with worse outcomes, at high certainty. Symptomatic intracranial haemorrhage and 90-day mortality did not differ. Within an observed range of 117-139 mmHg, higher achieved systolic pressure tracked with better functional outcome at group level. A JAMA Neurology review sets out when the HINTS examination applies: continuous dizziness with spontaneous nystagmus at rest, and only after central features have been screened for. Applied outside those conditions - most often to patients with no nystagmus - its accuracy falls, and the authors argue that recent emergency guidance has added to the confusion rather than resolved it. Nine randomised trials of transcranial alternating current stimulation in 357 people with dementia found a small immediate gain in global cognition (SMD 0.28, 95% CI 0.01-0.54, I2 39%) that did not persist at follow-up, with no effect on neuropsychiatric symptoms and no serious adverse events. A 42-patient pilot of N-acetylcysteine 1200 mg daily in Parkinson's disease reported a smaller one-year rise in total UPDRS with treatment than placebo (difference -4.1 points, 95% CI -7.6 to -0.5) and less decline in dopamine transporter binding, on 32 completers, unadjusted for multiplicity and explicitly exploratory.