Scoping Review and Commentary on Prognostication for Patients with Intracerebral Hemorrhage with Advances in Surgical Techniques
ConclusionWe provide the most comprehensive review to date of prognostic grading scales for patients with intracerebral hemorrhage. Current prognostic tools for patients with intracerebral hemorrhage remain limited and may overestimate risk of a poor outcome. As minimally invasive surgical techniques are developed, prognostic scales should account for surgical candidacy and outcomes. (Source: Neurocritical Care)
Source: Neurocritical Care - April 8, 2020 Category: Neurology Source Type: research

Early Initiation of Oral Antihypertensives Reduces Intensive Care Unit Stay and Hospital Cost for Patients with Hypertensive Intracerebral Hemorrhage
This study aimed to examine the effect of early versus late initiation of oral antihypertensives on ICU length of stay (LOS) and cost of hospitalization in patients with hypertensive intracerebral hemorrhage (ICH).MethodsThis is a single-center retrospective study of patients with hypertensive ICH treated with nicardipine infusion from January 1, 2013, to December 31, 2017. Patients were dichotomized into study and control groups, based on receiving oral antihypertensives within 24  h versus after 24 h of emergency department arrival. Baseline characteristics, duration of nicardipine infusion, LOS in the ICU and ...
Source: Neurocritical Care - April 6, 2020 Category: Neurology Source Type: research

The PET Sandwich: Using Serial FDG-PET Scans with Interval Burst Suppression to Assess Ictal Components of Disease
ConclusionsIn appropriately selected patients, FDG-PET scans while in burst suppression may help dissect the underlying pathophysiologic cause of IIC findings observed on EEG and guide tailored therapy. (Source: Neurocritical Care)
Source: Neurocritical Care - April 6, 2020 Category: Neurology Source Type: research

Neuromonitoring: No Longer a Spectator Sport
(Source: Neurocritical Care)
Source: Neurocritical Care - April 6, 2020 Category: Neurology Source Type: research

Genetic Variability in the Iron Homeostasis Pathway and Patient Outcomes After Aneurysmal Subarachnoid Hemorrhage
ConclusionsAmong the genes examined, our findings support a role forCP andCUBN in patient outcomes after aSAH. In an effort to translate these findings into clinical utility and improve outcomes after aSAH, additional research is needed to examine the functional roles of these genes after aSAH. (Source: Neurocritical Care)
Source: Neurocritical Care - April 3, 2020 Category: Neurology Source Type: research

Relations Between Early Neuromuscular Alterations, Gastrointestinal Dysfunction, and Clinical Nutrition in Critically Ill Patients: An Exploratory Single-center Cohort Study
(Source: Neurocritical Care)
Source: Neurocritical Care - April 3, 2020 Category: Neurology Source Type: research

Burden of Epileptiform Activity Predicts Discharge Neurologic Outcomes in Severe Acute Ischemic Stroke
ConclusionsElectrographic seizures and periodic and rhythmic patterns in patients with AIS are associated with worse outcomes in a dose-dependent manner. Future studies are needed to assess whether treatment of this EEG activity can improve outcomes. (Source: Neurocritical Care)
Source: Neurocritical Care - April 3, 2020 Category: Neurology Source Type: research

What is the Role of Continuous Electroencephalography in Acute Ischemic Stroke and the Relevance of the “Ictal-Interictal Continuum”?
(Source: Neurocritical Care)
Source: Neurocritical Care - April 3, 2020 Category: Neurology Source Type: research

MeningiSSS: A New Predictive Score to Support Decision on Invasive Procedures to Monitor or Manage the Intracerebral Pressure in Children with Bacterial Meningitis
In this study, we aimed to develop a new predictive score for children with bacterial meningitis and compare this with existing predictive scores and individual risk factors.MethodsWe developed the Meningitis Swedish Survival Score (MeningiSSS) based on a previous systematic review of risk factors. From this, we selected risk factors identified in moderate-to-high-quality studies that could be assessed at admission to the hospital. Using data acquired from medical records of 101 children with bacterial meningitis, we tested the overall capabilities of the MeningiSSS compared with four existing predictive scores using a rec...
Source: Neurocritical Care - March 19, 2020 Category: Neurology Source Type: research

