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Andreu Comas-Garcia, Daniel E Noyola, Sofía Bernal-Silva
No abstract text is available yet for this article.
March 19, 2018: Journal of Infectious Diseases
William H Curley, Peter B Forgacs, Henning U Voss, Mary M Conte, Nicholas D Schiff
Patients with severe brain injury are difficult to assess and frequently subject to misdiagnosis. 'Cognitive motor dissociation' is a term used to describe a subset of such patients with preserved cognition as detected with neuroimaging methods but not evident in behavioural assessments. Unlike the locked-in state, cognitive motor dissociation after severe brain injury is prominently marked by concomitant injuries across the cerebrum in addition to limited or no motoric function. In the present study, we sought to characterize the EEG signals used as indicators of cognition in patients with disorders of consciousness and examine their reliability for potential future use to re-establish communication...
March 19, 2018: Brain: a Journal of Neurology
Claire M Keene, Arjen Dondorp, Jane Crawley, Eric O Ohuma, Mavuto Mukaka
Background: Malaria burdens global health systems, and management with limited resources requires robust treatment guidelines and comprehensive planning. Expected length of stay (LOS) is useful in health-system planning, and factors influencing it can be targeted to reduce admission time and optimise service delivery. Methods: A secondary survival analysis of 1217 adult severe malaria patients from the South-East Asia Quinine Artesunate Malaria Trial, using a competing-risk approach...
March 19, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Thanh G Phan, Jian Chen, Shaloo Singhal, Henry Ma, Benjamin B Clissold, John Ly, Richard Beare
Background: Prognostication following hypoxic ischemic encephalopathy (brain injury) is important for clinical management. The aim of this exploratory study is to use a decision tree model to find clinical and MRI associates of severe disability and death in this condition. We evaluate clinical model and then the added value of MRI data. Method: The inclusion criteria were as follows: age ≥17 years, cardio-respiratory arrest, and coma on admission (2003-2011)...
2018: Frontiers in Neurology
Duygu Ferek Emir, Ibrahim Ulas Ozturan, Serkan Yilmaz
INTRODUCTION: Alpha lipoic acid (ALA) is a potent antioxidant used to treat a variety of disorders. Although ALA is considered a very safe supplement and intoxication is very rare, acute high-dose ingestions can cause mortality. In this report, we discuss a very rare case of ALA intoxication to increase awareness of this issue. CASE REPORT: A 22-year-old female was referred to our emergency department with ALA intoxication after ingesting a total of 18g of ALA with a suicidal intention...
March 13, 2018: American Journal of Emergency Medicine
D'Andrea K Joseph, Daniel Daman, Rae Lynne Kinler, Karyl Burns, Lenworth Jacobs
The aim of this study was to describe the management of severe blunt renal injuries at a Level I trauma hospital. Data were collected through a record review of patients admitted from January 1, 2000, to December 31, 2011. These data were compiled as part of our hospital's participation in the Nonoperative Management of Grade IV and V Blunt Renal Injuries: A Research Consortium of New England Centers for Trauma Study. Thirty-six patients with severe blunt renal injuries were identified. Twenty-nine (80.6%) underwent nonoperative management (NOM) for their injuries...
March 1, 2018: American Surgeon
Casey J Allen, Daniel J Baldor, Mena M Hanna, Nicholas Namias, M Ross Bullock, Jonathan R Jagid, Kenneth G Proctor
After traumatic brain injury, decompressive craniectomy (DC) is a second-tier, late therapy for refractory intracranial hypertension. We hypothesize that early DC, based on CT evidence of intracranial hypertension, improves intracranial pressure (ICP) and cerebral perfusion pressure (CPP). From September 2008 to January 2015, 286 traumatic brain injury patients requiring invasive ICP monitoring at a single Level I trauma center were reviewed. DC and non-DC patients were propensity score matched 1:1, based on demographics, hemodynamics, injury severity score (ISS), Glasgow Coma Scale (GCS), transfusion requirements, and need for vasopressor therapy...
March 1, 2018: American Surgeon
Urmil Pandya, Jill Pattison, Chris Karas, Michael O'Mara
Patients with traumatic intracranial hemorrhage (ICH) with a clinical indication for antithrombotic medication present a clinical dilemma, burdened by the task of weighing the risks of hemorrhage expansion against the risk of thrombosis. We sought to determine the effect of subdural hemorrhage on the risk of hemorrhage expansion after administration of antithrombotic medication. Medical records of 1626 trauma patients admitted with traumatic ICH between March 1, 2008, and March 31, 2013, to a Level I trauma center were retrospectively reviewed...
