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Seminars in Neurology

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https://www.readbyqxmd.com/read/28147425/erratum-medical-and-surgical-advances-in-intracerebral-hemorrhage-and-intraventricular-hemorrhage
#1
Wendy Ziai, J Ricardo Carhuapoma, Paul Nyquist, Daniel F Hanley
No abstract text is available yet for this article.
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147424/rehabilitation-after-cardiac-arrest-integration-of-neurologic-and-cardiac-rehabilitation
#2
Liesbeth W Boyce, Paulien H Goossens
Cognitive impairments are common after resuscitation. Severe cognitive impairments are easily recognized. Mild cognitive impairments are much more difficult to spot. Given the influence of cognitive problems in daily functioning, it is important to identify cognitive impairments at an early stage. Also, emotional problems, mainly depression and fear, are common in this group of patients. To optimize the care for patients after an out-of-hospital cardiac arrest, rehabilitation should focus on the physical approach through cardiac rehabilitation and on brain injury and associated cognitive impairments...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147423/follow-up-of-cardiac-arrest-survivors-why-how-and-when-a-practical-approach
#3
Gisela Lilja
Cardiac arrest (CA) survivors may experience cognitive, physical, or emotional problems that can affect their return to everyday activities and quality of life. To improve long-term outcomes, interventions after hospital discharge may be needed. A follow-up plan to identify CA survivors with increased risk of residual cognitive, physical, or emotional problems is important to target interventions and support. Current recommendations suggest that follow-up should include screening of potential problems, sharing information, and relevant referrals when needed...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147422/withdrawal-of-life-sustaining-therapy-after-cardiac-arrest
#4
Tobias Cronberg, Michael Kuiper
An increasing number of patients are successfully resuscitated from cardiac arrest (CA) and subsequently treated in an intensive care unit due to unconsciousness. Approximately half of these patients will die during the first weeks postarrest, typically after a determination of a poor neurologic prognosis and a decision to withdraw life-sustaining therapy (WLST). These decisions are guided by universal ethical principles. Neurologic prognostication, WLST, and functional outcome after CA are closely correlated, but routines vary between and within countries...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147421/blood-biomarkers-of-hypoxic-ischemic-brain-injury-after-cardiac-arrest
#5
Pascal Stammet
Biomarkers are part of the recommended outcome predictors after cardiac arrest. In general, blood biomarkers can easily be performed as routine laboratory tests, and they are unaffected by sedation, but bear the potential risk of laboratory errors. Nonetheless, if used properly, with the potential limitations in mind, they certainly help predict outcome after cardiac arrest. Among the routinely used and available blood biomarkers, neuron-specific enolase (NSE) has the best predictive value for poor outcome if measured serially from 24 to 72 hours...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147420/neuroimaging-in-cardiac-arrest-prognostication
#6
David M Greer, Ona Wu
Neuroimaging is commonly utilized in the evaluation of post-cardiac arrest patients, providing a unique ability to visualize and quantify structural brain injury that can complement clinical and electrophysiologic data. Despite its lack of validation, we would advocate that neuroimaging is a valuable prognostication tool, worthy of further study, and an essential part of the armamentarium when used in combination with other modalities in the assessment of the post-cardiac arrest patient. Herein, we discuss the data and its limitations for neuroimaging to date and how it is being studied prospectively...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147419/somatosensory-evoked-potentials-in-patients-with-hypoxic-ischemic-brain-injury
#7
Janneke Horn, Marleen C Tjepkema-Cloostermans
Predicting the future of patients with hypoxic-ischemic encephalopathy after successful cardiopulmonary resuscitation is often difficult. Registration of the median nerve somatosensory evoked potential (SSEP) can assist in the neurologic evaluation in these patients. In this article, the authors discuss the principles, applications, and limitations of SSEP registration in the intensive care unit, with a focus on prognostication. Registration of the SSEP is a very reliable and reproducible method, if it is performed and interpreted correctly...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147418/electroencephalography-as-a-prognostic-tool-after-cardiac-arrest
#8
Erik Westhall
Multiple prognostic tools are used to evaluate prognosis for comatose survivors resuscitated after cardiac arrest (CA). Next to the clinical neurologic examination, electroencephalography (EEG) is the most commonly used method to assess prognosis. However, the reliability of EEG has been limited by varying classification systems, interrater variability, and the influence of sedation. Another important purpose of EEG is to evaluate clinical and subclinical seizures. The American Clinical Neurophysiology Society (ACNS) recently proposed a standardized EEG terminology for critically ill patients suitable for use after CA...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147417/neurologic-prognostication-neurologic-examination-and-current-guidelines
