Sleep Measure Validation in a Pediatric Neurocritical Care Acquired Brain Injury Population
ConclusionsThe SDSC is a valid and reliable measure for assessing sleep disturbances in children after PNCC. Results support the use of the SDSC to measure sleep disturbances after PNCC. Targeted interventions for sleep disturbances may be key to overall patient recovery. (Source: Neurocritical Care)
Source: Neurocritical Care - December 3, 2019 Category: Neurology Source Type: research

Relationship Between Measures of Cerebrovascular Reactivity and Intracranial Lesion Progression in Acute TBI Patients: an Exploratory Analysis
ConclusionsOur preliminary findings suggest a possible link between autoregulatory failure and traumatic edema progression, which warrants re-evaluation in larger-scale prospective studies. (Source: Neurocritical Care)
Source: Neurocritical Care - December 3, 2019 Category: Neurology Source Type: research

Ability of Fibrin Monomers to Predict Progressive Hemorrhagic Injury in Patients with Severe Traumatic Brain Injury
This study sought to determine the ability of FM to predict PHI after severe TBI.MethodsWe conducted a prospective, observational study including all severe TBI patients admitted in the trauma center. Between September 2011 and September 2016, we enrolled patients with severe TBI into the derivation cohort. Between October 2016 and December 2018, we recruited the validation cohort on the same basis. Study protocol included FM measurements and standard coagulation test at admission and two computed tomography (CT) scans (upon arrival and at least 6  h thereafter). A PHI was defined by an increment in size of initial le...
Source: Neurocritical Care - December 3, 2019 Category: Neurology Source Type: research

Emergency Free-Hand Bedside Catheter Evacuation of Large Intracerebral Hematomas Following Thrombolysis for Ischemic Stroke: A Case Series
AbstractIntroductionSymptomatic intracerebral hemorrhage (sICH) following systemic thrombolysis for ischemic stroke is often devastating, and open surgical evacuation is considered dangerous due to the increased risk of perioperative bleeding, and stereotactic placement of a catheter is too time-consuming. We therefore evaluated the feasibility of a free-hand bedside catheter technique for emergency hematoma evacuation.MethodsPatients who had a supratentorial sICH after thrombolysis, a hematoma volume  >  30 ml, and an ensuing reduction in vigilance were consecutively treated with acute minimally inva...
Source: Neurocritical Care - December 3, 2019 Category: Neurology Source Type: research

Commentary on Associations of Radiographic Small Vessel Disease with Acute Intracerebral Hemorrhage Volume, Hematoma Expansion, and Intraventricular Hemorrhage
(Source: Neurocritical Care)
Source: Neurocritical Care - December 3, 2019 Category: Neurology Source Type: research

Comparison of Three Point-of-Care Ultrasound Views and MRI Measurements for Optic Nerve Sheath Diameter: A Prospective Validity Study
ConclusionOur findings suggest that absolute measurements should not be compared across different ultrasound orientations given the wide variability in the correlation between the ultrasound views used to assess the optic nerve sheath. The inferior and transverse ultrasound views are the most likely to yield high-quality images, although the specific view, for the best image, in an individual patient can vary. We would caution against absolute values of ONSD to indicate increased ICP, as it may be view dependent. (Source: Neurocritical Care)
Source: Neurocritical Care - December 2, 2019 Category: Neurology Source Type: research

Prostacyclin Affects the Relation Between Brain Interstitial Glycerol and Cerebrovascular Pressure Reactivity in Severe Traumatic Brain Injury
ConclusionsPR is correlated to the glycerol level in patients suffering from sTBI, a relationship that is not seen in the group treated with prostacyclin. Glycerol has been associated with membrane degradation and may support glycerol as a biomarker for vascular endothelial breakdown. Such a breakdown may impair the regulation of cerebrovascular PR. (Source: Neurocritical Care)
Source: Neurocritical Care - November 21, 2019 Category: Neurology Source Type: research

