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REVIEW
Anis Ben Abdeljelil, Gabrielle C Freire, Natalie Yanchar, Alexis F Turgeon, Suzanne Beno, Melanie Bérubé, Antonia Stang, Thomas Stelfox, Roger Zemek, Emilie Beaulieu, Isabelle J Gagnon, Belinda Gabbe, Francois Lauzier, Melanie Labrosse, Pier-Alexandre Tardif, Theony Deshommes, Janyce Gnanvi, Lynne Moore
Traumatic brain injury (TBI) is the leading cause of death and disability in children. Many clinical practice guidelines (CPGs) have addressed pediatric TBI in the last decade but significant variability in the use of these guidelines persists. Here, we systematically review CPGs recommendations for pediatric moderate-to-severe TBI, evaluate the quality of CPGs, synthesize the quality of evidence and strength of included recommendations, and identify knowledge gaps. A systematic search was conducted in MEDLINE® , Embase, Cochrane CENTRAL, Web of Science, and Web sites of organizations publishing recommendations on pediatric injury care...
November 2023: Journal of Neurotrauma
#2
RANDOMIZED CONTROLLED TRIAL
Laure Peter-Derex, Frédéric Philippeau, Pierre Garnier, Nathalie André-Obadia, Sébastien Boulogne, Hélène Catenoix, Philippe Convers, Laure Mazzola, Michel Gouttard, Maud Esteban, Julia Fontaine, Laura Mechtouff, Elodie Ong, Tae-Hee Cho, Norbert Nighoghossian, Nathalie Perreton, Anne Termoz, Julie Haesebaert, Anne-Marie Schott, Muriel Rabilloud, Christine Pivot, Carole Dhelens, Andrea Filip, Yves Berthezène, Sylvain Rheims, Florent Boutitie, Laurent Derex
BACKGROUND: The incidence of early seizures (occurring within 7 days of stroke onset) after intracerebral haemorrhage reaches 30% when subclinical seizures are diagnosed by continuous EEG. Early seizures might be associated with haematoma expansion and worse neurological outcomes. Current guidelines do not recommend prophylactic antiseizure treatment in this setting. We aimed to assess whether prophylactic levetiracetam would reduce the risk of acute seizures in patients with intracerebral haemorrhage...
September 2022: Lancet Neurology
#3
JOURNAL ARTICLE
Sean K O'Brien, Jennifer L Koehl, Lindsay B Demers, Bryan D Hayes, Megan E Barra
BACKGROUND: Hyperosmolar therapy is the cornerstone of medical management of sustained elevated intracranial pressure from cerebral edema. Acute intracranial hypertension and herniation is a medical emergency that requires rapid treatment and stabilization to prevent secondary brain injury or death. Intravenous hypertonic sodium chloride (NaCl) 23.4% is an effective treatment modality commonly used in this setting. Because of its high osmolarity, use has historically been limited primarily to central venous line administration as an intermittent infusion due to concerns about thrombophlebitis, injection site pain, and tissue necrosis or injury with extravasation...
April 2023: Neurocritical Care
#4
JOURNAL ARTICLE
Zvonimir Vrselja, Stefano G Daniele, John Silbereis, Francesca Talpo, Yury M Morozov, André M M Sousa, Brian S Tanaka, Mario Skarica, Mihovil Pletikos, Navjot Kaur, Zhen W Zhuang, Zhao Liu, Rafeed Alkawadri, Albert J Sinusas, Stephen R Latham, Stephen G Waxman, Nenad Sestan
The brains of humans and other mammals are highly vulnerable to interruptions in blood flow and decreases in oxygen levels. Here we describe the restoration and maintenance of microcirculation and molecular and cellular functions of the intact pig brain under ex vivo normothermic conditions up to four hours post-mortem. We have developed an extracorporeal pulsatile-perfusion system and a haemoglobin-based, acellular, non-coagulative, echogenic, and cytoprotective perfusate that promotes recovery from anoxia, reduces reperfusion injury, prevents oedema, and metabolically supports the energy requirements of the brain...
