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Seminars in Neurology

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https://www.readbyqxmd.com/read/27907969/neuroprotection-in-critical-care-neurology
#1
Menno R Germans, Hieronymus D Boogaarts, R Loch Macdonald
Ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic brain injury-all have in common early brain injury due to brain tissue destruction, reduced cerebral blood flow and oxygen delivery, and overall substantial morbidity and mortality. The pathophysiology of brain tissue damage likely includes common cellular mechanisms. Neuroprotection has seldom, if ever, been shown to reduce early brain injury. Secondary brain injury develops after these conditions due to macroscopic events such as increased intracranial pressure and reduced cerebral blood flow, as well as cellular processes including vascular damage, inflammation, and apoptotic/necrotic cell death...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907968/palliative-care-practice-in-neurocritical-care
#2
Andrea K Knies, David Y Hwang
Many neurocritically ill patients and their families have high amounts of palliative care needs. Multiple professional societies relevant to neurocritical care have released consensus statements on meeting palliative care needs in neuroscience intensive care units. In this review, the authors discuss the ongoing debate regarding what model of palliative care delivery is optimal, focus on the process of shared decision making during goals-of-care discussions, and briefly comment on transitions from intensive care to comfort care...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907967/modern-approach-to-brain-death
#3
Panayiotis N Varelas, Ariane Lewis
People die either when their heart and respiration stop or when their brain irreversibly stops functioning. This latter mode of death by neurologic criteria (also called brain death) emerged after the development of ventilators and intensive care units in the late 1950s and 1960s. Brain death is universally accepted as a modern entity, but the complex process for declaring a patient brain dead is not uniformly followed across country and state lines or even hospital policies, creating unacceptable variability and risks for falsely pronouncing a patient dead...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907966/getting-rid-of-weakness-in-the-icu-an-updated-approach-to-the-acute-management-of-myasthenia-gravis-and-guillain-barr%C3%A3-syndrome
#4
Alexis A Lizarraga, Karlo J Lizarraga, Michael Benatar
After prompt diagnosis, severe myasthenia gravis and Guillain-Barré syndrome (GBS) usually require management in the intensive care unit. In the myasthenic patient, recognition of precipitating factors is paramount, and frequent monitoring of bulbar, upper airway, and/or respiratory muscle strength is needed to identify impending myasthenic crisis. Noninvasive ventilation can be attempted prior to intubation and mechanical ventilation in the setting of respiratory failure. Cholinesterase inhibitors should be discontinued, but resumed prior to extubation, and steroid dosage could be increased once the airway is secured...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907965/movement-disorders-in-the-intensive-care-unit
#5
Sara M Schaefer, Rezvan Rostami, David M Greer
Movement disorders are common; yet to those without subspecialty experience they can be difficult to recognize, categorize, and manage. Although most frequently encountered in an outpatient setting, patients with movement disorders are commonly hospitalized and often admitted to the intensive care unit, leading to possible confusion about their proper care. In addition, movement disorders can arise in critical care settings for several reasons, including medication side effects, substance withdrawal, or development of a new syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#6
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907963/optimizing-medication-outcomes-in-neurocritical-care-focus-on-clinical-pharmacology
#7
Denise H Rhoney, Kathryn Morbitzer, Jimmi Hatton-Kolpek
Drug dosing in neurocritically ill patients presents enormous challenges for clinicians due to the complex pathophysiological alterations. These alterations are dynamic both between and within patients. Unpredictable exposure from standard dosing regimens, which were extrapolated to intensive care unit patients from healthy volunteer studies, may influence medication outcomes. Knowledge of potential alterations in pharmacokinetics/pharmacodynamics in these patients could be applied to maximize the clinical response and minimize adverse effects...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907962/critical-care-of-traumatic-cervical-spinal-cord-injuries-preventing-secondary-injury
#8
Gary Schwartzbauer, Deborah Stein
The incidence of traumatic spinal cord injury (SCI) has not changed much over the years due to an aging population suffering falls, yet advances have been made in quality of life and survival time. In addition to initial medical and surgical stabilization, modern intensive care unit (ICU) care throughout the critical early period following SCI is essential to avoid continued secondary injury to the spinal cord. Cervical SCI patients are particularly prone and sensitive to periods of cardiovascular instability and respiratory failure directly resulting from their injuries...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907961/critical-care-management-of-the-patient-with-traumatic-brain-injury
#9
G Duemani Reddy, Shankar Gopinath, Claudia Robertson
The critical care management of patients with traumatic brain injury is complex. The primary goal is to minimize the effects of secondary injury that would otherwise serve to further worsen neurologic function. This requires an understanding of the abnormal brain physiology that is found in these patients. In this article the authors discuss this physiology and describe suggested treatment strategies for these patients based on evidence-based guidelines.