Serum Caspase-3 Levels and Early Mortality of Patients with Malignant Middle Cerebral Artery Infarction
AbstractPurposeCirculating caspase-3 levels at 24  h of ischemic stroke were found to be associated with poorer functional neurological outcome in a previous study. The aim of this study was to determine whether there is an association between serum caspase-3 levels and early mortality in patients with malignant middle cerebral artery infarction ( MMCAI).MethodsWe included patients with MMCAI defined as computer tomography showing ischemic changes in more than 50% of the middle cerebral artery territory and Glasgow Coma Scale  ≤ 8. Serum caspase-3 levels at days 1, 4, and 8 of MMCAI were determined.Re...
Source: Neurocritical Care - November 21, 2019 Category: Neurology Source Type: research

Development of a Homemade Spinal Model for Simulation to Teach Ultrasound Guidance for Lumbar Puncture
ConclusionsAn inexpensive reusable non-commercial LP simulator can be an effective method for teaching invasive procedures like LPs, especially if it can be used both for palpation and US-guided procedures. The method outlined here can be easily reproduced in a relatively short amount of time. We recognize one limitation in the widespread dissemination of this technique being access to a 3D printer and digital designs for printing. Future studies will be necessary to determine the efficacy of the homemade LP simulator in teaching neurointensivist in training. (Source: Neurocritical Care)
Source: Neurocritical Care - November 21, 2019 Category: Neurology Source Type: research

High Arterial Glucose is Associated with Poor Pressure Autoregulation, High Cerebral Lactate/Pyruvate Ratio and Poor Outcome Following Traumatic Brain Injury
ConclusionsHigh arterial glucose was associated with poor outcome, poor pressure autoregulation, and cerebral energy metabolic disturbances. The latter two suggest a pathophysiological mechanism for the negative effect of arterial hyperglycemia, although further studies are needed to elucidate if the correlations are causal or confounded by other factors. (Source: Neurocritical Care)
Source: Neurocritical Care - November 21, 2019 Category: Neurology Source Type: research

Minimal Computed Tomography Attenuation Value Within the Hematoma is Associated with Hematoma Expansion and Poor Outcome in Intracerebral Hemorrhage Patients
This study involved spontaneous ICH patients of two cohorts who underwent baseline CT scan within 6  h after ICH onset and follow-up CT scan within 24 h after initial CT scan. We determined the critical value of the minimal CT attenuation value via retrospective analysis of the data from a derivation cohort. Then, a prospective study on the validation cohort of three clinical centers was perform ed for determining the association between the minimal CT attenuation value and hematoma expansion as well as poor outcome (modified Rankin Scale scores >  3) at 90 days by using univariate and multi...
Source: Neurocritical Care - November 21, 2019 Category: Neurology Source Type: research

Brushing Against the Tentorium: Traumatic Pseudoaneurysm of the Posterior Cerebral Artery
(Source: Neurocritical Care)
Source: Neurocritical Care - November 18, 2019 Category: Neurology Source Type: research

Risk Factors for Dysphagia and the Impact on Outcome After Spontaneous Subarachnoid Hemorrhage
AbstractBackgroundDespite the tremendous impact of swallowing disorders on outcome following ischemic stroke, little is known about the incidence of dysphagia after subarachnoid hemorrhage (SAH) and its contribution to hospital complications, length of intensive care unit stay, and functional outcome.MethodsThis is a retrospective analysis of an ongoing prospective cohort study. Swallowing ability was assessed in consecutive non-traumatic SAH patients admitted to our neurological intensive care unit using the Bogenhausen Dysphagia Score (BODS). A BODS  >  2 points indicated dysphagia. Functional outcome wa...
Source: Neurocritical Care - November 15, 2019 Category: Neurology Source Type: research

Treatment of Movement Disorder Emergencies in Autoimmune Encephalitis in the Neurosciences ICU
AbstractImmune response against neuronal and glial cell surface and cytosolic antigens is an important cause of encephalitis. It may be triggered by activation of the immune system in response to an infection (para-infectious), cancer (paraneoplastic), or due to a patient ’s tendency toward autoimmunity. Antibodies directed toward neuronal cell surface antigens are directly pathogenic, whereas antibodies with intracellular targets may become pathogenic if the antigen is transiently exposed to the cell surface or via activation of cytotoxic T cells. Immune-mediated encephalitis is well recognized and may require inten...
Source: Neurocritical Care - November 15, 2019 Category: Neurology Source Type: research

