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https://www.readbyqxmd.com/read/28004163/treatment-of-cerebral-vasospasm-following-aneurysmal-subarachnoid-haemorrhage-a-systematic-review-and-meta-analysis
#1
Grégoire Boulouis, Marc Antoine Labeyrie, Jean Raymond, Christine Rodriguez-Régent, Anne Claire Lukaszewicz, Damien Bresson, Wagih Ben Hassen, Denis Trystram, Jean Francois Meder, Catherine Oppenheim, Olivier Naggara
OBJECTIVES: To examine the clinical outcome of aneurysmal subarachnoid haemorrhage (aSAH) patients exposed to cerebral vasospasm (CVS)-targeted treatments in a meta-analysis and to evaluate the efficacy of intra-arterial (IA) approaches in patients with severe/refractory vasospasm. METHODS: Randomised controlled trials, prospective and retrospective observational studies reporting clinical outcomes of aSAH patients exposed to CVS targeted treatments, published between 2006-2016 were searched using PubMed, EMBASE and the Cochrane Library...
December 21, 2016: European Radiology
https://www.readbyqxmd.com/read/28004334/noninvasive-neuromonitoring-current-utility-in-subarachnoid-hemorrhage-traumatic-brain-injury-and-stroke
#2
Luisa Vinciguerra, Julian Bösel
Noninvasive neuromonitoring is increasingly being used to monitor the course of primary brain injury and limit secondary brain damage of patients in the neurocritical care unit. Proposed advantages over invasive neuromonitoring methods include a lower risk of infection and bleeding, no need for surgical installation, mobility and portability of some devices, and safety. The question, however, is whether noninvasive neuromonitoring is practical and trustworthy enough already. We searched the recent literature and reviewed English-language studies on noninvasive neuromonitoring in subarachnoid hemorrhage, traumatic brain injury, and ischemic and hemorrhagic stroke between the years 2010 and 2015...
December 21, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27829965/magnetic-resonance-imaging-characteristics-of-hyperacute-intracerebral-hemorrhage
#3
Sulaiman Iftikhar, Nicholas Rossi, Nitin Goyal, Nickalus Khan, Adam Arthur, Ramin Zand
BACKGROUND: Magnetic resonance imaging (MRI) of the brain is highly sensitive for detecting intracerebral hemorrhage (ICH). Understanding of the imaging characteristics of hyperacute ICH is limited secondary to availability and increased time to scan relative to other imaging modalities. OBJECTIVE: In this report, we present the MRI characteristics of two patients who developed ICH while on the MRI table. METHODS: A 44-year-old women presented with week-long headache associated with blurry vision and photophobia...
October 2016: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/23956559/transcranial-doppler-technique-and-common-findings-part-1
#4
Lokesh Bathala, Man Mohan Mehndiratta, Vijay K Sharma
Transcranial Doppler (TCD) can be aptly called as the doctor's stethoscope of the brain. Since its introduction in 1982, by Rune Aaslid, TCD has evolved as a diagnostic, monitoring, and therapeutic tool. During evaluation of patients with acute ischemic stroke, TCD combined with cervical duplex ultrasonography provides physiological information on the cerebral hemodynamics, which is often complementary to structural imaging. Currently, TCD is the only diagnostic tool that can provide real time information about cerebral hemodynamics and can detect embolization to the cerebral vessels...
April 2013: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/27011639/transcranial-doppler-techniques-and-advanced-applications-part-2
#5
Arvind K Sharma, Lokesh Bathala, Amit Batra, Man Mohan Mehndiratta, Vijay K Sharma
Transcranial Doppler (TCD) is the only diagnostic tool that can provide continuous information about cerebral hemodynamics in real time and over extended periods. In the previous paper (Part 1), we have already presented the basic ultrasound physics pertaining to TCD, insonation methods, and various flow patterns. This article describes various advanced applications of TCD such as detection of right-to-left shunt, emboli monitoring, vasomotor reactivity (VMR), monitoring of vasospasm in subarachnoid hemorrhage (SAH), monitoring of intracranial pressure, its role in stoke prevention in sickle cell disease, and as a supplementary test for confirmation of brain death...
