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https://www.readbyqxmd.com/read/29502715/aneurysmal-subarachnoid-hemorrhage-unanswered-questions
#1
REVIEW
Alejandro A Rabinstein, Giuseppe Lanzino
Optimizing outcomes after aneurysmal subarachnoid hemorrhage remains a challenge for neurosurgeons and neurointensivists alike. Although we have learned a lot about the pathophysiology of this disease, many clinical questions are still unanswered. In this review, the authors discuss some of these questions, including the current diagnostic value of lumbar puncture in patients with negative computed tomography scans, the treatment value of blood pressure reduction and antifibrinolytics for prevention of early rebleeding, the indication for antiseizure medications, the optimal management of hydrocephalus and intracranial pressure, the role of clipping, and the options for diagnosis and treatment of delayed cerebral ischemia...
April 2018: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/29435806/critical-west-nile-neuroinvasive-disease
#2
Maximiliano A Hawkes, Ivan D Carabenciov, Eelco F M Wijdicks, Alejandro A Rabinstein
BACKGROUND: Data to guide neurointensivists seeing patients with West Nile Neuroinvasive disease (WNND) are lacking. We present a comparatively large series of patients with WNND admitted to the intensive care unit (ICU) and provide data on their early diagnosis, triage to the ICU and predictors of short-term outcomes. METHODS: We retrospectively identified patients aged ≥ 18 years old with WNND from January 1999 to November 2016. Demographic and clinical data, the modified Rankin Scale at discharge and disposition were collected...
February 12, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29406894/neurologic-illness-in-zambia-a-neurointensivist-s-experience
#3
Merritt W Brown, Katie Ellen Foy, Christopher Chanda, Jacqueline Mulundika, Igor J Koralnik, Omar K Siddiqi
INTRODUCTION: Management of critically ill patients in dedicated intensive care units (ICUs) is the standard of care in high income countries (HICs), but remains uncommon in low and middle-income countries (LMICs). We sought to determine the prevalence of neurologic disorders in the ICU of a LMIC and examine if resource appropriate specialized neurocritical care training could benefit these patients. METHODS: From February to March 2017, a trained neurocritical care intensivist recorded encounters in the sole ICU at the University Teaching Hospital (UTH) in Lusaka, Zambia...
February 15, 2018: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29305756/on-aneurysmal-rupture-and-rerupture
#4
Eelco F M Wijdicks
A warning leak is a curious phenomenon attributed to cerebral aneurysms. Once the leak occurs, it has been postulated it could lead to a more catastrophic rebleeding. The designation "warning leak" trickled into neurosurgery vocabulary as early as the 1950s. The phenomenon has been poorly understood and characterized, but its presence spurs emergency physicians and neurointensivists to take action to secure the aneurysm. Rapid treatment of a recently discovered aneurysm is now commonplace, but it has not always been so...
January 5, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29262441/imaging-in-neurocritical-care-practice
#5
Craig Williamson, Larry Morgan, Joshua P Klein
The use of neuroimaging in conjunction with serial neurological examinations is a core component of modern neurocritical care practice. Although there is a growing role for other neuromonitoring techniques, the ability to quickly and accurately interpret images in the context of a patient's clinical status arguably remains the indispensable skill for neurocritical care practitioners. Due to its rapid acquisition time and excellent ability to detect intracerebral hemorrhage (ICH), cerebral edema, and signs of elevated intracranial pressure, computed tomography (CT) remains the most useful neuroimaging technique for intensive care unit (ICU) patients...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29239885/the-present-state-of-neurointensivist-training-in-the-united-states-a-comparison-to-other-critical-care-training-programs
#6
Evie G Marcolini, David B Seder, Jordan B Bonomo, Thomas P Bleck, J Claude Hemphill, Lori Shutter, Fred Rincon, Shelly D Timmons, Paul Nyquist
OBJECTIVE: This manuscript describes the state of neurocritical care fellowship training, compares its written standards to those of other critical care fellowship programs, and discusses how programmatic oversight by the United Council for Neurological Subspecialties should evolve to meet American College of Graduate Medical Education standards. This review is a work product of the Society of Critical Care Medicine Neuroscience section and was reviewed and approved by the Council of the Society of Critical Care Medicine...
February 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29203307/development-of-a-severe-traumatic-brain-injury-consensus-based-treatment-protocol-conference-in-latin-america
#7
Peter Hendrickson, James Pridgeon, Nancy R Temkin, Walter Videtta, Gustavo Petroni, Silvia Lujan, Nahuel Guadagnoli, Zulma Urbina, Perla Blanca Pahnke, Daniel Godoy, Gustavo Pinero, Freddy Sandi Lora, Sergio Aguilera, Andres M Rubiano, Caridad Soler Morejon, Manuel Jibaja, Hubiel Lopez, Ricardo Romero, Sureyya Dikmen, Kelley Chaddock, Randall M Chesnut
BACKGROUND: Severe traumatic brain injury (sTBI) is a significant global health problem disproportionately affecting low- and middle-income countries (LMICs). Management of intracranial hypertension in sTBI is crucial to survival and optimal recovery. Practitioners in high-income countries routinely use intracranial pressure (ICP) monitors although their usefulness has been questioned. ICP monitors are usually unavailable in LMICs. No consensus-based/tested protocols or literature exists for sTBI treatment without ICP monitoring...
