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Neurocritical Care

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https://www.readbyqxmd.com/read/29139015/defining-the-optimal-midline-shift-threshold-to-predict-poor-outcome-in-patients-with-supratentorial-spontaneous-intracerebral-hemorrhage
#1
Wen-Song Yang, Qi Li, Rui Li, Qing-Jun Liu, Xing-Chen Wang, Li-Bo Zhao, Peng Xie
BACKGROUND: Midline shift (MLS) has been associated with unfavorable outcome in patients with intracerebral hemorrhage (ICH). However, the optimal criteria to define the MLS measurements that indicate future outcome in ICH patients are absent, and the quantitative threshold of MLS that differentiates favorable and poor clinical outcome should be further explored. METHODS: We enrolled patients with ICH who underwent admission computed tomography (CT) within 6 h after onset of symptoms...
November 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29139014/the-ictal-interictal-continuum-to-treat-or-not-to-treat-and-how
#2
Clio Rubinos, Alexandra S Reynolds, Jan Claassen
Continuous electroencephalography (cEEG) monitoring is becoming increasingly used in neurologic and non-neurologic intensive care units (ICUs). Non-convulsive seizures (NCSz) and periodic discharges (PDs) are commonly seen in critically ill patients. Some of these PD patterns, also known as the ictal-interictal continuum (IIC), are associated with an increased risk of seizures and poor outcome. However, we do not fully understand the significance of these periodic patterns and the decision of how aggressively to treat remains controversial...
November 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29110267/the-journal-and-15%C3%A2-years
#3
EDITORIAL
Eelco F M Wijdicks
No abstract text is available yet for this article.
November 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29080068/cerebral-edema-after-cardiopulmonary-resuscitation-a-therapeutic-target-following-cardiac-arrest
#4
Erik G Hayman, Akil P Patel, W Taylor Kimberly, Kevin N Sheth, J Marc Simard
We sought to review the role that cerebral edema plays in neurologic outcome following cardiac arrest, to understand whether cerebral edema might be an appropriate therapeutic target for neuroprotection in patients who survive cardiopulmonary resuscitation. Articles indexed in PubMed and written in English. Following cardiac arrest, cerebral edema is a cardinal feature of brain injury and is a powerful prognosticator of neurologic outcome. Like other conditions characterized by cerebral ischemia/reperfusion, neuroprotection after cardiac arrest has proven to be difficult to achieve...
October 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29067633/implementation-of-continuous-video-electroencephalography-at-a-community-hospital-enhances-care-and-reduces-costs
#5
Brad J Kolls, Brian E Mace, Keith E Dombrowski
BACKGROUND: Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program...
October 24, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29067632/a-national-trial-on-differences-in-cerebral-perfusion-pressure-values-by-measurement-location
#6
Molly M McNett, Mary Kay Bader, Sarah Livesay, Susan Yeager, Cristina Moran, Arianna Barnes, Kimberly R Harrison, DaiWai M Olson
BACKGROUND: Cerebral perfusion pressure (CPP) is a key parameter in management of brain injury with suspected impaired cerebral autoregulation. CPP is calculated by subtracting intracranial pressure (ICP) from mean arterial pressure (MAP). Despite consensus on importance of CPP monitoring, substantial variations exist on anatomical reference points used to measure arterial MAP when calculating CPP. This study aimed to identify differences in CPP values based on measurement location when using phlebostatic axis (PA) or tragus (Tg) as anatomical reference points...
October 24, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29047014/a-callosal-catastrophe-toxic-leukoencephalopathy-associated-with-thermogenic-weight-loss-supplement-use
#7
Zakraus K Mahdavi, Ram Narayan, Shraddha Mainali, Benjamin M Greenberg, Venkatesh Aiyagari, David L McDonagh
BACKGROUND: The use of weight loss drugs and dietary supplements is common, but safety profiles for these drugs are largely unknown. Reports of toxicity have been published, and the use of these agents should be considered in clinical differential diagnoses. METHODS: We report the case of a patient with toxic leukoencephalopathy and hyponatremia associated with oral consumption of a thermogenic dietary supplement and essential oils. RESULTS: A 30-year-old woman presented after 2 days of headache, blurred vision, photophobia, vomiting, and hand spasms...
October 18, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29043546/compensatory-reserve-weighted-intracranial-pressure-and-its-association-with-outcome-after-traumatic-brain-injury
#8
L Calviello, J Donnelly, D Cardim, C Robba, F A Zeiler, P Smielewski, M Czosnyka
OBJECTIVE: We introduced 'compensatory-reserve-weighted intracranial pressure (ICP),' named 'weightedICP' for brevity, as a variable that may better describe changes leading to mortality after traumatic brain injury (TBI) over the standard mean ICP. METHODS: ICP was monitored prospectively in over 1023 sedated and ventilated patients. The RAP coefficient (R-correlation, A-amplitude, and P-pressure) was calculated as the running correlation coefficient between slow changes in the pulse amplitude of ICP and the mean ICP...
