The Feasibility and Validity of Objective and Patient-Reported Measurements of Cognition During Early Critical Illness Recovery
The objective of this study was to assess the feasibility and validity of objective and patient-reported cognition assessments for generalized use during early recovery from critical illness.MethodsPatients presented from the community with acute onset of either intracerebral hemorrhage (ICH) or sepsis as representative neurologic and systemic critical illnesses. Early cognitive assessments comprised the Glasgow Coma Scale (GCS), three NIH Toolbox cognition measures (Flanker Inhibitory Control and Attention Test, List Sorting Working Memory Test and Pattern Comparison Processing Speed Test) and two Patient Reported Outcome...
Source: Neurocritical Care - October 22, 2020 Category: Neurology Source Type: research

US Practitioner Attitudes Toward Tracheostomy Timing, Benefits, Risks, and Techniques for Severe Stroke Patients: A National Survey and National Inpatient Sample Analysis
(Source: Neurocritical Care)
Source: Neurocritical Care - October 22, 2020 Category: Neurology Source Type: research

Prevalence, Predictors, and Outcomes of Prolonged Mechanical Ventilation After Endovascular Stroke Therapy
ConclusionsAmong a nationally representative sample of hospitalizations, nearly one-in-six patients had prolonged mechanical ventilation after EVT. Heart failure and diabetes were significantly associated with prolonged mechanical ventilation following EVT. Prolonged ventilation was associated with significant increase in in-hospital mortality and morbidity. (Source: Neurocritical Care)
Source: Neurocritical Care - October 21, 2020 Category: Neurology Source Type: research

Acute Distress Respiratory Syndrome After Subarachnoid Hemorrhage: Incidence and Impact on the Outcome in a Large Multicenter, Retrospective Cohort
ConclusionsARDS has a low incidence in the first 7 days of ICU stay after aSAH, but it is associated with worse outcome. (Source: Neurocritical Care)
Source: Neurocritical Care - October 20, 2020 Category: Neurology Source Type: research

Reply to: ‘Beta-blockers for subarachnoid hemorrhage: When should we use them?’
(Source: Neurocritical Care)
Source: Neurocritical Care - October 19, 2020 Category: Neurology Source Type: research

Beta-Blockers for Subarachnoid Hemorrhage: When Should We Use Them?
(Source: Neurocritical Care)
Source: Neurocritical Care - October 19, 2020 Category: Neurology Source Type: research

Correction to: Assessment of Bacterial Colonization of  Intracranial Pressure Transducers: A Prospective Study
The original article was updated to correct the co-author name Suhan Senova in author list. The details mentioned here are correct. (Source: Neurocritical Care)
Source: Neurocritical Care - October 15, 2020 Category: Neurology Source Type: research

Remote Ischemic Pre-conditioning in Subarachnoid Hemorrhage: A Prospective Pilot Trial
ConclusionsThis pilot trial did demonstrate feasibility and safety. The shortened LOS in the LPO may implicate a protective role of RIPC and warrants future study. (Source: Neurocritical Care)
Source: Neurocritical Care - October 13, 2020 Category: Neurology Source Type: research

Cortical Blood Flow Insufficiency Scores with Computed Tomography Perfusion can Predict Outcomes in Aneurysmal Subarachnoid Hemorrhage Patients: A Cohort Study
AbstractBackgroundThe World Federation of Neurosurgical Societies (WFNS) scale is widely accepted for predicting outcomes for subarachnoid hemorrhage (SAH) patients. However, it is difficult to definitely predict outcomes for the most poor grade, WFNS grade 5. The present study aimed to investigate the prognostic ability of a novel classification using computed tomography perfusion (CTP) findings, called the cortical blood flow insufficiency (CBFI) scores.MethodsCTP was performed on admission for aneurysmal SAH followed by radical treatments within 72 hours of onset. Twenty-four cerebral cortex regions of interest (ROIs) w...
Source: Neurocritical Care - October 9, 2020 Category: Neurology Source Type: research

EEG Availability in the Intensive Care Setting: A Multicentre Study
(Source: Neurocritical Care)
Source: Neurocritical Care - October 9, 2020 Category: Neurology Source Type: research

Outcomes After Tracheostomy in Patients with Severe Acute Brain Injury: A Systematic Review and Meta-Analysis
ConclusionsOur findings suggest that about one in three patients with SABI who undergo tracheostomy may eventually achieve independence. Future research is needed to understand the reasons for the heterogeneity between studies and to identify those patients with promising outcomes as well as factors influencing outcome. (Source: Neurocritical Care)
Source: Neurocritical Care - October 9, 2020 Category: Neurology Source Type: research

