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https://www.readbyqxmd.com/read/29128928/serum-neuron-specific-enolase-may-be-a-marker-to-predict-the-severity-and-outcome-of-cerebral-venous-thrombosis
#1
Yanyu Hu, Ran Meng, Xuxiang Zhang, Linlin Guo, Sijie Li, Yan Wu, Jiangang Duan, Yuchuan Ding, Xunming Ji
The objective is to explore the effective of baseline serum neuron specific enolase (NSE) on predicting the severity and outcome in patients with cerebral venous thrombosis (CVT). A total of 156 patients confirmed as CVT in Xuanwu Hospital were enrolled in this retrospective study from March 2011 through September 2016. The severity was evaluated with the National Institutes of Health Stroke Score (NIHSS), intracranial pressure (ICP), and CVT-related complications; the outcome was evaluated by modified Rankin Scale (mRS); the relationship between baseline serum NSE and mRS was analyzed with receiver operating characteristic curve (ROC), logistic regression analysis, and Kaplan-Meier curves...
November 11, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28965156/decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-infarction-including-patients-with-additional-involvement-of-the-anterior-and-or-posterior-cerebral-artery-territory-outcome-analysis-and-definition-of-prognostic-factors
#2
Sven Kürten, Christopher Munoz, Kerim Beseoglu, Igor Fischer, Jason Perrin, Hans-Jakob Steiger
BACKGROUND: According to current evidence, adding decompressive craniectomy (DC) to best medical therapy reduces case fatality rate of malignant middle cerebral artery infarction by 50-75%. There is currently little information available regarding the outcome of subgroups, in particular of patients with extensive infarctions exceeding the territory of the middle cerebral artery. METHODS: The records of 101 patients with large hemispheric infarctions undergoing DC were retrospectively reviewed...
September 30, 2017: Acta Neurochirurgica
https://www.readbyqxmd.com/read/28934363/sex-related-differences-in-the-risk-factors-for-in-hospital-mortality-and-outcomes-of-ischemic-stroke-patients-in-rural-areas-of-taiwan
#3
Cheung-Ter Ong, Yi-Sin Wong, Sheng-Feng Sung, Chi-Shun Wu, Yung-Chu Hsu, Yu-Hsiang Su, Ling-Chien Hung
BACKGROUND AND PURPOSE: Sex-related differences in the clinical presentation and outcomes of stroke patients are issues that have attracted increased interest from the scientific community. The present study aimed to investigate sex-related differences in the risk factors for in-hospital mortality and outcome in ischemic stroke patients. METHODS: A total of 4278 acute ischemic stroke patients admitted to a stroke unit between January 1, 2007 and December 31, 2014 were included in the study...
2017: PloS One
https://www.readbyqxmd.com/read/28817088/the-role-of-neurogenic-inflammation-in-blood-brain-barrier-disruption-and-development-of-cerebral-oedema-following-acute-central-nervous-system-cns-injury
#4
REVIEW
Annabel J Sorby-Adams, Amanda M Marcoionni, Eden R Dempsey, Joshua A Woenig, Renée J Turner
Acute central nervous system (CNS) injury, encompassing traumatic brain injury (TBI) and stroke, accounts for a significant burden of morbidity and mortality worldwide, largely attributable to the development of cerebral oedema and elevated intracranial pressure (ICP). Despite this, clinical treatments are limited and new therapies are urgently required to improve patient outcomes and survival. Originally characterised in peripheral tissues, such as the skin and lungs as a neurally-elicited inflammatory process that contributes to increased microvascular permeability and tissue swelling, neurogenic inflammation has now been described in acute injury to the brain where it may play a key role in the secondary injury cascades that evolve following both TBI and stroke...
