Application of Near-Infrared Spectroscopy for the Detection of Delayed Cerebral Ischemia in Poor-Grade Subarachnoid Hemorrhage
ConclusionsNear-infrared spectroscopy shows some promising results for the detection of DCI in patients with poor-grade SAH. Further studies involving a large cohort of the SAH population are required to confirm our results. (Source: Neurocritical Care)
Source: Neurocritical Care - May 7, 2021 Category: Neurology Source Type: research

Relationship Between Non-contrast Computed Tomography Imaging Markers and Perihemorrhagic Edema Growth in Intracerebral Hemorrhage
AbstractObjectivesPerihemorrhagic edema (PHE) growth has been gradually considered as predictor for outcome of Intracerebral hemorrhage (ICH) patients. The aim of our study was to investigate correlation between non-contrast computed tomography (CT) markers and early PHE growth.MethodsICH patients between July 2011 and March 2017 were included in this retrospective analysis. ICH and PHE volumes were measured by using a validated semiautomatic volumetric algorithm. Nonparametric test was used for comparing PHE volume at different time points of non-contrast computed tomography (NCCT) imaging markers. Multivariable linear re...
Source: Neurocritical Care - May 3, 2021 Category: Neurology Source Type: research

Complex Approaches for a Complex Organ
(Source: Neurocritical Care)
Source: Neurocritical Care - April 30, 2021 Category: Neurology Source Type: research

Response to: “Precise Clinical Outcome in High-Grade Aneurysmal Subarachnoid Hemorrhage: Brain Oxygenation Matters!”
(Source: Neurocritical Care)
Source: Neurocritical Care - April 27, 2021 Category: Neurology Source Type: research

Precise Clinical Outcome in High-Grade Aneurysmal Subarachnoid Hemorrhage: Brain Oxygenation Matters!
(Source: Neurocritical Care)
Source: Neurocritical Care - April 27, 2021 Category: Neurology Source Type: research

Can a Dyadic Resiliency Program Improve Quality of Life in Cognitively Intact Dyads of Neuro-ICU Survivors and Informal Caregivers? Results from a Pilot RCT
ConclusionsIn this pilot study, we found improved QoL among survivors, but not in caregivers, who received RT and improvements sustained over time. These RT-related improvements were not significantly greater than those observed in the control. Results support a fully powered randomized controlled trial to allow for a definitive evaluation of RT-related effects among dyads of survivors of acute brain injury and their caregivers. (Source: Neurocritical Care)
Source: Neurocritical Care - April 21, 2021 Category: Neurology Source Type: research

The Antiedematous Effect of Exogenous Lactate Therapy in Traumatic Brain Injury: A Physiological and Mechanistic Approach
ConclusionsSL is an effective therapy for treating brain edema after TBI. This study suggests, for the first time, the potential role of chloride channels in the antiedematous effect induced by exogenous SL. (Source: Neurocritical Care)
Source: Neurocritical Care - April 20, 2021 Category: Neurology Source Type: research

Thromboelastography is a Marker for Clinically Significant Progressive Hemorrhagic Injury in Severe Traumatic Brain Injury
ConclusionsProlonged K time and narrower alpha angle were found to be associated with developing clinically significant PHI in patients with severe TBI. Despite differences detected in alpha angle, median values in both groups were within normal reference ranges. These abnormalities may reflect pathologic hypoactivity of fibrinogen, and further study is warranted to evaluate TEG-guided cryoprecipitate administration in this patient population. (Source: Neurocritical Care)
Source: Neurocritical Care - April 12, 2021 Category: Neurology Source Type: research

Association of Dose of Intracranial Hypertension with Outcome in Subarachnoid Hemorrhage
ConclusionsIn two cohorts of patients with aSAH, an association between duration and intensity of episodes of elevated ICP and 12-month neurological outcomes could be demonstrated and was visualized in a color-coded plot. (Source: Neurocritical Care)
Source: Neurocritical Care - April 12, 2021 Category: Neurology Source Type: research

Correction to: Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A Propensity Score-Matched Registry Study
A correction to this paper has been published:https://doi.org/10.1007/s12028-021-01225-0 (Source: Neurocritical Care)
Source: Neurocritical Care - April 12, 2021 Category: Neurology Source Type: research

