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https://www.readbyqxmd.com/read/28325462/management-of-recurrent-subdural-hematomas
#1
REVIEW
Virendra R Desai, Robert A Scranton, Gavin W Britz
Subdural hematomas commonly recur after surgical evacuation, at a rate of 2% to 37%. Risk factors for recurrence can be patient related, radiologic, or surgical. Patient-related risk factors include alcoholism, seizure disorders, coagulopathy, and history of ventriculoperitoneal shunt. Radiologic factors include poor brain reexpansion postoperatively, significant subdural air, greater midline shift, heterogeneous hematomas (layered or multi-loculated), and higher-density hematomas. Surgical factors include lack of or poor postoperative drainage...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325459/natural-history-of-acute-subdural-hematoma
#2
REVIEW
Rafael A Vega, Alex B Valadka
Because published guidelines for surgical decision-making in patients with acute subdural hematomas (ASDHs) are based largely on case series and other weak evidence, management often must be individualized. Nonoperative management is a viable option in many cases. The literature is divided about the effects of anticoagulant and antiplatelet medications on rapid growth of ASDHs and on their likelihood of progression to large chronic subdural hematomas. Close clinical and radiologic follow-up is needed, both acutely to detect rapid expansion of an ASDH, and subacutely to detect formation of a large subacute or chronic subdural hematoma...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325461/neurocritical-care-of-acute-subdural-hemorrhage
#3
REVIEW
Fawaz Al-Mufti, Stephan A Mayer
Although urgent surgical hematoma evacuation is necessary for most patients with subdural hematoma (SDH), well-orchestrated, evidenced-based, multidisciplinary, postoperative critical care is essential to achieve the best possible outcome. Acute SDH complicates approximately 11% of mild to moderate traumatic brain injuries (TBIs) that require hospitalization, and approximately 20% of severe TBIs. Acute SDH usually is related to a clear traumatic event, but in some cases can occur spontaneously. Management of SDH in the setting of TBI typically conforms to the Advanced Trauma Life Support protocol with airway taking priority, and management breathing and circulation occurring in parallel rather than sequence...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/28325463/perioperative-management-of-anticoagulation
#4
REVIEW
Daipayan Guha, R Loch Macdonald
Antiplatelet and anticoagulant drugs (antithrombotics) predispose to acute and chronic subdural hematomas. Patients on these drugs are at higher likelihood of presenting with larger hematomas and more severe neurologic deficits. Standard neurosurgical and neurocritical care of subdural hematomas involves reversal of antithrombosis preoperatively, whereas reversing antiplatelet drugs is less clear. This article highlights the spectrum of antithrombotic agents in common use, their mechanisms of action, and strategies for reversal...
April 2017: Neurosurgery Clinics of North America
https://www.readbyqxmd.com/read/23182529/improving-intensive-care-unit-quality-using-collaborative-networks
#5
REVIEW
Sam R Watson, Damon C Scales
Collaborative networks of intensive care units can help promote a quality-improvement agenda across an entire system or region. Proposed advantages include targeting a greater number of patients, sharing of resources, and common measurement systems for audit and feedback or benchmarking. This review focuses on elements that are essential for the success and sustainability of these collaborative networks, using as examples networks in Michigan and Ontario. More research is needed to understand the mechanisms through which collaborative networks lead to improved care delivery and to demonstrate their cost-effectiveness in comparison with other approaches to system-level quality improvement...
January 2013: Critical Care Clinics
https://www.readbyqxmd.com/read/28287909/clinical-evaluation-of-a-microwave-based-device-for-detection-of-traumatic-intracranial-hemorrhage
#6
Johan Ljungqvist, Stefan Candefjord, Mikael Persson, Lars Jönsson, Thomas Skoglund, Mikael Elam
Traumatic brain injury (TBI) is the leading cause of death and disability among young persons. A key to improve outcome for patients with TBI is to reduce the time from injury to definitive care by achieving high triage accuracy. Microwave technology (MWT) allows for a portable device to be used in the pre-hospital setting for detection of intracranial hematomas at the scene of injury, thereby enhancing early triage and allowing for more adequate early care. MWT has previously been evaluated for medical applications including the ability to differentiate between hemorrhagic and ischemic stroke...