January 2016: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/27894490/traumatic-brain-injury-advances
#6
REVIEW
Deborah M Stein, Cristina B Feather, Lena M Napolitano
There have been many recent advances in the management of traumatic brain injury (TBI). Research regarding established and novel therapies is ongoing. Future research must not only focus on development of new strategies but determine the long-term benefits or disadvantages of current strategies. In addition, the impact of these advances on varying severities of brain injury must not be ignored. It is hoped that future research strategies in TBI will prioritize large-scale trials using common data elements to develop large registries and databases, and leverage international collaborations...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27852691/medical-management-of-intracerebral-haemorrhage
#7
REVIEW
Floris H B M Schreuder, Shoichiro Sato, Catharina J M Klijn, Craig S Anderson
The global burden of intracerebral haemorrhage (ICH) is enormous. Developing evidence-based management strategies for ICH has been hampered by its diverse aetiology, high case fatality and variable cooperative organisation of medical and surgical care. Progress is being made through the conduct of collaborative multicentre studies with the large sample sizes necessary to evaluate therapies with realistically modest treatment effects. This narrative review describes the major consequences of ICH and provides evidence-based recommendations to support decision-making in medical management...
January 2017: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/27960192/transcranial-doppler
#8
Vijay K Sharma, Ka Sing Wong, Andrei V Alexandrov
Transcranial Doppler ultrasonography (TCD) is the only diagnostic modality that provides a reliable evaluation of intracranial blood flow patterns in real-time. The physiological information obtained from TCD is complementary to the anatomical details obtained from other neuroimaging modalities. TCD is relatively cheap, can be performed bedside, and allows monitoring in acute emergency settings. TCD criteria for intracranial stenosis have been validated against various forms of angiographic studies and serve as reliable tools for screening, diagnostic as well as follow up purposes...
2016: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/27808265/unruptured-intracranial-aneurysms-development-rupture-and-preventive-management
#9
REVIEW
Nima Etminan, Gabriel J Rinkel
Saccular unruptured intracranial aneurysms (UIAs) have a prevalence of 3% in the adult population, and are being increasingly detected because of improved quality and higher frequency of cranial imaging. Large amounts of data, providing varying levels of evidence, have been published on aneurysm development, progression and rupture, but less information is available on the risks and efficacy of preventive treatment. When deciding how to best manage UIAs, clinicians must consider the age and life expectancy of the patient, the estimated risk of rupture, the risk of complications attributed to preventive treatment, and the level of anxiety caused by the awareness of having an aneurysm...
November 3, 2016: Nature Reviews. Neurology
https://www.readbyqxmd.com/read/27894491/coagulopathy-of-trauma
#10
REVIEW
Mitchell J Cohen, S Ariane Christie
Coagulopathy is common after injury and develops independently from iatrogenic, hypothermic, and dilutional causes. Despite considerable research on the topic over the past decade, trauma-induced coagulopathy (TIC) continues to portend poor outcomes, including decreased survival. We review the current evidence regarding the diagnosis and mechanisms underlying trauma induced coagulopathy and summarize the debates regarding optimal management strategy including product resuscitation, potential pharmacologic adjuncts, and targeted approaches to hemostasis...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27740982/imaging-of-ischemic-stroke
#11
Michelle P Lin, David S Liebeskind
PURPOSE OF REVIEW: This article provides an overview of cerebrovascular hemodynamics, acute stroke pathophysiology, and collateral circulation, which are pivotal in the modern imaging of ischemic stroke that guides the care of the patient with stroke. RECENT FINDINGS: Neuroimaging provides extensive information on the brain and vascular health. Multimodal CT and MRI delineate the hemodynamics of ischemic stroke that may be used to guide treatment decisions and prognosticate regarding expected outcomes...
October 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27740993/ultrasound-in-neurology
#12
Georgios Tsivgoulis, Andrei V Alexandrov
PURPOSE OF REVIEW: Low cost, avoidance of irradiation, and high temporal resolution are inherent advantages of ultrasound imaging that translate into multiple clinical uses in many domains of neurology. This article presents clinical uses of ultrasound examination in cerebrovascular, neurodegenerative, and peripheral nervous system diseases. RECENT FINDINGS: Modern treatment and prevention of ischemic stroke rely on prompt diagnosis. Ultrasonography has found a place as a noninvasive screening test and bedside technique that provides estimates of the degree of stenosis as well as hemodynamic and structural information about intracranial and extracranial vessels in real time...
October 2016: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/27720004/epidemiology-of-ischemic-stroke
#13
REVIEW
Albert S Favate, David S Younger
Ischemic stroke is a heterogeneous multifactorial disorder recognized by the sudden onset of neurologic signs related directly to the sites of injury in the brain where the morbid process occurs. The evaluation of complex neurologic disorders, such as stroke, in which multiple genetic and epigenetic factors interact with environmental risk factors to increase the risk has been revolutionized by the genome-wide association studies (GWAS) approach. This article reviews salient aspects of ischemic stroke emphasizing the impact of neuroepidemiology and GWAS...
