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Neurocritical Care

Daniel Hänggi, Nima Etminan, Stephan A Mayer, E Francois Aldrich, Michael N Diringer, Erich Schmutzhard, Herbert J Faleck, David Ng, Benjamin R Saville, R Loch Macdonald
BACKGROUND: Nimodipine is the only drug approved in the treatment of aneurysmal subarachnoid hemorrhage (aSAH) in many countries. EG-1962, a product developed using the Precisa™ platform, is an extended-release microparticle formulation of nimodipine that can be administered intraventricularly or intracisternally. It was developed to test the hypothesis that delivering higher concentrations of extended-release nimodipine directly to the cerebrospinal fluid would provide superior efficacy compared to systemic administration...
July 16, 2018: Neurocritical Care
Eelco F M Wijdicks
The Harvard criteria for the definition of irreversible coma or brain death were a product of a multidisciplinary committee chaired by anesthesiologist Beecher. The Harvard criteria included unreceptivity, unresponsiveness, no movements or breathing, no reflexes with further delineation of brainstem reflexes, and a flat electroencephalogram (repeated after 24 h with no change). The apnea test involved disconnection of the ventilator for 3 min. Hypothermia or any other central nervous system depressant had to be excluded...
July 16, 2018: Neurocritical Care
Andrea Loggini, Raisa C Martinez, Christopher L Kramer
No abstract text is available yet for this article.
July 11, 2018: Neurocritical Care
Gyanendra Kumar, Oana M Dumitrascu, Chia-Chun Chiang, Cumara B O'Carroll, Andrei V Alexandrov
OBJECT: Cerebral catheter angiography is the gold standard for diagnosing cerebral artery vasospasm (vasospasm) in aneurysmal subarachnoid hemorrhage (SAH). We have previously published a meta-analysis of prediction of delayed cerebral ischemia (DCI) from transcranial Doppler (TCD) evidence of vasospasm. Analogous data relating to prediction of DCI have not been previously collated for cerebral angiography nor reconciled against TCD. METHODS: We searched PUBMED, the Cochrane database, and clinicaltrials...
July 11, 2018: Neurocritical Care
Aaron Sylvan Lord, Joseph Nicholson, Ariane Lewis
Hospital-acquired infections are common in neurointensive care units. We sought to review interventions which may reduce infection rates in neurocritically ill populations. We conducted a systematic review of studies targeting adult patients in neuro-intensive care units (neuro-ICUs) with an intervention designed to prevent ICU-acquired infections. Our outcome of interest was change in the prevalence or rates of infection between active and control arms of these studies. We excluded studies based on the following criteria: no English full-text version available; pediatric population; non-neurosciences ICU population; pre- or intraoperative methods to prevent infection; lack of discrete data for infection rates/prevalence; studies that were purely observational in nature and did not test an intervention; and studies performed in resource limited settings...
July 11, 2018: Neurocritical Care
Shahed Toossi, Asma M Moheet
Non-traumatic intracranial hemorrhage includes subarachnoid hemorrhage, subdural hemorrhage, and intracerebral hemorrhage (ICH), which can be classified as primary or secondary. Primary ICH is due to arterial hypertension or cerebral amyloid angiopathy, and secondary ICH is due to cerebral vascular malformations, coagulopathies, infectious complications, brain tumors, and illicit stimulant drug use. This review explores the epidemiology and management of non-traumatic ICH in women, with a focus on pregnancy and the post-partum period, defined as 6 weeks post-delivery...
July 11, 2018: Neurocritical Care
Johannes Koren, Johannes Herta, Simone Draschtak, Georg Pötzl, Franz Fürbass, Manfred Hartmann, Tilmann Kluge, Andreas Gruber, Christoph Baumgartner
BACKGROUND: Critical care continuous electroencephalography (CCEEG) represents the gold standard for detection of nonconvulsive status epilepticus (NCSE) in neurological critical care patients. It is unclear which findings on short-term routine EEG and which clinical parameters predict NCSE during subsequent CCEEG reliably. The aim of the present study was to assess the prognostic significance of changes within the first 30 min of EEG as well as of clinical parameters for the occurrence of NCSE during subsequent CCEEG...
