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Neurocritical Care

Eelco F M Wijdicks
Gastrointestinal complications, including hemorrhage, can occur with intracranial lesions and after craniotomy. As early as the 19th century, surgeons were aware that brain tumors could cause gastric ulcers and acute perforations. Investigators used animal experiments both to reproduce these clinical observations and to seek ways to block the effects. Gastrointestinal lesions were seen as a result of the stress of acute brain injury or as a direct consequence of brain surgery. The thinking at the time was markedly influenced by the presumed stress and psychic factors proposed by Cannon...
February 15, 2019: Neurocritical Care
Eelco F M Wijdicks
The origin of secondary brainstem hemorrhages following an acute expansive hemispheric lesion has been attributed to Henri Duret, who proposed that hemorrhaging was caused by a shock wave through the cerebral spinal fluid. However, other experiments have shown important findings correlating brainstem hemorrhages to arterial hemorrhages. Animal studies found that the rapidity of expansion of a lesion would be crucial in producing these lesions, but there was no consistent correlation with paratentorial grooving so commonly seen with increased intracranial pressure...
February 15, 2019: Neurocritical Care
Tarmo Niini, Aki Laakso, Päivi Tanskanen, Mika Niemelä, Teemu Luostarinen
OBJECTIVE: We reviewed retrospectively the perioperative treatment of microsurgically resected brain arteriovenous malformations (bAVMs) at the neurosurgical department of Helsinki University Hospital between the years 2006 and 2014. We examined the performance of the treatment protocol and the incidence of delayed postoperative hemorrhage (DPH). METHODS: The Helsinki protocol for postoperative treatment of bAVMs was used for the whole patient cohort of 121. The patients who had subsequent DPH were reviewed in more detail...
February 14, 2019: Neurocritical Care
Eelco F M Wijdicks
We now recognize that the main breathing generator resides principally in the medulla oblongata. Vivisectionists-specifically, Julien Legallois-discovered "the respiratory center." Cutting through the brainstem stops respiration but not if the medulla remains intact and the brain is sliced in successive portions. Pierre Flourens localized surgical ablation experiments further identified a 1-mm area in the medulla, which he called vital knot or node (noeud vital). Detailed characterization had to wait until the 1920s, when Lumsden carried out more specific transection experiments to improve morphological differentiation of the respiratory center into inspiratory and expiratory divisions...
February 14, 2019: Neurocritical Care
Marloes Witjes, P Edwin Vorstius Kruijff, Bernadette J J M Haase-Kromwijk, Johannes G van der Hoeven, Nichon E Jansen, Wilson F Abdo
BACKGROUND: The aim of this nationwide observational study is to identify modifiable factors in communication about organ donation that influence family consent rates. METHODS: Thirty-two intensivists specialized in organ donation systematically evaluated all consecutive organ donation requests with physicians in the Netherlands between January 2013 and June 2016, using a standardized questionnaire. RESULTS: Out of 2528 consecutive donation requests, 2095 (83%) were evaluated with physicians...
February 14, 2019: Neurocritical Care
Dionne E Swor, Leena F Thomas, Matthew B Maas, Daniela Grimaldi, Edward M Manno, Farzaneh A Sorond, Ayush Batra, Minjee Kim, Shyam Prabhakaran, Andrew M Naidech, Eric M Liotta
BACKGROUND: Fever is associated with worse outcome after intracerebral hemorrhage (ICH). Autonomic dysfunction, commonly seen after brain injury, results in reduced heart rate variability (HRV). We sought to investigate whether HRV was associated with the development of fever in patients with ICH. METHODS: We prospectively enrolled consecutive patients with spontaneous ICH in a single-center observational study. We included patients who presented directly to our emergency department after symptom onset, had a 10-second electrocardiogram (EKG) performed within 24 h of admission, and were in sinus rhythm...
February 12, 2019: Neurocritical Care
Han-Tao Li, Chih-Hong Lee, Tony Wu, Mei-Yun Cheng, Wei-En Johnny Tseng, Chun-Wei Chang, Hsiang-Yao Hsieh, Hsing-I Chiang, Chih-Yin Lin, Bao-Luen Chang, Wey-Ran Lin, Siew-Na Lim
BACKGROUND: The incidence of cefepime-induced neurotoxicity (CIN) has been previously underestimated, and there have only been sporadic reports from critical neurological settings. The present study aimed to investigate the potential factors associated with disease development, electroencephalography (EEG) sub-classification, and outcome measures. METHODS: The 10-year medical records of patients who underwent EEG between 2007 and 2016 at a tertiary medical center in Taiwan, and developed encephalopathy after cefepime therapy were retrospectively reviewed...