Association Between Ionized Calcium Level and Neurological Outcome in Endovascularly Treated Patients with Spontaneous Subarachnoid Hemorrhage: A Retrospective Cohort Study
ConclusionsOur study shows that hypocalcemia is associated with worse neurological outcome at discharge and development of early hydrocephalus in endovascularly treated patients with SSAH. Potential mechanisms include calcium-induced coagulopathy and higher blood pressure. Trials are needed to assess whether correction of hypocalcemia will lead to improved outcomes. (Source: Neurocritical Care)
Source: Neurocritical Care - April 7, 2021 Category: Neurology Source Type: research

Predictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making
ConclusionsFamily dissatisfaction with neuro-ICU shared decision-making support is not necessarily predicted by any preexisting family or patient variables but appears to correlate with participating in fewer formal family meetings during ICU admission. Future studies to improve family satisfaction with neurocritical care decision-making support should have broad inclusion criteria for participants and should consider promoting frequency of family meetings as a core strategy. (Source: Neurocritical Care)
Source: Neurocritical Care - April 5, 2021 Category: Neurology Source Type: research

Prothrombin Complex Concentrate for Emergent Reversal of Intracranial Hemorrhage in Patients with Ventricular Assist Devices
ConclusionsOur limited series found no thromboembolic complications immediately following anticoagulation reversal with PCC prior to resumption of anticoagulation. LDH trends may be useful to monitor thromboembolic risk after reversal. (Source: Neurocritical Care)
Source: Neurocritical Care - April 5, 2021 Category: Neurology Source Type: research

Invited Commentary on Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A Propensity Score-Matched Registry Study
(Source: Neurocritical Care)
Source: Neurocritical Care - April 2, 2021 Category: Neurology Source Type: research

Implementation of Multimodality Neurologic Monitoring Reporting in Pediatric Traumatic Brain Injury Management
AbstractBackground/ObjectiveMultimodality neurologic monitoring (MMM) is an emerging technique for management of traumatic brain injury (TBI). An increasing array of MMM-derived biomarkers now exist that are associated with injury severity and functional outcomes after TBI. A standardized MMM reporting process has not been well described, and a paucity of evidence exists relating MMM reporting in TBI management with functional outcomes or adverse events.MethodsProspective implementation of standardized MMM reporting at a single pediatric intensive care unit (PICU) is described that included monitoring of intracranial press...
Source: Neurocritical Care - March 31, 2021 Category: Neurology Source Type: research

Impact of Fever Prevention in Brain-Injured Patients (INTREPID): Study Protocol for a Randomized Controlled Trial
DiscussionThe INTREPID trial will provide the first results of the impact of a pivotal fever prevention intervention in patients with acute stroke (www.clinicaltrials.gov; NCT02996266; registered prospectively 05DEC2016). (Source: Neurocritical Care)
Source: Neurocritical Care - March 24, 2021 Category: Neurology Source Type: research

Physiological Responses to In-Bed Cycle Ergometry Treatment in Intensive Care Unit Patients with External Ventricular Drainage
ConclusionThese data suggest that supine CE in a heterogeneous cohort of neurocritical care patients with EVDs is safe and tolerable. Larger prospective studies are needed to determine the efficacy and optimal dose and timing of supine CE in neurocritical care patients. (Source: Neurocritical Care)
Source: Neurocritical Care - March 22, 2021 Category: Neurology Source Type: research

Response to: Comment on “Temporal Dynamics of ICP, CPP, PRx, and CPPopt in High‑Grade Aneurysmal Subarachnoid Hemorrhage and the Relation to Clinical Outcome”
(Source: Neurocritical Care)
Source: Neurocritical Care - March 22, 2021 Category: Neurology Source Type: research

Response to “Pay Attention to Blood Pressure and Oxygen Supply for Neurocritically Ill Patients: Each Pathology Deserves a Specific Treatment”
(Source: Neurocritical Care)
Source: Neurocritical Care - March 22, 2021 Category: Neurology Source Type: research

Pay Attention to Blood Pressure and Oxygen Supply for Neurocritically Ill Patients: Each Pathology Deserves a Specific Treatment
(Source: Neurocritical Care)
Source: Neurocritical Care - March 22, 2021 Category: Neurology Source Type: research

