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Neuro critical care

Chiara Robba, Andrea Ortu, Federico Bilotta, Alessandra Lombardo, Mypinder S Sekhon, Fabio Gallo, Basil F Matta
BACKGROUND: Veno-venous extra-corporeal membrane oxygenation (vv-ECMO) is an established salvage therapy for severe respiratory failure, and may provide an alternative form of treatment for trauma-induced acute respiratory distress syndrome (ARDS) when conventional treatments have failed. The need for systemic anticoagulation is a relative contraindication in patients with bleeding risks, especially in multi traumatic injury. METHODS: We describe a case series of four trauma patients with ARDS who were managed with ECMO admitted to the Neuro Critical Care Unit (NCCU) at Addenbrooke's Hospital, Cambridge (UK), from January 2000 to January 2016...
October 25, 2016: Journal of Trauma and Acute Care Surgery
Yannick Fogang, Benjamin Legros, Chantal Depondt, Nicolas Mavroudakis, Nicolas Gaspard
INTRODUCTION: Seizures are common in critically ill patients and prevalence can exceed 30% in the neuro-intensive care unit (ICU). Continuous EEG monitoring (cEEG) is the gold standard for seizure detection in critically ill patients. OBJECTIVES: To determine the yield of intermittent EEG (iEEG) to detect critically ill adult patients with seizures and to identify the factors that affect this yield. METHODS: We retrospectively analyzed cEEG data and medical records from 977 consecutive critically ill patients undergoing cEEG...
October 19, 2016: Neurophysiologie Clinique, Clinical Neurophysiology
Rani Ameena Bashir, Liza Espinoza, Sakeer Vayalthrikkovil, Jeffrey Buchhalter, Leigh Irvine, Luis Bello-Espinosa, Khorshid Mohammad
BACKGROUND: We report the impact of implementing continuous video electroencephalography monitoring for neonates with hypoxic-ischemic encephalopathy via a protocol in the context of neonatal neuro-critical care program. METHODS: Neonates with hypoxic-ischemic encephalopathy were studied retrospectively two years before and after implementing continuous video electroencephalography for 72 hours as a care protocol. Before continuous video electroencephalography, a 60-minute routine electroencephalography was performed at the discretion of the provider...
August 3, 2016: Pediatric Neurology
K A Popugaev, A Yu Lubnin, M V Zabelin, A S Samoylov
The autonomic nervous system (ANS) provides homeostasis due to the innervation of the secretory glands, smooth muscle and cardiac muscle. Higher centers of the ANS (primarily the hypothalamus, some centers of the brain stem and limbic system) form a integrative network, which plays a key role in coordinating the functioning of the endocrine, immune system and other parts of the central nervous system. Intracranial centers of the ANS are responsible for the consciousness, behavioral, emotional, and other components of the higher nervous activity...
March 2016: Anesteziologiia i Reanimatologiia
Nicola Pluchino, Marinella Russo, Andrea R Genazzani
Progesterone and allopregnanolone have crucial and different roles in brain development, function and recovery after injury. Pregnancy is characterized by an increased synthesis of progesterone and its neuro-active metabolites by the placenta, maternal and fetal brain. This supports the critical role of these steroids in maternal brain adaptation during pregnancy and development of the fetal brain. Moreover, allopregnanolone may play a brain-protective role during complications of pregnancy, complications of pregnancy, such as preterm delivery or intrauterine growth restriction (IUGR), by reducing the impact of hypoxia and excitotoxic brain damage or impairment myelination...
July 1, 2016: Hormone Molecular Biology and Clinical Investigation
(no author information available yet)
To meet the needs of critically ill patients with time-sensitive needs, the University of Maryland Medical Center (UMMC) created the Critical Care Resuscitation Unit (CCRU), a six-bed, short-stay ICU designed to accelerate care to resource-heavy patients who require immediate evaluation and treatment. The CCRU is modeled after UMMC's trauma resuscitation unit, but with resources and staff geared toward non-trauma, critically ill patients, many of whom require life-saving care. The unit is largely staffed by emergency providers who have undergone additional training in critical care...