A Pilot Study of Pharyngeal Electrical Stimulation for Orally Intubated ICU Patients with Dysphagia
ConclusionAlthough limited by its small size and non-blinded design, this is the first study demonstrating the benefits of PES in ICU patients still orally intubated, thus offering a potential new method to reduce morbidity, mortality, and economic burden in a mixed ICU population. In order to further investigate and strengthen our findings, a statistically powered, randomized controlled study is recommended. (Source: Neurocritical Care)
Source: Neurocritical Care - March 19, 2020 Category: Neurology Source Type: research

What is the Role of Hyperosmolar Therapy in Hemispheric Stroke Patients?
AbstractThe role of hyperosmolar therapy (HT) in large hemispheric ischemic or hemorrhagic strokes remains a controversial issue. Past and current stroke guidelines state that it represents a reasonable therapeutic measure for patients with either neurological deterioration or intracranial pressure (ICP) elevations documented by ICP monitoring. However, the lack of evidence for a clear effect of this therapy on radiological tissue shifts and clinical outcomes produces uncertainty with respect to the appropriateness of its implementation and duration in the context of radiological mass effect without clinical correlates of ...
Source: Neurocritical Care - March 19, 2020 Category: Neurology Source Type: research

Intervascular Line Infections: Can We Prevent Them? Bring on the Team!
(Source: Neurocritical Care)
Source: Neurocritical Care - March 19, 2020 Category: Neurology Source Type: research

Another Pitfall in Brain Death Diagnosis: Return of Cerebral Function After Determination of Brain Death by Both Clinical and Radionuclide Cerebral Perfusion Imaging
(Source: Neurocritical Care)
Source: Neurocritical Care - March 10, 2020 Category: Neurology Source Type: research

Serum Glial Fibrillary Acidic Protein in Acute Stroke
(Source: Neurocritical Care)
Source: Neurocritical Care - March 5, 2020 Category: Neurology Source Type: research

Intracranial Pressure Threshold Heuristics in Traumatic Brain Injury: One, None, Many!
(Source: Neurocritical Care)
Source: Neurocritical Care - March 5, 2020 Category: Neurology Source Type: research

“Take a Number”—Precision Monitoring Directs Precision Therapy
(Source: Neurocritical Care)
Source: Neurocritical Care - March 5, 2020 Category: Neurology Source Type: research

Electroencephalogram Changes During Cheyne –Stokes Respiration in Acutely Ill Hospitalized Patients
(Source: Neurocritical Care)
Source: Neurocritical Care - February 28, 2020 Category: Neurology Source Type: research

Validation of the 2HELPS2B Seizure Risk Score in Acute Brain Injury Patients
In this study, we aim to validate the 2HELPS2B score in ABI and determine its relative predictive accuracy compared to a broader set of clinical and electrographic factors.MethodsWe queried the Critical Care EEG Monitoring Research Consortium database for ABI patients age ≥ 18 with >  6 h of continuous EEG monitoring; data were collected between February 2013 and November 2018. The primary outcome was electrographic seizure. Clinical factors considered were age, coma, encephalopathy, ABI subtype, and acute suspected or confirmed pre-EEG clinical seizure. Electrographic factor s included 18 E...
Source: Neurocritical Care - February 27, 2020 Category: Neurology Source Type: research

Effect of Locally Delivered Nimodipine Microparticles on Spreading Depolarization in Aneurysmal Subarachnoid Hemorrhage
ConclusionsThese results are consistent with a beneficial effect of locally delivered nimodipine (EG-1962) on SD after aSAH in more severely injured patients who are at risk of delayed cerebral ischemia related to SD. Larger studies are warranted to test this effect. (Source: Neurocritical Care)
Source: Neurocritical Care - February 26, 2020 Category: Neurology Source Type: research

Burst Suppression: Causes and Effects on Mortality in Critical Illness
ConclusionsOur analysis clarifies how important factors contribute to mortality in ICU patients. Burst suppression appears to contribute to mortality but is primarily an effect of critical illness rather than iatrogenic use of propofol. (Source: Neurocritical Care)
Source: Neurocritical Care - February 24, 2020 Category: Neurology Source Type: research