Comment on “Temporal Dynamics of ICP, CPP, PRx, and CPPopt in High-Grade Aneurysmal Subarachnoid Hemorrhage and the Relation to Clinical Outcome”
(Source: Neurocritical Care)
Source: Neurocritical Care - March 22, 2021 Category: Neurology Source Type: research

Toxic Metabolic Encephalopathy in Hospitalized Patients with COVID-19
AbstractBackgroundToxic metabolic encephalopathy (TME) has been reported in 7 –31% of hospitalized patients with coronavirus disease 2019 (COVID-19); however, some reports include sedation-related delirium and few data exist on the etiology of TME. We aimed to identify the prevalence, etiologies, and mortality rates associated with TME in severe acute respiratory syndrome c oronavirus 2 (SARS-CoV-2)-positive patients.MethodsWe conducted a retrospective, multicenter, observational cohort study among patients with reverse transcriptase –polymerase chain reaction-confirmed SARS-CoV-2 infection hospitalized at four...
Source: Neurocritical Care - March 16, 2021 Category: Neurology Source Type: research

Prognostic Value of a Structural Brain MRI Score in the Acute Phase of Aneurysmal Subarachnoid Hemorrhage: A Pilot Study
ConclusionsIn this pilot study, a qualitative scoring system using anatomically defined MRI FLAIR and DWI signal abnormalities identified in the acute phase of aSAH was linked to 6-month functional outcome. However, these scores did not add prognostic value to established indices of neurological severity. (Source: Neurocritical Care)
Source: Neurocritical Care - March 9, 2021 Category: Neurology Source Type: research

The Historical Trajectory of the Apnea Test in Brain Death Determination
(Source: Neurocritical Care)
Source: Neurocritical Care - March 9, 2021 Category: Neurology Source Type: research

Impact of Arterial Carbon Dioxide and Oxygen Content on Cerebral Autoregulation Monitoring Among Children Supported by ECMO
AbstractBackgroundCerebral autoregulation (CA) impairment is associated with neurological complications among children supported by extracorporeal membrane oxygenation (ECMO). Severe variations of arterial CO2 (PaCO2) and O2 (PaO2) tension after ECMO onset are common and associate with mortality and poor neurological outcome. The impact of gas exchange on CA among critically ill patients is poorly studied.MethodsRetrospective analysis of data collected prospectively from 30 children treated with veno-arterial or veno-venous ECMO in the PICU of Nantes University Hospital, France. A correlation coefficient between the variat...
Source: Neurocritical Care - March 9, 2021 Category: Neurology Source Type: research

Increase in Ventricle Size and the Evolution of White Matter Changes on Serial Imaging in Critically Ill Patients with COVID-19
AbstractBackgroundEvolution of brain magnetic resonance imaging (MRI) findings in critically ill patients with coronavirus disease 2019 (COVID-19) is unknown.MethodsWe retrospectively reviewed 4530 critically ill patients with COVID-19 admitted to three tertiary care hospitals in New York City from March 1 to June 30, 2020 to identify patients who had more than one brain MRI. We reviewed the initial and final MRI for each patient to (1) measure the percent change in the bicaudate index and third ventricular diameter and (2) evaluate changes in the presence and severity of white matter changes.ResultsTwenty-one patients had...
Source: Neurocritical Care - March 5, 2021 Category: Neurology Source Type: research

Effect of Race –Ethnicity and CT Angiography on Renal Injury During Blood Pressure Treatment for Intracerebral Hemorrhage
ConclusionWe found no association between race –ethnicity or CTA and AKI during the acute management of ICH in a real-life stroke population. Our findings suggest that CTA can be safely obtained in acute ICH, even in populations of diverse race–ethnicity who may be more prone to adverse kidney events. CTA did not contribute to developing AKI . (Source: Neurocritical Care)
Source: Neurocritical Care - March 5, 2021 Category: Neurology Source Type: research

Serum Biomarkers of Regeneration and Plasticity are Associated with Functional Outcome in Pediatric Neurocritical Illness: An Exploratory Study
ConclusionsBlood-based biomarkers of regeneration and plasticity may hold prognostic utility for functional impairment among pediatric patients with neurocritical illness and warrant further investigation. (Source: Neurocritical Care)
Source: Neurocritical Care - March 4, 2021 Category: Neurology Source Type: research

