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Neurointensive care

Eva Magdalena Korf, Volker Martin Tronnier, Jan Gliemroth, Jan Nils Küchler
We report a misinterpretation of bilateral mydriasis as blown pupils related to elevated intracranial pressure (ICP) under volatile sedation with isoflurane (Anesthetic Conserving Device [AnaConDa], Hudson RCI, Uppland Vasby, Sweden) in a 59-year-old patient with a severe traumatic brain injury with frontal contusion. The patient showed bilateral mydriasis and a missing light reflex 8 hours after changing sedation from intravenous treatment with midazolam and esketamine to volatile administration of isoflurane...
November 30, 2016: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Daniel N Hertle, Christopher Beynon, Jan O Neumann, Edgar Santos, Renan Sánchez-Porras, Andreas W Unterberg, Oliver W Sakowitz
STUDY OBJECTIVE: Recent experimental evidence identified GABAergic sedation as a possible cause for deprived neuroregeneration and poor outcome after acute brain injury. Patients with aneurysmal subarachnoid hemorrhage are often sedated, and GABAergic sedation, such as midazolam and propofol, is commonly used. DESIGN: Retrospective cohort study based on a prospectively established database. SETTING: Single-center neurointensive care unit. PATIENTS: Twenty-nine patients after subarachnoid hemorrhage...
December 2016: Journal of Clinical Anesthesia
Michael Trujillo, Paul B Perrin, Karoline Doser, Anne Norup
Objective: No studies have examined the impact of personality traits on mental health among caregivers of individuals with severe brain injury. Therefore, the purpose of the current study was to construct linear growth models to examine whether the personality traits of family members of individuals with severe brain injury could predict the trajectories of their own mental health-related quality of life (HRQoL), anxiety, and depression beginning in a neurointensive care unit through 1 year after injury. Method: Danish family members of individuals with severe brain injury (n = 52) completed the Short Form-36 assessing mental HRQoL (vitality, social functioning, role limitations-emotional, mental health), anxiety, and depression across 5 time points during the 1st year after injury...
October 17, 2016: Rehabilitation Psychology
Samira Saadoun, Marios C Papadopoulos
This paper challenges the current management of acute traumatic spinal cord injury based on our experience with monitoring from the injury site in the neurointensive care unit. We argue that the concept of bony decompression is inadequate. The concept of optimum spinal cord perfusion pressure, which differs between patients, is introduced. Such variability suggests individualized patient treatment. Failing to optimize spinal cord perfusion limits the entry of systemically administered drugs into the injured cord...
October 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
Juan Antonio Llompart-Pou, Mario Chico-Fernández, Marcelino Sánchez-Casado, Fermín Alberdi-Odriozola, Francisco Guerrero-López, María Dolores Mayor-García, Javier González-Robledo, María Ángeles Ballesteros-Sanz, Rubén Herrán-Monge, Rafael León-López, Lucía López-Amor, Ana Bueno-González
BACKGROUND: Injury patterns may differ in trauma patients when age is considered. This information is relevant in the management of trauma patients and for planning preventive measures. METHODS: We included in the study all patients admitted for traumatic disease in the participating ICUs from November 23(rd), 2012 to July 31(st), 2015 with complete records. Data on epidemiology, injury patterns, severity scores, acute management, resources utilisation and outcome were recorded and compared in the following groups of age: ≤55years (young adults), 56-65 years (adults), 66-75 years (elderly), >75years (very elderly)...
September 2016: Injury
David P Lerner, Jennifer Kim, Saef Izzy
BACKGROUND: The American Academy of Neurology (AAN) has established a core curriculum of topics for residency training in neurocritical care. At present there is limited data evaluating neurology residency education within the neurological intensive care unit. This study evaluates learner concerns with the neurological intensive care unit. METHODS: The Communication Committee and Resident & Fellow Taskforce within the Neurocritical Care Society (NCS) developed an online survey that consisted of 20 selection and free-text based questions...
September 12, 2016: Neurocritical Care
Hannah C Glass, David H Rowitch
Neonatal encephalopathy due to intrapartum events is estimated at 1 to 2 per 1000 live births in high-income countries. Outcomes have improved over the past decade due to implementation of therapeutic hypothermia, the only clinically available neuroprotective strategy for hypoxic-ischemic encephalopathy. Neonatal encephalopathy is the most common condition treated within a neonatal neurocritical care unit. Neonates with encephalopathy benefit from a neurocritical care approach due to prevention of secondary brain injury through attention to basic physiology, earlier recognition and treatment of neurologic complications, consistent management using guidelines and protocols, and use of optimized teams at dedicated referral centers...
