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Neurological critical care

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https://www.readbyqxmd.com/read/28637781/detecting-optic-nerve-head-swelling-on-ultrasound-and-optical-coherence-tomography-in-children-and-young-people-an-observational-study
#1
Annegret Hella Dahlmann-Noor, Gillian W Adams, Moritz Claudius Daniel, Alison Davis, Joanne Hancox, Melanie Hingorani, Patricia Ibanez, Becky McPhee, Himanshu Patel, Marie Restori, Clare Roberts, Maria Theodorou, James Acheson
BACKGROUND: Following high-profile cases, referrals for evaluation of 'suspicious optic discs' to eye clinics in the UK have sharply increased, asking ophthalmologists to reliably distinguish between true and pseudopapilloedema. Optic nerve sheath dilatation (ONSD) on ocular ultrasound (US) is considered a reliable sign of true papilloedema, but this test is not widely available. Recently, anterior bowing of Bruch's membrane (BM) and increased retinal nerve fibre layer thickness on optical coherence tomography (OCT) have emerged as indicators of intracranial hypertension, and OCT is widely available...
June 21, 2017: British Journal of Ophthalmology
https://www.readbyqxmd.com/read/28629473/emergency-treatment-with-levetiracetam-or-phenytoin-in-status-epilepticus-in-children-the-eclipse-study-study-protocol-for-a-randomised-controlled-trial
#2
Mark D Lyttle, Carrol Gamble, Shrouk Messahel, Helen Hickey, Anand Iyer, Kerry Woolfall, Amy Humphreys, Naomi E A Bacon, Louise Roper, Franz E Babl, Stuart R Dalziel, Mary Ryan, Richard E Appleton
BACKGROUND: Convulsive status epilepticus (CSE) is the most common life-threatening neurological emergency in childhood. These children are also at risk of significant morbidity, with acute and chronic impact on the family and the health and social care systems. The current recommended first-choice, second-line treatment in children aged 6 months and above is intravenous phenytoin (fosphenytoin in the USA), although there is a lack of evidence for its use and it is associated with significant side effects...
June 19, 2017: Trials
https://www.readbyqxmd.com/read/28628591/movement-system-diagnosis
#3
Ann F Van Sant
BACKGROUND AND PURPOSE: This article presents the concept of movement system diagnoses (MSDxs), including an examination of the evolution of the ideas that are shaping the development of MSDxs. SUMMARY OF KEY POINTS: Ideas leading to development of the need for MSDxs are traced, and an overview of Diagnosis Dialog and points of consensus are provided. Four examples from areas of neurologic and pediatric practice where additional work is needed on movement system diagnosis are highlighted...
July 2017: Journal of Neurologic Physical Therapy: JNPT
https://www.readbyqxmd.com/read/28619065/open-issues-in-mucopolysaccharidosis-type-i-hurler
#4
REVIEW
Rossella Parini, Federica Deodato, Maja Di Rocco, Edoardo Lanino, Franco Locatelli, Chiara Messina, Attilio Rovelli, Maurizio Scarpa
Mucopolysaccharidosis I-Hurler (MPS I-H) is the most severe form of a metabolic genetic disease caused by mutations of IDUA gene encoding the lysosomal α-L-iduronidase enzyme. MPS I-H is a rare, life-threatening disease, evolving in multisystem morbidity including progressive neurological disease, upper airway obstruction, skeletal deformity and cardiomyopathy. Allogeneic hematopoietic stem cell transplantation (HSCT) is currently the gold standard for the treatment of MPS I-H in patients diagnosed and treated before 2-2...
June 15, 2017: Orphanet Journal of Rare Diseases
https://www.readbyqxmd.com/read/28612133/brain-specific-serum-biomarkers-predict-neurological-morbidity-in-diagnostically-diverse-pediatric-intensive-care-unit-patients
#5
Alicia K Au, Michael J Bell, Ericka L Fink, Rajesh K Aneja, Patrick M Kochanek, Robert S B Clark
BACKGROUND: Unexpected neurological morbidity in Pediatric Intensive Care Units (PICUs) remains high and is difficult to detect proactively. Brain-specific biomarkers represent a novel approach for early detection of neurological injury. We sought to determine whether serum concentrations of neuron-specific enolase (NSE), myelin basic protein (MBP), and S100B, specific for neurons, oligodendrocytes, and glia, respectively, were predictive of neurological morbidity in critically ill children...