Critical ICP in Subarachnoid Hemorrhage: How High and How Long?
(Source: Neurocritical Care)
Source: Neurocritical Care - March 2, 2021 Category: Neurology Source Type: research

The Discovery of Acute Alcohol Withdrawal as a Cause of Delirium
(Source: Neurocritical Care)
Source: Neurocritical Care - March 2, 2021 Category: Neurology Source Type: research

Secondary Hematoma Evacuation and Outcome After Initial Conservative Approach for Patients with Cerebellar Hematoma Larger than 3  cm
AbstractBackgroundIn patients with spontaneous cerebellar intracerebral hemorrhage (ICH) guidelines advocate evacuation when the hematoma diameter is>  3 cm. We studied outcome in patients with cerebellar ICH>  3 cm who did not undergo immediate hematoma evacuation.MethodsWe included consecutive patients with cerebellar ICH>  3 cm at two academic hospitals between 2008 and 2017. Patients who died  3 cm of whom 22 (23%) died
Source: Neurocritical Care - March 2, 2021 Category: Neurology Source Type: research

The Tangled History of Brain –Heart Pathways in Acute Brain Injury
(Source: Neurocritical Care)
Source: Neurocritical Care - March 2, 2021 Category: Neurology Source Type: research

Historical Appreciation of Brain Vulnerability from Pure Hypoxemia
(Source: Neurocritical Care)
Source: Neurocritical Care - February 23, 2021 Category: Neurology Source Type: research

Predictors of Surrogate Decision Makers Selecting Life-Sustaining Therapy for Severe Acute Brain Injury Patients: An Analysis of US Population Survey Data
AbstractBackgroundPatients with a severe acute brain injury admitted to the intensive care unit often have a poor neurological prognosis. In these situations, a clinician is responsible for conducting a goals-of-care conversation with the patient ’s surrogate decision makers. The diversity in thought and background of surrogate decision makers can present challenges during these conversations. For this reason, our study aimed to identify predictive characteristics of US surrogate decision makers’ favoring life-sustaining treatment (LST) over comfort measures only for patients with severe acute brain injury.Meth...
Source: Neurocritical Care - February 23, 2021 Category: Neurology Source Type: research

Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A Propensity Score-Matched Registry Study
ConclusionsIntracerebral hemorrhage was detected in every tenth patient with ARDS. Despite statistically higher rates of antiplatelet therapy and therapeutic anticoagulation in COVID-19 patients, we found a similar rate of ICH in patients with ARDS due to COVID-19 compared to other causes of ARDS. (Source: Neurocritical Care)
Source: Neurocritical Care - February 23, 2021 Category: Neurology Source Type: research

To Decompress or Not? An Expected Utility Inspired Approach To Shared decision-making For Supratentorial Ischemic Stroke
AbstractPatients with large territorial supratentorial infarctions are at high risk of cerebral edema, increased intracranial pressure, tissue herniation and death. There is strong evidence supporting prompt decompressive craniectomy after large hemispheric ischemic stroke as a means to reduce mortality. Nevertheless, functional outcomes can vary significantly. Clinical trials have traditionally judged these outcomes by a priori dichotomization without taking into account individual patient and caregiver preferences. If these are not incorporated into shared decision-making, there are significant risks in both directions, ...
Source: Neurocritical Care - February 18, 2021 Category: Neurology Source Type: research

Structure and Outcomes of Educational Programs for Training Non-electroencephalographers in Performing and Screening Adult EEG: A Systematic Review
AbstractObjectiveTo qualitatively and quantitatively summarize curricula, teaching methods, and effectiveness of educational programs for training bedside care providers (non-experts) in the performance and screening of adult electroencephalography (EEG) for nonconvulsive seizures and other patterns.MethodsPRISMA methodological standards were followed. MEDLINE, EMBASE, Cochrane, CINAHL, WOS, Scopus, and MedEdPORTAL databases were searched from inception until February 26, 2020 with no restrictions. Abstract and full-text review was completed in duplicate. Studies were included if they were original research; involved non-e...
Source: Neurocritical Care - February 16, 2021 Category: Neurology Source Type: research

Common Data Elements for COVID-19 Neuroimaging: A GCS-NeuroCOVID Proposal
(Source: Neurocritical Care)
Source: Neurocritical Care - February 11, 2021 Category: Neurology Source Type: research