February 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29163327/the-state-of-neurocritical-care-fellowship-training-and-attitudes-toward-accreditation-and-certification-a-survey-of-neurocritical-care-fellowship-program-directors
#8
Rajat Dhar, Venkatakrishna Rajajee, Anna Finley Caulfield, Matthew B Maas, Michael L James, Avinash Bhargava Kumar, Stephen A Figueroa, David McDonagh, Agnieszka Ardelt
Neurocritical care as a recognized and distinct subspecialty of critical care has grown remarkably since its inception in the 1980s. As of 2016, there were 61 fellowship training programs accredited by the United Council for Neurologic Subspecialties (UCNS) in the United States and more than 1,000 UCNS-certified neurointensivists from diverse medical backgrounds. In late 2015, the Program Accreditation, Physician Certification, and Fellowship Training (PACT) Committee of the Neurocritical Care Society (NCS) was convened to promote and support excellence in the training and certification of neurointensivists...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29119023/improvement-in-quality-metrics-outcomes-and-patient-and-family-satisfaction-in-a-neurosciences-intensive-care-unit-after-creation-of-a-dedicated-neurocritical-care-team
#9
Yaw Sarpong, Premkumar Nattanmai, Ginger Schelp, Robert Bell, Keerthivaas Premkumar, Erin Stapleton, Ashley McCormick, Christopher R Newey
Introduction: Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU). Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU. Methods: This is a retrospective study of data over 36 months from a 14-bed NSICU evaluating quality outcome measures and anonymous patient satisfaction questionnaires before and after neurointensivists appointment...
2017: Critical Care Research and Practice
https://www.readbyqxmd.com/read/28973661/cerebral-ischemic-reperfusion-injury-following-recanalization-of-large-vessel-occlusions
#10
Fawaz Al-Mufti, Krishna Amuluru, William Roth, Rolla Nuoman, Mohammad El-Ghanem, Philip M Meyers
Although stroke has recently dropped to become the nation's fifth leading cause of mortality, it remains the top leading cause of morbidity and disability in the US. Recent advances in stroke treatment, including intravenous fibrinolysis and mechanical thromboembolectomy, allow treatment of a greater proportion of stroke patients than ever before. While intra-arterial fibrinolysis with recombinant tissue plasminogen is an effective for treatment of a broad range of acute ischemic strokes, endovascular mechanical thromboembolectomy procedures treat severe strokes due to large artery occlusions, often resistant to intravenous drug...
July 11, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28860331/the-screening-and-management-of-pituitary-dysfunction-following-traumatic-brain-injury-in-adults-british-neurotrauma-group-guidance
#11
REVIEW
Chin Lik Tan, Seyed Alireza Alavi, Stephanie E Baldeweg, Antonio Belli, Alan Carson, Claire Feeney, Anthony P Goldstone, Richard Greenwood, David K Menon, Helen L Simpson, Andrew A Toogood, Mark Gurnell, Peter J Hutchinson
Pituitary dysfunction is a recognised, but potentially underdiagnosed complication of traumatic brain injury (TBI). Post-traumatic hypopituitarism (PTHP) can have major consequences for patients physically, psychologically, emotionally and socially, leading to reduced quality of life, depression and poor rehabilitation outcome. However, studies on the incidence of PTHP have yielded highly variable findings. The risk factors and pathophysiology of this condition are also not yet fully understood. There is currently no national consensus for the screening and detection of PTHP in patients with TBI, with practice likely varying significantly between centres...
November 2017: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/28480662/impact-of-neurointensivist-co-management-on-the-clinical-outcomes-of-patients-admitted-to-a-neurosurgical-intensive-care-unit
#12
Jeong Am Ryu, Jeong Hoon Yang, Chi Ryang Chung, Gee Young Suh, Seung Chyul Hong
Limited data are available on improved outcomes after initiation of neurointensivist co-management in neurosurgical intensive care units (NSICUs) in Korea. We evaluated the impact of a newly appointed neurointensivist on the outcomes of neurosurgical patients admitted to an intensive care unit (ICU). This retrospective observational study involved neurosurgical patients admitted to the NSICU at Samsung Medical Center between March 2013 and May 2016. Neurointensivist co-management was initiated in October 1 2014...