March 13, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/27960167/intracranial-arteries-anatomy-and-collaterals
#7
REVIEW
David S Liebeskind, Louis R Caplan
Anatomy, physiology, and pathophysiology are inextricably linked in patients with intracranial atherosclerosis. Knowledge of abnormal or pathological conditions such as intracranial atherosclerosis stems from detailed recognition of the normal pattern of vascular anatomy. The vascular anatomy of the intracranial arteries, both at the level of the vessel wall and as a larger structure or conduit, is a reflection of physiology over time, from in utero stages through adult life. The unique characteristics of arteries at the base of the brain may help our understanding of atherosclerotic lesions that tend to afflict specific arterial segments...
2016: Frontiers of Neurology and Neuroscience
https://www.readbyqxmd.com/read/28243998/shunt-devices-for-neurointensivists-complications-and-management
#8
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...
February 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28187810/management-of-infections-associated-with-neurocritical-care
#9
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/28244000/changes-in-cerebral-perfusion-with-induced-hypertension-in-aneurysmal-subarachnoid-hemorrhage-a-pilot-and-feasibility-study
#10
Amanda Murphy, Airton Leonardo de Oliveira Manoel, R Loch Macdonald, Andrew Baker, Ting-Yim Lee, Tom Marotta, Walter Montanera, Richard Aviv, Aditya Bharatha
BACKGROUND: The effects of induced hypertension (IH) on cerebral perfusion after subarachnoid hemorrhage (SAH) are unclear. The objectives of this investigation are to: (1) determine whether there are differences in cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) measured with computed tomography perfusion (CTP) before and after IH; (2) evaluate differences in the presence of infarction and clinical outcome between patients with and without IH. METHODS: We performed a retrospective cohort analysis of 25 aneurysmal SAH patients...
February 27, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28203777/2017-infectious-diseases-society-of-america-s-clinical-practice-guidelines-for-healthcare-associated-ventriculitis-and-meningitis
#11
Allan R Tunkel, Rodrigo Hasbun, Adarsh Bhimraj, Karin Byers, Sheldon L Kaplan, W Michael Scheld, Diederik van de Beek, Thomas P Bleck, Hugh J L Garton, Joseph R Zunt
No abstract text is available yet for this article.
February 14, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28214798/intensive-blood-pressure-lowering-in-patients-with-acute-intracerebral-haemorrhage-clinical-outcomes-and-haemorrhage-expansion-systematic-review-and-meta-analysis-of-randomised-trials
#12
Gregoire Boulouis, Andrea Morotti, Joshua N Goldstein, Andreas Charidimou
INTRODUCTION: It is unclear whether intensive lowering of blood pressure (BP) at the acute phase of intracerebral haemorrhage (ICH) is beneficial. We performed a meta-analysis of randomised controlled trials (RCTs) to assess whether intensive BP lowering in patients with acute ICH is safe and effective in improving clinical outcomes. METHODS: We searched PubMed, EMBASE and the Cochrane databases for relevant RCTs and calculated pooled OR for 3-month mortality (safety outcome) and 3-month death or dependency (modified Rankin Scale (mRs) ≥3;efficacy outcome), in patients with acute ICH randomised to either intensive BP-lowering or standard BP-lowering treatment protocols...
