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icp stroke outcome

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...
September 6, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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
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...
2016: Critical Care: the Official Journal of the Critical Care Forum
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...
2016: Critical Care: the Official Journal of the Critical Care Forum
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
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
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
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...
2015: International Journal of Molecular Sciences
P B Sporns, J Minnerup, N Warneke, R Dziewas, U Hanning, S Berkemeyer, T Zoubi, W Heindel, W Schwindt, T Niederstadt
BACKGROUND: The increasing use of endovascular treatments has led to higher recanalization rates and better clinical outcomes compared with intravenous thrombolysis alone. Stent retrievers represent the latest development for recanalization of large vessel occlusions. Decompressive hemicraniectomy has proved beneficial in patients suffering from rising intracranial pressure after malignant stroke. AIMS AND/OR HYPOTHESIS: We investigated the effect of the implementation of stent retriever treatment on the frequency of hemicraniectomy as a surrogate marker for infarct size and thus for poor neurological outcome...
December 4, 2015: Clinical Neuroradiology
Hyung-Min Kwon, Michael J Lynn, Tanya N Turan, Colin P Derdeyn, David Fiorella, Bethany F Lane, Jean Montgomery, L Scott Janis, Zoran Rumboldt, Marc I Chimowitz
IMPORTANCE: Intracranial arterial stenosis (ICAS) and small vessel disease (SVD) may coexist. There are limited data on the frequency and risk factors for coexistent SVD and the effect of SVD on stroke recurrence in patients receiving medical treatment for ICAS. OBJECTIVE: To investigate the frequency and risk factors for SVD and the effect of SVD on stroke recurrence in patients with ICAS. DESIGN, SETTING, AND PARTICIPANTS: A post hoc analysis of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study, a prospective, multicenter clinical trial...
January 2016: JAMA Neurology
T P Zonneveld, A Algra, D W J Dippel, L J Kappelle, R J van Oostenbrugge, Y B W E M Roos, M J Wermer, H B van der Worp, P J Nederkoorn, N D Kruyt
BACKGROUND: Intravenous thrombolysis (IVT) with (recombinant) tissue plasminogen activator is an effective treatment in acute ischemic stroke. However, IVT is contraindicated when blood pressure is above 185/110 mmHg, because of an increased risk on symptomatic intracranial hemorrhage. In current Dutch clinical practice, two distinct strategies are used in this situation. The active strategy comprises lowering blood pressure with antihypertensive agents below these thresholds to allow start of IVT...
2015: BMC Neurology
David Decker, Lisa Collier, Tsz Lau, Raul Olivera, Glenn Roma, Christopher Leonardo, Hilary Seifert, Derrick Rowe, Keith R Pennypacker
Cerebral edema after stroke is associated with poor neurological outcomes. Current therapies are limited to osmotic agents, such as hypertonic saline (HS), which reduce intracranial pressure. Although studies have demonstrated edema reductions following HS, tissue survival has not been thoroughly examined. Additionally, the efficacy of promising pharmacological agents has not been evaluated for synergy with osmotic agents. Conivaptan is an FDA-approved vasopressin receptor antagonist that may exert both osmotic and anti-inflammatory effects...
2016: Acta Neurochirurgica. Supplement
Tor Brommeland, Pål Nicolay Rydning, Are Hugo Pripp, Eirik Helseth
BACKGROUND: Decompressive craniectomy (DC) may be performed in patients with acutely raised intracranial pressure due to traumatic brain injury or stroke. It is later followed by a cranioplasty procedure (CP) in the surviving patients. This procedure is associated with a high frequency of post-operative complications. Identifying risk factors for these adverse events is important in order to improve the clinical outcome. This study examines possible predictive parameters for post-operative complications in CP...
2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Saurabh Saigal, Jai Prakash Sharma, Ritika Dhurwe, Sanjay Kumar, Mohan Gurjar
Targeted temperature management (TTM) in today's modern era, especially in intensive care units represents a promising multifaceted therapy for a variety of conditions. Though hypothermia is being used since Hippocratic era, the renewed interest of late has been since early 21(st) century. There have been multiple advancements in this field and varieties of cooling devices are available at present. TTM requires careful titration of its depth, duration and rewarming as it is associated with side-effects. The purpose of this review is to find out the best evidence-based clinical practice criteria of therapeutic hypothermia in critical care settings...