Looking Twice the Wrong Way: The Challenge of Diagnosing Acute Basilar Artery Occlusion
(Source: Neurocritical Care)
Source: Neurocritical Care - October 9, 2020 Category: Neurology Source Type: research

Correction to: Early EEG for  Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation
The original article was updated to change the incorrect institutional author to DINAMO study group in the author list, also modifications have been made to Table  1, the line “History of acute brain injury” changed from italic to regular font and the line “At ICU admission” was moved to another row below. (Source: Neurocritical Care)
Source: Neurocritical Care - October 9, 2020 Category: Neurology Source Type: research

Continuous Monitoring of Cerebral Autoregulation in Children Supported by Extracorporeal Membrane Oxygenation: A Pilot Study
ConclusionCA assessment is feasible in pediatric ECMO. The first 24  h following ECMO represents the most critical period regarding CA. Impaired autoregulation is significantly more severe among patients who experience ANE. (Source: Neurocritical Care)
Source: Neurocritical Care - October 8, 2020 Category: Neurology Source Type: research

Neurocritical Care Society Virtual 18th Annual Meeting, September 22 –25, 2020
(Source: Neurocritical Care)
Source: Neurocritical Care - October 7, 2020 Category: Neurology Source Type: research

18th Annual Meeting, Neurocritical Care Society September 22 –25, 2020 Phoenix, Arizona
(Source: Neurocritical Care)
Source: Neurocritical Care - October 7, 2020 Category: Neurology Source Type: research

Intensive Care Unit —Acquired Weakness in Children: A Prospective Observational Study Using Simplified Serial Electrophysiological Testing (PEDCIMP Study)
ConclusionsChildren admitted with PRISM  >  20 have a very low incidence of intensive care unit—acquired weakness by serial clinical and abbreviated electrophysiological evaluation. (Source: Neurocritical Care)
Source: Neurocritical Care - October 6, 2020 Category: Neurology Source Type: research

Cerebrovascular Complications in Early Survivors of Civilian Penetrating Brain Injury
ConclusionAcute traumatic cerebrovascular injury is a prevalent complication in civilian PBI, frequently involving both the arterial and venous sinus systems. Although some radiographic features might be associated with presence of vascular injury, assessment of the intracranial vasculature in the acute phase of all PBI is essential for early diagnosis. Treatment of vascular injury remains variable depending on local practice. (Source: Neurocritical Care)
Source: Neurocritical Care - October 5, 2020 Category: Neurology Source Type: research

Monitoring the Burden of Seizures and Highly Epileptiform Patterns in Critical Care with a Novel Machine Learning Method
ConclusionsRuling out seizures accurately in a large proportion of cases can help prevent unnecessary or aggressive over-treatment in critical care settings, where empiric treatment with antiseizure medications is currently prevalent. Clarit γ’s high sensitivity for SE and high negative predictive value for cases without epileptiform activity make it a useful tool for triaging treatment and the need for urgent neurological consultation. (Source: Neurocritical Care)
Source: Neurocritical Care - October 5, 2020 Category: Neurology Source Type: research

COVID-19-Associated Acute Multi-infarct Encephalopathy in an Asymptomatic CADASIL Patient
(Source: Neurocritical Care)
Source: Neurocritical Care - October 5, 2020 Category: Neurology Source Type: research

Variability in Serum Sodium Concentration and Prognostic Significance in Severe Traumatic Brain Injury: A Multicenter Observational Study
AbstractBackground/ObjectiveDysnatremia is common in severe traumatic brain injury (TBI) patients and may contribute to mortality. However, serum sodium variability has not been studied in TBI patients. We hypothesized that such variability would be independently associated with mortality.MethodsWe collected 6-hourly serum sodium levels for the first 7  days of ICU admission from 240 severe TBI patients in 14 neurotrauma ICUs in Europe and Australia. We evaluated the association between daily serum sodium standard deviation (dNaSD), an index of variability, and 28-day mortality.ResultsPatients were 46  ±...
Source: Neurocritical Care - October 1, 2020 Category: Neurology Source Type: research