July 2016: ED Management: the Monthly Update on Emergency Department Management
Charles B Mikell, Timothy G Dyster, Jan Claassen
Seizures commonly occur in a variety of serious neurological illnesses, and lead to additional morbidity and worsened outcomes. Recently, it has become clear that not all seizures in the acute brain injury setting are evident on scalp EEG. To address this, we have developed a protocol for depth electrode placement in the neuro-intensive care unit for patients in whom the clinical suspicion of occult seizures is high. In the current manuscript, we review the literature on depth EEG monitoring for ictal events in critically-ill, unconscious patients, focusing on the incidence of seizures not detected with scalp EEG in various conditions...
October 2016: Seizure: the Journal of the British Epilepsy Association
Sarat C Yenesetti, M J Manjunath, Cftri Muralidhara
BACKGROUND Owing to the increasing aged population globally, disorders and diseases of the CNS are anticipated to increase and heavily impact the health care. As these neurodegenerative diseases (NDD) are complex, multifactorial and do not have identified etiological factors, unfortunately drugs developed for the purpose have not met with the expected success. Hence, there has been a constant demand for development of natural therapeutic adjuvants which are safe and possess the potential to attenuate multiple pathways...
June 14, 2016: Recent Patents on CNS Drug Discovery
M Colomo, T Chamroo, N Muchoki, J Darroch, G De la Cerda
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
L Piquilloud, A Polupan, I Matskovskiy, A Oshorov, D Novotni, T Laubscher, M Oddo, P Jolliet, J P Revelly
No abstract text is available yet for this article.
December 2015: Intensive Care Medicine Experimental
Vivek Kalra, Shahul Sikkander Shaw, Stacey Dixon, Divyen K Shah, Paul Clarke
UNLABELLED: Cerebral function monitoring is widely used in neonatal intensive care, but its potential role in assessment of older infants is scarcely reported. We reviewed the use of cerebral function monitoring on a general paediatric ward in a series of young infants admitted with abnormal movements. Review of the amplitude-integrated EEG obtained by cerebral function monitoring revealed electrographic seizures in four of seven infants monitored. We also surveyed general paediatric wards in hospitals in our region of the UK to ask about current use of cerebral function monitoring and local availability of formal electroencephalography services...
August 2016: European Journal of Pediatrics
Anush Karamyan, Martin W Dünser, Douglas J Wiebe, Georg Pilz, Peter Wipfler, Vaclav Chroust, Helmut F Novak, Larissa Hauer, Eugen Trinka, Johann Sellner
BACKGROUND: Over the course of multiple sclerosis (MS) several conditions may arise that require critical care. We aimed to study the reasons for admission and outcome in patients with MS admitted to a neuro-intensive care unit (NICU). METHODS: We retrospectively searched the electronic charts of a 9-bedded NICU in a tertiary hospital for patients with a diagnosis of multiple sclerosis (MS) from 1993-2015, and matched them to NICU controls without MS based on age and gender...
2016: PloS One
Abhishek A Bavle, Frank Y Lin, D Williams Parsons
Recent advances in genome-scale sequencing methods have resulted in a significant increase in our understanding of the biology of human cancers. When applied to pediatric central nervous system (CNS) tumors, these remarkable technological breakthroughs have facilitated the molecular characterization of multiple tumor types, provided new insights into the genetic basis of these cancers, and prompted innovative strategies that are changing the management paradigm in pediatric neuro-oncology. Genomic tests have begun to affect medical decision making in a number of ways, from delineating histopathologically similar tumor types into distinct molecular subgroups that correlate with clinical characteristics, to guiding the addition of novel therapeutic agents for patients with high-risk or poor-prognosis tumors, or alternatively, reducing treatment intensity for those with a favorable prognosis...
May 2016: Oncology (Williston Park, NY)
R Grieve, Z Sadique, M Gomes, M Smith, F E Lecky, P J A Hutchinson, D K Menon, K M Rowan, D A Harrison
BACKGROUND: For critically ill adult patients with acute traumatic brain injury (TBI), we assessed the clinical and cost-effectiveness of: (a) Management in dedicated neurocritical care units versus combined neuro/general critical care units within neuroscience centres. (b) 'Early' transfer to a neuroscience centre versus 'no or late' transfer for those who present at a non-neuroscience centre. METHODS: The Risk Adjustment In Neurocritical care (RAIN) Study included prospective admissions following acute TBI to 67 UK adult critical care units during 2009-11...