September 2016: Clinics in Perinatology
Veronica Crespo, Michael L Luke James
Neuromuscular diseases are syndromic disorders that affect nerve, muscle, and/or neuromuscular junction. Knowledge about the management of these diseases is required for anesthesiologists, because these may frequently be encountered in the intensive care unit, operating room, and other settings. The challenges and advances in management for some of the neuromuscular diseases most commonly encountered in the operating room and neurointensive care unit are reviewed.
September 2016: Anesthesiology Clinics
Jeremy S Dority, Jeffrey S Oldham
Subarachnoid hemorrhage (SAH) is a debilitating, although uncommon, type of stroke with high morbidity, mortality, and economic impact. Modern 30-day mortality is as high as 40%, and about 50% of survivors have permanent disability. Care at high-volume centers with dedicated neurointensive care units is recommended. Euvolemia, not hypervolemia, should be targeted, and the aneurysm should be secured early. Neither statin therapy nor magnesium infusions should be initiated for delayed cerebral ischemia. Cerebral vasospasm is just one component of delayed cerebral edema...
September 2016: Anesthesiology Clinics
R M Surve, R Muthuchellappan, G S U Rao, M Philip
BACKGROUND: Literature suggests poorer outcomes during anaemia as well as following red blood cell transfusion (BT) in brain injured patients. Recently, central venous oxygen saturation (ScvO2 ) has been proposed as a physiological trigger to guide red BT. In this study, we looked at ScvO2 changes following BT in patients admitted to a neurointensive care unit (NICU). STUDY DESIGN: In this prospective, observational study, adult, acutely ill neurological patients of >18 years were recruited...
August 1, 2016: Transfusion Medicine
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
Mingwei Huang, Jian Wang, Xiaowei Ni, Gang Chen, Laifa Kong
Despite the lack of resources and materials, there has been an increasing demand for acute neurological care due to the heavy burden of neurocritical illness in most developing countries, including China where morbidity and mortality of severe neurological and neurosurgical disorders remains high. Neurointensive care units did not start appearing in China until the late 1980s. While great progress has been made in the last 2 decades in the establishment of equipped neurocritical care centers, advancement in medical infrastructure, streamlined resident training programs, and multidisciplinary care teams, there remain areas that warrant improvement in order to care for our growing patient population...
June 30, 2016: World Neurosurgery
Jens P Dreier, Martin Fabricius, Cenk Ayata, Oliver W Sakowitz, C William Shuttleworth, Christian Dohmen, Rudolf Graf, Peter Vajkoczy, Raimund Helbok, Michiyasu Suzuki, Alois J Schiefecker, Sebastian Major, Maren Kl Winkler, Eun-Jeung Kang, Denny Milakara, Ana I Oliveira-Ferreira, Clemens Reiffurth, Gajanan S Revankar, Kazutaka Sugimoto, Nora F Dengler, Nils Hecht, Brandon Foreman, Bart Feyen, Daniel Kondziella, Christian K Friberg, Henning Piilgaard, Eric S Rosenthal, M Brandon Westover, Anna Maslarova, Edgar Santos, Daniel Hertle, Renán Sánchez-Porras, Sharon L Jewell, Baptiste Balança, Johannes Platz, Jason M Hinzman, Janos Lückl, Karl Schoknecht, Michael Schöll, Christoph Drenckhahn, Delphine Feuerstein, Nina Eriksen, Viktor Horst, Julia S Bretz, Paul Jahnke, Michael Scheel, Georg Bohner, Egill Rostrup, Bente Pakkenberg, Uwe Heinemann, Jan Claassen, Andrew P Carlson, Christina M Kowoll, Svetlana Lublinsky, Yoash Chassidim, Ilan Shelef, Alon Friedman, Gerrit Brinker, Michael Reiner, Sergei A Kirov, R David Andrew, Eszter Farkas, Erdem Güresir, Hartmut Vatter, Lee S Chung, K C Brennan, Thomas Lieutaud, Stephane Marinesco, Andrew Ir Maas, Juan Sahuquillo, Markus A Dahlem, Frank Richter, Oscar Herreras, Martyn G Boutelle, David O Okonkwo, M Ross Bullock, Otto W Witte, Peter Martus, Arn Mjm van den Maagdenberg, Michel D Ferrari, Rick M Dijkhuizen, Lori A Shutter, Norberto Andaluz, André P Schulte, Brian MacVicar, Tomas Watanabe, Johannes Woitzik, Martin Lauritzen, Anthony J Strong, Jed A Hartings
Spreading depolarizations (SD) are waves of abrupt, near-complete breakdown of neuronal transmembrane ion gradients, are the largest possible pathophysiologic disruption of viable cerebral gray matter, and are a crucial mechanism of lesion development. Spreading depolarizations are increasingly recorded during multimodal neuromonitoring in neurocritical care as a causal biomarker providing a diagnostic summary measure of metabolic failure and excitotoxic injury. Focal ischemia causes spreading depolarization within minutes...