June 13, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28612089/the-intensive-care-delirium-research-agenda-a-multinational-interprofessional-perspective
#6
REVIEW
Pratik P Pandharipande, E Wesley Ely, Rakesh C Arora, Michele C Balas, Malaz A Boustani, Gabriel Heras La Calle, Colm Cunningham, John W Devlin, Julius Elefante, Jin H Han, Alasdair M MacLullich, José R Maldonado, Alessandro Morandi, Dale M Needham, Valerie J Page, Louise Rose, Jorge I F Salluh, Tarek Sharshar, Yahya Shehabi, Yoanna Skrobik, Arjen J C Slooter, Heidi A B Smith
Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy, and the neurosciences sought to address five questions: (1) What is the current standard of care in managing ICU delirium? (2) What have been the major recent advances in delirium research and care? (3) What are the common delirium beliefs that have been challenged by recent trials? (4) What are the remaining areas of uncertainty in delirium research? (5) What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium, identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda...
June 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28611828/heads-up-a-novel-provocative-maneuver-to-guide-acute-ischemic-stroke-management
#7
Latisha K Ali, Julius K Weng, Sidney Starkman, Jeffrey L Saver, Doojin Kim, Bruce Ovbiagele, Brian H Buck, Nerses Sanossian, Paul Vespa, Oh Young Bang, Reza Jahan, Gary R Duckwiler, Fernando Viñuela, David S Liebeskind
BACKGROUND: A common dilemma in acute ischemic stroke management is whether to pursue recanalization therapy in patients with large vessel occlusions but minimal neurologic deficits. We describe and report preliminary experience with a provocative maneuver, i.e. 90-degree elevation of the head of bed for 30 min, which stresses collaterals and facilitates decision-making. METHODS: A prospective cohort study of <7.5 h of acute anterior circulation territory ischemia patients with minimal deficits despite middle cerebral artery (MCA) or internal carotid artery (ICA) occlusive disease...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28591056/epidemiology-and-clinical-analysis-of-critical-patients-with-child-maltreatment-admitted-to-the-intensive-care-units
#8
En-Pei Lee, Shao-Hsuan Hsia, Jing-Long Huang, Jainn-Jim Lin, Oi-Wa Chan, Chia-Ying Lin, Kuang-Lin Lin, Yu-Ching Chang, I-Jun Chou, Fu-Song Lo, Jung Lee, Yi-Chen Hsin, Pei-Chun Chan, Mei-Hua Hu, Cheng-Hsun Chiu, Han-Ping Wu
Children with abuse who are admitted to the intensive care unit (ICU) may have high mortality and morbidity and commonly require critical care immediately. It is important to understand the epidemiology and clinical characteristics of these critical cases of child maltreatment.We retrospectively evaluated the data for 355 children with maltreatments admitted to the ICU between 2001 and 2015. Clinical factors were analyzed and compared between the abuse and the neglect groups, including age, gender, season of admission, identifying settings, injury severity score (ISS), etiologies, length of stay (LOS) in the ICU, clinical outcomes, and mortality...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28583583/temporal-changes-of-oxidative-stress-markers-in-escherichia-coli-k1-induced-experimental-meningitis-in-a-neonatal-rat-model
#9
Vijayasree V Giridharan, Lutiana R Simões, Valdemira S Dagostin, Jaqueline S Generoso, Gislaine T Rezin, Drielly Florentino, Jhonata P Muniz, Allan Collodel, Fabricia Petronilho, Joao Quevedo, Tatiana Barichello
Despite advances in antimicrobial therapy and advanced critical care neonatal bacterial meningitis has a mortality rate of over 10% and induces neurological sequelae in 20-50% of cases. Escherichia coli K1 (E. coli K1) is the most common gram-negative organism causing neonatal meningitis and is the second most common cause behind group B streptococcus. We previously reported that an E. coli K1 experimental meningitis infection in neonatal rats resulted in habituation and aversive memory impairment and a significant increase in cytokine levels in adulthood...