July 11, 2018: Neurocritical Care
Li Tu, Xiujuan Liu, Tian Li, Xiulin Yang, Yipin Ren, Qian Zhang, Huan Yao, Xiang Qu, Qian Wang, Tian Tian, Jinyong Tian
BACKGROUND: Prognostic significance of serum calcium level in patients with intracerebral hemorrhage is not well studied. The aim of the study was to identify if a relationship between admission serum calcium level and prognosis exists in patients with intracerebral hemorrhage. METHODS: A total of 1262 confirmed intracerebral hemorrhage patients were included. Demographic data, medical history, medicine history, laboratory data, imaging data, clinical score, and progress note were collected from their medical records...
July 11, 2018: Neurocritical Care
KongMiao Lu, HaiRong Wang, XiaoLi Ge, QingHua Liu, Miao Chen, Yong Shen, Xuan Liu, ShuMing Pan
BACKGROUND: To investigate the effects of hyperbaric oxygen (HBO) on brain damage and autophagy levels in a rat model of middle cerebral artery occlusion. METHODS: Neurologic injury and infarcted areas were evaluated according to the modified neurological severity score and 2,3,5-triphenyltetrazolium chloride staining. Western blots were used to determine beclin1, caspase-3 and fodrin1 protein expression. Beclin1 protein expression (an autophagy marker), positive terminal dUTP nick-end labeling (TUNEL) staining (an apoptosis marker) and positive propidium iodide (PI) staining (a necrosis marker) were detected by immunofluorescence...
July 9, 2018: Neurocritical Care
Kai Liu, Bo Song, Yuan Gao, Lu Zhao, Hui Fang, Yunchao Wang, Lulu Pei, Kaihao Han, Shen Li, Yusheng Li, Yuming Xu
BACKGROUND: Anemia is associated with unfavorable functional outcome in ischemic and hemorrhagic stroke. However, the relationship between anemia and prognosis in patients with cerebral venous thrombosis (CVT) has not been studied. METHODS: Consecutive CVT patients were retrospectively identified from November 2011, through January 2017. Anemia was defined according to the World Health Organization criteria (non-pregnant female hemoglobin level < 120 g/L, pregnant female < 110 g/L and male < 130 g/L), which was further classified as mild, moderate, and severe anemia according to hemoglobin concentration, and as microcytic, normocytic, and macrocytic anemia according to mean corpuscular volume...
July 9, 2018: Neurocritical Care
Andreas H Kramer, Philippe L Couillard, David A Zygun, Marcel J Aries, Clare N Gallagher
BACKGROUND: Guidelines recommend maintaining cerebral perfusion pressure (CPP) between 60 and 70 mmHg in patients with severe traumatic brain injury (TBI), but acknowledge that optimal CPP may vary depending on cerebral blood flow autoregulation. Previous retrospective studies suggest that targeting CPP where the pressure reactivity index (PRx) is optimized (CPPopt ) may be associated with improved recovery. METHODS: We performed a retrospective cohort study involving TBI patients who underwent PRx monitoring to assess issues of feasibility relevant to future interventional studies: (1) the proportion of time that CPPopt could be detected; (2) inter-observer variability in CPPopt determination; and (3) agreement between manual and automated CPPopt estimates...
July 9, 2018: Neurocritical Care
Ali Daneshmand, Karl N Krecke, Eelco F M Wijdicks
BACKGROUND: Flow diverters are increasingly used to treat complex ruptured intracranial aneurysms. Most complications are ischemic and seen early after placement. METHODS: We present a patient with 3 year duration of neurologic symptoms and seizures as a result of lesions associated with a inflammatory response to embolized polymer coating. RESULTS: Over a period of 3 years MRI abnormalities were noted with substantial gadolinium enhancement of the stent but with resolution after corticosteroids...