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907960/multimodality-monitoring-illuminating-the-comatose-human-brain
#10
Charles L Francoeur, Margaret Pain, Stephan A Mayer
The field of neurocritical care has evolved tremendously in recent years, a development explained vastly by the advent of neurophysiological monitoring. From basic intracranial pressure measurements to brain tissue oxygenation, microdialysis, cerebral blood flow (CBF), and surface and intracortical electroencephalography (EEG), our ability to detect and control physiologic endpoints of brain function in comatose patients has grown substantially. The integration of these data gave birth to the concept of multimodality monitoring (MMM)...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907959/status-epilepticus-in-the-intensive-care-unit
#11
Adriana Bermeo-Ovalle, Thomas Bleck
Status epilepticus (SE) is a common neurologic emergency and a frequent reason for admission to the intensive care unit. During the last decade, the advent and availability of diagnostic tools for the recognition of nonconvulsive SE has highlighted an even higher incidence of this condition among the critically ill. New alternatives in treatment have also become available within recent years. The recommendation of early escalation toward the use of general anesthetics in the treatment of convulsive SE follows the theory that the duration of the event defines the aggressiveness of the condition and the potential for long-term neuronal injury...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907958/critical-care-management-after-cardiac-arrest
#12
Hans Friberg, Tobias Cronberg
Sudden cardiac arrest is a devastating event with high mortality and substantial morbidity among survivors. Early recognition and intervention to restore circulation is the primary goal; once that is achieved, the path toward a meaningful recovery starts. Initial in-hospital care is focused on emergency cardiac care, but soon there is a change to a more brain-oriented critical care including targeted temperature management, brain monitoring, sedation, and repeated neurologic assessments. In patients who show early signs of awakening from coma once sedation has been stopped, the prognosis is generally good...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907957/surgical-strategies-for-spontaneous-intracerebral-hemorrhage
#13
Wendy Ziai, J Ricardo Carhuapoma, Paul Nyquist, Daniel F Hanley
In recent decades, the medical and surgical treatment of intracerebral hemorrhage (ICH) have become the focus of a number of scientific investigations. This effort has been led by an international group of neurologists and neurosurgeons with the goal of studying functional recovery and developing new medical and surgical treatments to facilitate improved clinical outcomes. Currently, two of the most pressing ICH investigational goals are (1) early blood pressure control, and (2) safe hematoma volume reduction...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907956/intensive-care-management-of-the-endovascular-stroke-patient
#14
Julian Bösel
Acute ischemic stroke caused by the occlusion of large brain vessels can be treated effectively by mechanical thrombectomy, as proved by recent strong and consistent evidence from high-quality randomized trials. This new era of endovascular stroke treatment, however, poses particular challenges that go far beyond the so far gold standard of intravenous thrombolysis alone. Because these stroke patients usually present with severe neurologic deficits, may be unstable from cardiac or pulmonary instability, have to endure an invasive intervention of sometimes long duration, may suffer complications and require close postinterventional follow-up, they often demand intensive care measures...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907955/decompressive-craniectomy-in-neurocritical-care
#15
Erik G Hayman, David B Kurland, Zachary Grunwald, Sebastian Urday, Kevin N Sheth, J Marc Simard
Neurosurgeons increasingly use decompressive craniectomy (DC) in neurocritical care. In this review, the authors summarize the topic of DC for the neurointensivist. Following a brief overview of the procedure, the major indications for the procedure are described. This includes a review of the literature regarding well-established indications, such as infarction and traumatic brain injury, as well as lesser known indications, including intracerebral hemorrhage, ruptured cerebrovascular malformations, sinus thrombosis, and infection...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907954/today-s-approach-to-treating-brain-swelling-in-the-neuro-intensive-care-unit
#16
Shreyansh Shah, W Taylor Kimberly
Brain swelling is an urgent clinical problem that frequently accompanies ischemic stroke, brain hemorrhage, and traumatic brain injury; it increases morbidity and mortality associated with them. It occurs due to failure of membrane transporters and leakage of the blood-brain barrier (BBB), resulting in combination of cytotoxic, ionic, and vasogenic edema. Currently, decompressive craniectomy and osmotherapy are the mainstays of management, but these therapies do not halt the underlying molecular cascade leading to brain swelling...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907953/management-of-the-pediatric-neurocritical-care-patient
#17
Christopher M Horvat, Haifa Mtaweh, Michael J Bell
Pediatric neurocritical care is a growing subspecialty of pediatric intensive care that focuses on the management of acute neurological diseases in children. A brief history of the field of pediatric neurocritical care is provided. Neuromonitoring strategies for children are reviewed. Management of major categories of acute childhood central neurologic diseases are reviewed, including treatment of diseases associated with intracranial hypertension, seizures and status epilepticus, stroke, central nervous system infection and inflammation, and hypoxic-ischemic injury...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907952/neurology-of-critical-care
#18
Eelco F M Wijdicks
It is a truism that care of the patient with an acutely severe neurologic illness starts with a full neurologic examination. Neurologic examination is followed by tests (neuroimaging and laboratory) resulting in a diagnosis (presumptive or definitive) and treatment (definitive or preemptive) and followed by admission for supportive care and more treatment. The sequence of decisions depends on the diagnosis, but treatment may be needed to diagnose a neurologic disorder. To find out what underlies the acute presentation of certain neurologic conditions requires (1) interpretation of neurologic findings, (2) interpretation of neuroimaging, (3) linking laboratory abnormalities to certain clinical neurologic findings, and (4) evaluation of improvement or refractoriness after treatment...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907951/neurocritical-care-and-emergency-neurology
#19
Kevin N Sheth
No abstract text is available yet for this article.
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27907950/kevin-n-sheth-md-faha-fccm-fncs-fana-faan
#20
David M Greer
No abstract text is available yet for this article.
December 2016: Seminars in Neurology
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