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Neurocritical Care

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https://www.readbyqxmd.com/read/27905046/in-hospital-mortality-with-use-of-percutaneous-endoscopic-gastrostomy-in-traumatic-brain-injury-patients-results-of-a-nationwide-population-based-study
#1
Rabail Chaudhry, Sachin Batra, Omar L Mancillas, Robert Wegner, Navneet Grewal, George W Williams
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a frequently performed invasive procedure that has been associated with high short-term mortality. Its use of special interest in traumatic brain injury (TBI) patients as nutrition support constitutes important issues in intensive care of this group. We used a national database to determine the incidence of, and factors associated with, in-hospital mortality among TBI patients undergoing PEG. METHODS: We conducted a retrospective study using the US nationwide inpatient sample to analyze data from all hospitalizations in 2008 with International Classification of Diseases, Ninth Revision, diagnostic and procedure codes identifying patients with TBI and hemorrhagic stroke who received PEG...
November 30, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27873234/eeg-monitoring-and-antiepileptic-drugs-in-children-with-severe-tbi
#2
Christopher M Ruzas, Peter E DeWitt, Kimberly S Bennett, Kevin E Chapman, Nicole Harlaar, Tellen D Bennett
BACKGROUND: Traumatic brain injury (TBI) causes substantial morbidity and mortality in US children. Post-traumatic seizures (PTS) occur in 11-42% of children with severe TBI and are associated with unfavorable outcome. Electroencephalographic (EEG) monitoring may be used to detect PTS and antiepileptic drugs (AEDs) may be used to treat PTS, but national rates of EEG and AED use are not known. The purpose of this study was to describe the frequency and timing of EEG and AED use in children hospitalized after severe TBI...
November 21, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27873233/four-score-predicts-early-outcome-in-patients-after-traumatic-brain-injury
#3
Tee-Tau Eric Nyam, Kam-Hou Ao, Shu-Yu Hung, Mei-Li Shen, Tzu-Chieh Yu, Jinn-Rung Kuo
BACKGROUND: The aim of the study was to determine whether the Full Outline of UnResponsiveness (FOUR) score, which includes eyes opening (E), motor function (M), brainstem reflex (B), and respiratory pattern (R), can be used as an alternate method to the Glasgow Coma Scale (GCS) in predicting intensive care unit (ICU) mortality in traumatic brain injury (TBI) patients. METHODS: From January 2015 to June 2015, patients with isolated TBI admitted to the ICU were enrolled...
November 21, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27848125/the-effect-of-positive-end-expiratory-pressure-on-intracranial-pressure-and-cerebral-hemodynamics
#4
Myles D Boone, Sayuri P Jinadasa, Ariel Mueller, Shahzad Shaefi, Ekkehard M Kasper, Khalid A Hanafy, Brian P O'Gara, Daniel S Talmor
BACKGROUND: Lung protective ventilation has not been evaluated in patients with brain injury. It is unclear whether applying positive end-expiratory pressure (PEEP) adversely affects intracranial pressure (ICP) and cerebral perfusion pressure (CPP). We aimed to evaluate the effect of PEEP on ICP and CPP in a large population of patients with acute brain injury and varying categories of acute lung injury, defined by PaO2/FiO2. METHOD: Retrospective data were collected from 341 patients with severe acute brain injury admitted to the ICU between 2008 and 2015...
November 15, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27848124/reversible-cerebral-vasoconstriction-syndrome-and-posterior-reversible-encephalopathy-syndrome-associated-with-intracranial-hypotension
#5
Katharina Feil, Robert Forbrig, Franziska S Thaler, Julian Conrad, Suzette Heck, Franziska Dorn, Hans-Walter Pfister, Andreas Straube
BACKGROUND: Reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES) are both rare disorders. The pathophysiology of both diseases is not yet fully understood. METHODS: We report the unique case of a 19-year-old comatose woman who was brought to the ER after a series of generalized tonic-clonic seizures 6 days post peridural anesthesia for cesarean section. Vital signs and initial laboratory testing including urine analysis and drug screening were unremarkable...
November 15, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27844466/perihematomal-edema-expansion-rates-and-patient-outcomes-in-deep-and-lobar-intracerebral-hemorrhage
#6
Zachary Grunwald, Lauren A Beslow, Sebastian Urday, Anastasia Vashkevich, Alison Ayres, Steven M Greenberg, Joshua N Goldstein, Audrey Leasure, Fu-Dong Shi, Kristopher T Kahle, Thomas W K Battey, J Marc Simard, Jonathan Rosand, W Taylor Kimberly, Kevin N Sheth
BACKGROUND: Perihematomal edema (PHE) expansion rate may predict functional outcome following spontaneous intracerebral hemorrhage (ICH). We hypothesized that the effect of PHE expansion rate on outcome is greater for deep versus lobar ICH. METHODS: Subjects (n = 115) were retrospectively identified from a prospective ICH cohort enrolled from 2000 to 2013. Inclusion criteria were age ≥ 18 years, spontaneous supratentorial ICH, and known onset time. Exclusion criteria were primary intraventricular hemorrhage (IVH), trauma, subsequent surgery, or warfarin-related ICH...