Comparison of Pressure Reactivity Index and Mean Velocity Index to Evaluate Cerebrovascular Reactivity During Induced Arterial Blood Pressure Variations in Severe Brain Injury
AbstractObjectivesTo compare the assessment of cerebral autoregulation by cerebrovascular reactivity indices based on intracranial pressure (Pressure Reactivity Index, PRx) and on transcranial Doppler (Mean Velocity Index, Mx) during controlled variations of arterial blood pressure in severe brain injury. Primary outcome was the agreement between both cerebrovascular reactivity indices measured by the Bland-and-Altman method. Secondary outcomes were the association of cerebrovascular reactivity indices with arterial blood pressure variation, and the comparison of optimal cerebral perfusion pressures determined by both indi...
Source: Neurocritical Care - September 30, 2020 Category: Neurology Source Type: research

The Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID): Development of Case Report Forms for Global Use
AbstractSince its original report in January 2020, the coronavirus disease 2019 (COVID-19) due to Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection has rapidly become one of the deadliest global pandemics. Early reports indicate possible neurological manifestations associated with COVID-19, with symptoms ranging from mild to severe, highly variable prevalence rates, and uncertainty regarding causal or coincidental occurrence of symptoms. As neurological involvement of any systemic disease is frequently associated with adverse effects on morbidity and mortality, obtaining accurate and consistent global ...
Source: Neurocritical Care - September 17, 2020 Category: Neurology Source Type: research

Neurological Prognostication Using Electroencephalogram in Adult Veno-arterial Extracorporeal Membrane Oxygenation: Limitations and Recommendations
(Source: Neurocritical Care)
Source: Neurocritical Care - September 15, 2020 Category: Neurology Source Type: research

Assessment of Bacterial Colonization of Intracranial Pressure Transducers: A Prospective Study
ConclusionsWe observed no ICPT-related cerebral infections although colonization was identified on all ICPTs using NGS and SEM. Mature biofilm was the main bacterial lifestyle on the ICPTs. (Source: Neurocritical Care)
Source: Neurocritical Care - September 14, 2020 Category: Neurology Source Type: research

Commentary on TNF-R1 Correlates with Cerebral Perfusion and Acute Ischemia Following Subarachnoid Hemorrhage
(Source: Neurocritical Care)
Source: Neurocritical Care - September 14, 2020 Category: Neurology Source Type: research

Craniopuncture for Spontaneous Intracerebral Hemorrhage: Ahead of its Time or Behind the Times?
(Source: Neurocritical Care)
Source: Neurocritical Care - September 14, 2020 Category: Neurology Source Type: research

Cefepime and Acute Encephalopathy: There ’s More to This Story
(Source: Neurocritical Care)
Source: Neurocritical Care - September 14, 2020 Category: Neurology Source Type: research

The Importance of P bt O 2 Probe Location for Data Interpretation in Patients with Intracerebral Hemorrhage
ConclusionsIn the acute phase, BTH was more common in the perilesional area compared to healthy brain tissue. The improvement of BTH in the perilesional area over time may be the result of targeted treatment interventions and tissue regeneration. Due to the localized measurement of invasive neuromonitoring devices, integration of probe location in the clinical management of ICH patients and in research protocols seems mandatory. (Source: Neurocritical Care)
Source: Neurocritical Care - September 10, 2020 Category: Neurology Source Type: research

Hypertonic Sodium Lactate to Alleviate Functional Deficits Following Diffuse Traumatic Brain Injury: An Osmotic or a Lactate-Related Effect?
AbstractBackgroundThere has been growing interest in the use of hypertonic sodium lactate (HSL) solution following traumatic brain injury (TBI) in humans. However, little is known about the effects of HSL on functional deficits with respect to the hyperosmotic nature of HSL.MethodsWe have compared the effects of HSL solution and isotonic saline solution using sensorimotor and cognitive tests for 14  days post-trauma in animals. Thirty minutes after trauma (impact-acceleration model), anesthetized rats were randomly allocated to receive a 2-h infusion of isotonic saline solution (TBI-saline group) or HSL (TBI-HSL group...
Source: Neurocritical Care - September 8, 2020 Category: Neurology Source Type: research

Multifaceted Benefit of Whole Blood Versus Lactated Ringer ’s Resuscitation After Traumatic Brain Injury and Hemorrhagic Shock in Mice
AbstractBackgroundDespite increasing use in hemorrhagic shock (HS), whole blood (WB) resuscitation for polytrauma with traumatic brain injury (TBI) is largely unexplored. Current TBI guidelines recommend crystalloid for prehospital resuscitation. Although WB outperforms lactated Ringer ’s (LR) in increasing mean arterial pressure (MAP) in TBI + HS models, effects on brain tissue oxygenation (PbtO2), and optimal MAP remain undefined.MethodsC57BL/6 mice (n = 72) underwent controlled cortical impact followed by HS (MAP = 25–27 mmHg). Ipsilateral hippocampal PbtO2 (n&t...
Source: Neurocritical Care - September 3, 2020 Category: Neurology Source Type: research