October 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29043545/early-brain-injury-associated-with-systemic-inflammation-after-subarachnoid-hemorrhage
#9
Jude Savarraj, Kaushik Parsha, Georgene Hergenroeder, Sungho Ahn, Tiffany R Chang, Dong H Kim, H Alex Choi
BACKGROUND: Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) is defined as brain injury occurring within 72 h of aneurysmal rupture. Although EBI is the most significant predictor of outcomes after aSAH, its underlying pathophysiology is not well understood. We hypothesize that EBI after aSAH is associated with an increase in peripheral inflammation measured by cytokine expression levels and changes in associations between cytokines. METHODS: aSAH patients were enrolled into a prospective observational study and were assessed for markers of EBI: global cerebral edema (GCE), subarachnoid hemorrhage early brain edema score (SEBES), and Hunt-Hess grade...
October 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29043544/icp-versus-laser-doppler-cerebrovascular-reactivity-indices-to-assess-brain-autoregulatory-capacity
#10
F A Zeiler, J Donnelly, D Cardim, D K Menon, P Smielewski, M Czosnyka
BACKGROUND: To explore the relationship between various autoregulatory indices in order to determine which approximate small vessel/microvascular (MV) autoregulatory capacity most accurately. METHODS: Utilizing a retrospective cohort of traumatic brain injury patients (N = 41) with: transcranial Doppler (TCD), intracranial pressure (ICP) and cortical laser Doppler flowmetry (LDF), we calculated various continuous indices of autoregulation and cerebrovascular responsiveness: A...
October 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/29038971/the-implementation-of-targeted-temperature-management-an-evidence-based-guideline-from-the-neurocritical-care-society
#11
Lori Kennedy Madden, Michelle Hill, Teresa L May, Theresa Human, Mary McKenna Guanci, Judith Jacobi, Melissa V Moreda, Neeraj Badjatia
BACKGROUND: Targeted temperature management (TTM) is often used in neurocritical care to minimize secondary neurologic injury and improve outcomes. TTM encompasses therapeutic hypothermia, controlled normothermia, and treatment of fever. TTM is best supported by evidence from neonatal hypoxic-ischemic encephalopathy and out-of-hospital cardiac arrest, although it has also been explored in ischemic stroke, traumatic brain injury, and intracranial hemorrhage patients. Critical care clinicians using TTM must select appropriate cooling techniques, provide a reasonable rate of cooling, manage shivering, and ensure adequate patient monitoring among other challenges...
October 16, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28983856/effect-of-hhh-therapy-on-regional-cbf-after-severe-subarachnoid-hemorrhage-studied-by-bedside-xenon-enhanced-ct
#12
Henrik Engquist, Elham Rostami, Elisabeth Ronne-Engström, Pelle Nilsson, Anders Lewén, Per Enblad
BACKGROUND: Management of delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is difficult and still carries controversies. In this study, the effect of therapeutic hypervolemia, hemodilution, and hypertension (HHH-therapy) on cerebral blood flow (CBF) was assessed by xenon-enhanced computerized tomography (XeCT) hypothesizing an increase in CBF in poorly perfused regions. METHODS: Bedside XeCT measurements of regional CBF in mechanically ventilated SAH patients were routinely scheduled for day 0-3, 4-7, and 8-12...
October 5, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28983801/electronic-health-data-predict-outcomes-after-aneurysmal-subarachnoid-hemorrhage
#13
Sahar F Zafar, Eva N Postma, Siddharth Biswal, Lucas Fleuren, Emily J Boyle, Sophia Bechek, Kathryn O'Connor, Apeksha Shenoy, Durga Jonnalagadda, Jennifer Kim, Mouhsin S Shafi, Aman B Patel, Eric S Rosenthal, M Brandon Westover
BACKGROUD: Using electronic health data, we sought to identify clinical and physiological parameters that in combination predict neurologic outcomes after aneurysmal subarachnoid hemorrhage (aSAH). METHODS: We conducted a single-center retrospective cohort study of patients admitted with aSAH between 2011 and 2016. A set of 473 predictor variables was evaluated. Our outcome measure was discharge Glasgow Outcome Scale (GOS). For laboratory and physiological data, we computed the minimum, maximum, median, and variance for the first three admission days...
