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ICU NEURO

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195 papers 100 to 500 followers
https://www.readbyqxmd.com/read/29369063/long-term-outcome-following-decompressive-craniectomy-an-inconvenient-truth
#1
Stephen Honeybul, Kwok M Ho, Grant R Gillett
PURPOSE OF REVIEW: There is little doubt that decompressive craniectomy can reduce mortality following malignant middle cerebral infarction or severe traumatic brain injury. However, the concern has always been that the reduction in mortality comes at the cost of an increase in the number of survivors with severe neurological disability. RECENT FINDINGS: There has been a number of large multicentre randomized trials investigating surgical efficacy of the procedure...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29369064/neuro-icu-patient-disposition-optimal-venue-for-acute-needs
#2
Rafael Badenes, Chiara Robba, Fabio S Taccone, Federico Bilotta
PURPOSE OF REVIEW: This article revises the recent evidence on ICU admission criteria for acute neurological patients [traumatic brain injury (TBI) patients, postoperative neurosurgical procedures and stroke]. RECENT FINDINGS: The appropriate utilization of ICU beds is essential, but it is complex and a challenge to attain. To date there are no widely accepted international guidelines for managing these acute brain-injured patients (stroke, TBI, postneurosurgery) in the ICU...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29401173/clinical-presentation-of-autoimmune-and-viral-encephalitides
#3
Divyanshu Dubey, Michel Toledano, Andrew McKeon
PURPOSE OF REVIEW: We describe clinical and diagnostic features of various autoimmune and viral encephalitis subtypes. RECENT FINDINGS: Population-based studies have demonstrated both autoimmune and viral causes have similar prevalence and incident rates. Repertoire of autoimmune biomarkers has considerably increased with discovery of many novel neural antibodies including glial fibrillary acidic proteinα-immunoglobulin G. Similarly, with use of next generation sequencing and DNA libraries, many viral causes are being detected which would have been categorized as encephalitis of unknown cause a decade ago...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29401175/is-hemoglobin-good-for-cerebral-oxygenation-and-clinical-outcome-in-acute-brain-injury
#4
Shane W English, Lauralyn McIntyre
PURPOSE OF REVIEW: The purpose of this review is to highlight the role of hemoglobin in cerebral physiology and pathophysiology. We review the existing as well as recent evidence detailing the effects of red blood cell transfusion on cerebral oxygenation and clinical outcome. RECENT FINDINGS: Hemoglobin is a key component in oxygen delivery, and thus cerebral oxygenation. Higher hemoglobin levels and red blood cell transfusion are associated with higher cerebral oxygen delivery and decreased cerebral ischemic burden...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29517981/pain-management-in-neurocritical-care-an-update
#5
Athir Morad, Salia Farrokh, Alexander Papangelou
PURPOSE OF REVIEW: Pain management in neurocritical care is a subject often avoided because of concerns over the side-effects of analgesics and the potential to cause additional neurological injury with treatment. The sedation and hypercapnia caused by opioids have been feared to mask the neurological examination and contribute to elevations in intracranial pressure. Nevertheless, increasing attention to patient satisfaction has sparked a resurgence in pain management. As opioids have remained at the core of analgesic therapy, the increasing attention to pain has contributed to a growing epidemic of opioid dependence...
April 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29293475/pharmacokinetics-and-pharmacodynamics-of-antibiotics-in-central-nervous-system-infections
#6
Roland Nau, Jana Seele, Marija Djukic, Helmut Eiffert
PURPOSE OF REVIEW: The barriers surrounding the central nervous system (CNS) together with the emergence of multiresistant pathogens pose a therapeutic challenge for the effective treatment of CNS infections. RECENT FINDINGS: In addition to vancomycin, colistin and aminoglycosides, classically used for intrathecal injection, drug concentrations in cerebrospinal fluid after intrathecal injection of daptomycin and tigecyclin were recently studied. SUMMARY: The entry of antiinfectives into the CNS compartments is determined by the physicochemical properties of the drug and by conditions in the host...
February 2018: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/29030715/point-of-care-transcranial-doppler-by-intensivists
#7
REVIEW
Vincent Issac Lau, Robert Thomas Arntfield
In the unconscious patient, there is a diagnostic void between the neurologic physical exam, and more invasive, costly and potentially harmful investigations. Transcranial color-coded sonography and two-dimensional transcranial Doppler imaging of the brain have the potential to be a middle ground to bridge this gap for certain diagnoses. With the increasing availability of point-of-care ultrasound devices, coupled with the need for rapid diagnosis of deteriorating neurologic patients, intensivists may be trained to perform point-of-care transcranial Doppler at the bedside...
