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Critical Care Neurology

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https://www.readbyqxmd.com/read/28728045/postdiagnosis-neurological-care-for-patients-with-psychogenic-nonepileptic-spells-pnes
#1
Chloe E Hill, Hannah Schwartz, Nabila Dahodwala, Brian Litt, Kathryn A Davis
OBJECTIVE: This study investigated continuity of neurological care for patients discharged from the epilepsy monitoring unit (EMU) with a diagnosis of psychogenic nonepileptic spells (PNES). Because PNES are seizure-like episodes that cannot be explained by abnormal electrical brain activity, they are challenging for patients to understand and accept. Consequently, after diagnosis, patients commonly fail to start recommended psychotherapy and instead pursue redundant medical care. As consistent relationships with healthcare providers may help, we instituted standard follow-up for patients diagnosed with PNES...
July 17, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28720571/the-integrated-stress-response-in-hypoxia-induced-diffuse-white-matter-injury
#2
Benjamin Ll Clayton, Aaron Huang, Rejani B Kunjamma, Ani Solanki, Brian Popko
Currently no treatments exist for preterm infants with diffuse white matter injury (DWMI) caused by hypoxia. Due to improved care of preterm neonates and increased recognition by advanced imaging techniques, the prevalence of DWMI is increasing. A better understanding of the pathophysiology of DWMI is therefore of critical importance. The integrated stress response (ISR), a conserved eukaryotic response to myriad stressors including hypoxia, may play a role in hypoxia-induced DWMI and may represent a novel target for much needed therapies...
July 18, 2017: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/28718341/diagnostic-yield-and-outcomes-of-computed-tomography-of-the-head-in-critically-ill-nontrauma-patients
#3
Fabian Finkelmeier, Sophie Walter, Kai-Henrik Peiffer, Anjali Cremer, Andrea Tal, Thomas Vogl, Stefan Zeuzem, Stephan Fichtlscherer, Mireen Friedrich-Rust, Jörg Bojunga, Harald Farnik
BACKGROUND: Computed tomography of the head (HCT) is a widely used diagnostic tool, especially for emergency and trauma patients. However, the diagnostic yield and outcomes of HCT for patients on medical intensive care units (MICUs) are largely unknown. METHODS: We retrospectively evaluated all head CTs from patients admitted to a single-center MICU during a 5-year period for CT indications, diagnostic yield, and therapeutic consequences. Uni- and multivariate analyses for the evaluation of risk factors for positive head CT were conducted...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28717647/intracranial-hematoma-detection-by-near-infrared-spectroscopy-in-a-helicopter-emergency-medical-service-practical-experience
#4
Patrick Schober, Sebastiaan M Bossers, Lothar A Schwarte
In (helicopter) emergency medical services, (H)EMS, the prehospital detection of intracranial hematomas should improve patient care and the triage to specialized neurosurgical hospitals. Recently, noninvasive detection of intracranial hematomas became possible by applying transcranial near infrared spectroscopy (NIRS). Herein, second-generation devices are currently available, for example, the Infrascanner 2000 (Infrascan), that appear suited also for prehospital (H)EMS applications. Since (H)EMS operations are time-critical, we studied the Infrascanner 2000 as a "first-time-right" monitor in healthy volunteers (n = 17, hospital employees, no neurologic history)...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28716014/the-comprehensive-post-acute-stroke-services-compass-study-design-and-methods-for-a-cluster-randomized-pragmatic-trial
#5
Pamela W Duncan, Cheryl D Bushnell, Wayne D Rosamond, Sara B Jones Berkeley, Sabina B Gesell, Ralph B D'Agostino, Walter T Ambrosius, Blair Barton-Percival, Janet Prvu Bettger, Sylvia W Coleman, Doyle M Cummings, Janet K Freburger, Jacqueline Halladay, Anna M Johnson, Anna M Kucharska-Newton, Gladys Lundy-Lamm, Barbara J Lutz, Laurie H Mettam, Amy M Pastva, Mysha E Sissine, Betsy Vetter
BACKGROUND: Patients discharged home after stroke face significant challenges managing residual neurological deficits, secondary prevention, and pre-existing chronic conditions. Post-discharge care is often fragmented leading to increased healthcare costs, readmissions, and sub-optimal utilization of rehabilitation and community services. The COMprehensive Post-Acute Stroke Services (COMPASS) Study is an ongoing cluster-randomized pragmatic trial to assess the effectiveness of a comprehensive, evidence-based, post-acute care model on patient-centered outcomes...