September 2015: Indian Journal of Critical Care Medicine
D V Cheboksarov, A V Butrov, O A Shevelev, V G Amcheslavsky, N N Pulina, M A Buntina, I M Sokolov
Development of new means and methods of cerebral temperature monitoring is an actual problem due to the fact that severity and outcomes of diseases in patients with brain damages (strokes, a head trauma) in big degree depend on development of neurogenetic fever and a local cerebral hyperthermia. The temperature monitoring, which is carried out by the implanted sensors, is applied in neurosurgical patients and is practically not used in patients with disorders of cerebral bloodflow. In this regard, noninvasive techniques of brain temperature registration are developing: proton nuclear magnetic resonance spectroscopy and registration of own electromagnetic radiation (EMR) at the high range of frequencies (microwave)...
January 2015: Anesteziologiia i Reanimatologiia
J Claude Hemphill, Steven M Greenberg, Craig S Anderson, Kyra Becker, Bernard R Bendok, Mary Cushman, Gordon L Fung, Joshua N Goldstein, R Loch Macdonald, Pamela H Mitchell, Phillip A Scott, Magdy H Selim, Daniel Woo
PURPOSE: The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. METHODS: A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence...
July 2015: Stroke; a Journal of Cerebral Circulation
Damon Klebe, Devin McBride, Jerry J Flores, John H Zhang, Jiping Tang
Cerebral hemorrhages account for 15-20 % of stroke sub-types and have very poor prognoses. The mortality rate for cerebral hemorrhage patients is between 40 and 50 %, of which at least half of the deaths occur within the first 2 days, and 75 % of survivors are incapable of living independently after 1 year. Current emergency interventions involve lowering blood pressure and reducing intracranial pressure by controlled ventilations or, in the worst case scenarios, surgical intervention. Some hemostatic and coagulatherapeutic interventions are being investigated, although a few that were promising in experimental studies have failed in clinical trials...
December 2015: Journal of Neuroimmune Pharmacology: the Official Journal of the Society on NeuroImmune Pharmacology
Arthur R Kurzbuch
In patients with traumatic brain injury (TBI) and ischemic hemispheric stroke (IHS), supratentorial decompressive craniectomy (DC) is performed when intracranial pressure (ICP) is unresponsive to medical treatment. There are numerous publications about the indications of supratentorial DC, the selection of patients eligible for surgery, the complications of the procedure, and the neurological outcome of operated patients. Only few papers, however, describe comprehensively the technical aspects of this procedure...
October 2015: Neurosurgical Review
Z Ltaief, N Ben-Hamouda, T Suys, R T Daniel, A O Rossetti, M Oddo
Management of neurocritical care patients is focused on the prevention and treatment of secondary brain injury, i.e. the number of pathophysiological intracerebral (edema, ischemia, energy dysfunction, seizures) and systemic (hyperthermia, disorders of glucose homeostasis) events that occur following the initial insult (stroke, hemorrhage, head trauma, brain anoxia) that may aggravate patient outcome. The current therapeutic paradigm is based on multimodal neuromonitoring, including invasive (intracranial pressure, brain oxygen, cerebral microdialysis) and non-invasive (transcranial doppler, near-infrared spectroscopy, EEG) tools that allows targeted individualized management of acute coma in the early phase...
December 10, 2014: Revue Médicale Suisse
Stacy Y Chu, Kevin N Sheth
Decompressive craniectomy (DC) involves the removal of a portion of the skull in the setting of life threatening brain edema or potentially uncontrollable intracranial pressures. Often performed on an emergent basis, evaluation and arrangement for DC should be swift and decisive. However, the evidence base for DC in the wide range of conditions for which it is currently performed is still developing. The procedure is associated with a number of complications and ethical considerations; thus, its place in contemporary practice remains controversial...
February 2015: Current Treatment Options in Neurology
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