Lipid Peroxidation and Antioxidant Consumption as Early Markers of Neurosurgery-Related Brain Injury in Children
ConclusionsOur results indicate that lipid peroxidation increases consistently following brain surgery, and it is accompanied by a decrease in antioxidant defences; intraventricular catheterization offers a unique chance of oxidative process monitoring. Further studies are needed to evaluate whether monitoring post-neurosurgical oxidative stress in CSF is of prognostic utility. (Source: Neurocritical Care)
Source: Neurocritical Care - November 6, 2019 Category: Neurology Source Type: research

Regional Cerebral Hypoperfusion from Acute Subdural Hematoma
(Source: Neurocritical Care)
Source: Neurocritical Care - November 1, 2019 Category: Neurology Source Type: research

A Young Woman Presenting with Encephalopathy: A Case Report
(Source: Neurocritical Care)
Source: Neurocritical Care - November 1, 2019 Category: Neurology Source Type: research

The Frontal Bone Window for Transcranial Doppler Ultrasonography in Critically Ill Patients: Validation of a New Approach in the ICU
ConclusionsIn ICU, the FBW was able to insonate the ACA in 45% of patients admitted for brain injury, without the use of contrast agents. The FBW could improve the detection of ACA vasospasms. (Source: Neurocritical Care)
Source: Neurocritical Care - October 29, 2019 Category: Neurology Source Type: research

Sonographic Demonstration of a Perfusion-Dependent Stroke with Negative MRI and a Flow-Limiting Stenosis
(Source: Neurocritical Care)
Source: Neurocritical Care - October 29, 2019 Category: Neurology Source Type: research

The Use of Standardized Management Protocols for Critically Ill Patients with Non-traumatic Subarachnoid Hemorrhage: A Systematic Review
AbstractThe use of standardized management protocols (SMPs) may improve patient outcomes for some critical care diseases. Whether  SMPs improve outcomes after subarachnoid hemorrhage (SAH) is currently unknown. We aimed to study the effect of SMPs on 6-month mortality and neurologic outcomes following SAH. A systematic review of randomized control trials (RCTs) and observational studies was performed by searching multiple ind exing databases from their inception through January 2019. Studies were limited to adult patients (age ≥ 18) with non-traumatic SAH reporting mortality, neurologic outcomes, dela...
Source: Neurocritical Care - October 28, 2019 Category: Neurology Source Type: research

Vitamin K Antagonist (Phenprocoumon) and Subarachnoid Hemorrhage: A Single-Center, Matched-Pair Analysis
AbstractBackgroundDemographic changes are leading to an aging society with a growing number of patients relying on anticoagulation, and vitamin K antagonists (VKA) are still widely used. As mortality and functional outcomes are worse in case of VKA-associated hemorrhagic stroke, phenprocoumon treatment seems to be a negative prognostic factor in case of subarachnoid hemorrhage (SAH). The purpose of this study was to analyze whether phenprocoumon treatment does worsen the outcome after non-traumatic SAH.MethodsAll patients treated for non-traumatic SAH between January 2007 and December 2016 in our institution were retrospec...
Source: Neurocritical Care - October 28, 2019 Category: Neurology Source Type: research

Key Points to Consider When Evaluating Andexxa for Formulary Addition
(Source: Neurocritical Care)
Source: Neurocritical Care - October 22, 2019 Category: Neurology Source Type: research

Increased Neutrophil-to-Lymphocyte Ratio is Associated with Unfavorable Functional Outcome in Acute Ischemic Stroke
AbstractBackgroundInflammatory response is the hallmark of secondary brain injury in stroke patients. Neutrophil-to-lymphocyte ratio (NLR) emerged as a marker for functional outcome in several diseases.ObjectivesTo investigate the association between NLR on admission and during hospital stay and functional outcome in acute ischemic stroke (AIS).MethodsThis observational study included all consecutive AIS patients admitted at a German stroke center covering 2011 –2013. Patient characteristics and clinical data were retrieved from institutional databases. Multivariate analysis was conducted to investigate parameters as...
Source: Neurocritical Care - October 15, 2019 Category: Neurology Source Type: research