June 17, 2016: Journal of Cerebral Blood Flow and Metabolism
A Ercole, E P Thelin, A Holst, B M Bellander, D W Nelson
BACKGROUND: An understanding of the kinetics of a biomarker is essential to its interpretation. Despite this, little kinetic modelling of blood biomarkers can be found in the literature. S100b is an astrocyte related marker of brain injury used primarily in traumatic brain injury (TBI). Serum levels are expected to be the net result of a multi-compartmental process. The optimal sample times for TBI prognostication, and to follow injury development, are unclear. The purpose of this study was to develop a kinetic model to characterise the temporal course of serum S100b concentration after primary traumatic brain injury...
June 17, 2016: BMC Neurology
Yusuf Tunali, Eren Fatma Akcil, Ozlem Korkmaz Dilmen
No abstract text is available yet for this article.
2016: Anaesthesiology Intensive Therapy
Anneli Thelandersson, Bengt Nellgård, Sven-Erik Ricksten, Åsa Cider
BACKGROUND: Physiotherapy is an important part of treatment after severe brain injuries and stroke, but its effect on intracranial and systemic hemodynamics is minimally investigated. Therefore, the aim of this study was to assess the effects of an early bedside cycle exercise on intracranial and systemic hemodynamics in critically ill patients when admitted to a neurointensive care unit (NICU). METHODS: Twenty critically ill patients suffering from brain injuries or stroke were included in this study performed in the NICU at Sahlgrenska University Hospital...
May 23, 2016: Neurocritical Care
Sandhya Ravikumar, Poysophon Poysophon, Roy Poblete, May Kim-Tenser
We describe a case report of fulminant Guillain-Barré syndrome (GBS) mimicking brain death. A previously healthy 60-year-old male was admitted to the neurointensive care unit after developing rapidly progressive weakness and respiratory failure. On presentation, the patient was found to have absent brainstem and spinal cord reflexes resembling that of brain death. Acute motor axonal neuropathy, a subtype of GBS, was diagnosed by cerebrospinal fluid and nerve conduction velocity testing. An electroencephalogram showed that the patient had normal, appropriately reactive brain function...
2016: Frontiers in Neurology
Kirk Stucky, Jennifer E Jutte, Ann Marie Warren, James C Jackson, Nancy Merbitz
PURPOSE/OBJECTIVE: The aims of this survey study were to (a) examine the frequency of health-service psychology involvement in intensive and critical-care settings; (b) characterize the distinguishing features of these providers; and (c) examine unique or distinguishing features of the hospital setting in which these providers are offering services. RESEARCH METHOD/DESIGN: χ2 analyses were conducted for group comparisons of health-service psychologists: (a) providing services in critical care versus those with no or limited critical care activity and (b) involved in both critical care and rehabilitation versus those only involved in critical care...
May 2016: Rehabilitation Psychology
R Manet, E A Schmidt, F Vassal, D Charier, L Gergelé
INTRODUCTION: External lumbar drainage (ELD) of cerebrospinal fluid (CSF) in posttraumatic refractory intracranial hypertension (ICHT) is controversial. We report our experience of ELD in ICHT associated with acute disturbance of CSF flow within subarachnoid spaces (SASs). MATERIALS AND METHODS: Four adult patients admitted to the neurointensive care unit for severe TBI who presented with secondary ICHT are retrospectively reported. When refractory to second-tier therapy, if external ventricular drainage were not possible or failed, and in the absence of an indication for craniotomy to treat a mass lesion or decompressive craniectomy, we assessed the evolution of CSF volume within cranial SAS and checked the presence of basal cisterns and the absence of tonsillar herniation to evaluate interest in and the safety of ELD...
2016: Acta Neurochirurgica. Supplement
Martin Shaw, Ian Piper, Christopher Hawthorne
Intracranial pressure (ICP) monitoring is a key clinical tool in the assessment and treatment of patients in neurointensive care. ICP morphology analysis can be useful in the classification of waveform features.A methodology for the decomposition of an ICP signal into clinically relevant dimensions has been devised that allows the identification of important ICP waveform types. It has three main components. First, multi-resolution convolution analysis is used for the main signal decomposition. Then, an impulse function is created, with multiple parameters, that can represent any form in the signal under analysis...
2016: Acta Neurochirurgica. Supplement
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