November 14, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27844465/blood-flow-diversion-as-a-primary-treatment-method-for-ruptured-brain-aneurysms-concerns-controversy-and-future-directions
#7
Brian P Walcott, Matthew J Koch, Christopher J Stapleton, Aman B Patel
Flow diversion is a novel treatment for brain aneurysms that works by redirecting blood flow away from the aneurysm. Immediately after placement of the stent, blood flow stagnates within the aneurysm dome and it undergoes thrombosis. Over time, a new endothelium develops across the neck, thereby reconstructing the parent vessel and curing the aneurysm. The use of this treatment method for ruptured aneurysms has two specific concerns: 1) risk of hemorrhage from the aneurysm after treatment because of potential delayed aneurysm occlusion; and 2) hemorrhagic complications from antiplatelet use, which is required to prevent thromboembolic complications from the device...
November 14, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27844464/the-safety-and-effectiveness-of-intravenous-lacosamide-for-refractory-status-epilepticus-in-the-critically-ill
#8
C R Newey, N M Le, C Ahrens, P Sahota, S Hantus
BACKGROUND: Status epilepticus (SE) often does not respond to initial treatment. A second-line agent with a less established safety and efficacy profile is then required. This study examined the safety of intravenous (IV) lacosamide (LCM) in a critically ill population and obtained an estimate of effectiveness in patients with refractory SE on continuous video EEG monitoring (cEEG). METHODS: Retrospective review of critically ill patients in SE on cEEG treated with IV LCM from June 2009 to April 2011...
November 14, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27822741/isolated-brain-trauma-in-cats-triggers-rapid-onset-of-hypovolemia
#9
Peter Bentzer, Per-Olof Grände
BACKGROUND: Hemodynamic instability responsive to fluid resuscitation is common after a traumatic brain injury (TBI), also in the absence of systemic hemorrhage. The present study tests if an isolated severe TBI induces a decrease in plasma volume (PV). METHODS: The study was performed in three groups of anesthetized and tracheostomized male cats (n = 21). In one group (n = 8), the cats were prepared with a cranial borehole (10 mm i.d) used to expose the brain to a fluid percussion brain injury (FPI) (1...
November 7, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27822739/an-association-between-icp-derived-data-and-outcome-in-tbi-patients-the-role-of-sample-size
#10
Brenno Cabella, Joseph Donnelly, Danilo Cardim, Xiuyun Liu, Manuel Cabeleira, Peter Smielewski, Christina Haubrich, Peter J A Hutchinson, Dong-Joo Kim, Marek Czosnyka
BACKGROUND: Many demographic and physiological variables have been associated with TBI outcomes. However, with small sample sizes, making spurious inferences is possible. This paper explores the effect of sample sizes on statistical relationships between patient variables (both physiological and demographic) and outcome. METHODS: Data from head-injured patients with monitored arterial blood pressure, intracranial pressure (ICP) and outcome assessed at 6 months were included in this retrospective analysis...
November 7, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27796770/ruptured-mca-aneurysm-presenting-as-intracerebral-hemorrhage
#11
Christopher P Robinson, Nicholas L Zalewski, Alejandro A Rabinstein
No abstract text is available yet for this article.
October 28, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27785694/an-nihss-of-0-and-a-very-disabling-stroke
#12
Sherri A Braksick, Eelco F M Wijdicks
No abstract text is available yet for this article.
October 26, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27761730/influence-of-glycemic-control-on-endogenous-circulating-ketone-concentrations-in-adults-following-traumatic-brain-injury
#13
Stephanie M Wolahan, Mayumi L Prins, David L McArthur, Courtney R Real, David A Hovda, Neil A Martin, Paul M Vespa, Thomas C Glenn
BACKGROUND: The objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) on endogenous ketogenesis in severely head-injured adults. METHODS: The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7-8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed...
October 19, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27757915/the-impact-of-red-blood-cell-transfusion-on-cerebral-tissue-oxygen-saturation-in-severe-traumatic-brain-injury
#14
Victoria A McCredie, Simone Piva, Marlene Santos, Wei Xiong, Airton Leonardo de Oliveira Manoel, Andrea Rigamonti, Gregory M T Hare, Martin G Chapman, Andrew J Baker
BACKGROUND: There are a range of opinions on the benefits and thresholds for the transfusion of red blood cells in critically ill patients with traumatic brain injury (TBI) and an urgent need to understand the neurophysiologic effects. The aim of this study was to examine the influence of red blood cell transfusions on cerebral tissue oxygenation (SctO2) in critically ill TBI patients. METHODS: This prospective observational study enrolled consecutive TBI patients with anemia requiring transfusion...