March 1, 2018: American Surgeon
Eric J Charles, Nicholas J Napoli, Lily E Johnston, Carrie A Foster, Deirdre A Goode, Trevor B Parker, Eleanor A Sharp, Laura Barnes, Jeffrey S Young
The most common mechanism of traumatic injury is ground-level fall. The objective of this study was to understand how patients sustaining falls and their outcomes have evolved. An institutional trauma database was used to identify adult patients who suffered a fall and were admitted to a Level I trauma center during two distinct time periods: 1998 to 2003 (past) and 2008 to 2013 (current). Data on anticoagulant use and comorbidities was gathered by retrospective chart review of patients treated during 2003 and 2013...
March 1, 2018: American Surgeon
Jessica H Beard, Niels D Martin, Patrick M Reilly, Mark J Seamon
Time of admission and surgeon experience may explain variations in trauma outcomes. We hypothesized that earlier admission time by a more experienced trauma surgeon leads to improved outcomes after injury. We conducted a retrospective cohort study using trauma registry and performance improvement data at our Level 1 trauma center. Consecutive patients presenting at night from 2013 to 2014 were dichotomized into early (6:00 pm-12:00 am) and late (12:01 am-7:00 am) cohorts. Second year trauma fellows acting as attendings and staff trauma surgeons were categorized as less and more experienced, respectively...
March 1, 2018: American Surgeon
Michelle Hershman, Raymond Carmody, Unni K Udayasankar
History A 19-year-old woman with no pertinent medical history was brought to the emergency department after being found unconscious on her bathroom floor by her roommate. In the preceding weeks, she had reported intractable nausea and vomiting, for which she had been taking ondansetron. No other medications had been prescribed. The day prior to presentation, she had contacted her mother and described increasing confusion. Glasgow coma scale score on arrival in the emergency department was 4. Intravenous naloxone was administered, without immediate response...
April 2018: Radiology
Richard Wennberg, Carmen Hiploylee, Peter Tai, Charles H Tator
BACKGROUND: Epidemiologic studies have suggested that concussion, or mild traumatic brain injury (mTBI), is associated with a twofold or greater increase in relative risk for the development of post-traumatic epilepsy. To assess the clinical validity of these findings, we analyzed the incidence of epilepsy in a large cohort of post-concussion patients in whom concussion was strictly defined according to international guidelines. METHODS: A retrospective cohort study of 330 consecutive post-concussion patients followed by a single concussion specialist...
March 20, 2018: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Soojin Park, Murad Megjhani, Hans-Peter Frey, Edouard Grave, Chris Wiggins, Kalijah L Terilli, David J Roh, Angela Velazquez, Sachin Agarwal, E Sander Connolly, J Michael Schmidt, Jan Claassen, Noemie Elhadad
To develop and validate a prediction model for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) using a temporal unsupervised feature engineering approach, demonstrating improved precision over standard features. 488 consecutive SAH admissions from 2006 to 2014 to a tertiary care hospital were included. Models were trained on 80%, while 20% were set aside for validation testing. Baseline information and standard grading scales were evaluated: age, sex, Hunt Hess grade, modified Fisher Scale (mFS), and Glasgow Coma Scale (GCS)...
March 20, 2018: Journal of Clinical Monitoring and Computing
Sae Min Kwon, Kyu-Sun Choi, Hyeong-Joong Yi, Yong Ko, Young-Soo Kim, Koang-Hum Bak, Hyoung-Joon Chun, Young-Jun Lee, Ji Young Lee
This study aimed to evaluate the effect of brain atrophy on the functional outcome of patients with moderate-volume basal ganglia hemorrhage. Of 1003 patients with spontaneous intracerebral hemorrhage, 124 with moderate-volume basal ganglia hemorrhage (hematoma volume of 20-50 mL) were enrolled. The intercaudate distance (ICD) and sylvian fissure ratio (SFR) were used as linear brain atrophy parameters. The patients were divided into groups with favorable and unfavorable outcomes, according to the Glasgow Outcome Scale score, 90 days after symptom onset...