July 9, 2018: Neurocritical Care
Yu-Zhi Gao, Mao Zhang
No abstract text is available yet for this article.
July 9, 2018: Neurocritical Care
Timothy D Lewis, Kelly A Dehne, Kathryn Morbitzer, Denise H Rhoney, Casey Olm-Shipman, J Dedrick Jordan
Due to an error introduced during the production process, J. Dedrick Jordan's name was improperly tagged in the original publication of this article. It is tagged correctly here.
July 9, 2018: Neurocritical Care
Vytautas Petkus, Aidanas Preiksaitis, Solventa Krakauskaite, Laimonas Bartusis, Romanas Chomskis, Yasin Hamarat, Erika Zubaviciute, Saulius Vosylius, Saulius Rocka, Arminas Ragauskas
BACKGROUND: This prospective study of an innovative non-invasive ultrasonic cerebrovascular autoregulation (CA) monitoring method is based on real-time measurements of intracranial blood volume (IBV) reactions following changes in arterial blood pressure. In this study, we aimed to determine the clinical applicability of a non-invasive CA monitoring method by performing a prospective comparative clinical study of simultaneous invasive and non-invasive CA monitoring on intensive care patients...
June 27, 2018: Neurocritical Care
Mostafa Jafari, Mario Di Napoli, Yvonne H Datta, Eric M Bershad, Afshin A Divani
Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke, with a high rate of mortality and morbidity. Even with the best current medical or surgical interventions, outcomes remain poor. The location and initial hematoma volume are strong predictors of mortality. Hematoma expansion (HE) is a further marker of poor prognosis that may be at least partly preventable. Several risk factors for HE have been identified, including baseline ICH volume, anticoagulation, and computed tomography angiography spot signs...
June 27, 2018: Neurocritical Care
Christopher R Andersen, Emily Fitzgerald, Anthony Delaney, Simon Finfer
Consensus on appropriate outcome measures to use in aneurysmal subarachnoid hemorrhage (aSAH) research has not been established, although the transition toward a core outcome set (COS) would provide significant benefits. To inform COS development, we conducted a systematic review to identify outcome measures included in reports of randomized clinical trials (RCTs) of interventions in patients with aSAH. Ovid Medline, EMBASE, CINAHL, and CENTRAL were searched. RCTs investigating aSAH published between January 1996 and May 2015 were included...
June 27, 2018: Neurocritical Care
Jennifer H Kang, Aatif M Husain, Joel C Morgenlander
BACKGROUND: Electroencephalogram (EEG) findings of generalized periodic discharges (GPDs) with triphasic morphology were introduced as a metabolic phenomenon, but more recently have been associated with epileptic phenomenon. Resolution of EEG findings along with clinical improvement from treatment is diagnostic. The known causes of reversible, isolated loss of OVR include medication toxicity, lead exposure, and thiamine deficiency, but its association with nonconvulsive status epilepticus (NCSE) has never been published...
June 27, 2018: Neurocritical Care
Adrian A Jarquin-Valdivia, Robbie Franklin
No abstract text is available yet for this article.
June 27, 2018: Neurocritical Care
Guang-Dong Lu, Zi-Qi Ren, Jin-Xing Zhang, Qing-Quan Zu, Hai-Bin Shi
BACKGROUND: We performed a meta-analysis to evaluate the outcomes of acute ischemic stroke (AIS) in patients treated with mechanical thrombectomy (MT), according to diabetes mellitus and admission glucose level (AGL). METHODS: We systematically reviewed previous studies in PubMed that reported outcomes of MT in AIS patients and their relationships with diabetes mellitus or AGL. We used functional independence (modified Rankin score ≤ 2 at 3 months) as the primary end point...
June 26, 2018: Neurocritical Care
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