August 2016: British Journal of Neurosurgery
Katerina Placha, Dominika Luptakova, Ladislav Baciak, Eduard Ujhazy, Ivo Juranek
Neonatal brain hypoxic-ischemic injury represents a serious health care and socio-economical problem since it is one of the most common causes of mortality and morbidity of newborns. Neonatal hypoxic-ischemic encephalopathy is often associated with signs of perinatal asphyxia, with an incidence of about 2-4 per 1,000 live births and mortality rate up to 20%. In about one half of survivors, cerebral hypoxic-ischemic insult may result in more or less pronounced neuro-psychological sequelae of immediate or delayed nature, such as seizures, cerebral palsy or behavioural and learning disabilities, including attention-deficit hyperactivity disorder...
2016: Neuro Endocrinology Letters
Mark H Wilson
For 200 years, the 'closed box' analogy of intracranial pressure (ICP) has underpinned neurosurgery and neuro-critical care. Cushing conceptualised the Monro-Kellie doctrine stating that a change in blood, brain or CSF volume resulted in reciprocal changes in one or both of the other two. When not possible, attempts to increase a volume further increase ICP. On this doctrine's "truth or relative untruth" depends many of the critical procedures in the surgery of the central nervous system. However, each volume component may not deserve the equal weighting this static concept implies...
August 2016: Journal of Cerebral Blood Flow and Metabolism
S G Ball, Zohaib Iqbal
Hyponatraemia is the most common electrolyte abnormality encountered by physicians in the hospital setting. It is associated with increased mortality and length of hospital stay. However, the basis of the relationship of hyponatraemia with clinical outcome is not clear. Doubt remains as to whether the relationship is causal. It may reflect the association of two independent variables both of which are linked with disease severity. Serum sodium concentration is regulated through integrated neuro-humeral mechanisms that overlap with those regulating circulating volume...
March 2016: Best Practice & Research. Clinical Endocrinology & Metabolism
Jutta Maria Birkhoff, Cesare Garberi, Laura Re
The aim of this case report is to underline the importance of possible legal consequences of the behavioral variant of frontotemporal dementia (bvFTD). This disease is associated with antisocial behavior, impulse control disorder and cognitive and personality impairment, which are often the earliest manifestations of the bvFTD. One of the antisocial behaviors possibly associated with this neurodegenerative disease is pathological stealing. This case report is about a 50-year-old Italian man who had a regular life until 2010...
July 2016: International Journal of Law and Psychiatry
Zhiqi Li, Xing Wu, Jian Yu, Xuehai Wu, Zhuoying Du, Yirui Sun, Qiang Yuan, Jin Hu
BACKGROUND: Nosocomial meningitis and ventriculitis (MEN) are serious complications in neuro-critical care unit (NCCU) patients. Few data are available on the risk factors and mortality rates among NCCU patients with these disorders caused by multi-drug-resistant (MDR) pathogens. Our aim was to identify the risk factors for MEN caused by such pathogens and in-hospital deaths in critically ill neurologic patients and to evaluate the impact of empirical combination antibiotic therapy (ECAT) on the outcomes of these patients...
August 2016: Surgical Infections
Masumeh HemmatiMaslakpak, Masumeh Farhadi, Javid Fereidoni
BACKGROUND: The use of coping strategies in reducing the adverse effects of stress can be helpful. Nero-linguistic programming (NLP) is one of the modern methods of psychotherapy. This study aimed to determine the effect of NLP on occupational stress in nurses working in critical care units of Urmia. MATERIALS AND METHODS: This study was carried out quasi-experimentally (before-after) with control and experimental groups. Of all the nurses working in the critical care units of Urmia Imam Khomeini and Motahari educational/therapeutic centers, 60 people participated in this survey...
January 2016: Iranian Journal of Nursing and Midwifery Research
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