July 17, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28713526/recent-developments-in-the-treatment-of-spinal-epidural-abscesses
#6
REVIEW
Adam E M Eltorai, Syed S Naqvi, Ashok Seetharam, Bielinsky A Brea, Chad Simon
Spinal epidural abscess (SEA) is a serious condition that can be challenging to diagnose due to nonspecific symptomology and delayed presentation. Despite this, it requires prompt recognition and management in order to prevent permanent neurologic sequelae. Several recent studies have improved our understanding of SEA. Herein, we summarize the recent literature from the past 10 years relevant to SEA diagnosis, management and outcome. While surgical care remains the mainstay of treatment, a select subset of SEA patients may be managed without operative intervention...
June 23, 2017: Orthopedic Reviews
https://www.readbyqxmd.com/read/28713493/a-new-strategy-in-neurocritical-care-nurse-continuing-stroke-education-a-hybrid-simulation-pilot-study
#7
Christopher Ryan Newey, Robert Bell, Melody Burks, Premkumar Nattanmai
INTRODUCTION: High-fidelity simulation is frequently utilized in medical education. Its use in the neurosciences is limited by the inherent limitations of the manikin to simulate neurological changes. We report here the use of a hybrid simulation - a combination of lecture and high-fidelity manikin - in the education of neurosciences nurses, involved in care of neurocritical care patients. METHODS: Neurosciences nurses from at the University of Missouri, Columbia, MO, USA, which is an academic, tertiary-care medical center participated in the simulation during Spring of 2016...
May 2017: Electronic Physician
https://www.readbyqxmd.com/read/28712106/sensitivity-and-specificity-of-urinalysis-samples-in-critically-ill-patients
#8
Sean P Lee, Terrie Vasilopoulos, Thomas James Gallagher
BACKGROUND: Preemptive screening of urine for patients admitted to an intensive care unit can result in misinterpretation of data and over- or under-treatment of urinary tract infection. METHODS: Data were studied from 169 consecutive patients admitted to the neurologic or burn intensive care unit at Shands Hospital at the University of Florida. All patients had a urinary catheter in place at the time of admission. Urinalysis and urine culture were sent for analysis...
July 16, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28711662/the-clinical-and-prognostic-value-of-motor-abnormalities-in-psychosis-and-the-importance-of-instrumental-assessment
#9
REVIEW
Peter N van Harten, Sebastian Walther, Jerillyn S Kent, Scott R Sponheim, Vijay A Mittal
Motor abnormalities comprise several clinical signs intrinsic to psychosis. Critically, these features are of prognostic value in individuals at-risk for psychosis, and for those in early stages of psychotic disorders. Motor abnormalities such as tremor, rigidity, and neurological soft signs often go unrecognized. Currently, advances in this area are limited by a paucity of theoretical conceptions categorizing or linking these behaviors to underlying neurobiology affected in psychosis. However, emerging technological advances have significantly improved the ability to detect and assess motor abnormalities with objective instruments in a timely and reliable manner...
July 12, 2017: Neuroscience and Biobehavioral Reviews
https://www.readbyqxmd.com/read/28706860/targeted-temperature-management-in-neurological-intensive-care-unit
#10
REVIEW
Sombat Muengtaweepongsa, Winchana Srivilaithon
Targeted temperature management (TTM) shows the most promising neuroprotective therapy against hypoxic/ischemic encephalopathy (HIE). In addition, TTM is also useful for treatment of elevated intracranial pressure (ICP). HIE and elevated ICP are common catastrophic conditions in patients admitted in Neurologic intensive care unit (ICU). The most common cause of HIE is cardiac arrest. Randomized control trials demonstrate clinical benefits of TTM in patients with post-cardiac arrest. Although clinical benefit of ICP control by TTM in some specific critical condition, for an example in traumatic brain injury, is still controversial, efficacy of ICP control by TTM is confirmed by both in vivo and in vitro studies...
