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Neurocritical Care

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https://www.readbyqxmd.com/read/29327153/the-effect-of-therapeutic-mild-hypothermia-on-brain-microvascular-endothelial-cells-during-ischemia-reperfusion-injury
#1
Yao Chen, Lin Wang, Yun Zhang, Yaxiong Zhou, Wei Wei, Zhi Wan
BACKGROUND: To determine the cerebral protective effects of mild hypothermia (MH) on cerebral microcirculation. METHODS: We established ischemia-reperfusion (I/R) injury and MH treatment models with rat brain microvascular endothelial cells (RBMECs) in vitro and examined the apoptotic changes. The cultured RBMECs were randomly divided into the control group, I/R group, and MH group, which was further divided into two subgroups: intra-ischemia hypothermia (IIH) and post-ischemia hypothermia (PIH)...
January 11, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29327152/the-prevalence-and-impact-of-status-epilepticus-secondary-to-intracerebral-hemorrhage-results-from-the-us-nationwide-inpatient-sample
#2
Amol Mehta, Benjamin E Zusman, Lori A Shutter, Ravi Choxi, Ahmed Yassin, Arun Antony, Parthasarathy D Thirumala
BACKGROUND: Status epilepticus (SE) has been identified as a predictor of morbidity and mortality in many acute brain injury patient populations. We aimed to assess the prevalence and impact of SE after intracerebral hemorrhage (ICH) in a large patient sample to overcome limitations in previous small patient sample studies. METHODS: We queried the Nationwide Inpatient Sample for patients admitted for ICH from 1999 to 2011, excluding patients with other acute brain injuries...
January 11, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29327151/impact-of-admission-hypertension-on-rates-of-acute-kidney-injury-in-intracerebral-hemorrhage-treated-with-intensive-blood-pressure-control
#3
Hannah Hewgley, Stephen C Turner, Joseph E Vandigo, Jacob Marler, Heather Snyder, Jason J Chang, G Morgan Jones
BACKGROUND: Current guidelines recommend that rapid systolic blood pressure (SBP) lowering to 140 mmHg may be considered in intracerebral hemorrhage (ICH) patients regardless of initial SBP. However, limited safety data exist in patients presenting with varying degrees of severe hypertension. The purpose of this study was to determine whether there was an increased risk of acute kidney injury (AKI) based upon degree of presentation hypertension in ICH patients whose blood pressure was reduced intensively...
January 11, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29313314/duration-of-agitation-fluctuations-of-consciousness-and-associations-with-outcome-in-patients-with-subarachnoid-hemorrhage
#4
Michael E Reznik, Ali Mahta, J Michael Schmidt, Hans-Peter Frey, Soojin Park, David J Roh, Sachin Agarwal, Jan Claassen
BACKGROUND: Agitation is common after subarachnoid hemorrhage (SAH) and may be independently associated with outcomes. We sought to determine whether the duration of agitation and fluctuating consciousness were also associated with outcomes in patients with SAH. METHODS: We identified all patients with positive Richmond Agitation Sedation Scale (RASS) scores from a prospective observational cohort of patients with SAH from 2011 to 2015. Total duration of agitation was extrapolated for each patient using available RASS scores, and 24-h mean and standard deviation (SD) of RASS scores were calculated for each patient...
January 8, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29313313/relationship-of-coagulopathy-and-platelet-dysfunction-to-transfusion-needs-after-traumatic-brain-injury
#5
Grace Martin, Dhavan Shah, Nora Elson, Ryan Boudreau, Dennis Hanseman, Timothy A Pritts, Amy T Makley, Brandon Foreman, Michael D Goodman
BACKGROUND: Coagulopathy and platelet dysfunction commonly develop after traumatic brain injury (TBI). Thromboelastography (TEG) and platelet function assays (PFAs) are often performed at the time of admission; however, their roles in assessing post-TBI coagulopathy have not been investigated. We hypothesized that compared to blunt TBI, penetrating TBI would (1) demonstrate greater coagulopathy by TEG, (2) be associated with abnormal PFA results, and (3) require more blood product transfusions...
January 8, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29313312/influence-of-single-dose-antibiotic-prophylaxis-for-early-onset-pneumonia-in-high-risk-intubated-patients
#6
Timothy D Lewis, Kelly A Dehne, Kathryn Morbitzer, Denise H Rhoney, Casey Olm-Shipman, J Dedrick Jordan
BACKGROUND: Early-onset pneumonia (EOP) after endotracheal intubation is common among critically ill patients with a neurologic injury and is associated with worse clinical outcomes. METHODS: This retrospective cohort study observed outcomes pre- and post-implementation of an EOP prophylaxis protocol which involved the administration of a single dose of ceftriaxone 2 g around the time of intubation. The study included patients ≥ 18 years who were admitted to the University of North Carolina Medical Center (UNCMC) neuroscience intensive care unit (NSICU) between April 1, 2014, and October 26, 2016, and intubated for ≥ 72 h...
