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Neurocritical Care

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https://www.readbyqxmd.com/read/28324264/reverse-locked-in-syndrome
#1
Pooja Raibagkar, Ram V Chavali, Tamara B Kaplan, Jennifer A Kim, Meaghan V Nitka, Sherry H-Y Chou, Brian L Edlow
BACKGROUND: Basilar artery occlusion can cause locked-in syndrome, which is characterized by quadriplegia, anarthria, and limited communication via eye movements. Here, we describe an uncommon stroke syndrome associated with endovascular recanalization of the top of the basilar artery: "reverse locked-in syndrome." METHODS: We report the case of a patient with atypical neurological deficits caused by acute ischemic stroke of the midbrain tegmentum. We perform neuroanatomic localization of the patient's infarcts by mapping the magnetic resonance imaging (MRI) data onto a brainstem atlas...
March 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28324263/decannulation-and-functional-outcome-after-tracheostomy-in-patients-with-severe-stroke-decast-a-prospective-observational-study
#2
Hauke Schneider, Franziska Hertel, Matthias Kuhn, Maximilian Ragaller, Birgit Gottschlich, Anne Trabitzsch, Markus Dengl, Marcus Neudert, Heinz Reichmann, Sigrid Wöpking
BACKGROUND: Tracheostomy is performed in ventilated stroke patients affected by persisting severe dysphagia, reduced level of consciousness, or prolonged mechanical ventilation. The study aim was to determine the frequency and predictors of successful decannulation and long-term functional outcome in tracheotomized stroke patients. METHODS: A prospective single-center observational study recruited ventilated patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage...
March 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28324262/coxsackie-b3-b4-related-acute-flaccid-myelitis
#3
Sung-Min Cho, Steven MacDonald, Jennifer A Frontera
No abstract text is available yet for this article.
March 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28324261/prophylactic-anticonvulsants-in-intracerebral-hemorrhage
#4
Jason Mackey, Ashley D Blatsioris, Elizabeth A S Moser, Ravan J L Carter, Chandan Saha, Alec Stevenson, Abigail L Hulin, Darren P O'Neill, Aaron A Cohen-Gadol, Thomas J Leipzig, Linda S Williams
BACKGROUND AND PURPOSE: Prophylactic anticonvulsants are routinely prescribed in the acute setting for intracerebral hemorrhage (ICH) patients, but some studies have reported an association with worse outcomes. We sought to characterize the prevalence and predictors of prophylactic anticonvulsant administration after ICH as well as guideline adherence. We also sought to determine whether prophylactic anticonvulsants were independently associated with poor outcome. METHODS: We performed a retrospective study of primary ICH in our two academic centers...
March 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28324260/stroke-and-intracranial-hemorrhage-in-heartmate-ii-and-heartware-left-ventricular-assist-devices-a-systematic-review
#5
Sung M Cho, Nader Moazami, Jennifer A Frontera
BACKGROUND: Ischemic stroke and intracranial hemorrhage (ICH) following left ventricular assist device (LVAD) placement are major causes of morbidity. The incidence and mortality associated with these events stratified by device type have not been systematically explored. METHODS: A systematic review of PubMed was conducted from January 2007 through June 2016 for all English-language articles involving HeartMate II (HMII) and HeartWare LVAD patients. Ischemic stroke and/or ICH incidence (events per patient-year) and associated mortality rates were abstracted for each device type...
March 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28251577/neurologic-complications-of-transplantation
#6
Rajat Dhar
Neurologic disturbances including encephalopathy, seizures, and focal deficits complicate the course 10-30% of patients undergoing organ or stem cell transplantation. While much or this morbidity is multifactorial and often associated with extra-cerebral dysfunction (e.g., graft dysfunction, metabolic derangements), immunosuppressive drugs also contribute significantly. This can either be through direct toxicity (e.g., posterior reversible encephalopathy syndrome from calcineurin inhibitors such as tacrolimus in the acute postoperative period) or by facilitating opportunistic infections in the months after transplantation...
March 1, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28244001/relating-clinical-and-electrophysiological-parameters-in-death-determination-in-a-laboratory-model-of-progressive-hypoxemia
#7
Eugene Park, Elaine Liu, Sam D Shemie, Andrew J Baker
BACKGROUND: Death after withdrawal of mechanical ventilation frequently follows the sequence of progressive hypoxemia and hypotension leading to cardiac arrest. Accurate timing of the determination of death is fundamental to trust in controlled donation after circulatory death (cDCD) programs and is generally based on cessation of circulation (pulselessness), brain function (apnea), and the passage of time. If death is understood to be the unresuscitatable loss of brain function, the clinical determination that death following apnea and pulselessness has occurred is largely inferential...