October 18, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27757914/risks-of-routinely-clamping-external-ventricular-drains-for-intrahospital-transport-in-neurocritically-ill-cerebrovascular-patients
#15
Nophanan Chaikittisilpa, Abhijit V Lele, Vivian H Lyons, Bala G Nair, Shu-Fang Newman, Patricia A Blissitt, Monica S Vavilala
BACKGROUND: Current guidelines recommend routine clamping of external ventricular drains (EVD) for intrahospital transport (IHT). The aim of this project was to describe intracranial hemodynamic complications associated with routine EVD clamping for IHT in neurocritically ill cerebrovascular patients. METHODS: We conducted a retrospective review of cerebrovascular adult patients with indwelling EVD admitted to the neurocritical care unit (NICU) during the months of September to December 2015 at a tertiary care center...
October 18, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27677909/risk-of-hyponatremia-in-patients-with-aneurysmal-subarachnoid-hemorrhage-treated-with-exogenous-vasopressin-infusion
#16
Nancy Marr, Jessica Yu, Demetrios J Kutsogiannis, Sherif Hanafy Mahmoud
BACKGROUND: Vasopressin is one of the vasopressors used to augment blood pressure in subarachnoid hemorrhage (SAH) patients with clinically significant vasospasm. The purpose of the present study was to determine whether the administration of vasopressin to a population of SAH patients was an independent predictor of developing hyponatremia. METHODS: A retrospective review on the health records of 106 patients admitted to the University of Alberta Hospital Neurosciences ICU, Edmonton AB, Canada, with SAH from June 2013 to December 2015 was conducted...
September 27, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27677908/abcc8-single-nucleotide-polymorphisms-are-associated-with-cerebral-edema-in-severe-tbi
#17
Ruchira M Jha, Ava M Puccio, David O Okonkwo, Benjamin E Zusman, Seo-Young Park, Jessica Wallisch, Philip E Empey, Lori A Shutter, Robert S B Clark, Patrick M Kochanek, Yvette P Conley
OBJECTIVE: Cerebral edema (CE) in traumatic brain injury (TBI) is the consequence of multiple underlying mechanisms and is associated with unfavorable outcomes. Genetic variability in these pathways likely explains some of the clinical heterogeneity observed in edema development. A role for sulfonylurea receptor-1 (Sur1) in CE is supported. However, there are no prior studies examining the effect of genetic variability in the Sur1 gene (ABCC8) on the development of CE. We hypothesize that ABCC8 single nucleotide polymorphisms (SNPs) are predictive of CE...
September 27, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27660177/subarachnoid-hemorrhage-and-spinal-subdural-hematoma-due-to-acute-csf-hypotension
#18
Christopher S Graffeo, Avital Perry, Eelco F M Wijdicks
BACKGROUND: Intracranial subarachnoid hemorrhage (SAH) and spinal subdural hematoma (SDH) are rare complications of spine surgery, thought to be precipitated by cerebrospinal fluid (CSF) hypotension in the setting of an intraoperative durotomy or postoperative CSF leak. Considerable clinical variability has been reported, requiring a high level of clinical suspicion in patients with a new, unexplained neurologic deficit after spine surgery. METHODS: Case report...
September 22, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27629275/volume-of-plasma-expansion-and-functional-outcomes-in-stroke
#19
Joseph B Miller, Christopher Lewandowski, Charles R Wira, Andrew Taylor, Charlotte Burmeister, Robert Welch
BACKGROUND: Plasma expansion in acute ischemic stroke has potential to improve cerebral perfusion, but the long-term effects on functional outcome are mixed in prior trials. The goal of this study was to evaluate how the magnitude of plasma expansion affects neurological recovery in acute stroke. METHODS: This was a secondary analysis of data from the Albumin in Acute Stroke Part 2 trial investigating the relationship between the magnitude of overall intravenous volume infusion (crystalloid and colloid) to clinical outcome...
September 14, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27624215/post-ischemic-myoclonic-status-following-cardiac-arrest-in-young-drug-users
#20
Sherri A Braksick, Alejandro A Rabinstein, Eelco F M Wijdicks, Jennifer E Fugate, Sara Hocker
BACKGROUND: Myoclonic status may be observed following cardiac arrest and has previously been identified as a poor prognostic indicator in regard to return of neurologic function. We describe a unique situation in post-cardiac arrest patients with myoclonic status and hypothesize possible predictors of a good neurologic outcome. METHODS: Case series. RESULTS: We illustrate two cases of cardiac arrest due to a respiratory cause in young patients with evidence of illicit drug use at the time of hospital admission that suffered post-ischemic myoclonic status...
September 13, 2016: Neurocritical Care
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