Diagnostic Accuracy of Glial Fibrillary Acidic Protein and Ubiquitin Carboxy - Terminal Hydrolase - L1 Serum Concentrations for Differentiating Acute Intracerebral Hemorrhage from Ischemic Stroke
AbstractBackgroundBiomarkers indicative of intracerebral hemorrhage (ICH) may help triage acute stroke patients in the pre-hospital phase. We hypothesized that serum concentration of glial fibrillary acidic protein (GFAP) in combination with ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), measured by a rapid bio-assay, could be used to distinguish ICH from ischemic stroke.MethodsThis prospective two-center study recruited patients with a clinical diagnosis of acute stroke both in the pre-hospital phase and at hospital admission (within 4 and 6  h after symptom onset, respectively). Blood samples were analyzed for co...
Source: Neurocritical Care - February 24, 2020 Category: Neurology Source Type: research

Neurological Pupil Index as an Indicator of Neurological Worsening in Large Hemispheric Strokes
In this study, we investigated whether quantitative pupillary response could help identify the neurological worsening due to brain swelling in patients with large hemispheric strokes.MethodsQuantitative pupillary assessment using an automated pupillometer (NPi-100) was performed between April 2017 and August 2019 for patients suffering large hemispheric strokes. Consecutive pupillary responses were measured every 2 or 4  h as a part of routine clinical care. We compared the mean neurological pupil index (NPi) values, NPi value at the time of neurological deterioration, and percentage change in NPi from the immediate p...
Source: Neurocritical Care - February 24, 2020 Category: Neurology Source Type: research

Are Direct Anticoagulants Safer in Traumatic Brain Injury Compared to Warfarin?
(Source: Neurocritical Care)
Source: Neurocritical Care - February 24, 2020 Category: Neurology Source Type: research

The Influence of Diffusion Weighted Imaging Lesions on Outcomes in Patients with Acute Spontaneous Intracerebral Hemorrhage
AbstractBackground/ObjectiveDiffusion weighted imaging (DWI) lesions have been well described in patients with acute spontaneous intracerebral hemorrhage (sICH). However, there are limited data on the influence of these lesions on sICH functional outcomes. We conducted a prospective observational cohort study with blinded imaging and outcomes assessment to determine the influence of DWI lesions on long-term outcomes in patients with acute sICH. We hypothesized that DWI lesions are associated with worse modified Rankin Scale (mRS) at 3  months after hospital discharge.MethodsConsecutive sICH patients meeting study crit...
Source: Neurocritical Care - February 18, 2020 Category: Neurology Source Type: research

Improving Prediction of Favourable Outcome After 6  Months in Patients with Severe Traumatic Brain Injury Using Physiological Cerebral Parameters in a Multivariable Logistic Regression Model
ConclusionsCurrent TBI outcome prediction models can be improved by the addition of neuromonitoring bedside parameters measured continuously within the first 24  h after the start of neuromonitoring. As these factors might be modifiable by treatment during the admission, testing in a larger (multicenter) data set is warranted. (Source: Neurocritical Care)
Source: Neurocritical Care - February 13, 2020 Category: Neurology Source Type: research

Hyperchloremia, not Concomitant Hypernatremia, Independently Predicts Early Mortality in Critically Ill Moderate –Severe Traumatic Brain Injury Patients
ConclusionsWhen concomitantly adjusting for the burden of hyperchloremia and hypernatremia, only hyperchloremia was independently associated with in-hospital mortality in our msTBI cohort. Pending validation, our findings may provide the rationale for future studies with targeted interventions to reduce hyperchloremia and improve outcomes in msTBI patients. (Source: Neurocritical Care)
Source: Neurocritical Care - February 10, 2020 Category: Neurology Source Type: research

A Perspective from the Neurocritical Care Society and the Society of Critical Care Medicine: Team-Based Care for Neurological Critical Illness
AbstractThe Neurocritical Care Society and the Society of Critical Care Medicine have worked together to create a perspective regarding theStandards of Neurologic Critical Care Units (Moheet et al. in Neurocrit Care 29:145 –160, 2018). The most neurologically ill or injured patients warrant the highest standard of care available; this supports the need for defining and establishing specialized neurological critical care units. Rather than interpreting the Standards as being exclusionary, it is most appropriate to em brace them in the setting of team-based care. Since there are many more patients than there are highly...
Source: Neurocritical Care - February 10, 2020 Category: Neurology Source Type: research