June 3, 2017: Neuroscience Letters
https://www.readbyqxmd.com/read/28583018/a-review-of-cd19-targeted-immunotherapies-for-relapsed-or-refractory-acute-lymphoblastic-leukemia
#10
Ryan K DasGupta, Bernard L Marini, Joslyn Rudoni, Anthony J Perissinotti
Aim Novel immunotherapies have generated high response rates and unique adverse effects among patients with relapsed or refractory acute lymphoblastic leukemia. Therapies engaging endogenous T-cells against acute lymphoblastic leukemia are emerging for children and adults with various poor prognostic factors, thus accurate knowledge of immunotherapies is necessary for their effective implementation in the future. In this review, we evaluate clinical trial data regarding chimeric antigen receptor T-cells and blinatumomab, for the treatment of relapsed or refractory acute lymphoblastic leukemia...
January 1, 2017: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/28578120/intraspinal-pressure-monitoring-and-extensive-duroplasty-in-the-acute-phase-of-traumatic-spinal-cord-injury-a-systematic-review
#11
REVIEW
Tykocki Tomasz, Lukasz Poniatowski, Marcin Czyz, Michael Koziara, Guy Wynne-Jones
The prognosis in cervical spinal cord injury (SCI) is poor and surgical and neuro intensive care management need further improvement. Monitoring of the intraspinal pressure (ISP) at early stage after tSCI is clinically useful. Obtaining continuous spinal cord perfusion pressure (SCPP) measurements based on the difference between mean arterial pressure (MAP) and ISP allows offering best medical and surgical treatment during this critical phase of tSCI. The optimal SCPP was found to be between 90-100mmHg and MAP of 110-130...
May 31, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28548479/insular-gliomas-a-surgical-reappraisal-based-on-a-systematic-review-of-the-literature
#12
Domenico Murrone, Rodolfo Maduri, Afif Afif, Domenico Chirchiglia, Isabelle Pelissou-Guyotat, Jacques Guyotat, Francesco Signorelli
INTRODUCTION: Insular gliomas are heterogeneous lesions whose management presents multiple challenges for their tendency to affect young patients in good neurological and cognitive conditions, their deep anatomic location and proximity with critical functional and vascular structures. The appropriate management of insular gliomas requires a multidisciplinary evidence-centred teamwork grounded on the best anatomic, neurophysiological and oncological knowledge. The present study provides a reappraisal of the management of insular gliomas based on a systematic review of the literature with the aim of guiding clinicians in the management of such tumors...
May 25, 2017: Journal of Neurosurgical Sciences
https://www.readbyqxmd.com/read/28547318/a-systematic-review-of-alpha-2-agonists-for-sedation-in-mechanically-ventilated-neurocritical-care-patients
#13
Alexandre Tran, Henrietta Blinder, Brian Hutton, Shane W English
The use of sedative medications is commonplace in intensive care units (ICUs) and an invaluable clinical tool for the intensive care physician. Sedation for critically ill, mechanically ventilated patients provides an opportunity to reduce anxiety, discomfort as well as ventilator intolerance and dyssynchrony. Alpha-2 agonists in particular have become increasingly popular for use in the neurocritical care population due to their proposed effectiveness in facilitating examinations and procedures as well as reducing the need for adjunctive agents...
May 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28530457/-patient-turnover-in-a-multidisciplinary-emergency-department
#14
Csaba Varga, Zsuzsanna Lelovics, Viktor Soós, Tibor Oláh
INTRODUCTION: More than twenty emergency departments were opened across Hungary in the past years. Data deficiency on patient flow, trends and lack of knowledge of indicators could raise numerous logistical and organisational problems. AIM: Collection, analysis and provision of data to facilitate successful operations of emergency medical care services. METHOD: During a three-year period investigated, at the multidisciplinary Emergency Department of "Moritz Kaposi" Teaching Hospital, data on patient flow (n = 106,203), epidemiology, triage and international classification of diseases were analysed...
May 2017: Orvosi Hetilap
https://www.readbyqxmd.com/read/28514888/seeing-is-believing-healthcare-professionals-perceptions-of-a-complex-intervention-to-improve-care-towards-the-end-of-life-a-qualitative-interview-study
#15
Katherine Bristowe, Irene Carey, Adrian Hopper, Susanna Shouls, Wendy Prentice, Irene J Higginson, Jonathan Koffman
BACKGROUND: Methods to improve care, trust and communication are important in acute hospitals. Complex interventions aimed at improving care of patients approaching the end of life are increasingly common. While evaluating outcomes of complex interventions is essential, exploring healthcare professionals' perceptions is also required to understand how they are interpreted; this can inform training, education and implementation strategies to ensure fidelity and consistency in use. AIM: To explore healthcare professionals' perceptions of using a complex intervention (AMBER care bundle) to improve care for people approaching the end of life and their understandings of its purpose within clinical practice...