June 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/28437224/structure-process-and-culture-of-intensive-care-units-treating-patients-with-severe-traumatic-brain-injury-survey-of-centers-participating-in-the-american-college-of-surgeons-trauma-quality-improvement-program
#13
Aziz S Alali, Victoria A McCredie, Todd G Mainprize, David Gomez, Avery B Nathens
Outcome after severe traumatic brain injury (TBI) differs substantially between hospitals. Explaining this variation begins with understanding the differences in structures and processes of care, particularly at intensive care units (ICUs) where acute TBI care takes place. We invited trauma medical directors (TMDs) from 187 centers participating in the American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) to complete a survey. The survey domains included ICU model, type, availability of specialized units, staff, training programs, standard protocols and order sets, approach to withdrawal of life support, and perceived level of neurosurgeons' engagement in the ICU management of TBI...
October 1, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28352638/variability-in-diagnosing-brain-death-at-an-academic-medical-center
#14
Ashutosh Pandey, Pradeep Sahota, Premkumar Nattanmai, Christopher R Newey
Objective. Research continues to highlight variability in hospital policy and documentation of brain death. The aim of our study was to characterize how strictly new guidelines of American Academy of Neurology (AAN) for death by neurological criteria were practiced in our hospital prior to appointment of neurointensivists. Method. This is a retrospective study of adults diagnosed as brain dead from 2011 to 2015. Descriptive statistics compared five categories: preclinical testing, neurological examination, apnea tests, ancillary test, and documentation of time of death...
2017: Neuroscience Journal
https://www.readbyqxmd.com/read/28343456/implementation-of-neurocritical-care-is-associated-with-improved-outcomes-in-traumatic-brain-injury
#15
Mypinder S Sekhon, Peter Gooderham, Brian Toyota, Navid Kherzi, Vivien Hu, Vinay K Dhingra, Morad S Hameed, Dean R Chittock, Donald E Griesdale
Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients...
July 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/28243998/shunt-devices-for-neurointensivists-complications-and-management
#16
G Smith, J Pace, A Scoco, G Singh, K Kandregula, S Manjila, C Ramos-Estebanez
Cerebrospinal fluid diversion has become the mainstay treatment in hydrocephalus for over 50 years. As the number of patients with ventricular shunt systems increases, neurointensivists are becoming the first-line physicians for many of these patients. When symptoms of a shunt malfunction are suspected and access to a neurosurgeon is limited or delayed, workup and temporizing measures must be initiated. The article highlights the functional nuances, complications, and management of current programmable shunt valves and their MRI sensitivity...
October 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28225527/neuro-trauma-or-med-surg-intensive-care-unit-does-it-matter-where-multiple-injuries-patients-with-traumatic-brain-injury-are-admitted-secondary-analysis-of-the-american-association-for-the-surgery-of-trauma-multi-institutional-trials-committee-decompressive
#17
MULTICENTER STUDY
Sarah Lombardo, Thomas Scalea, Jason Sperry, Raul Coimbra, Gary Vercruysse, Toby Enniss, Gregory J Jurkovich, Raminder Nirula
INTRODUCTION: Patients with nontraumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without traumatic brain injury (TBI) fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU. METHODS: This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28190429/the-scope-of-neurology-of-critical-illness
#18
REVIEW
E F M Wijdicks
Critical illness increases the probability of a neurologic complication. There are many reasons to consult a neurologist in a critically ill patient and most often it is altered alertness with no intuitive plausible explanation. Other common clinical neurologic problems facing the intensive care specialist and consulting neurologist in everyday decisions are coma following prolonged cardiovascular surgery, newly perceived motor asymmetry, seizures or other abnormal movements, and generalized muscle weakness...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187810/management-of-infections-associated-with-neurocritical-care
#19
REVIEW
L Rivera-Lara, W Ziai, P Nyquist
The reported incidence of hospital-acquired infections (HAIs) in the neurointensive care unit (NICU) ranges from 20% to 30%. HAIs in US hospitals cost between $28 and $45 billion per year in direct medical costs. These infections are associated with increased length of hospital stay and increased morbidity and mortality. Infection risk is increased in NICU patients due to medication side-effects, catheter and line placement, neurosurgical procedures, and acquired immune suppression secondary to steroid/barbiturate use and brain injury itself...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187805/the-history-of-neurocritical-care
#20
E F M Wijdicks
Critical care medicine came into sharp focus in the second part of the 20th century. The care of acutely ill neurologic patients in the USA may have originated in postoperative neurosurgical units, but for many years patients with neurocritical illness were admitted to intensive care units next to patients with general medical or surgical conditions. Neurologists may have had their first exposure to the complexity of neurocritical care during the poliomyelitis epidemics, but few were interested. Much later, the development of neurocritical care as a legitimate subspecialty was possible as a result of a new cadre of neurologists, with support by departments of neurosurgery and anesthesia, who appreciated their added knowledge and expertise in care of acute neurologic illness...
2017: Handbook of Clinical Neurology
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