Stroke is the second leading cause of death worldwide following ischemic heart disease, and the fifth in the United States. The video-sharing database, YouTube, is the second most popular visited website with more than 2 billion users, thus it's increasingly being used as a medium for delivering health information. We aimed to evaluate the quality, reliability and audience engagement of stroke-related YouTube videos. In October 2019 we conducted a search on YouTube using 5 keywords: stroke, brain attack, hemorrhagic stroke, ischemic stroke and transient ischemic attack. We selected the first 30 videos from each search query for further analysis. The validated DISCERN instrument was used (a score of 0-5 per question) to assess the videos by four independent raters. We then recorded qualitative data and quantitative data for each video. After sorting through 150 stroke videos, a total of 101 unique YouTube videos met our inclusion criteria. We found that the mean overall quality of YouTube videos according to DISCERN is of fair quality. Most videos (65.3%) were uploaded by hospitals, mentioned the symptoms of stroke (66.3%), had a doctor speaking (60.4%) and contained diagrams (20.8%). YouTube is a useful source of gathering information about treatment choices for patients and their families as the quality of YouTube videos is fair. The audience engagement suggestions in our paper may help content creators improve the appeal of YouTube videos.

Background and purpose Owing to their peculiar features and rare occurrence, ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery are challenging by both surgical and endovascular approaches and their proper management is uncertain. We therefore aimed to define the currently optimal treatment of ruptured BBAs in terms of mortality, outcome, rebleeding, and recurrence. Method An in-depth search of electronic databases, gray literature and internet resources for ruptured BBAs was performed and complemented by data retrieval during neurosurgical congresses. Clinical and radiological characteristics, intervention details, outcomes, and the impact factor of the source journal were pooled. Results The pooled cohort comprised 311 patients. Neither surgical nor endovascular methods had an impact on clinical outcome, aneurysm regrowth, remote bleeding, or complication rate. By contrast, aneurysm clipping was a predictor of intraoperative bleeding (OR 6.5; 95% CI 1.2 to 34.3), and stent-assisted coiling increased the likelihood of a second treatment (OR 4.1; 95% CI 1.3 to 13.1), its conversion to another modality (OR 4.7; 95% CI 1.4 to 16.0), and incomplete aneurysm obliteration (OR 2.6; 95% CI 1.0 to 6.6). Higher impact journals were more likely to publish papers on endovascular techniques, particularly flow-diverter stents. Conclusions None of the methods is unequivocally superior. Considering its inefficiency, stent-assisted coiling should be undertaken with caution. A time-delimited systematic review is needed to establish the most accurate treatment for ruptured BBAs.

Failed back surgery syndrome (FBSS) is complex and recurrent chronic pain after spinal surgery. Several important patient and surgery related risk factors play roles in development of FBSS. Inadequate selection of the candidates for the spinal surgeries is one of the most crucial causes. The guidelines suggest that conservative management featuring pharmacologic approaches and rehabilitation should be introduced first. For therapy-refractory FBSS, spinal cord stimulation (SCS) is recommended in selected patients. Treatment efficacy for FBSS has increased over the years with the majority of patients experiencing pain relief and reduced medicinal load. Improved quality of life can also be achieved using SCS. Cost-effectiveness of SCS still remains unclear. However evidence for SCS role in FBSS is controversial, SCS can be beneficial for carefully classified patients.