May 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28501751/the-state-of-everyday-quantitative-eeg-use-in-canada-a-national-technologist-survey
#16
Marcus C Ng, Kara Gillis
PURPOSE: This study sought to determine the state of quantitative EEG (QEEG) use in Canada, as QEEG may provide a partial solution to the issue of escalating EEG demand against insufficient health care resources. METHODS: A 10-item survey questionnaire was administered to participants at the annual meeting of the Canadian Association of Electroneurophysiology Technologists, which was held in parallel with the annual meeting of the Canadian Neurological Sciences Federation...
July 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/28491493/brainstem-shape-is-affected-by-clinical-course-in-the-neonatal-intensive-care-unit
#17
Marcus Lo, Leire Zubiaurre-Elorza, Conor Wild, Annika C Linke, David S C Lee, Victor K Han, Rhodri Cusack
The brainstem, critical for motor function, autonomic regulation, and many neurocognitive functions, undergoes rapid development from the third trimester. Accordingly, we hypothesized it would be vulnerable to insult during this period, and that a difficult clinical course in the neonatal intensive care unit (NICU) would affect development, and be reflected through atypical shape. Our study population consisted of 66 neonates - all inpatients from the NICU at Victoria Hospital, London Health Sciences Centre, ON, Canada, of which 45 entered the final analysis...
2017: NeuroImage: Clinical
https://www.readbyqxmd.com/read/28484929/functional-mri-for-assessment-of-the-default-mode-network-in-acute-brain-injury
#18
Daniel Kondziella, Patrick M Fisher, Vibeke Andrée Larsen, John Hauerberg, Martin Fabricius, Kirsten Møller, Gitte Moos Knudsen
BACKGROUND: Assessment of the default mode network (DMN) using resting-state functional magnetic resonance imaging (fMRI) may improve assessment of the level of consciousness in chronic brain injury, and therefore, fMRI may also have prognostic value in acute brain injury. However, fMRI is much more challenging in critically ill patients because of cardiovascular vulnerability, intravenous sedation, and artificial ventilation. METHODS: Using resting-state fMRI, we investigated the DMN in a convenience sample of patients with acute brain injury admitted to the intensive care unit...
May 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28484823/-prolonged-weaning-during-early-neurological-and-neurosurgical-rehabilitation-s2k-guideline-published-by-the-weaning-committee-of-the-german-neurorehabilitation-society-dgnr
#19
REVIEW
J D Rollnik, J Adolphsen, J Bauer, M Bertram, J Brocke, C Dohmen, E Donauer, M Hartwich, M D Heidler, V Huge, S Klarmann, S Lorenzl, M Lück, M Mertl-Rötzer, T Mokrusch, D A Nowak, T Platz, L Riechmann, F Schlachetzki, A von Helden, C W Wallesch, D Zergiebel, M Pohl
Prolonged weaning of patients with neurological or neurosurgery disorders is associated with specific characteristics, which are taken into account by the German Society for Neurorehabilitation (DGNR) in its own guideline. The current S2k guideline of the German Society for Pneumology and Respiratory Medicine is referred to explicitly with regard to definitions (e.g., weaning and weaning failure), weaning categories, pathophysiology of weaning failure, and general weaning strategies. In early neurological and neurosurgery rehabilitation, patients with central of respiratory regulation disturbances (e...
May 8, 2017: Der Nervenarzt
https://www.readbyqxmd.com/read/28478880/neurologic-intensive-care-unit-electrolyte-management
#20
REVIEW
Craig Hutto, Mindy French
Dysnatremia is a common finding in the intensive care unit (ICU) and may be a predictor for mortality and poor clinical outcomes. Depending on the time of onset (ie, on admission vs later in the ICU stay), the incidence of dysnatremias in critically ill patients ranges from 6.9% to 15%, respectively. The symptoms of sodium derangement and their effect on brain physiology make early recognition and correction paramount in the neurologic ICU. Hyponatremia in brain injured patients can lead to life-threatening conditions such as seizures and may worsen cerebral edema and contribute to alterations in intracranial pressure...
June 2017: Nursing Clinics of North America
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