Temperature Variability Does Not Attenuate the Beneficial Effects of Therapeutic Hypothermia on Cellular Apoptosis and Endoplasmic Reticulum Stress in the Cerebral Cortex of a Swine Cardiac Arrest Model
ConclusionTH can reduce neuronal apoptosis by ERS, while temperature variability does not attenuate this beneficial effect. (Source: Neurocritical Care)
Source: Neurocritical Care - September 1, 2020 Category: Neurology Source Type: research

Identifying the Specific Subtype of Intracerebral Hemorrhage that is Indicated for Minimally Invasive Craniopuncture
This study was designed to identify factors that predict postoperative CSF outflow and the specific subtype of ICHV that may benefit from MIC.MethodsA total of 189 MIC needles applied to 125 ICHV patients were retrospectively analyzed. Univariate and multivariate analyses were used to identify independent predictive factors of postoperative CSF outflow.ResultsA density of the whole hematoma of  ≤ 59 HU [odds ratio (OR) = 8.572, 95% confidence interval (CI) 3.235–22.714,P 
Source: Neurocritical Care - August 26, 2020 Category: Neurology Source Type: research

Association of Dexamethasone with Shunt Requirement, Early Disability, and Medical Complications in Aneurysmal Subarachnoid Hemorrhage
ConclusionsDXM use among patients with aSAH did not relate to the rate of EVD and VPS placement, duration of EVD treatment, and functional disability at discharge but increased the risk of medical complications. (Source: Neurocritical Care)
Source: Neurocritical Care - August 25, 2020 Category: Neurology Source Type: research

Correction to: Evaluation of  Volumetric Change of Intracerebral Hemorrhage in Patients Treated with Thrombolysis for Intraventricular Hemorrhage
The author name Kerim Beseoglu has been corrected and the details given in this correction are correct. (Source: Neurocritical Care)
Source: Neurocritical Care - August 25, 2020 Category: Neurology Source Type: research

Anticoagulation use and Hemorrhagic Stroke in SARS-CoV-2 Patients Treated at a New York Healthcare System
ConclusionWe observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in patients with COVID-19 infection occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in patients with COVID-19. (Source: Neurocritical Care)
Source: Neurocritical Care - August 23, 2020 Category: Neurology Source Type: research

TNF-R1 Correlates with Cerebral Perfusion and Acute Ischemia Following Subarachnoid Hemorrhage
ConclusionIncreased levels of TNF-R1 in arterial and venous blood correlate with worse cerebral perfusion and with increased burden of acute ischemic lesions in the first 72  h after SAH. Venous levels of TNF-R1 and DWI lesions were associated with poor outcome at 6 months. These results highlight the pathophysiological role of TNF-α pathways in SAH and suggest a possible role of combined imaging and laboratorial markers in determining prognosis in acute SAH. (Source: Neurocritical Care)
Source: Neurocritical Care - August 19, 2020 Category: Neurology Source Type: research

Is It Really Third Ventricle? A Pitfall in the Diagnosis of Hydrocephalus by Brain Ultrasound
(Source: Neurocritical Care)
Source: Neurocritical Care - August 19, 2020 Category: Neurology Source Type: research

The Clinical Usefulness of Targeted Temperature Management in Acute Ischemic Stroke with Malignant Trait After Endovascular Thrombectomy
AbstractBackground/ObjectiveTargeted temperature management (TTM) may be more beneficial after endovascular treatment (EVT) in patients with a large ischemic core. Therefore, we assessed the usefulness of TTM for such patients from a multicenter endovascular registry.MethodsAnterior circulation stroke patients who underwent endovascular recanalization were included; acute ischemic stroke with malignant traits was designated as (1) baseline Alberta Stroke Program Early CT Score (ASPECTS) below 6 and (2) diffusion-weighted imaging (DWI) lesion volume measurement (>  82 ml) or National Institutes of Health Stro...
Source: Neurocritical Care - August 17, 2020 Category: Neurology Source Type: research