August 17, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28806209/refractory-intracranial-hypertension-the-role-of-decompressive-craniectomy
#5
Martin Smith
Raised intracranial pressure (ICP) is associated with worse outcomes after acute brain injury, and clinical guidelines advocate early treatment of intracranial hypertension. ICP-lowering therapies are usually administered in a stepwise manner, starting with safer first-line interventions, while reserving higher-risk options for patients with intractable intracranial hypertension. Decompressive craniectomy is a surgical procedure in which part of the skull is removed and the underlying dura opened to reduce brain swelling-related raised ICP; it can be performed as a primary or secondary procedure...
August 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28642178/neurologic-outcome-after-decompressive-craniectomy-predictors-of-outcome-in-different-pathologic-conditions
#6
Taco Goedemans, Dagmar Verbaan, Bert A Coert, Bertjan J Kerklaan, René van den Berg, Jonathan M Coutinho, Tessa van Middelaar, Paul J Nederkoorn, William Peter Vandertop, Pepijn van den Munckhof
OBJECTIVE: Decompressive craniectomy (DC) has been proposed as a lifesaving treatment in patients with elevated intracranial pressure, but its effectiveness on reaching a favorable neurologic outcome remains unclear. We identified predictors of outcome in a large, single-center cohort of patients undergoing DC for different pathologic conditions. METHODS: This retrospective study included all patients undergoing DC from 2006 to 2014. The 1-year outcome, assessed using the Glasgow Outcome Scale (GOS), was dichotomized into favorable (GOS 4-5) and unfavorable (GOS 1-3) outcome...
September 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28187816/multimodal-neurologic-monitoring
#7
REVIEW
G Korbakis, P M Vespa
Neurocritical care has two main objectives. Initially, the emphasis is on treatment of patients with acute damage to the central nervous system whether through infection, trauma, or hemorrhagic or ischemic stroke. Thereafter, attention shifts to the identification of secondary processes that may lead to further brain injury, including fever, seizures, and ischemia, among others. Multimodal monitoring is the concept of using various tools and data integration to understand brain physiology and guide therapeutic interventions to prevent secondary brain injury...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187799/management-of-intracerebral-hemorrhage
#8
REVIEW
A M Thabet, M Kottapally, J Claude Hemphill
Intracerebral hemorrhage (ICH) is a potentially devastating neurologic injury representing 10-15% of stroke cases in the USA each year. Numerous risk factors, including age, hypertension, male gender, coagulopathy, genetic susceptibility, and ethnic descent, have been identified. Timely identification, workup, and management of this condition remain a challenge for clinicians as numerous factors can present obstacles to achieving good functional outcomes. Several large clinical trials have been conducted over the prior decade regarding medical and surgical interventions...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28130682/therapies-for-hemorrhagic-transformation-in-acute-ischemic-stroke
#9
REVIEW
Joshua A Stone, Joshua Z Willey, Salah Keyrouz, James Butera, Ryan A McTaggart, Shawna Cutting, Brian Silver, Bradford Thompson, Karen L Furie, Shadi Yaghi
Hemorrhagic transformation occurs in about 10-15% of patients with acute ischemic stroke. The treatment of hemorrhagic conversion is complex and includes blood pressure management, reversing coagulopathy, and managing its complications including increased intracranial pressure. Future research should be directed on identifying indications to treat and use of appropriate homeostatic regimens to effectively reverse the different anticoagulants and thrombolytic agents in an attempt to improve outcomes of patients with hemorrhagic transformation...
January 2017: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/27998316/decompressive-craniectomy-for-malignant-middle-cerebral-artery-infarction-in-a-16-year-old-boy-a-case-report
#10
Simon Lammy, Paul Fivey, Meharpal Sangra
BACKGROUND: Cryptogenic stroke frequently occurs in younger patients and has a high risk of recurrence. Consequently, secondary prevention is often suboptimal as there is no known risk factor to target. This case demonstrates an unexpected finding of middle cerebral artery infarction and extensive malignant transformation in a 16-year-old boy more than a day post-admission. The lack of a proven culprit lesion makes this case even more intriguing and subsequently raises questions of cryptogenic mechanisms in the context of unrelated trauma...