January 8, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29305758/ventriculostomy-and-risk-of-upward-herniation-in-patients-with-obstructive-hydrocephalus-from-posterior-fossa-mass-lesions
#7
Sherri A Braksick, Benjamin T Himes, Kendall Snyder, Jamie J Van Gompel, Jennifer E Fugate, Alejandro A Rabinstein
BACKGROUND: Patients with posterior fossa lesions causing obstructive hydrocephalus present a unique clinical challenge, as relief of hydrocephalus can improve symptoms, but the perceived risk of upward herniation must also be weighed against the risk of worsening or continued hydrocephalus and its consequences. The aim of our study was to evaluate for clinically relevant upward herniation following external ventricular drainage (EVD) in patients with obstructive hydrocephalus due to posterior fossa lesions...
January 5, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29305757/metabolic-encephalopathy-behind-the-name
#8
Eelco F M Wijdicks
Metabolic encephalopathy may be the most common diagnosis in consultative acute neurology. The origin of this term is not generally known but can be traced back. The term replaced more commonly used designations such as organic or functional. The term metabolic encephalopathy was originally linked to organ dysfunction but subsequently became more imprecise. When it expanded to include a large number of diseases, it evolved to "metabolic neuronal dysfunction" and soon could not be distinguished from "quiet delirium" and other designations...
January 5, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29305756/on-aneurysmal-rupture-and-rerupture
#9
Eelco F M Wijdicks
A warning leak is a curious phenomenon attributed to cerebral aneurysms. Once the leak occurs, it has been postulated it could lead to a more catastrophic rebleeding. The designation "warning leak" trickled into neurosurgery vocabulary as early as the 1950s. The phenomenon has been poorly understood and characterized, but its presence spurs emergency physicians and neurointensivists to take action to secure the aneurysm. Rapid treatment of a recently discovered aneurysm is now commonplace, but it has not always been so...
January 5, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29299753/factors-associated-with-the-outcome-of-very-elderly-patients-with-large-hemispheric-infarction-treated-with-medical-management-only
#10
Sudhir Datar, Christopher McLouth, Patrick Reynolds
BACKGROUND: Large ischemic stroke in the very elderly population is presumed to invariably carry a poor prognosis and clinicians may refrain from continuing intensive care. Many elderly patients are not surgical candidates, and there is a paucity of data outlining the real-world outcomes of continued medical management. Our objective is to identify the factors associated with the outcome of very elderly patients with large hemispheric infarction (LHI) treated with medical management alone...
January 3, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29297141/lactulose-a-simple-sugar-in-a-complex-encephalopathy
#11
Eelco F M Wijdicks
Hepatic encephalopathy is a common encephalopathy and one of the very few that are treatable. Lactulose has remained a standard pharmaceutical intervention and is listed as one of the World Health Organization's Essential Medicines. The discovery of lactulose, the acid dialysis proof of concept, and the role of Bircher are not well known. This historical vignette reviews the gradual understanding of the complex liver-brain connection, the effective treatment of hepatic stupor with lactulose, and the immediate relevance of lactulose to the practice of consultative neurocritical care...
January 2, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29294223/the-incidence-of-catheter-tract-hemorrhage-and-catheter-placement-accuracy-in-the-clear-iii-trial
#12
Achim Müller, W Andrew Mould, W David Freeman, Nichol McBee, Karen Lane, Rachel Dlugash, Rick Thompson, Saman Nekoovaght-Tak, Vikram Madan, Hasan Ali, Agnieszka Stadnik, Issam Awad, Daniel Hanley, Wendy C Ziai
BACKGROUND: Incidence of catheter tract hemorrhage (CTH) after initial ventriculostomy placement ranges from 10 to 34%. We investigated CTH incidence in the Clot Lysis: Evaluation of Accelerated Resolution of Intraventricular Hemorrhage Phase III trial. METHODS: Prospective observational analysis of 1000 computer tomography (CT) scans from all 500 patients enrolled in the trial. All catheters were evaluated on first CT post-placement and on last CT prior to randomization for placement location and CTH size, location, and severity...
January 2, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29294222/tracing-the-roots-of-neurocritical-care
#13
Eelco F M Wijdicks
No abstract text is available yet for this article.