Association Between Perihematomal Perfusion and Intracerebral Hemorrhage Outcome
AbstractBackgroundThe prognostic impact of perihematomal hypoperfusion in patients with acute intracerebral hemorrhage (ICH) remains unclear. We tested the hypothesis that perihematomal hypoperfusion predicts poor ICH outcome and explored whether hematoma growth (HG) is the pathophysiological mechanism behind this association.MethodsA prospectively collected single-center cohort of consecutive ICH patients undergoing computed tomography perfusion on admission was analyzed. Cerebral blood flow (pCBF) was measured in the manually outlined perihematomal low-density area. pCBF was categorized into normal (40 –55 mL/...
Source: Neurocritical Care - February 10, 2020 Category: Neurology Source Type: research

Through the Eyes of Monkeys: Questions About Uncal Herniation
(Source: Neurocritical Care)
Source: Neurocritical Care - February 10, 2020 Category: Neurology Source Type: research

Lost in Translational Neurology: From Anemic Decerebration to Anoxic-Ischemic Brain Injury
(Source: Neurocritical Care)
Source: Neurocritical Care - February 10, 2020 Category: Neurology Source Type: research

Comparison of Traumatic Intracranial Hemorrhage Expansion and Outcomes Among Patients on Direct Oral Anticoagulants Versus Vitamin k Antagonists
ConclusionsWe report anticoagulation-associated tICH outcomes predominantly due to fall-related subdural hematomas. Patients on DOACs had lower tICH expansion rates although not statistically significantly different from VKA-treated patients. DOAC-treated patients had favorable outcomes versus VKA group following tICH despite low use of reversal strategies. DOAC use may be a safer alternative to VKA in patients at risk of traumatic brain hemorrhage. (Source: Neurocritical Care)
Source: Neurocritical Care - February 7, 2020 Category: Neurology Source Type: research

Diagnostic Value of Electroencephalography with Ten Electrodes in Critically Ill Patients
ConclusionsReduced EEG with ten electrodes in circumferential configuration preserves key features of the traditional EEG system. Discrepancies between rm-EEG and fm-EEG as reported in some of the past studies can be in part due to methodological factors such as choice of gold standard diagnosis, asymmetric access to ancillary clinical information, and inter-rater variability rather than detection failure of rm-EEG as a result of electrode reduction per se. (Source: Neurocritical Care)
Source: Neurocritical Care - February 7, 2020 Category: Neurology Source Type: research

Outcomes of Acute Stroke Patients Requiring Mechanical Ventilation: Study Protocol for the SPICE Multicenter Prospective Observational Study
ConclusionsThe SPICE multicenter study will investigate 1-year outcomes, ethical issues, as well as care pathways of acute stroke patients requiring invasive ventilation in the ICU. Gathered data will delineate human resources and facilities needs for adequate management. The identification of prognostic factors at the acute phase will help to identify patients who may benefit from prolonged intensive care and rehabilitation.Trial registration: NCT03335995. (Source: Neurocritical Care)
Source: Neurocritical Care - February 5, 2020 Category: Neurology Source Type: research

Relationship of White Matter Lesions with Intracerebral Hemorrhage Expansion and Functional Outcome: MISTIE II and CLEAR III
AbstractBackground/ObjectiveIntracerebral hemorrhage (ICH) patients commonly have concomitant white matter lesions (WML) which may be associated with poor outcome. We studied if WML affects hematoma expansion (HE) and post-stroke functional outcome in a post hoc analysis of patients from randomized controlled trials.MethodsIn ICH patients from the clinical trials MISTIE II and CLEAR III, WML grade on diagnostic computed tomography (dCT) scan (dCT,  33% or>  6 mL ICH volume increase from dCT to the last pre-randomization CT (  10.4 mL total clot volume increase, and a subgroup analysis incl...
Source: Neurocritical Care - February 5, 2020 Category: Neurology Source Type: research

Incidence, Risk Factors, and Outcomes of Ventilator-Associated Pneumonia in Traumatic Brain Injury: A Meta-analysis
This study estimates the incidence, risk factors, and outcomes of VAP in patients with TBI and provides evidence for prevention and treatment. PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched from the earliest records to May 2018. Data involving the incidence, risk factors, and outcomes were extracted for meta-analysis. The results showed that the incidence of VAP was 36% (95% confidence interval (CI) 31 –41%); risk factors analyses showed that smoking [odds ratio (OR) 2.13; 95% CI 1.16–3.92], tracheostomy (OR 9.55; 95% CI 3.24–28.17), blood transfusion on admission (OR 2.54; 9...
Source: Neurocritical Care - February 1, 2020 Category: Neurology Source Type: research