April 2019: Nature
#5
REVIEW
Jo Ellen Wilson, Matthew F Mart, Colm Cunningham, Yahya Shehabi, Timothy D Girard, Alasdair M J MacLullich, Arjen J C Slooter, E Wesley Ely
Delirium, a syndrome characterized by an acute change in attention, awareness and cognition, is caused by a medical condition that cannot be better explained by a pre-existing neurocognitive disorder. Multiple predisposing factors (for example, pre-existing cognitive impairment) and precipitating factors (for example, urinary tract infection) for delirium have been described, with most patients having both types. Because multiple factors are implicated in the aetiology of delirium, there are likely several neurobiological processes that contribute to delirium pathogenesis, including neuroinflammation, brain vascular dysfunction, altered brain metabolism, neurotransmitter imbalance and impaired neuronal network connectivity...
November 12, 2020: Nature Reviews. Disease Primers
#6
REVIEW
William J Powers
New England Journal of Medicine, Volume 383, Issue 3, Page 252-260, July 2020.
July 16, 2020: New England Journal of Medicine
#7
JOURNAL ARTICLE
Gregory W J Hawryluk, Andres M Rubiano, Annette M Totten, Cindy O'Reilly, Jamie S Ullman, Susan L Bratton, Randall Chesnut, Odette A Harris, Niranjan Kissoon, Lori Shutter, Robert C Tasker, Monica S Vavilala, Jack Wilberger, David W Wright, Angela Lumba-Brown, Jamshid Ghajar
When the fourth edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury were finalized in late 2016, it was known that the results of the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) randomized controlled trial of decompressive craniectomy would be public after the guidelines were released. The guideline authors decided to proceed with publication but to update the decompressive craniectomy recommendations later in the spirit of "living guidelines," whereby topics are updated more frequently, and between new editions, when important new evidence is published...
September 1, 2020: Neurosurgery
#8
REVIEW
Michael S Phipps, Carolyn A Cronin
Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset...
February 13, 2020: BMJ: British Medical Journal
#9
REVIEW
Thomas A Gibson, Robert E Weiss, Benjamin C Sun
INTRODUCTION: We performed a systematic review and meta-analysis to identify predictors of serious clinical outcomes after an acute-care evaluation for syncope. METHODS: We identified studies that assessed for predictors of short-term (≤30 days) serious clinical events after an emergency department (ED) visit for syncope. We performed a MEDLINE search (January 1, 1990 - July 1, 2017) and reviewed reference lists of retrieved articles. The primary outcome was the occurrence of a serious clinical event (composite of mortality, arrhythmia, ischemic or structural heart disease, major bleed, or neurovascular event) within 30 days...
May 2018: Western Journal of Emergency Medicine
#10
JOURNAL ARTICLE
Jules Morgan
No abstract text is available yet for this article.
February 2020: Lancet Neurology
#11
REVIEW
Shehzad Khalid, R Shane Tubbs
We have reviewed here the neuroanatomical and neuropsychological literature of the human brain and have proposed the various pain mechanisms that we currently know of. Essentially when tissue is damaged, peripheral nociceptors are activated continuously and prostanoids are hence produced. Nonsteroidal anti-inflammatory drugs (NSAIDs) and medications aim to target these prostanoids to treat the inflammatory component of pain. Normal pain tends to have a protective response. It is important for the nervous system to learn and recognize this painful stimulus earlier and quicker with repeated exposure to avoid tissue damage...
October 6, 2017: Curēus
#12
REVIEW
William J Powers, Alejandro A Rabinstein, Teri Ackerson, Opeolu M Adeoye, Nicholas C Bambakidis, Kyra Becker, José Biller, Michael Brown, Bart M Demaerschalk, Brian Hoh, Edward C Jauch, Chelsea S Kidwell, Thabele M Leslie-Mazwi, Bruce Ovbiagele, Phillip A Scott, Kevin N Sheth, Andrew M Southerland, Deborah V Summers, David L Tirschwell
BACKGROUND AND PURPOSE: The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. METHODS: Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise...
March 2018: Stroke; a Journal of Cerebral Circulation
#13
REVIEW
Christopher R Carpenter, Adnan M Hussain, Michael J Ward, Gregory J Zipfel, Susan Fowler, Jesse M Pines, Marco L A Sivilotti
BACKGROUND: Spontaneous subarachnoid hemorrhage (SAH) is a rare, but serious etiology of headache. The diagnosis of SAH is especially challenging in alert, neurologically intact patients, as missed or delayed diagnosis can be catastrophic. OBJECTIVES: The objective was to perform a diagnostic accuracy systematic review and meta-analysis of history, physical examination, cerebrospinal fluid (CSF) tests, computed tomography (CT), and clinical decision rules for spontaneous SAH...