October 13, 2017: Critical Ultrasound Journal
https://www.readbyqxmd.com/read/29310136/device-closure-versus-medical-therapy-alone-for-patent-foramen-ovale-in-patients-with-cryptogenic-stroke-a-systematic-review-and-meta-analysis
#8
Rahman Shah, Mannu Nayyar, Ion S Jovin, Abdul Rashid, Beatrix R Bondy, Tai-Hwang M Fan, Michael P Flaherty, Sunil V Rao
Background: The optimal strategy for preventing recurrent stroke in patients with cryptogenic stroke and patent foramen ovale (PFO) is unknown. Purpose: To compare transcatheter PFO closure with medical therapy alone for prevention of recurrent stroke in patients with PFO and cryptogenic stroke. Data Sources: PubMed and the Cochrane Library (without language restrictions) from inception to October 2017, reference lists, and abstracts from cardiology meetings...
March 6, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29282104/association-between-continuous-hyperosmolar-therapy-and-survival-in-patients-with-traumatic-brain-injury-a-multicentre-prospective-cohort-study-and-systematic-review
#9
Karim Asehnoune, Sigismond Lasocki, Philippe Seguin, Thomas Geeraerts, Pierre François Perrigault, Claire Dahyot-Fizelier, Catherine Paugam Burtz, Fabrice Cook, Dominique Demeure Dit Latte, Raphael Cinotti, Pierre Joachim Mahe, Camille Fortuit, Romain Pirracchio, Fanny Feuillet, Véronique Sébille, Antoine Roquilly
BACKGROUND: Intracranial hypertension (ICH) is a major cause of death after traumatic brain injury (TBI). Continuous hyperosmolar therapy (CHT) has been proposed for the treatment of ICH, but its effectiveness is controversial. We compared the mortality and outcomes in patients with TBI with ICH treated or not with CHT. METHODS: We included patients with TBI (Glasgow Coma Scale ≤ 12 and trauma-associated lesion on brain computed tomography (CT) scan) from the databases of the prospective multicentre trials Corti-TC, BI-VILI and ATLANREA...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29351760/glycaemic-control-targets-after-traumatic-brain-injury-a-systematic-review-and-meta-analysis
#10
Jeroen Hermanides, Mark P Plummer, Mark Finnis, Adam M Deane, Jonathan P Coles, David K Menon
BACKGROUND: Optimal glycaemic targets in traumatic brain injury (TBI) remain unclear. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing intensive with conventional glycaemic control in TBI requiring admission to an intensive care unit (ICU). METHODS: We systematically searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to November 2016. Outcomes of interest included ICU and in-hospital mortality, poor neurological outcome, the incidence of hypoglycaemia and infective complications...
January 19, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29176349/epidemiology-of-community-acquired-bacterial-meningitis
#11
Matthijs C Brouwer, Diederik van de Beek
PURPOSE OF REVIEW: The epidemiology of bacterial meningitis has been dynamic in the past 30 years following introduction of conjugated vaccines against Haemophilus influenzae type B, Streptococcus pneumoniae and Neisseria meningitidis. The purpose of this review is to describe recent developments in bacterial meningitis epidemiology. RECENT FINDINGS: The incidence of bacterial meningitis in Western countries (Finland, Netherlands, and the United States) gradually declined by 3-4% per year to 0...
February 2018: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/29059119/early-management-of-acute-cerebrovascular-accident
#12
Jody Manners, Alexis Steinberg, Lori Shutter
PURPOSE OF REVIEW: Stroke is common and often presents as a neurologic emergency that requires rapid evaluation and treatment to minimize debilitation. Recent advances in therapy expanded time windows for intra-arterial thrombectomy in ischemic stroke, and surgical interventions for clot evacuation in large intracranial hemorrhage have recently proven feasible. This review discusses recent data regarding new therapeutic options in both ischemic and hemorrhagic stroke, notably in scenarios in which therapy was previously limited to supportive care...
December 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28781176/electrical-neuromodulation-of-the-respiratory-system-after-spinal-cord-injury
#13
REVIEW
Jan T Hachmann, Peter J Grahn, Jonathan S Calvert, Dina I Drubach, Kendall H Lee, Igor A Lavrov
Spinal cord injury (SCI) is a complex and devastating condition characterized by disruption of descending, ascending, and intrinsic spinal circuitry resulting in chronic neurologic deficits. In addition to limb and trunk sensorimotor deficits, SCI can impair autonomic neurocircuitry such as the motor networks that support respiration and cough. High cervical SCI can cause complete respiratory paralysis, and even lower cervical or thoracic lesions commonly result in partial respiratory impairment. Although electrophrenic respiration can restore ventilator-independent breathing in select candidates, only a small subset of affected individuals can benefit from this technology at this moment...