March 19, 2018: Scientific Reports
Gaëlle Cheisson, Sophie Jacqueminet, Emmanuel Cosson, Carole Ichai, Anne-Marie Leguerrier, Bogdan Nicolescu-Catargi, Alexandre Ouattara, Igor Tauveron, Paul Valensi, Dan Benhamou
Follow on from continuous intravenous administration of insulin with an electronic syringe (IVES) is an important element in the postoperative management of a diabetic patient. The basal-bolus scheme is the most suitable taking into account the nutritional supply and variable needs for insulin, reproducing the physiology of a normal pancreas: (i) slow (long-acting) insulin (= basal) which should immediately take over from IVES insulin simulating basal secretion; (ii) ultra-rapid insulin to simulate prandial secretion (= bolus for the meal); and (iii) correction of possible hyperglycaemia with an additional ultra-rapid insulin bolus dose...
March 16, 2018: Anaesthesia, Critical Care & Pain Medicine
Yonatan Edel, Rivka Mamet
The porphyrias are a group of rare metabolic disorders, inherited or acquired, along the heme biosynthetic pathway, which could manifest with neurovisceral and/or cutaneous symptoms, depending on the defective enzyme. Neurovisceral porphyrias are characterized by acute attacks, in which excessive heme production is induced following exposure to a trigger. An acute attack usually presents with severe abdominal pain, vomiting, and tachycardia. Other symptoms which could appear include hypertension, hyponatremia, peripheral neuropathy, and mild mental symptoms...
March 15, 2018: Rambam Maimonides Medical Journal
Vera Spatenkova, Pavlina Krejzarova, Jaroslav Jedlicka
Introduction: Dysphagia is a risk factor for aspiration pneumonia and acute respiratory failure in acute stroke patients. Dysphagia lusoria is caused by compression on the esophagus from artery lusoria, when the aberrant right subclavian artery arises from the descending aortic arch. We present a rare case report of pre-stroke undiagnosed dysphagia lusoria as a cause of aspiration pneumonia with acute respiratory failure in a 67-year-old female patient admitted with a minor left intracerebral hemorrhage in the left basal ganglia...
2018: SAGE Open Medical Case Reports
Brin Freund, James J Gugger, Alexandra Reynolds, William O Tatum, Jan Claassen, Peter W Kaplan
PURPOSE: Periodic discharges (PDs) are EEG patterns denoting brain dysfunction and ictal tendency. Their exact meaning regarding etiology and outcomes is not well known. In particular, bilateral independent PDs (BIPDs) are poorly described. METHODS: We performed a retrospective, multicenter study evaluating neuroimaging, epileptic, clinical, and EEG correlates of BIPDs. RESULTS: Twenty-five patients studied with a mean Glasgow Coma Scale 6...
March 15, 2018: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Joseph P Herbert, Sidish S Venkataraman, Ali H Turkmani, Liang Zhu, Marcia L Kerr, Rajan P Patel, Irma T Ugalde, Stephen A Fletcher, David I Sandberg, Charles S Cox, Ryan S Kitagawa, Arthur L Day, Manish N Shah
OBJECTIVE The objective of this study was to assess the incidence, diagnosis, and treatment of pediatric blunt cerebrovascular injury (BCVI) at a busy Level 1 trauma center and to develop a tool for accurately predicting pediatric BCVI and the need for diagnostic testing. METHODS This is a retrospective cohort study of a prospectively collected database of pediatric patients who had sustained blunt trauma (patient age range 0-15 years) and were treated at a Level 1 trauma center between 2005 and 2015. Digital subtraction angiography, MR angiography, or CT angiography was used to confirm BCVI...
March 16, 2018: Journal of Neurosurgery. Pediatrics
Min-Qing Wang, Xu Zhao, Xiao-Fei Wang, Chao Han, De-Guang Xing, Cheng-Wei Wang
BACKGROUND: The purpose of this study was to assess the outcomes in aggressively treated patients with aneurysmal intracerebral hematoma (ICH) and signs of brain herniation, and to investigate possible predictive factors. METHODS: This retrospective study included 43 patients with aneurysmal ICH who presented with brain herniation at emergency department (ED) admission and received aggressive surgical treatment between 2008 and 2016. Emergency surgical clipping, removal of hematoma, and external decompression were combined as an aggressive surgical treatment...
March 12, 2018: World Neurosurgery
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