December 20, 2016: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/27867477/hyperbaric-oxygen-therapy-in-experimental-and-clinical-stroke
#11
REVIEW
Wei-Wei Zhai, Liang Sun, Zheng-Quan Yu, Gang Chen
Stroke, which is defined as a neurologic deficit caused by sudden impaired blood supply, has been considered as a common cause of death and disability for decades. The World Health Organization has declared that almost every 5 seconds a new stroke occurs, placing immense socioeconomic burdens. However, the effective and available treatment strategies are still limited. Additionally, the most effective therapy, such as thrombolysis and stenting for ischemic stroke, generally requires a narrow therapeutic time window after the event...
April 2016: Medical Gas Research
https://www.readbyqxmd.com/read/27798981/hydrocephalus-associated-with-childhood-nonaccidental-head-trauma
#12
Sudhakar Vadivelu, Harold L Rekate, Debra Esernio-Jenssen, Mark A Mittler, Steven J Schneider
OBJECTIVE The incidence of posttraumatic ventriculomegaly (PTV) and shunt-dependent hydrocephalus after nonaccidental head trauma (NAHT) is unknown. In the present study, the authors assessed the timing of PTV development, the relationship between PTV and decompressive craniectomy (DC), and whether PTV necessitated placement of a permanent shunt. Also, NAHT/PTV cases were categorized into a temporal profile of delay in admission and evaluated for association with outcomes at discharge. METHODS The authors retrospectively reviewed the cases of patients diagnosed with NAHT throughout a 10-year period...
November 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27612672/noninvasive-assessment-of-the-intracranial-pressure-in-non-traumatic-intracranial-hemorrhage
#13
Michael Vaiman, Tal Sigal, Itzhak Kimiagar, Inessa Bekerman
The article describes the modified technique of measuring the diameters of the optic nerve sheath (ONSD) for assessment of the intracranial pressure (ICP) in patients with intracerebral or subarachnoid hemorrhage (SAH). The CT scans of 443 patients were analyzed retrospectively. The ONSDs were measured at 3mm behind the globe and at the point where the ophthalmic artery crosses the optic nerve. The ONSD/eyeball transverse diameter (ETD) ratio was calculated. The correlation analysis was performed with the Glasgow Coma Scale score, Hemispheric Stroke Scale score, Glasgow Outcome Score, and invasive ICP readings...
December 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27261957/pre-trauma-center-management-of-intracranial-pressure-in-severe-pediatric-traumatic-brain-injury
#14
Gregory Hansen, Patrick J McDonald, Doug Martin, Jeff K Vallance
OBJECTIVES: Pre-trauma center care is a critical component in severe pediatric traumatic brain injury (TBI). For geographically large trauma catchment areas, optimizing increased intracranial pressure (ICP) management may potentially improve outcomes. This retrospective study examined ICP management in nontrauma centers and during interfacility transport to the trauma center. METHODS: Charts from a pediatric level I trauma center were reviewed for admissions between 2008 and 2013...
June 2, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27145814/optimizing-sedation-in-patients-with-acute-brain-injury
#15
REVIEW
Mauro Oddo, Ilaria Alice Crippa, Sangeeta Mehta, David Menon, Jean-Francois Payen, Fabio Silvio Taccone, Giuseppe Citerio
Daily interruption of sedative therapy and limitation of deep sedation have been shown in several randomized trials to reduce the duration of mechanical ventilation and hospital length of stay, and to improve the outcome of critically ill patients. However, patients with severe acute brain injury (ABI; including subjects with coma after traumatic brain injury, ischaemic/haemorrhagic stroke, cardiac arrest, status epilepticus) were excluded from these studies. Therefore, whether the new paradigm of minimal sedation can be translated to the neuro-ICU (NICU) is unclear...