Neurocritical Care Quality Improvement Practices: A Survey of Members of the Neurocritical Care Society
ConclusionA dedicated staffed NCCU QI program occurs in a minority of NCC units, and the lack of such programs may lead to clinician dissatisfaction. Institutional and departmental support may be critical elements of a successful and satisfactory implementation of NCCU QI. (Source: Neurocritical Care)
Source: Neurocritical Care - October 15, 2019 Category: Neurology Source Type: research

Diagnostic Reliability of Headset-Type Continuous Video EEG Monitoring for Detection of ICU Patterns and NCSE in Patients with Altered Mental Status with Unknown Etiology
ConclusionsHS-cv EEG monitoring is highly reliable in detecting abnormal EEG patterns, with moderate reliability for PDs and NCSE, and rapidly initiates cEEG monitoring in patients with AMS with unknown etiology. (Source: Neurocritical Care)
Source: Neurocritical Care - October 15, 2019 Category: Neurology Source Type: research

The Irreversible Neurogenic Stress Cardiomyopathy During Large Supratentorial Brain Tumor Resection
(Source: Neurocritical Care)
Source: Neurocritical Care - October 9, 2019 Category: Neurology Source Type: research

High Serum DNA and RNA Oxidative Damage in Non-surviving Patients with Spontaneous Intracerebral Hemorrhage
The objective of this study was to determine whether there is an association between oxidative damage of serum D NA and ribonucleic acid (RNA) and mortality in patients with ICH.MethodsIn this observational and prospective study, patients with severe supratentorial ICH (defined as Glasgow Coma Scale  
Source: Neurocritical Care - October 9, 2019 Category: Neurology Source Type: research

Changes of Endothelin-1 and Nitric Oxide Systems in Brain Tissue During Mild Hypothermia in a Porcine Model of Cardiac Arrest
ConclusionsThe ET-1 system is activated, while inducible NOS is inhibited in brain tissue during MH after resuscitation. (Source: Neurocritical Care)
Source: Neurocritical Care - October 8, 2019 Category: Neurology Source Type: research

mRNA Expression Profiles from Whole Blood Associated with Vasospasm in Patients with Subarachnoid Hemorrhage
In this study, we evaluated inflammatory and prothrombotic pathways by examining mRNA expression in whole blood of SAH patients with and without vasospasm.MethodsAdult SAH patients with vasospasm (n = 29) and without vasospasm (n = 21) were matched for sex, race/ethnicity, and aneurysm treatment method. Diagnosis of vasospasm was made by angiography. mRNA expression was measured by Affymetrix Human Exon 1.0 ST Arrays. SAH patients with vasospasm were compared to those without vasospasm by ANCOVA to identify differential gene, exon, and alternatively spliced transcript expression. Analyses were a...
Source: Neurocritical Care - October 8, 2019 Category: Neurology Source Type: research

Combined Treatment with Hydrophilic and Lipophilic Statins Improves Neurological Outcomes Following Experimental Cardiac Arrest in Mice
ConclusionCombination treatment with two different types of statins at the correct dose may be a promising approach to neuroprotection following CA/CPR. (Source: Neurocritical Care)
Source: Neurocritical Care - October 7, 2019 Category: Neurology Source Type: research

A Unique Signature of Cardiac-Induced Cranial Forces During Acute Large Vessel Stroke and Development of a Predictive Model
AbstractBackgroundCranial accelerometry is used to detect cerebral vasospasm and concussion. We explored this technique in a cohort of code stroke patients to see whether a signature could be identified to aid in the diagnosis of large vessel occlusion (LVO) stroke.MethodsA military-grade three-axis accelerometer was affixed to a headset. Accelerometer and electrocardiogram (ECG) outputs were digitized at 1.6  kHz. We call the resulting digitized signals the “headpulse.” Three-minute recordings were performed immediately after computed tomography (CT) angiography (CTA) and/or immediately before and after a...
Source: Neurocritical Care - October 7, 2019 Category: Neurology Source Type: research

