Background/Objectives: The benefits of liberal transfusion strategies for neurological outcomes in critically ill patients with acute brain injuries (ABIs) remain uncertain due to conflicting evidence and potential risks. This study aimed to evaluate the efficacy and safety of a liberal transfusion strategy in adults with ABI. Methods: A systematic review of PubMed, Scopus, and the Cochrane Library was conducted from inception until 18 December 2024. Randomized clinical trials (RCTs) comparing liberal and restrictive transfusion strategies in adult patients admitted to intensive care units with ABI were included. The primary outcome was unfavorable neurological function at the last follow-up, defined as Glasgow Outcome Scale (GOS) score <4, Extended GOS score 3. Results: Among 5859 screened records, five RCTs (2385 patients) met the inclusion criteria. Liberal transfusion significantly reduced unfavorable neurological outcomes (RR, 0.88; 95% CI, 0.82–0.95; p = 0.0009) without affecting mortality (RR, 0.97; 95% CI, 0.84–1.11; p = 0.66). A meta-analysis of two studies (n = 1465 patients) showed improved functional independence with liberal strategies (MD, 6.70; 95% CI, 2.07–11.33; p = 0.005) but no difference in quality of life (p = 0.30). Sepsis or septic shock occurred less frequently in the liberal group (RR, 0.68; 95% CI, 0.50–0.92; p = 0.01). Subgroup analysis indicated that liberal strategies improved neurological outcome in traumatic brain injury (TBI) patients (RR, 0.89; 95% CI, 0.82–0.97; p = 0.01) but did not yield significant differences in spontaneous subarachnoid hemorrhage (p = 0.09). Conclusions: Liberal transfusion strategies safely improve neurological outcomes in adults with ABI, specifically in the subgroup of TBI, whereas further studies are needed in patients with SAH.

Objective: Developmental and epileptic encephalopathies (DEEs) are associated with high premature mortality and increased risk of sudden unexpected death in epilepsy (SUDEP). However, epidemiological data remain limited, particularly for specific syndromes such as Dravet syndrome (DS), Lennox–Gastaut syndrome (LGS), and infantile epileptic spasms syndrome (IESS). To address this gap, we conducted a Bayesian meta‐analysis of randomized controlled trials (RCTs) and corresponding long‐term open‐label extension (OLE) studies. Methods: All‐cause mortality and SUDEP incidence rates were estimated using hierarchical Bayesian models with moderately informative priors derived from the literature. A negative binomial likelihood was used for all‐cause mortality, whereas a Poisson likelihood was used for SUDEP. Subgroup analysis were conducted for DS, LGS, and IESS. Results: Thirty‐seven RCTs and 15 OLE studies were included, comprising 3757 patients with DEEs (2221 LGS, 998 DS, 369 IESS, and 169 other DEEs). Across pooled data, 37 deaths occurred, including 2 definite, 12 probable, and 1 possible SUDEP. In the overall DEE population, the Bayesian posterior median estimated mortality rate was 8.76 per 1000 person‐years (PY; 95% credible interval [CrI], 5.50–13.89), and SUDEP rate was 4.32 per 1000 PY (95% CrI, 2.66–6.64). In LGS, mortality was 7.05 per 1000 PY and SUDEP was 3.4 per 1000 PY. In DS, mortality was 8.0 per 1000 PY, with a SUDEP rate of 7.59 per 1000 PY. In IESS, mortality was 9.41 per 1000 PY and SUDEP was 2.79 per 1000 PY. Significance: SUDEP accounted for approximately half of deaths in the overall DEE population and in LGS, with a proportionally greater contribution in DS. Potential trial‐related underestimation should be considered when interpreting these findings, as features of trial‐based datasets could have contributed to lower observed mortality and SUDEP estimates. Prospective population‐based studies are needed to more accurately define the real‐world incidence of SUDEP in DEEs.

Recent studies have reported that endovascular thrombectomy (ET) may improve neurological outcomes in large-core stroke.We performed a systematic review and meta-analysis to compare the pooled efficacy and safety of ET and of the best medical treatment among patients with large-core stroke.We searched the PubMed/MEDLINE, Scopus, and Cochrane databases from inception to November 2023. The inclusion criteria were randomized controlled trials (RCTs) comparing ET and the best medical treatment available among patients with large-core stroke (Alberta Stroke Program Early Computed Tomography Score [ASPECTS] < 6 or ischemic core > 50 mL on perfusion imaging) within 24 hours of symptom onset.We included 6 RTCs comprising 1,887 patients (ET group: n = 945). Endovascular thrombectomy was associated with good neurological outcomes (odds ratio [OR]: 2.92; 95% confidence interval [95%CI]: 2.17–3.93), or independent walking (OR: 2.22; 95%CI: 1.72–2.86). Trial sequential analysis confirmed a robust statistical significance for good neurological outcomes favoring ET. Endovascular thrombectomy was associated with higher risks of developing intracranial bleeding (OR: 2.65; 95%CI: 1.35–5.22) and symptomatic intracranial bleeding (OR: 1.83; 95%CI: 1.14–2.94). There were no differences between the groups regarding mortality or decompressive craniectomy. Patients submitted to non-contrast computed tomography (CT) with CT angiography (CTA) scans were analyzed separately and showed good neurological outcomes, comparable to those of the patients submitted to other imaging modalities (OR: 3.24; 95%CI: 1.52–6.92).Endovascular thrombectomy was associated with good neurological outcomes and independent walking in patients with large-core acute ischemic stroke. However, it was also associated with an increased risk of developing intracranial bleeding. Non-contrast head CT with CTA scans may be appropriate for screening patients to undergo ET.