June 26, 2017: World Journal of Methodology
https://www.readbyqxmd.com/read/28705583/prevalence-and-risk-factors-for-colonization-by-clostridium-difficile-and-extended-spectrum-%C3%AE-lactamase-producing-enterobacteriaceae-in-rehabilitation-clinics-in-germany
#11
Mardjan Arvand, Claudia Ruscher, Gudrun Bettge-Weller, Markus Goltz, Yvonne Pfeifer
BACKGROUND: Rehabilitation clinics may vary widely in terms of type of care provided, duration of hospital stay, and case severity. Only few data are available on prevalence of Clostridium difficile or extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) colonization in rehabilitation clinics in Germany. AIM: This study investigated the frequency of intestinal colonization by these pathogens among patients in rehabilitation clinics of different specialization...
July 10, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28700476/peripheral-monocytosis-as-a-predictive-factor-for-adverse-outcome-in-the-emergency-department-survey-based-on-a-register-study
#12
Mathias Hensel, Lena Grädel, Alexander Kutz, Sebastian Haubitz, Andreas Huber, Beat Mueller, Philipp Schuetz, Thomas Hügle
Monocytosis is associated with chronic infections such as tuberculosis or endocarditis as well as rheumatic and myeloproliferative disorders. Monocytes are also involved in the pathogenesis of atherosclerosis, coronary artery disease, and stroke. The value of monocytosis as a prognostic marker in different diagnostic groups in the emergency setting, however, has not been investigated so far.The aim of the article is to study monocytosis as an outcome factor in the emergency setting.In a Swiss register study, we analyzed monocyte counts in 4238 patients aged >18 years who were admitted to the emergency department of a regional tertiary care hospital...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28699794/valbenazine-for-the-treatment-of-tardive-dyskinesia
#13
Lauren C Seeberger, Robert A Hauser
Tardive dyskinesia (Td) is a hyperkinetic movement disorder that may result from treatment with antipsychotics or other dopamine receptor blocking agents. Underlying pathophysiology is incompletely understood but since the 1970s dopamine depleting agents have been used to reduce involuntary movements. The search for safe, effective treatments for Td is ongoing. Valbenazine, a novel VMAT2 inhibitor, has recently been FDA approved for treatment of Td. Areas Covered: An overview of Td, unmet medical needs and current treatment guidelines are presented...
July 12, 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28680316/electroencephalographic-patterns-recorded-by-continuous-eeg-monitoring-in-patients-with-change-of-consciousness-in-the-neurological-intensive-care-unit
#14
Ebru Altindağ, Zeynep Vildan Okudan, Sedef Tavukçu Özkan, Yakup Krespi, Betül Baykan
INTRODUCTION: Our aim was to examine the frequency of various electrographic patterns including periodic discharges (PD), repetitive spike waves (RSW), rhythmic delta activities (RDA), nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) in continuous EEG monitoring (cEEG) of the critically ill patients with change of consciousness and the presence of specific clinical and laboratory findings associated with these important patterns in this study. METHODS: Patients with changes of consciousness in the neurological intensive care unit (NICU) were consecutively monitored with cEEG during 2 years...
June 2017: Noro Psikiyatri Arsivi
https://www.readbyqxmd.com/read/28676312/multiple-sclerosis-frequency-cost-and-economic-burden-in-the-united-states
#15
Alex Y Chen, Amy O Chonghasawat, Kevin L Leadholm
Multiple sclerosis (MS) is one of the most common neurological diseases, affecting young and middle-aged adults. The full economic cost of managing chronic MS is substantial. To investigate the recent trend of medical cost and economic burden of MS management in the United States (U.S.), we inquired for available data from the National Inpatient Sample database (NIS; from 1994 to 2013). The annual rates of changes were determined by linear regression analysis. We found an estimated half million increase in MS admissions, annually, which was projected to exceed 43...