Evaluation of the Accuracy of Standard Renal Function Equations in Critically Ill Patients with Subarachnoid Hemorrhage
AbstractBackgroundObtaining an accurate estimation of renal function is germane to optimizing care in critically ill patients. However, there is no consensus on the most accurate renal function assessment to utilize in this patient population, particularly in aneurysmal subarachnoid hemorrhage (aSAH) patients. Thus, the objective of this observational study was to determine the comparability of renal function equations to body surface area (BSA)-adjusted 8-h creatinine clearance (CrCl) in aSAH patients.MethodsA PubMed search investigated the applicability of various renal function equations in critically ill patient popula...
Source: Neurocritical Care - October 7, 2019 Category: Neurology Source Type: research

A Proposal for a New Protocol for Sonographic Assessment of the Optic Nerve Sheath Diameter: The CLOSED Protocol
AbstractMeasuring and monitoring of intracranial pressure is considered standard of care in patients with suspected intracranial hypertension. Sonographic assessment of the optic nerve sheath diameter (ONSD) has been promising and potentially useful for noninvasive intracranial hypertension screening. ONSD measurements are easy to perform, repeatable at bedside, fast, low cost, and radiation-free. However, they are still burdened by inter-rater variability, lack of ultrasound (US) setting standardization (e.g., US frequency, focus depth, etc.), and possible artifacts. To overcome this problem, we propose the CLOSED protoco...
Source: Neurocritical Care - October 3, 2019 Category: Neurology Source Type: research

Cyclosporine A Plus Ischemic Postconditioning Improves Neurological Function in Rats After Cardiac Resuscitation
ConclusionIschemic postconditioning combined with CsA exerted a better neuroprotective effect after CPR than did either postconditioning or CsA alone. Inhibiting the opening of the mPTP is not the only neuroprotective mechanism. (Source: Neurocritical Care)
Source: Neurocritical Care - October 1, 2019 Category: Neurology Source Type: research

A Bibliometric Analysis of the Most Cited Articles in Neurocritical Care Research
AbstractBibliometric analyses may indicate the most active journals, authors, countries, institutions and specialties by evaluating the most cited articles in a given research field. To the authors ’ knowledge, there is no bibliometric analysis regarding neurocritical care research. Thus, the aim of this study is to analyze and to provide a scope of the current scientific production in this area. The 100 most cited articles in the neurocritical care research were retrieved from the research “(neurocritical) AND (care)” in the Scopus database. The variables collected and included in this analysis were: num...
Source: Neurocritical Care - September 23, 2019 Category: Neurology Source Type: research

Clinical Determination of Brain Death in Children Supported by Extracorporeal Membrane Oxygenation
ConclusionsClinical determination of brain death, including apnea testing, can be performed in pediatric patients supported by ECMO. The ECMO circuit can be effectively modified during apnea testing to achieve a timely rise in carbon dioxide while maintaining oxygenation and hemodynamic stability. (Source: Neurocritical Care)
Source: Neurocritical Care - September 23, 2019 Category: Neurology Source Type: research

Gap Analysis Regarding Prognostication in Neurocritical Care: A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society
ConclusionsPrognostication in neurocritical care is important, and current prognostic models are limited. This gap analysis provides a summary assessment of issues that could be addressed in future studies and evidence-based guidelines in order to improve the process of prognostication. (Source: Neurocritical Care)
Source: Neurocritical Care - September 23, 2019 Category: Neurology Source Type: research

Brain Venous Blood Outflow
(Source: Neurocritical Care)
Source: Neurocritical Care - September 23, 2019 Category: Neurology Source Type: research

Autoregulation Monitoring is Important: Even After Aneurysmal Subarachnoid Hemorrhage —Isn’t it?
(Source: Neurocritical Care)
Source: Neurocritical Care - September 23, 2019 Category: Neurology Source Type: research

Commentary: Feasibility and Safety of Transnasal High Flow Air to Reduce Core Body Temperature
(Source: Neurocritical Care)
Source: Neurocritical Care - September 23, 2019 Category: Neurology Source Type: research