November 2016: Neurologic Clinics
https://www.readbyqxmd.com/read/27847685/early-decompressive-craniectomy-for-malignant-cerebral-infarction-meta-analysis-and-clinical-decision-algorithm
#14
REVIEW
Christopher D Streib, Linda M Hartman, Bradley J Molyneaux
BACKGROUND: Decompressive craniectomy (DC) is an aggressive life-saving surgical intervention for patients with malignant cerebral infarction (MCI). However, DC remains inconsistently and infrequently utilized, primarily due to enduring concern that increased survival occurs only at the cost of poor functional outcome. Our aim was to clarify the role of DC performed within 48 hours (early DC) for patients with MCI, including patients aged >60 years. METHODS: We performed a meta-analysis of all available randomized controlled trials comparing early DC to best medical care for MCI...
October 2016: Neurology. Clinical Practice
https://www.readbyqxmd.com/read/27324997/endoscopic-and-microscopic-microvascular-decompression
#15
REVIEW
Matthew Piazza, John Y K Lee
The introduction of the endoscope into the neurosurgeon's armamentarium has revolutionized ventral and anterior skull-base surgery and, more recently, has been used in the surgical treatment of cerebellopontine angle (CPA) pathology. The utilization of the endoscope in microvascular decompression (MVD) for trigeminal neuralgia and other associated cranial nerve hyperactivity syndromes allows for unparalleled panoramic views and illumination of the neurovascular structures within the CPA and identification of vessel-nerve contact traditionally unseen using the microscope...
July 2016: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27637392/pathophysiology-of-traumatic-brain-injury
#16
REVIEW
Melissa J McGinn, John T Povlishock
This article provides a concise overview, at the structural and functional level, of those changes evoked by traumatic brain injury across the spectrum of the disease. Using data derived from animals and humans, the pathogenesis of focal versus diffuse brain damage is presented for consideration of its overall implications for morbidity. Emphasis is placed on contusion and its potential expansion in concert with diffuse changes primarily assessed at the axonal level. Concomitant involvement of neuroexcitation and its role in global and focal metabolic changes is considered...
October 2016: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27637393/imaging-evaluation-of-acute-traumatic-brain-injury
#17
REVIEW
Christopher A Mutch, Jason F Talbott, Alisa Gean
Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Imaging plays an important role in the evaluation, diagnosis, and triage of patients with TBI. Recent studies suggest that it also helps predict patient outcomes. TBI consists of multiple pathoanatomic entities. This article reviews the current state of TBI imaging including its indications, benefits and limitations of the modalities, imaging protocols, and imaging findings for each of these pathoanatomic entities. Also briefly surveyed are advanced imaging techniques, which include several promising areas of TBI research...
October 2016: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27637395/cerebral-metabolism-and-the-role-of-glucose-control-in-acute-traumatic-brain-injury
#18
REVIEW
Manuel M Buitrago Blanco, Giyarpuram N Prashant, Paul M Vespa
This article reviews key concepts of cerebral glucose metabolism, neurologic outcomes in clinical trials, the biology of the neurovascular unit and its involvement in secondary brain injury after traumatic brain insults, and current scientific and clinical data that demonstrate a better understanding of the biology of metabolic dysfunction in the brain, a concept now known as cerebral metabolic energy crisis. The use of neuromonitoring techniques to better understand the pathophysiology of the metabolic crisis is reviewed and a model that summarizes the triphasic view of cerebral metabolic disturbance supported by existing scientific data is outlined...
October 2016: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27637397/cerebral-edema-in-traumatic-brain-injury-pathophysiology-and-prospective-therapeutic-targets
#19
REVIEW
Ethan A Winkler, Daniel Minter, John K Yue, Geoffrey T Manley
Traumatic brain injury is a heterogeneous disorder resulting from an external force applied to the head. The development of cerebral edema plays a central role in the evolution of injury following brain trauma and is closely associated with neurologic outcomes. Recent advances in the understanding of the molecular and cellular pathways contributing to the posttraumatic development of cerebral edema have led to the identification of multiple prospective therapeutic targets. The authors summarize the pathogenic mechanisms underlying cerebral edema and highlight the molecular pathways that may be therapeutically targeted to mitigate cerebral edema and associated sequelae following traumatic brain injury...
October 2016: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/27637399/seizures-and-the-role-of-anticonvulsants-after-traumatic-brain-injury
#20
REVIEW
Lara L Zimmermann, Ramon Diaz-Arrastia, Paul M Vespa
Posttraumatic seizures are a common complication of traumatic brain injury. Posttraumatic epilepsy accounts for 20% of symptomatic epilepsy in the general population and 5% of all epilepsy. Early posttraumatic seizures occur in more than 20% of patients in the intensive care unit and are associated with secondary brain injury and worse patient outcomes. Most posttraumatic seizures are nonconvulsive and therefore continuous electroencephalography monitoring should be the standard of care for patients with moderate or severe brain injury...
October 2016: Neurosurgery Clinics of North America
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