Finding the Right Osmotic Agent: Why Mannitol Prevailed
(Source: Neurocritical Care)
Source: Neurocritical Care - February 9, 2021 Category: Neurology Source Type: research

Von Leyden ’s Contribution to the Elusive Syndrome of Acute Basilar Artery Occlusion
(Source: Neurocritical Care)
Source: Neurocritical Care - February 9, 2021 Category: Neurology Source Type: research

Reviewer Thank You
(Source: Neurocritical Care)
Source: Neurocritical Care - February 4, 2021 Category: Neurology Source Type: research

Response to: Communication and Well-Being Considerations in Disorders of Consciousness
(Source: Neurocritical Care)
Source: Neurocritical Care - February 4, 2021 Category: Neurology Source Type: research

Transient Intracranial Circulatory Arrest Evidenced at the Time of Intracranial Aneurysm Rupture: Case Report
(Source: Neurocritical Care)
Source: Neurocritical Care - February 1, 2021 Category: Neurology Source Type: research

Cerebrovascular Autoregulation Monitoring in the Management of Adult Severe Traumatic Brain Injury: A Delphi Consensus of Clinicians
ConclusionThe Delphi process resulted in 25 consensus statements addressing the pathophysiology of impaired CA, and its impact on cerebral perfusion pressure targets and outcome. A research agenda was proposed emphasizing the need for better validated CA assessment methods as well as the focused investigation of the application of CA-guided management in clinical care using prospective safety, feasibility and efficacy studies. (Source: Neurocritical Care)
Source: Neurocritical Care - January 25, 2021 Category: Neurology Source Type: research

Cerebral Autoregulation: The Concept the Legend the Promise
(Source: Neurocritical Care)
Source: Neurocritical Care - January 25, 2021 Category: Neurology Source Type: research

Electroencephalography, Hospital Complications, and Longitudinal Outcomes After Subarachnoid Hemorrhage
ConclusionAlthough new or worsening EAs and cEEG background deterioration have both been shown to predict DCI, only new or worsening EAs are associated with a sustained impairment in functional outcome. This novel finding raises the potential for identifying therapeutic targets that may also influence outcomes. (Source: Neurocritical Care)
Source: Neurocritical Care - January 22, 2021 Category: Neurology Source Type: research

Development of Neurological Emergency Simulations for Assessment: Content Evidence and Response Process
ConclusionsWe demonstrated two sources of validity in ten simulation cases for assessment in neurological emergencies. (Source: Neurocritical Care)
Source: Neurocritical Care - January 21, 2021 Category: Neurology Source Type: research

Intracerebral Hemorrhage with Intraventricular Extension Associated with Loss of Consciousness at Symptom Onset
AbstractBackgroundIn patients with spontaneous intracerebral hemorrhage (ICH), pre-hospital markers of disease severity might be useful to potentially triage patients to undergo early interventions.ObjectiveHere, we tested whether loss of consciousness (LOC) at the onset of ICH is associated with intraventricular hemorrhage (IVH) on brain computed tomography (CT).MethodsAmong 3000 ICH cases from ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage study, NS069763), we included patients with complete ICH/IVH volumetric CT measurements and excluded those with seizures at ICH onset. Trained investigators extracted data...
Source: Neurocritical Care - January 21, 2021 Category: Neurology Source Type: research

Communication and Well-Being Considerations in Disorders of Consciousness
(Source: Neurocritical Care)
Source: Neurocritical Care - January 21, 2021 Category: Neurology Source Type: research

Neuroprotective Pentapeptide, CN-105, Improves Outcomes in Translational Models of Intracerebral Hemorrhage
AbstractBackgroundIntracerebral hemorrhage (ICH) is a devastating form of cerebrovascular disease for which there are no approved pharmacological interventions that improve outcomes. Apolipoprotein E (apoE) has emerged as a promising therapeutic target given its isoform-specific neuroprotective properties and ability to modify neuroinflammatory responses. We developed a 5-amino acid peptide, CN-105, that mimics the polar face of the apoE helical domain involved in receptor interactions, readily crosses the blood –brain barrier, and improves outcomes in well-established preclinical ICH models. In the current study, we...
Source: Neurocritical Care - January 21, 2021 Category: Neurology Source Type: research