The Dilemma of Resuming Antithrombotic Therapy After Intracranial Hemorrhage in Patients With Left Ventricular Assist Devices
ConclusionDespite timing of resumption of antithrombotic therapy after ICH, recurrent hemorrhagic events can be expected in one-quarter of these patients over the subsequent year. (Source: Neurocritical Care)
Source: Neurocritical Care - September 17, 2019 Category: Neurology Source Type: research

Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit
AbstractWithin the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cogni...
Source: Neurocritical Care - September 4, 2019 Category: Neurology Source Type: research

Global Survey of Outcomes of Neurocritical Care Patients: Analysis of the PRINCE Study Part 2
ConclusionPRINCE is the first study to evaluate care patterns of neurocritical patients worldwide. The data suggest that there is a wide variability in clinical care resources and patient characteristics. Neurological severity of illness and the absence of a dedicated NCCU are independent predictors of in-patient mortality. (Source: Neurocritical Care)
Source: Neurocritical Care - September 4, 2019 Category: Neurology Source Type: research

Reply to: Ratio of Optic Nerve Sheath Diameter to Eyeball Transverse Diameter by Ultrasound Can Predict Intracranial Hypertension in Traumatic Brain Injury Patients: A Prospective Study
(Source: Neurocritical Care)
Source: Neurocritical Care - September 4, 2019 Category: Neurology Source Type: research

Palliative Care in the Neuro-ICU: Perceptions, Practice Patterns, and Preferences of Neurointensivists
AbstractIntroductionThe proportion of hospitals with specialist palliative care services in the USA has increased substantially over the past decade. Severe acute brain injury presents with unique challenges, especially regarding quality of life. The growth and increased recognition of neurocritical care as a subspecialty has not been paralleled by studies regarding how best to integrate palliative care for this unique patient population. Thus, we surveyed members of the Neurocritical Care Society (NCS) to explore current practice patterns, perceptions, and preferences regarding integration of palliative care in the neurol...
Source: Neurocritical Care - August 29, 2019 Category: Neurology Source Type: research

Ratio of Optic Nerve Sheath Diameter to Eyeball Transverse Diameter by Ultrasonography to Predict Raised Intracranial Pressure in Traumatic Brain Injury
(Source: Neurocritical Care)
Source: Neurocritical Care - August 29, 2019 Category: Neurology Source Type: research

Comparison of Outcomes After Treatment of Large Vessel Occlusion in a Critical Care Resuscitation Unit or a Neurocritical Care Unit
ConclusionThe CCRU increased AIS-LVO patients ’ access to definitive care and reduced their transfer time from outlying medical facilities while achieving outcomes similar to those attained by patients treated in the subspecialty NCCU. We conclude that a resuscitation unit can complement the NCCU to care for patients in the hyperacute phase o f AIS-LVO. (Source: Neurocritical Care)
Source: Neurocritical Care - August 26, 2019 Category: Neurology Source Type: research

High-Dose Intravenous Ascorbic Acid: Ready for Prime Time in Traumatic Brain Injury?
AbstractTraumatic brain injury (TBI) is one of the leading public health problems in the USA and worldwide. It is the number one cause of death and disability in children and adults between ages 1 –44. Despite efforts to prevent TBIs, the incidence continues to rise. Secondary brain injury occurs in the first hours and days after the initial impact and is the most effective target for intervention. Inflammatory processes and oxidative stress play an important role in the pathomechanism of T BI and are exacerbated by impaired endogenous defense mechanisms, including depletion of antioxidants. As a reducing agent, free...
Source: Neurocritical Care - August 22, 2019 Category: Neurology Source Type: research

Hemorrhagic Shock After Lumbar Puncture
(Source: Neurocritical Care)
Source: Neurocritical Care - August 22, 2019 Category: Neurology Source Type: research

Correction to: Gap Analysis Regarding Prognostication in Neurocritical Care: A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society
This article was updated to correct the spelling of Karl Georg Haeusler. (Source: Neurocritical Care)
Source: Neurocritical Care - August 21, 2019 Category: Neurology Source Type: research