Correction to: 2019 Neurocritical Care Survey: Physician Compensation, Unit Staffing and Structure
The original article had a typo in Table  2, the “N” for males and females should be switched. The corrected table is shown below: (Source: Neurocritical Care)
Source: Neurocritical Care - August 17, 2020 Category: Neurology Source Type: research

Liver Fibrosis and Perihematomal Edema Growth in Primary Intracerebral Hemorrhage
ConclusionsIn a multicenter cohort of patients with primary intracerebral hemorrhage, a liver fibrosis score was not associated with PHE volume or growth. (Source: Neurocritical Care)
Source: Neurocritical Care - August 16, 2020 Category: Neurology Source Type: research

Multimorbidity and Critical Care Neurosurgery: Minimizing Major Perioperative Cardiopulmonary Complications
AbstractWith increasing prevalence of chronic diseases, multimorbid patients have become commonplace in the neurosurgical intensive care unit (neuro-ICU), offering unique management challenges. By reducing physiological reserve and interacting with one another, chronic comorbidities pose a greatly enhanced risk of major postoperative medical complications, especially cardiopulmonary complications, which ultimately exert a negative impact on neurosurgical outcomes. These premises underscore the importance of perioperative optimization, in turn requiring a thorough preoperative risk stratification, a basic understanding of a...
Source: Neurocritical Care - August 12, 2020 Category: Neurology Source Type: research

Personalized Connectome Mapping to Guide Targeted Therapy and Promote Recovery of Consciousness in the Intensive Care Unit
We report the protocol for STIMPACT (Stimulant TherapyTargeted toIndividualized ConnectivityMaps toPromote ReACTivation of Consciousness), a CCTP-based trial in which intravenous methylphenidate will be used for targeted stimulation of dopaminergic circuits within the subcortical ascending arousal network (ClinicalTrials.gov NCT03814356). The scientific premise of the CCTP and the STIMPACT trial is that personalized brain network mapping in the ICU can identify patients whose connectomes are amenable to neuromodulation. Phase 1 of the STIMPACT trial is an open-label, safety and dose-finding study in 22 patients with disord...
Source: Neurocritical Care - August 12, 2020 Category: Neurology Source Type: research

Crisis Resource Management and High-Performing Teams in Hyperacute Stroke Care
ConclusionsAs stroke care processes evolve during these trying times, the importance of consistent, safe, and efficacious care facilitated by CRM principles offers a unique avenue to alleviate human factors and support high-performing teams. (Source: Neurocritical Care)
Source: Neurocritical Care - August 12, 2020 Category: Neurology Source Type: research

Alcohol Withdrawal Syndrome in Neurocritical Care Unit: Assessment and Treatment Challenges
AbstractAlcohol withdrawal syndrome (AWS) can range from mild jittery movements, nausea, sweating to more severe symptoms such as seizure and death. Severe AWS can worsen cognitive function, increase hospital length of stay, and in-hospital mortality and morbidity. Due to a lack of reliable history of present illness in many patients with neurological injury as well as similarities in clinical presentation of AWS and some commonly encountered neurological syndromes, the true incidence of AWS in neurocritical care patients remains unknown. This review discusses challenges in the assessment and treatment of AWS in patients w...
Source: Neurocritical Care - August 12, 2020 Category: Neurology Source Type: research

Brain abscess complicating venous ischemic stroke: a rare occurrence
(Source: Neurocritical Care)
Source: Neurocritical Care - August 12, 2020 Category: Neurology Source Type: research

Precision Medicine for Traumatic Coma
(Source: Neurocritical Care)
Source: Neurocritical Care - August 12, 2020 Category: Neurology Source Type: research

Early EEG for Prognostication Under Venoarterial Extracorporeal Membrane Oxygenation
ConclusionStandard EEG abnormalities recorded at time of VA-ECMO initiation are predictive of unfavorable outcomes. However, the low sensitivity of these parameters highlights the need for a multimodal evaluation for improving management of care and prognostication. (Source: Neurocritical Care)
Source: Neurocritical Care - August 11, 2020 Category: Neurology Source Type: research

Thrombotic and Hemorrhagic Neurological Complications in Critically Ill COVID-19 Patients
(Source: Neurocritical Care)
Source: Neurocritical Care - August 11, 2020 Category: Neurology Source Type: research

Updated Nomenclature of Delirium and Acute Encephalopathy: Authors ’ Reply
(Source: Neurocritical Care)
Source: Neurocritical Care - August 11, 2020 Category: Neurology Source Type: research