September 2016: Academic Emergency Medicine
#14
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
#15
REVIEW
Rafael Yuste
For over a century, the neuron doctrine--which states that the neuron is the structural and functional unit of the nervous system--has provided a conceptual foundation for neuroscience. This viewpoint reflects its origins in a time when the use of single-neuron anatomical and physiological techniques was prominent. However, newer multineuronal recording methods have revealed that ensembles of neurons, rather than individual cells, can form physiological units and generate emergent functional properties and states...
August 2015: Nature Reviews. Neuroscience
#16
MULTICENTER STUDY
David Sayer, Ben Bloom, Katalin Fernando, Stuart Jones, Sally Benton, Shumontha Dev, Sathish Deverapalli, Tim Harris
OBJECTIVES: The objective was to determine the incidence of subarachnoid hemorrhage (SAH) diagnosed by lumbar puncture (LP) when the head computed tomography (CT) was reported as demonstrating no subarachnoid blood. METHODS: Data were obtained on patients who received LP to diagnose or exclude SAH attending six hospitals over 5 years. Subsequent investigations and outcomes were reviewed in all patients with LPs that did not exclude SAH. RESULTS: A total of 2,248 patients were included...
November 2015: Academic Emergency Medicine
#17
REVIEW
Daniel Agustin Godoy, Gustavo Rene Piñero, Patricia Koller, Luca Masotti, Mario Di Napoli
Spontaneous intracerebral hemorrhage is a type of stroke associated with poor outcomes. Mortality is elevated, especially in the acute phase. From a pathophysiological point of view the bleeding must traverse different stages dominated by the possibility of re-bleeding, edema, intracranial hypertension, inflammation and neurotoxicity due to blood degradation products, mainly hemoglobin and thrombin. Neurological deterioration and death are common in early hours, so it is a true neurological-neurosurgical emergency...
August 4, 2015: World Journal of Critical Care Medicine
#18
Tariq K Halasa, Rami James N Aoun, Mithun G Sattur, Bernard R Bendok
No abstract text is available yet for this article.
October 2015: Neurosurgery
#19
REVIEW
John P Betjemann, Daniel H Lowenstein
Status epilepticus is a common neurological emergency with considerable associated health-care costs, morbidity, and mortality. The definition of status epilepticus as a prolonged seizure or a series of seizures with incomplete return to baseline is under reconsideration in an effort to establish a more practical definition to guide management. Clinical research has focused on early seizure termination in the prehospital setting. The approach of early escalation to anaesthetic agents for refractory generalised convulsive status epilepticus, rather than additional trials of second-line anti-epileptic drugs, to avoid neuronal injury and pharmaco-resistance associated with prolonged seizures is gaining momentum...
June 2015: Lancet Neurology
#20
RANDOMIZED CONTROLLED TRIAL
Olvert A Berkhemer, Puck S S Fransen, Debbie Beumer, Lucie A van den Berg, Hester F Lingsma, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke J H Wermer, Marianne A A van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A van Oostayen, Geert J Lycklama à Nijeholt, Jelis Boiten, Patrick A Brouwer, Bart J Emmer, Sebastiaan F de Bruijn, Lukas C van Dijk, L Jaap Kappelle, Rob H Lo, Ewoud J van Dijk, Joost de Vries, Paul L M de Kort, Willem Jan J van Rooij, Jan S P van den Berg, Boudewijn A A M van Hasselt, Leo A M Aerden, René J Dallinga, Marieke C Visser, Joseph C J Bot, Patrick C Vroomen, Omid Eshghi, Tobien H C M L Schreuder, Roel J J Heijboer, Koos Keizer, Alexander V Tielbeek, Heleen M den Hertog, Dick G Gerrits, Renske M van den Berg-Vos, Giorgos B Karas, Ewout W Steyerberg, H Zwenneke Flach, Henk A Marquering, Marieke E S Sprengers, Sjoerd F M Jenniskens, Ludo F M Beenen, René van den Berg, Peter J Koudstaal, Wim H van Zwam, Yvo B W E M Roos, Aad van der Lugt, Robert J van Oostenbrugge, Charles B L M Majoie, Diederik W J Dippel
BACKGROUND: In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a beneficial effect on functional outcome is lacking. METHODS: We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset...
January 1, 2015: New England Journal of Medicine
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