February 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28244000/changes-in-cerebral-perfusion-with-induced-hypertension-in-aneurysmal-subarachnoid-hemorrhage-a-pilot-and-feasibility-study
#8
Amanda Murphy, Airton Leonardo de Oliveira Manoel, R Loch Macdonald, Andrew Baker, Ting-Yim Lee, Tom Marotta, Walter Montanera, Richard Aviv, Aditya Bharatha
BACKGROUND: The effects of induced hypertension (IH) on cerebral perfusion after subarachnoid hemorrhage (SAH) are unclear. The objectives of this investigation are to: (1) determine whether there are differences in cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) measured with computed tomography perfusion (CTP) before and after IH; (2) evaluate differences in the presence of infarction and clinical outcome between patients with and without IH. METHODS: We performed a retrospective cohort analysis of 25 aneurysmal SAH patients...
February 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28243999/physiological-effects-of-early-incremental-mobilization-of-a-patient-with-acute-intracerebral-and-intraventricular-hemorrhage-requiring-dual-external-ventricular-drainage
#9
Sowmya Kumble, Elizabeth K Zink, Mackenzie Burch, Sandra Deluzio, Robert D Stevens, Mona N Bahouth
BACKGROUND: Recent trials have challenged the notion that very early mobility benefits patients with acute stroke. It is unclear how cerebral autoregulatory impairments, prevalent in this population, could be affected by mobilization. The safety of mobilizing patients who have external ventricular drainage (EVD) devices for cerebrospinal fluid diversion and intracranial pressure (ICP) monitoring is another concern due to risk of device dislodgment and potential elevation in ICP. We report hemodynamic and ICP responses during progressive, device-assisted mobility interventions performed in a critically ill patient with intracerebral hemorrhage (ICH) requiring two EVDs...
February 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28243998/shunt-devices-for-neurointensivists-complications-and-management
#10
G Smith, J Pace, A Scoco, G Singh, K Kandregula, S Manjila, C Ramos-Estebanez
Cerebrospinal fluid diversion has become the mainstay treatment in hydrocephalus for over 50 years. As the number of patients with ventricular shunt systems increases, neurointensivists are becoming the first-line physicians for many of these patients. When symptoms of a shunt malfunction are suspected and access to a neurosurgeon is limited or delayed, workup and temporizing measures must be initiated. The article highlights the functional nuances, complications, and management of current programmable shunt valves and their MRI sensitivity...
February 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28243997/safety-and-effectiveness-of-factor-viii-inhibitor-bypassing-activity-feiba-and-fresh-frozen-plasma-in-oral-anticoagulant-associated-intracranial-hemorrhage-a-retrospective-analysis
#11
Ellen B Yin, Benedict Tan, Thuy Nguyen, Miguel Salazar, Kimberly Putney, Pramod Gupta, Jose I Suarez, Eric M Bershad
BACKGROUND: Oral anticoagulant (OAT)-associated intracranial hemorrhage (ICH) is a life-threatening emergency for which prothrombin complex concentrates (PCC) are considered first-line reversal agents. The only approved PCC in the USA for warfarin-associated ICH is non-activated PCC. Little data are available regarding the safety and effectiveness of factor VIII inhibitor bypassing activity (FEIBA) which is an activated prothrombin complex concentrate (aPCC). The aim of this analysis was to assess the safety and effectiveness of FEIBA compared to fresh frozen plasma (FFP) for reversal of OAT-associated ICH...
February 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28181102/cerebrospinal-fluid-nlrp3-is-increased-after-severe-traumatic-brain-injury-in-infants-and-children
#12
Jessica S Wallisch, Dennis W Simon, Hülya Bayır, Michael J Bell, Patrick M Kochanek, Robert S B Clark
BACKGROUND: Inflammasome-mediated neuroinflammation may cause secondary injury following traumatic brain injury (TBI) in children. The pattern recognition receptors NACHT domain-, Leucine-rich repeat-, and PYD-containing Protein 1 (NLRP1) and NLRP3 are essential components of their respective inflammasome complexes. We sought to investigate whether NLRP1 and/or NLRP3 abundance is altered in children with severe TBI. METHODS: Cerebrospinal fluid (CSF) from children (n = 34) with severe TBI (Glasgow coma scale score [GCS] ≤8) who had externalized ventricular drains (EVD) placed for routine care was evaluated for NLRP1 and NLRP3 at 0-24, 25-48, 49-72, and >72 h post-TBI and was compared to infection-free controls that underwent lumbar puncture to rule out CNS infection (n = 8)...
February 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28176180/prevention-of-hypoxemia-during-apnea-testing-a-comparison-of-oxygen-insufflation-and-continuous-positive-airway-pressure
#13
Andreas H Kramer, Philippe Couillard, Ryan Bader, Peter Dhillon, Demetrios J Kutsogiannis, Christopher J Doig
BACKGROUND: Apnea testing is an essential step in the clinical diagnosis of brain death. Current international guidelines recommend placement of an oxygen (O2) insufflation catheter into the endotracheal tube to prevent hypoxemia, but use of a continuous positive airway pressure (CPAP) valve may be more effective at limiting arterial partial pressure of O2 (PO2) reduction. METHODS: We performed a multicenter study assessing consecutive apnea tests in 14 intensive care units (ICUs) in two cities utilizing differing protocols...