October 5, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28932993/oxygen-therapy-with-high-flow-nasal-cannula-as-an-effective-treatment-for-perioperative-pneumocephalus-case-illustrations-and-pathophysiological-review
#14
Jason L Siegel, Karen Hampton, Alejandro A Rabinstein, Diane McLaughlin, Jose L Diaz-Gomez
Pneumocephalus (PNC) is a condition in which when air is trapped inside the intracranial vault. The causes are varied, but include trauma and intracranial surgery. Treatment of PNC typically consists of augmenting patient oxygenation with the attempt of washing out pulmonary nitrogen, creating a gradient in which nitrogen in the intracranial air bubble diffuses out of the lungs via the blood. Though several high flow methods have been tested, the ideal mode of oxygenation has not fully been investigated. Here we present 3 cases of post-operative PNC who we felt were symptomatic from PNC...
September 20, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28932982/cerebral-fat-embolism-recognition-complications-and-prognosis
#15
Daniel Agustín Godoy, Mario Di Napoli, Alejandro A Rabinstein
Fat embolism syndrome (FES) is a rare syndrome caused by embolization of fat particles into multiple organs including the brain. It typically manifests with petechial rash, deteriorating mental status, and progressive respiratory insufficiency, usually occurring within 24-48 h of trauma with long-bone fractures or an orthopedic surgery. The diagnosis of FES is based on clinical and imaging findings, but requires exclusion of alternative diagnoses. Although there is no specific treatment for FES, prompt recognition is important because it can avoid unnecessary interventions and clarify prognosis...
September 20, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28929392/preventing-early-bouncebacks-to-the-neurointensive-care-unit-a-retrospective-analysis-and-quality-improvement-pilot
#16
David G Coughlin, Monisha A Kumar, Neha N Patel, Rebecca L Hoffman, Scott E Kasner
BACKGROUND: Early unplanned readmissions of "bouncebacks" to intensive care units are a healthcare quality metric and result in higher mortality and greater cost. Few studies have examined bouncebacks to the neurointensive care unit (neuro-ICU), and we sought to design and implement a quality improvement pilot to reduce that rate. METHODS: First, we performed a retrospective chart review of 504 transfers to identify potential bounceback risk factors. Risk factors were assessed on the day of transfer by the transferring physician identifying patients as "high risk" or "low risk" for bounceback...
September 19, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28929378/external-ventricular-drains-after-subarachnoid-hemorrhage-is-less-more
#17
David Y Chung, Stephan A Mayer, Guy A Rordorf
External ventricular drains (EVD) are essential in the early management of hydrocephalus and elevated intracranial pressure after subarachnoid hemorrhage (SAH). Once in place, management of the EVD is thought to influence long-term patient outcomes, rates of ventriculitis, incidence of delayed cerebral ischemia, need for a ventriculoperitoneal shunt, and intensive care unit (ICU) and hospital length of stay. The available evidence supports adopting early clamp trials and intermittent cerebrospinal fluid (CSF) drainage...
September 19, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28929375/abstracts-presented-at-the-neurocritical-care-society-ncs-15th-annual-meeting
#18
(no author information available yet)
No abstract text is available yet for this article.
September 19, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28929324/stress-ulcer-prophylaxis-in-neurocritical-care
#19
Jeffrey F Barletta, Alicia J Mangram, Joseph F Sucher, Victor Zach
Stress ulcer prophylaxis (SUP) with acid-suppressive drug therapy is widely utilized in critically ill patients following neurologic injury for the prevention of clinically important stress-related gastrointestinal bleeding (CIB). Data supporting SUP, however, largely originates from studies conducted during an era where practices were vastly different than what is considered routine by today's standard. This is particularly true in neurocritical care patients. In fact, the routine provision of SUP has been challenged due to an increasing prevalence of adverse drug events with acid-suppressive therapy and the perception that CIB rates are sparse...
September 19, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28875429/regional-differences-in-cerebral-glucose-metabolism-after-cardiac-arrest-and-resuscitation-in-rats-using-18-f-fdg-positron-emission-tomography-and-autoradiography
#20
Alessandro Putzu, Silvia Valtorta, Giuseppe Di Grigoli, Matthias Haenggi, Sara Belloli, Antonio Malgaroli, Marco Gemma, Giovanni Landoni, Luigi Beretta, Rosa Maria Moresco
BACKGROUND: Cardiac arrest is an important cause of morbidity and mortality. Brain injury severity and prognosis of cardiac arrest patients are related to the cerebral areas affected. To this aim, we evaluated the variability and the distribution of brain glucose metabolism after cardiac arrest and resuscitation in an adult rat model. METHODS: Ten rats underwent 8-min cardiac arrest, induced with a mixture of potassium and esmolol, and resuscitation, performed with chest compressions and epinephrine...
September 5, 2017: Neurocritical Care
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