#9
Claudio Sandroni, Sonia D'Arrigo
Clinical examination is paramount for prognostication in patients who are comatose after resuscitation from cardiac arrest. At 72 hours from recovery of spontaneous circulation (ROSC), an absent or extensor motor response to pain (M ≤ 2) is a very sensitive, but not specific predictor of poor neurologic outcome. Bilaterally absent pupillary or corneal reflexes are less sensitive, but highly specific predictors. Besides the clinical examination, investigations such as somatosensory evoked potentials (SSEPs), electroencephalography (EEG), blood levels of neuron-specific enolase (NSE), or imaging studies can be used for neuroprognostication...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147416/treatment-of-seizures-and-postanoxic-status-epilepticus
#10
Alexandra S Reynolds, Jan Claassen
Seizures are a common occurrence following cardiac arrest and may occur both during targeted temperature management and after rewarming. Postanoxic seizures may be nonconvulsive and very difficult to diagnose without electroencephalography (EEG) or associated with prominent myoclonus. Importantly, to date no randomized controlled trials are available to guide the management of seizures in patients with cardiac arrest. Seizure prophylaxis is not recommended, and when seizures are diagnosed they are typically treated the same as seizures in other patients with acute brain injury...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147415/improving-survival-after-cardiac-arrest
#11
Conrad Arnfinn Bjørshol, Eldar Søreide
Each year, approximately half a million people suffer out-of-hospital cardiac arrest (CA) in Europe: The majority die. Survival after CA varies greatly between regions and countries. The authors give an overview of the important elements necessary to promote improved survival after CA as a function of the chain of survival and formula for survival concepts. The chain of survival incorporates bystanders (who identify warning symptoms, call the emergency dispatch center, initiate cardiopulmonary resuscitation [CPR]), dispatchers (who identify CA, and instruct and reassure the caller), first responders (who provide high-quality CPR, early defibrillation), paramedics and other prehospital care providers (who continue high-quality CPR, and provide timely defibrillation and advanced life support, transport to CA center), and hospitals (targeted temperature management, percutaneous coronary intervention, delayed prognostication)...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147414/the-brain-after-cardiac-arrest
#12
Jonathan Elmer, Clifton W Callaway
Cardiac arrest is common and deadly. Most patients who are treated in the hospital after achieving return of spontaneous circulation still go on to die from the sequelae of anoxic brain injury. In this review, the authors provide an overview of the mechanisms and consequences of postarrest brain injury. Special attention is paid to potentially modifiable mechanisms of secondary brain injury including seizures, hyperpyrexia, cerebral hypoxia and hypoperfusion, oxidative injury, and the development of cerebral edema...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147413/cardiac-issues-in-cardiac-arrest
#13
Wulfran Bougouin, Alain Cariou
The prognosis of cardiac arrest (CA) remains poor, with a survival rate at hospital discharge between 6 and 10%. To improve this disappointing outcome, efforts are needed regarding each step in the chain of survival. In this review, the authors focus on cardiac issues, as the heart itself could be both a cause and a target in this setting. Acute myocardial infarction is very illustrative of this duality. As it is a frequent cause of CA, an early invasive strategy (through immediate coronary angiography) has been proposed by several teams and is now recommended in specific situations...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147412/cardiac-arrest-and-cardiopulmonary-resuscitation
#14
Jerry P Nolan
In this review, the author summarizes the incidence, causes, and survival associated with out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). The resuscitation guideline process is outlined, and the impact of resuscitation interventions is discussed. The incidence of OHCA treated by emergency medical services varies throughout the world, but is in the range of 30 to 50 per 100,000 of the population. Survival-to-hospital-discharge rates also vary, but are in the range of 8 to 10% for many countries...
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147411/hypoxic-ischemic-encephalopathy
#15
Hans Friberg, Tobias Cronberg
No abstract text is available yet for this article.
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/28147410/tobias-cronberg-md-phd-and-hans-friberg-md-phd-edic
#16
David M Greer
No abstract text is available yet for this article.
February 2017: Seminars in Neurology
https://www.readbyqxmd.com/read/27907969/neuroprotection-in-critical-care-neurology
#17
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
#18
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
#19
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
#20
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
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