February 7, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28097621/practice-patterns-of-venous-thromboembolism-prophylaxis-in-underweight-critically-ill-patients-with-neurologic-injury
#14
Kevin Betthauser, Hannah Pope, Mollie Gowan, Theresa Human
PURPOSE: Venous thromboembolism (VTE) prophylaxis in underweight patients with neurologic injury remains unaddressed by guidelines and primary literature. This study aimed to describe VTE prophylaxis strategies employed in this population and compare the impact of underweight and non-obese patients on thrombotic and bleeding events. METHODS: A retrospective review of adults admitted with a diagnosis of neurologic injury to a neurology/neurosurgery intensive care unit (ICU) over 6 years...
January 17, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28078616/physician-power-to-declare-death-by-neurologic-criteria-threatened
#15
Ariane Lewis, Thaddeus Mason Pope
BACKGROUND: Three recent lawsuits that address declaration of brain death (BD) garnered significant media attention and threaten to limit physician power to declare BD. METHODS: We discuss these cases and their consequences including: the right to refuse an apnea test, accepted medical standards for declaration of BD, and the irreversibility of BD. RESULTS: These cases warrant discussion because they threaten to: limit physicians' power to determine death; incite families to seek injunctions to continue organ support after BD; and force hospitals to dispense valuable resources to dead patients in lieu of patients with reparable illnesses or injuries...
January 11, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28063121/monitoring-of-electrical-activity-of-the-diaphragm-shows-failure-of-t-piece-trial-earlier-than-protocol-based-parameters-in-prolonged-weaning-in-non-communicative-neurological-patients
#16
Oliver Trapp, Mascha Fiedler, Michael Hartwich, Martin Schorl, Armin Kalenka
BACKGROUND: The weaning target in tracheotomised patients is not extubation, but spontaneous breathing without the support of a ventilator. Overloading the respiratory pump during such spontaneous breathing trials is unfavorable, prolongs weaning time, and increases morbidity and mortality. The goal of this study was to evaluate the electrical activity of the diaphragm during a t-piece trial in non-communicative neurological patients and the comparison to clinical parameters of exhaustion...
January 6, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28054291/elevated-serum-glial-fibrillary-acidic-protein-gfap-is-associated-with-poor-functional-outcome-after-cardiopulmonary-resuscitation
#17
Kirsten Helwig, Florian Seeger, Hans Hölschermann, Volker Lischke, Tibo Gerriets, Marion Niessner, Christian Foerch
BACKGROUND: The neurological prognosis of patients after cardiopulmonary resuscitation (CPR) is difficult to assess. GFAP is an astrocytic intermediate filament protein released into bloodstream in case of cell death. We performed a prospective study aiming to compare the predictive potential of GFAP after resuscitation to the more widely used biomarker neuron-specific enolase (NSE). METHODS: One hundred patients were included at 48 h (tolerance interval ±12 h) after cardiac arrest...
January 4, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28054290/treatment-of-hyponatremia-in-patients-with-acute-neurological-injury
#18
Theresa Human, Aaron M Cook, Brian Anger, Kathleen Bledsoe, Amber Castle, David Deen, Haley Gibbs, Christine Lesch, Norah Liang, Karen McAllen, Christopher Morrison, Dennis Parker, A Shaun Rowe, Denise Rhoney, Kiranpal Sangha, Elena Santayana, Scott Taylor, Eljim Tesoro, Gretchen Brophy
BACKGROUND: Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. METHODS: This retrospective, multicenter, observational study identified 400 ICU patients, from 17 centers, admitted for ≥48 h with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), intraparenchymal hemorrhage, or intracranial tumors between January 1, 2011 and July 31, 2012...
January 4, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28054289/procalcitonin-is-a-poor-predictor-of-non-infectious-fever-in-the-neurocritical-care-unit
#19
Karin Halvorson, Sameer Shah, Corey Fehnel, Bradford Thompson, N Stevenson Potter, Mitchell Levy, Linda Wendell
BACKGROUND: Fever is a common occurrence in the Neurocritical Care Unit (NCCU). It is reported that up to 50 % of these fevers are associated with a non-infectious source. As this is a diagnosis of exclusion, a complete fever evaluation must be done to rule out infection. Procalcitonin (PCT) has been identified as a possible biomarker to distinguish infectious from non-infectious etiologies of fever. We hypothesized that PCT could be used as a predictor of infectious fever in febrile patients with intracranial hemorrhage admitted to the NCCU...
January 4, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28054288/post-traumatic-stress-disorder-and-complicated-grief-are-common-in-caregivers-of-neuro-icu-patients
#20
Stephen A Trevick, Aaron S Lord
BACKGROUND: To explore the effect of end of life and other palliative decision making scenarios on the mental health of family members of patients in the neuro-intensive care unit. METHODS: Decision makers of patients in the neuro-ICU at a large, urban, academic medical center meeting palliative care triggers were identified from November 10, 2014, to August 27, 2015. Interviews were conducted at 1 and 6 months post-enrollment. At 1 month, the Inventory of Complicated Grief-Revised (ICG-R), Impact of Events Scale-Revised (IES-R), and the Family Satisfaction-ICU (FS-ICU) were performed along with basic demographic questionnaires...
January 4, 2017: Neurocritical Care
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