February 12, 2019: Neurocritical Care
David Roh, Chung-Huan Sun, Santosh Murthy, Mitchell S V Elkind, Samuel S Bruce, Kara Melmed, Natasha Ironside, Amelia Boehme, Kevin Doyle, Daniel Woo, Hooman Kamel, Soojin Park, Sachin Agarwal, E Sander Connolly, Jan Claassen
BACKGROUND: Hematoma expansion (HE) after intracerebral hemorrhage (ICH) is associated with worse outcome. Lobar ICHs are known to have better outcomes compared to deep ICH; however, it is unclear whether there are HE differences between these locations. We sought to investigate the hypothesis that lobar ICH has less HE compared to deep ICH. METHODS: Primary ICH patients admitted between 2009 and 2016 were included in a prospective single-center ICH cohort study...
February 12, 2019: Neurocritical Care
Venkatakrishna Rajajee, Craig A Williamson, Robert J Fontana, Anthony J Courey, Parag G Patil
No abstract text is available yet for this article.
February 12, 2019: Neurocritical Care
Maddalena De Bernardo, Livio Vitiello, Nicola Rosa
No abstract text is available yet for this article.
February 7, 2019: Neurocritical Care
Daniel Garbin Di Luca, Nathaniel J Mohney, Mohan Kottapally
No abstract text is available yet for this article.
February 6, 2019: Neurocritical Care
Martin Kieninger, Michael Gruber, Isabella Knott, Katja Dettmer, Peter J Oefner, Sylvia Bele, Christina Wendl, Simon Tuemmler, Bernhard Graf, Christoph Eissnert
BACKGROUND: Oral nimodipine is used for prophylaxis and treatment of delayed cerebral ischemia in patients with aneurysmal or perimesencephalic subarachnoid hemorrhage (SAH). In cases of serious refractory cerebral vasospasm, a continuous intra-arterial (IA) infusion of nimodipine (CIAN) may be required to avoid cerebral ischemia. Nimodipine can cause arterial hypotension requiring either a dosage reduction or its discontinuation. Aim of the present study was to examine the effect of different nimodipine formulations on arterial blood pressure in aneurysmal or perimesencephalic SAH patients and to measure the plasma levels after both, peroral administration as tablet or solution and IA infusion...
February 6, 2019: Neurocritical Care
David Roh, Tiffany Chang, Christopher Zammit, Gebhard Wagener, Alexandra S Reynolds, Nina Yoh, Mitchell S V Elkind, Kevin Doyle, Amelia Boehme, Andrew Eisenberger, Richard O Francis, Soojin Park, Sachin Agarwal, E Sander Connolly, Jan Claassen, Eldad Hod
BACKGROUND: Lobar intracerebral hemorrhage (ICH) is known to have better clinical outcomes and preliminary evidence of less hematoma expansion compared to deep ICH. No functional coagulation differences between lobar and deep ICH have been identified using traditional plasma-based coagulation tests. We investigated for coagulation differences between lobar and deep ICH using whole-blood coagulation testing (Rotational Thromboelastometry: [ROTEM]). METHODS: Clinical, radiographic, and laboratory data were prospectively collected for primary ICH patients enrolled in a single-center ICH study...
January 28, 2019: Neurocritical Care
Małgorzata M Miller, Jessica Lowe, Muhib Khan, Muhammad U Azeem, Susanne Muehlschlegel, Adalia H Jun-O'Connell, Richard P Goddeau, Majaz Moonis, Danielle Gritters, Brian Silver, Nils Henninger
BACKGROUND/OBJECTIVE: Recent studies indicated that functional outcome after intracranial hemorrhage (ICH) related to direct oral anticoagulation (DOAC-ICH) is similar, if not better, than vitamin K antagonist (VKA)-related ICH (VKA-ICH) due to a smaller initial hematoma volume (HV). However, the association with hematoma expansion (HE) and location is not well understood. METHODS: We retrospectively analyzed 102 consecutive patients with acute non-traumatic ICH on oral anticoagulation therapy to determine HV and HE stratified by hematoma location, and the relation to the 90-day outcome...