July 1, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28675111/outcomes-of-tracheostomy-with-concomitant-and-delayed-percutaneous-endoscopic-gastrostomy-in-the-neuroscience-critical-care-unit
#16
Christa O'Hana S Nobleza, Vinciya Pandian, Ravirasmi Jasti, David H Wu, Marek A Mirski, Romergryko G Geocadin
BACKGROUND: In patients with severe neurologic conditions, percutaneous endoscopic gastrostomy (PEG) is typically performed either alone or with a tracheostomy. The characteristics and outcomes of patients receiving PEG concomitantly with a tracheostomy (CTPEG) and those receiving delayed PEG (DPEG) after a tracheostomy were compared. METHODS: Retrospective cohort study in a 24-bed neuroscience critical care unit (NCCU) at a tertiary care hospital. Consecutive patients admitted to the NCCU from April 2007 to July 2013 who underwent percutaneous tracheostomy and gastrostomy by the percutaneous tracheostomy team were included and grouped according to the timing of PEG placement: CTPEG versus DPEG...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28673511/reirradiation-of-the-spine-with-stereotactic-radiosurgery-efficacy-and-toxicity
#17
David Boyce-Fappiano, Erinma Elibe, Bo Zhao, M Salim Siddiqui, Ian Lee, Jack Rock, Samuel Ryu, Farzan Siddiqui
PURPOSE: To determine the potential benefits and adverse effects associated with reirradiating the spinal cord when at least 1 course of radiation therapy (RT) is stereotactic radiosurgery (SRS). METHODS AND MATERIALS: This institutional review board-approved retrospective review included 162 patients (237 reirradiated spine lesions). All patients received SRS at our institution between 2001 and 2013. Electronic medical records were reviewed for clinical exams and radiologic tests (computed tomography/magnetic resonance imaging)...
May 25, 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/28668768/low-brain-tissue-oxygenation-contributes-to-the-development-of-delirium-in-critically-ill-patients-a-prospective-observational-study
#18
Michael D Wood, David M Maslove, John G Muscedere, Andrew G Day, J Gordon Boyd
PURPOSE: To test the hypothesis that poor brain tissue oxygenation (BtO2) during the first 24h of critical illness correlates with the proportion of time spent delirious. We also sought to define the physiological determinants of BtO2. MATERIALS AND METHODS: Adult patients admitted to the ICU within the previous 24h were considered eligible for enrollment if they required mechanical ventilation, and/or vasopressor support. BtO2 was measured using near-infrared spectroscopy, for 24h after enrollment...
June 15, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28666290/-venous-paravasation-after-augmentation-of-pedicle-screws-an-underestimated-risk
#19
Axel Prokop, Manuela Sagerer, Wolfgang Rupp, Marc Chmielnicki
Cement-augmented pedicle screws can increase the stability of fixators for unstable vertebral fractures in the elderly. Fixators can be inserted quickly and with minimally invasive techniques, reducing surgical risks. From March 2012 until July 2014, we treated 40 patients with percutaneous augmented fixators for unstable vertebral fractures. Average age was 77.5 years. During the six month observation period, no patients died. There were no neurological deficits. On VAS, average pain decreased from 8.5 to 4...
June 30, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28661784/identifying-key-words-in-9-1-1-calls-for-stroke-a-mixed-methods-approach
#20
Christopher T Richards, Baiyang Wang, Eddie Markul, Frank Albarran, Doreen Rottman, Neelum T Aggarwal, Patricia Lindeman, Leslee Stein-Spencer, Joseph M Weber, Kenneth S Pearlman, Katie L Tataris, Jane L Holl, Diego Klabjan, Shyam Prabhakaran
OBJECTIVES: Identifying stroke during a 9-1-1 call is critical to timely prehospital care. However, emergency medical dispatchers (EMDs) recognize stroke in less than half of 9-1-1 calls, potentially due to the words used by callers to communicate stroke signs and symptoms. We hypothesized that callers do not typically use words and phrases considered to be classical descriptors of stroke, such as focal neurologic deficits, but that a mixed-methods approach can identify words and phrases commonly used by 9-1-1 callers to describe acute stroke victims...
June 29, 2017: Prehospital Emergency Care
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