April 2017: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/28190433/seizures-in-the-critically-ill
#13
J Ch'ang, J Claassen
Critically ill patients with seizures are either admitted to the intensive care unit because of uncontrolled seizures requiring aggressive treatment or are admitted for other reasons and develop seizures secondarily. These patients may have multiorgan failure and severe metabolic and electrolyte disarrangements, and may require complex medication regimens and interventions. Seizures can be seen as a result of an acute systemic illness, a primary neurologic pathology, or a medication side-effect and can present in a wide array of symptoms from convulsive activity, subtle twitching, to lethargy...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28190445/management-of-neurologic-complications-of-coagulopathies
#14
J D Vanderwerf, M A Kumar
Coagulopathy is common in intensive care units (ICUs). Many physiologic derangements lead to dysfunctional hemostasis; these may be either congenital or acquired. The most devastating outcome of coagulopathy in the critically ill is major bleeding, defined by transfusion requirement, hemodynamic instability, or intracranial hemorrhage. ICU coagulopathy often poses complex management dilemmas, as bleeding risk must be tempered with thrombotic potential. Coagulopathy associated with intracranial hemorrhage bears directly on prognosis and outcome...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28207601/advanced-monitoring-in-traumatic-brain-injury-microdialysis
#15
Keri L H Carpenter, Adam M H Young, Peter J Hutchinson
PURPOSE OF REVIEW: Here, we review the present state-of-the-art of microdialysis for monitoring patients with severe traumatic brain injury, highlighting the newest developments. Microdialysis has evolved in neurocritical care to become an established bedside monitoring modality that can reveal unique information on brain chemistry. RECENT FINDINGS: A major advance is recent consensus guidelines for microdialysis use and interpretation. Other advances include insight obtained from microdialysis into the complex, interlinked traumatic brain injury disorders of electrophysiological changes, white matter injury, inflammation and metabolism...
April 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28187808/diagnosis-and-management-of-acute-encephalitis
#16
REVIEW
J J Halperin
Encephalitis is typically viral (approximately half of diagnosed cases) or autoimmune (about a quarter) with the remainder remaining undiagnosable at this time. All require general supportive care but only a minority requires intensive care admission - in these intubation, to protect the airway or to treat status epilepticus with anesthetic drugs, may be needed. In some dysautonomia with wide blood pressure fluctuations is the principal concern. Remarkably, in addition to supportive care, specific treatment options are available for the majority - immune-modulating therapy for those with autoimmune disorders, antiviral therapy for herpes simplex 1 and 2, and varicella-zoster encephalitis...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28187816/multimodal-neurologic-monitoring
#17
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/28187815/principles-of-intracranial-pressure-monitoring-and-treatment
#18
REVIEW
M Czosnyka, J D Pickard, L A Steiner
Intracranial pressure (ICP) is governed by volumes of intracranial blood, cerebrospinal fluid, and brain tissue. Expansion of any of these volumes will trigger compensatory changes in the other compartments, resulting in initially limited change in ICP. Due to the rigid skull, once compensatory mechanisms are exhausted, ICP rises very rapidly. Intracranial hypertension is associated with unfavorable outcome in brain-injured patients. This chapter discusses the pathophysiology of raised ICP, as well as typical waveforms, monitoring techniques, and clinical management...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28153852/effect-of-heparin-on-secondary-brain-injury-in-patients-with-subarachnoid-hemorrhage-an-additional-h-therapy-in-vasospasm-treatment
#19
REVIEW
Markus Bruder, Sae-Yeon Won, Sepide Kashefiolasl, Marlies Wagner, Nina Brawanski, Nazife Dinc, Volker Seifert, Juergen Konczalla
OBJECTIVE: Secondary brain injury leads to high morbidity and mortality rates in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, evidence-based treatment strategies are sparse. Since heparin has various effects on neuroinflammation, microthromboembolism and vasomotor function, our objective was to determine whether heparin can be used as a multitarget prophylactic agent to ameliorate morbidity in SAH. METHODS: Between June 1999 and December 2014, 718 patients received endovascular treatment after rupture of an intracranial aneurysm at our institution; 197 of them were treated with continuous unfractionated heparin in therapeutic dosages after the endovascular procedure...
February 2, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28169856/postinterventional-critical-care-management-of-aneurysmal-subarachnoid-hemorrhage
#20
Sudhir Datar, Alejandro A Rabinstein
PURPOSE OF REVIEW: Subarachnoid hemorrhage from a ruptured aneurysm (aSAH) is a complex disorder with the potential to have devastating effects on the brain as well as other organ systems. After more than 3 decades of research, the underlying pathophysiologic mechanisms remain incompletely understood and important questions remain regarding the evaluation and management of these patients. The purpose of this review is to analyze the recent literature and improve our understanding of certain key clinical aspects...
April 2017: Current Opinion in Critical Care
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