January 28, 2019: Neurocritical Care
Isabel Fragata, Alejandro Bustamante, Anna Penalba, Patrícia Ferreira, Ana Paiva Nunes, Patrícia Canhão, Joan Montaner
BACKGROUND: There is increasing evidence for the role of inflammation in clinical outcome after subarachnoid hemorrhage (SAH). Specifically, the TNF-alfa(α) pathway seems to be relevant after SAH. Although the TNF-α main receptor, TNF-R1 is associated with aneurysm growth and rupture, its relation to prognosis is unknown. We sought to compare TNF-R1 levels in peripheral venous blood and arterial blood closer to the ruptured aneurysm to study the association of TNF-R1 blood levels with poor prognosis (modified Rankin Scale  > 2 at discharge, 3 and 6 months) and complications (hydrocephalus or delayed cerebral ischemia/DCI) following SAH...
January 23, 2019: Neurocritical Care
Fumiaki Oka, David Y Chung, Michiyasu Suzuki, Cenk Ayata
BACKGROUND: Delayed cerebral ischemia (DCI) is among the most dreaded complications following aneurysmal subarachnoid hemorrhage (SAH). Despite advances in neurocritical care, DCI remains a significant cause of morbidity and mortality, prolonged intensive care unit and hospital stay, and high healthcare costs. Large artery vasospasm has classically been thought to lead to DCI. However, recent failure of clinical trials targeting vasospasm to improve outcomes has underscored the disconnect between large artery vasospasm and DCI...
January 22, 2019: Neurocritical Care
Silvia Schönenberger, Dorothea Weber, Matthias N Ungerer, Johannes Pfaff, Simon Schieber, Lorenz Uhlmann, Pia Heidenreich, Martin Bendszus, Meinhard Kieser, Wolfgang Wick, Markus A Möhlenbruch, Peter A Ringleb, Julian Bösel
BACKGROUND AND PURPOSE: Although the treatment window for mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) has been extended in recent years, it has been proven that recanalizing treatment must be administered as soon as possible. We present a new standard operating procedure (SOP) to reduce in-house delay, standardize periinterventional management and improve patient safety during MT. METHODS: KEep Evaluating Protocol Simplification In Managing Periinterventional Light Sedation for Endovascular Stroke Treatment (KEEP SIMPLEST) was a prospective, single-center observational study aimed to compare aspects of periinterventional management in AIS patients treated according to our new SOP using a combination of esketamine and propofol with patients having been randomized into conscious sedation (CS) in the Sedation versus Intubation for Endovascular Stroke TreAtment (SIESTA) trial...
January 18, 2019: Neurocritical Care
Bethany Young, Megan Moyer, William Pino, David Kung, Eric Zager, Monisha A Kumar
BACKGROUND/OBJECTIVE: In November 2014, our Neurointensive Care Unit began a multi-phased progressive early mobilization initiative for patients with subarachnoid hemorrhage and an external ventricular drain (EVD). Our goal was to transition from a culture of complete bed rest (Phase 0) to a physical and occupational therapy (PT/OT)-guided mobilization protocol (Phase I), and ultimately to a nurse-driven mobilization protocol (Phase II). We hypothesized that nurses could mobilize patients as safely as an exclusively PT/OT-guided approach...
January 18, 2019: Neurocritical Care
Charlene Ong
No abstract text is available yet for this article.
January 14, 2019: Neurocritical Care
Sung-Min Cho, Nader Moazami, Stuart Katz, Adarsh Bhimraj, Nabin K Shrestha, Jennifer A Frontera
BACKGROUND: Infection has been associated with stroke in patients with left ventricular assist devices (LVAD); however, little data exist on the timing, type and mortality impact of infection-related stroke. METHODS: Prospectively collected data of HeartMate II (N = 332) and HeartWare (N = 70) LVAD patients from a single center were reviewed. Only strokes (ischemic or hemorrhagic) that occurred within 6 weeks following a LVAD infection were considered in analyses...
January 14, 2019: Neurocritical Care
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