May 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27145751/regulation-of-the-cerebral-circulation-bedside-assessment-and-clinical-implications
#16
REVIEW
Joseph Donnelly, Karol P Budohoski, Peter Smielewski, Marek Czosnyka
Regulation of the cerebral circulation relies on the complex interplay between cardiovascular, respiratory, and neural physiology. In health, these physiologic systems act to maintain an adequate cerebral blood flow (CBF) through modulation of hydrodynamic parameters; the resistance of cerebral vessels, and the arterial, intracranial, and venous pressures. In critical illness, however, one or more of these parameters can be compromised, raising the possibility of disturbed CBF regulation and its pathophysiologic sequelae...
May 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27145035/effect-of-a-72-hour-stroke-care-bundle-on-early-outcomes-after-acute-stroke-a-non-randomised-controlled-study
#17
Jane Nakibuuka, Martha Sajatovic, Joaniter Nankabirwa, Charles Ssendikadiwa, Nelson Kalema, Arthur Kwizera, Jayne Byakika-Tusiime, Anthony J Furlan, James Kayima, Edward Ddumba, Elly Katabira
BACKGROUND: Integrated care pathways (ICP) in stroke management are increasingly being implemented to improve outcomes of acute stroke patients. We evaluated the effect of implementing a 72 hour stroke care bundle on early outcomes among patients admitted within seven days post stroke to the national referral hospital in Uganda. METHODS: In a one year non-randomised controlled study, 127 stroke patients who had 'usual care' (control group) were compared to 127 stroke patients who received selected elements from an ICP (intervention group)...
2016: PloS One
https://www.readbyqxmd.com/read/26873759/management-of-refractory-intracranial-pressure
#18
REVIEW
Jennifer D Robinson
Patients with refractory intracranial pressure represent a challenge to the multidisciplinary critical care team. Myriad diagnoses: traumatic brain injury, subarachnoid hemorrhage, intracranial hemorrhage, and ischemic stroke, are among the causes commonly seen in patients with elevated intracranial pressure. Clinicians tasked with caring for these patients must be aware of available interventions and management strategies to improve outcomes. Nurses as the bedside clinician most frequently assessing these patients are ideally situated to detect changes and act efficiently to lower refractory intracranial pressure...
March 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/26763913/early-tracheostomy-in-ventilated-stroke-patients-study-protocol-of-the-international-multicentre-randomized-trial-setpoint2-stroke-related-early-tracheostomy-vs-prolonged-orotracheal-intubation-in-neurocritical-care-trial-2
#19
RANDOMIZED CONTROLLED TRIAL
Silvia Schönenberger, Wolf-Dirk Niesen, Hannah Fuhrer, Colleen Bauza, Christina Klose, Meinhard Kieser, José I Suarez, David B Seder, Julian Bösel
BACKGROUND: Tracheostomy is a common procedure in long-term ventilated critical care patients and frequently necessary in those with severe stroke. The optimal timing for tracheostomy is still unknown, and it is controversial whether early tracheostomy impacts upon functional outcome. METHOD: The Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2 (SETPOINT2) is a multicentre, prospective, randomized, open-blinded endpoint (PROBE-design) trial...
April 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/26690122/advances-in-intracranial-pressure-monitoring-and-its-significance-in-managing-traumatic-brain-injury
#20
REVIEW
Usmah Kawoos, Richard M McCarron, Charles R Auker, Mikulas Chavko
Intracranial pressure (ICP) measurements are essential in evaluation and treatment of neurological disorders such as subarachnoid and intracerebral hemorrhage, ischemic stroke, hydrocephalus, meningitis/encephalitis, and traumatic brain injury (TBI). The techniques of ICP monitoring have evolved from invasive to non-invasive-with both limitations and advantages. Some limitations of the invasive methods include short-term monitoring, risk of infection, restricted mobility of the subject, etc. The invasiveness of a method limits the frequency of ICP evaluation in neurological conditions like hydrocephalus, thus hampering the long-term care of patients with compromised ICP...
December 4, 2015: International Journal of Molecular Sciences
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