January 2, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29288292/c-miller-fisher-and-the-comatose-patient
#14
Eelco F M Wijdicks
Neurologic examination of the comatose patient has gradually matured. Less than 50 years ago, neurological examination in coma became a regular part of textbooks with separate chapters devoted to the topic but many were deficient in detail. In 1969, C.M. Fisher published an extraordinary 56-page paper on the examination of the comatose patient. The paper-one of Fisher's gems-is not well known and infrequently cited. The many new observations collected in this comprehensive paper are reviewed in this vignette, which highlights not only how these contributions shaped our thinking on coma but also questioned shaky concepts...
December 29, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29288291/transfusion-of-blood-products-in-the-neurocritical-care-unit-an-exploration-of-rationing-and-futility
#15
Deepa P Malaiyandi, Galen V Henderson, Michael A Rubin
Rationing is the allocation of scarce resources, which in healthcare necessarily requires withholding potentially beneficial treatments from some individuals. While it often entails a negative connotation, rationing is unavoidable because need is limitless and resources are not. How rationing occurs is important, because it not only affects individual lives, but also reflects society's most important values. At the core of any rationing, decision is how much a limited resource may benefit a patient, which can be particularly difficult to determine in the practice of neurocritical care, as prognosis is often uncertain...
December 29, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29274051/stroke-and-craniectomy
#16
Eelco F M Wijdicks
Neurosurgical involvement in the care of major stroke complications has yielded striking results in the subtentorial region but equivocal outcomes in the supratentorial compartment. Most neurosurgeons want to see some degree of deterioration before proceeding; thus, timing will be debated. Viewpoints have changed over the years regarding surgical or medical intervention, but in many patients the procedure has not produced a definitive change in outcome other than preventing death from terminal brainstem shift...
December 22, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29274050/the-first-ct-scan-of-the-brain-entering-the-neurologic-information-age
#17
Eelco F M Wijdicks
Computed tomography (CT) scan of the brain transitioned clinical neurology from the educated-guess world to the real computer-age world. One of the first CT scans-published by the British neuroradiologist James Ambrose-showed an intracranial hemorrhage and also suggested the use of iodine to demonstrate abnormal blood-brain barrier. In the USA, CT scans were rapidly commercialized and first placed at Mayo Clinic and Massachusetts General Hospital in the summer of 1973. CT scanning of the brain has revolutionized diagnostic acute neurology and neurosurgery and was the overture to an even larger revolution-magnetic resonance imaging...
December 22, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29260443/medulla-oblongata-hemorrhage-and-reverse-takotsubo-cardiomyopathy
#18
Kevin T Gobeske, Maurice E Sarano, Jennifer E Fugate, Eelco F Wijdicks
BACKGROUND: Acute brain injury with strong surges of adrenergic outflow has resulted in takotsubo cardiomyopathy, but there are surprisingly few reports of takotsubo cardiomyopathy after intracranial hemorrhage, and none have been described from hemorrhage within the brainstem. RESULTS: We describe a patient with reverse and reversible cardiomyopathy following a hemorrhage in the lateral medulla oblongata. While it is limited in size, the location of the hemorrhage caused acute systolic failure with left ventricular ejection fraction of 27% and vasopressor requirement for cardiogenic shock and pulmonary edema...
December 19, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29150777/glibenclamide-and-therapeutic-hypothermia-have-comparable-effect-on-attenuating-global-cerebral-edema-following-experimental-cardiac-arrest
#19
Shin Nakayama, Noriko Taguchi, Yumi Isaka, Takako Nakamura, Makoto Tanaka
BACKGROUND: Cerebral edema is one of the major causes of mortality following cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). A subunit of the sulfonylurea receptor 1-transient receptor potential M4 (Sur1-TRPM4) channel has been implicated in the pathogenesis of ischemia-evoked cerebral edema. In this study, we examined whether glibenclamide (GBC), a Sur1-TRPM4 channel inhibitor, attenuates cerebral edema following CA/CPR and further examined the efficacy of GBC combined with therapeutic hypothermia...
November 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29150776/hyperpyrexia-as-the-presenting-symptom-of-intracranial-hypotension
#20
Omar Hussein, Michel Torbey
INTRODUCTION: Hyperpyrexia is a severely elevated core body temperature secondary to an elevated hypothalamic set thermo-regulatory threshold. Hyperthermia is an elevated core body temperature beyond the normal hypothalamic set thermo-regulatory threshold. Intracranial hypotension can present with a wide variety of symptoms ranging from orthostatic headache up to coma. We report a rare case of hyperpyrexia associated with intracranial hypotension. METHODS: A case report of a 55-year-old female patient with a history of angiogram-negative subarachnoid hemorrhage status post-ventriculoperitoneal (VP) shunt placement six years prior to admission who suddenly developed encephalopathy and high fever...
November 17, 2017: Neurocritical Care
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