Predicting Malignant Cerebral Edema After Large Hemispheric Stroke
(Source: Neurocritical Care)
Source: Neurocritical Care - February 1, 2020 Category: Neurology Source Type: research

Autonomic Dysfunction in Guillain –Barré Syndrome Puts Patients at Risk
(Source: Neurocritical Care)
Source: Neurocritical Care - February 1, 2020 Category: Neurology Source Type: research

Safety and Tolerability of Rapid Administration Undiluted Levetiracetam
ConclusionsRapid administration of undiluted LEV doses  ≤ 1000 mg were well tolerated with no concentration-related side effects. Further prospective research is needed to confirm this observation as well as the safety of higher doses. (Source: Neurocritical Care)
Source: Neurocritical Care - February 1, 2020 Category: Neurology Source Type: research

Transcranial Doppler Monitoring of Dialysis Disequilibrium in an ESRD Patient with Traumatic Brain Injury
(Source: Neurocritical Care)
Source: Neurocritical Care - February 1, 2020 Category: Neurology Source Type: research

Neurocritical Care: A Growing International Collaborative
(Source: Neurocritical Care)
Source: Neurocritical Care - February 1, 2020 Category: Neurology Source Type: research

Multiple Brain Abscesses Due to Odontogenic Infection
(Source: Neurocritical Care)
Source: Neurocritical Care - January 31, 2020 Category: Neurology Source Type: research

The Impact of Resilience Factors and Anxiety During Hospital Admission on Longitudinal Anxiety Among Dyads of Neurocritical Care Patients Without Major Cognitive Impairment and Their Family Caregivers
AbstractBackground/ObjectiveAnxiety is common in patients experiencing neurocritical illness and their family caregivers. Resilience factors like mindfulness and coping skills may be protective against symptoms of emotional distress, including anxiety. Less is known about the interplay of anxiety symptoms and resilience factors between patients and caregivers. The purpose of this study is to examine the trajectory of anxiety symptoms among dyads of neurocritical care patients without major cognitive impairment and their family caregivers and to elucidate the relationship between resiliency (e.g., mindfulness and coping) an...
Source: Neurocritical Care - January 29, 2020 Category: Neurology Source Type: research

Beta-Blockade in Aneurysmal Subarachnoid Hemorrhage: a Systematic Review and Meta-Analysis
ConclusionsIn adult patients with aSAH, beta-blocker therapy is associated with a mortality benefit. Studies are generally of a low quality with considerable clinical heterogeneity. Prospective large interventional trials with patient centered outcomes are required to validate this finding. (Source: Neurocritical Care)
Source: Neurocritical Care - January 28, 2020 Category: Neurology Source Type: research

The Clinicians Who Recognized Meningitis
(Source: Neurocritical Care)
Source: Neurocritical Care - January 28, 2020 Category: Neurology Source Type: research

Suspended (but No Animation) White ’s Isolated Brain Experiments
(Source: Neurocritical Care)
Source: Neurocritical Care - January 27, 2020 Category: Neurology Source Type: research

Brain Storming in Brain Trauma
(Source: Neurocritical Care)
Source: Neurocritical Care - January 24, 2020 Category: Neurology Source Type: research

Homage to the Pioneers and Their Treatment of Spinal Cord Injury
(Source: Neurocritical Care)
Source: Neurocritical Care - January 24, 2020 Category: Neurology Source Type: research

When Did We Start Talking About no Recovery in Critical Illness?
(Source: Neurocritical Care)
Source: Neurocritical Care - January 24, 2020 Category: Neurology Source Type: research

Breaking Down Myasthenic Crisis
(Source: Neurocritical Care)
Source: Neurocritical Care - January 24, 2020 Category: Neurology Source Type: research

Recording Neurogenic Breathing Patterns in Acute Brain Injury
(Source: Neurocritical Care)
Source: Neurocritical Care - January 24, 2020 Category: Neurology Source Type: research