September 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28895024/tuberculosis-meningitis
#14
REVIEW
Kassem Bourgi, Christina Fiske, Timothy R Sterling
PURPOSE OF REVIEW: As the most severe form of tuberculosis (TB), TB meningitis disproportionately affects developing countries and results in significant morbidity and mortality. In this report, we review recent updates in the epidemiology, diagnosis, and management of TB meningitis. RECENT FINDINGS: Young children and people living with HIV continue to be at highest risk for TB meningitis. Early diagnosis remains challenging, especially since conventional diagnostic tests have sub-optimal sensitivity and specificity...
September 11, 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28929294/neurologic-complications-of-infective-endocarditis-recent-findings
#15
REVIEW
Marie Cantier, Mikael Mazighi, Isabelle Klein, J P Desilles, Michel Wolff, J F Timsit, Romain Sonneville
PURPOSE OF REVIEW: The purpose of this paper is to provide recent insights in management of neurologic complications of left-sided infective endocarditis (IE). RECENT FINDINGS: Cerebral lesions observed in IE patients are thought to involve synergistic pathophysiological mechanisms including thromboembolism, sepsis, meningitis, and small-vessel cerebral vasculitis. Brain MRI represents a major tool for the detection of asymptomatic events occurring in the majority of patients...
September 19, 2017: Current Infectious Disease Reports
https://www.readbyqxmd.com/read/28816118/paroxysmal-sympathetic-hyperactivity-the-storm-after-acute-brain-injury
#16
REVIEW
Geert Meyfroidt, Ian J Baguley, David K Menon
A substantial minority of patients who survive an acquired brain injury develop a state of sympathetic hyperactivity that can persist for weeks or months, consisting of periodic episodes of increased heart rate and blood pressure, sweating, hyperthermia, and motor posturing, often in response to external stimuli. The unifying term for the syndrome-paroxysmal sympathetic hyperactivity (PSH)-and clear diagnostic criteria defined by expert consensus were only recently established. PSH has predominantly been described after traumatic brain injury (TBI), in which it is associated with worse outcomes...
September 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28743791/imaging-in-acute-ischaemic-stroke-pearls-and-pitfalls
#17
REVIEW
James Caldwell, Manraj K S Heran, Ben McGuinness, P Alan Barber
Prompt and accurate diagnosis is the foundation of acute ischaemic stroke care. Multiple positive endovascular thrombectomy trials in ischaemic stroke patients with large vessel occlusions have further emphasised this but also added complexity to treatment decisions. CT angiography is now routine for patients who present with an acute stroke syndrome around the world. Members of the neurology and stroke teams (rather than radiologists) are often the first doctors to lay eyes on the CT images and are best equipped to integrate the clinical picture with the imaging findings...
October 2017: Practical Neurology
https://www.readbyqxmd.com/read/26261769/brain-lung-crosstalk-implications-for-neurocritical-care-patients
#18
REVIEW
Ségolène Mrozek, Jean-Michel Constantin, Thomas Geeraerts
Major pulmonary disorders may occur after brain injuries as ventilator-associated pneumonia, acute respiratory distress syndrome or neurogenic pulmonary edema. They are key points for the management of brain-injured patients because respiratory failure and mechanical ventilation seem to be a risk factor for increased mortality, poor neurological outcome and longer intensive care unit or hospital length of stay. Brain and lung strongly interact via complex pathways from the brain to the lung but also from the lung to the brain...
August 4, 2015: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/26416129/intubation-of-the-neurologically-injured-patient
#19
REVIEW
Joshua Bucher, Alex Koyfman
BACKGROUND: Intubation of the neurologically injured patient is a critical procedure that must be done in a manner to prevent further neurologic injury. Although many different medications and techniques have been used to meet specific needs, there is little to no evidence to support many claims. OBJECTIVE: To review the literature regarding important topics relating to intubating patients with neurologic injury. DISCUSSION: Airway management requires ideal preoxygenation and airway maneuvers to minimize manipulation of the larynx and to maximize first-pass success...
December 2015: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/25385844/prognosis-of-patients-with-bilateral-fixed-dilated-pupils-secondary-to-traumatic-extradural-or-subdural-haematoma-who-undergo-surgery-a-systematic-review-and-meta-analysis
#20
REVIEW
John Scotter, Susan Hendrickson, Hani J Marcus, Mark H Wilson
PRIMARY OBJECTIVE: To review the prognosis of patients with bilateral fixed and dilated pupils secondary to traumatic extradural (epidural) or subdural haematoma who undergo surgery. METHODS: A systematic review and meta-analysis was performed using random effects models. The Cochrane Central Register of Controlled Trials and PubMed databases were searched to identify relevant publications. Eligible studies were publications that featured patients with bilateral fixed and dilated pupils who underwent surgical evacuation of traumatic extra-axial haematoma, and reported on the rate of favourable outcome (Glasgow Outcome Score 4 or 5)...
August 2015: Emergency Medicine Journal: EMJ
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