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

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

Association of Epileptiform Abnormality on Electroencephalography with Development of Epilepsy After Acute Brain Injury
ConclusionsEAs on cEEG in patients with ABI are associated with a greater than three-fold increased risk of new-onset epilepsy. cEEG findings in ABI may therefore be a useful risk stratification tool for assessing long-term risk of seizures and serve as a biomarker for new-onset epilepsy. (Source: Neurocritical Care)
Source: Neurocritical Care - January 20, 2021 Category: Neurology Source Type: research

Cognitive Assessments in Critical Care Patient Populations: Methodological Considerations
(Source: Neurocritical Care)
Source: Neurocritical Care - January 20, 2021 Category: Neurology Source Type: research

Association of Severe Acute Kidney Injury with Mortality and Healthcare Utilization Following Isolated Traumatic Brain Injury
We examined the association of severe AKI with hospital mortality and healthcare utilization following isolate severe TBI.MethodsWe conducted a retrospective cohort study using the National Trauma Data Bank from 2007 to 2014. We identified a cohort of adult patients with isolated severe TBI and described the incidence of severe AKI, corresponding to Acute Kidney Injury Network stage 3 disease or greater. We examined the association of severe AKI with the primary outcome of hospital mortality using multivariable logistic regression models. In secondary analyses, we examined the association of severe AKI with dialysis cathet...
Source: Neurocritical Care - January 13, 2021 Category: Neurology Source Type: research

The Neurocritical Care Society Gender Parity Analysis in Grants and Recognition Awards
ConclusionsOur data reveal gender disparity, mainly for scientific or research awards. Prompt evaluation of the cause and further actions to address gender disparity in NCS grants and recognition awards is needed to establish gender equity in this area. (Source: Neurocritical Care)
Source: Neurocritical Care - January 13, 2021 Category: Neurology Source Type: research

Association of Cerebral Oxymetry with Short-Term Outcome in Critically ill Children Undergoing Extracorporeal Membrane Oxygenation
AbstractBackgroundAcute brain injury (ABI) is a frequent complication of pediatric extracorporeal membrane oxygenation (ECMO) that could be detected by continuous neuromonitoring. Cerebral near-infrared spectroscopy (NIRS) allows monitoring of cerebral oxygenation.ObjectiveTo assess whether an impaired cerebral oxygenation was associated with short-term outcome during pediatric ECMO.MethodsWe conducted a single-center retrospective study in a pediatric intensive care unit. Children under 18  years old were included if receiving veno-venous or veno-arterial ECMO with concurrent NIRS monitoring. Cerebral saturation impa...
Source: Neurocritical Care - January 12, 2021 Category: Neurology Source Type: research

Cerebrospinal Fluid Lactate Levels, Brain Lactate Metabolism and Neurologic Outcome in Patients with Out-of-Hospital Cardiac Arrest
AbstractBackground/ObjectiveCerebrospinal fluid (CSF) and serum lactate levels were assessed to predict poor neurologic outcome 3  months after return of spontaneous circulation (ROSC). We compared arterio-CSF differences in the lactate (ACDL) levels between two neurologic outcome groups.MethodsThis retrospective observational study involved out-of-hospital cardiac arrest (OHCA) survivors who had undergone target temperature management. CSF and serum samples were obtained immediately (lactate0), and at 24 (lactate24), 48 (lactate48), and 72 (lactate72) h after ROSC, and ACDL was calculated at each time point. The prim...
Source: Neurocritical Care - January 11, 2021 Category: Neurology Source Type: research

Temporal Dynamics of ICP, CPP, PRx, and CPPopt in High-Grade Aneurysmal Subarachnoid Hemorrhage and the Relation to Clinical Outcome
AbstractBackgroundHigh intracranial pressure (ICP) and low cerebral perfusion pressure (CPP) may induce secondary brain injury following aneurysmal subarachnoid hemorrhage (aSAH). In the current study, we aimed to determine the temporal incidence of insults above/below certain ICP/CPP thresholds, the role of pressure autoregulation in CPP management (PRx and CPPopt), and the relation to clinical outcome.MethodsIn this retrospective study, 242 patients were included with aSAH, who were treated in the neurointensive care unit, Uppsala University Hospital, Sweden, 2008 –2018, with ICP monitoring the first 10 days p...
Source: Neurocritical Care - January 9, 2021 Category: Neurology Source Type: research

Should We Assess Diaphragmatic Function During Mechanical Ventilation Weaning in Guillain –Barré Syndrome and Myasthenia Gravis Patients?
(Source: Neurocritical Care)
Source: Neurocritical Care - January 9, 2021 Category: Neurology Source Type: research

Is the CT Blend Sign Composed of Two Parts of Blood with Different Age?
ConclusionsThe CT blend sign observed in humans might be composed of two parts of blood with different ages. The hypodense area might be blood with older age and the hyperdense area might be new bleeding. (Source: Neurocritical Care)
Source: Neurocritical Care - January 6, 2021 Category: Neurology Source Type: research

High Serum Soluble Fas Ligand Levels in Non-survivor Traumatic Brain Injury Patients
AbstractPurposeSoluble Fas Ligand (sFasL) is one of the main ligands that activates the apoptosis extrinsic pathway. Higher expression of FasL in brain samples and higher cerebrospinal fluid FasL concentrations in traumatic brain injury (TBI) patients than in controls have been found. However, the potential association between blood sFasL concentrations and TBI mortality has not been reported. Therefore, the objective of this study was to determine whether that association exists.MethodsWe included patients with a severe isolated TBI, defined as  
Source: Neurocritical Care - January 6, 2021 Category: Neurology Source Type: research

Andexanet Alfa Versus 4-Factor Prothrombin Complex Concentrate for Reversal of Factor Xa Inhibitors in Intracranial Hemorrhage
ConclusionIn this limited sample of patients, we found no difference in neuroimaging stability, functional outcome and thrombotic events when comparing AA and 4F-PCC in patients with FXi-related ICH. Since our analysis is likely underpowered, a multi-center collaborative network devoted to this question is warranted. (Source: Neurocritical Care)
Source: Neurocritical Care - January 6, 2021 Category: Neurology Source Type: research

Sustained Low-Efficiency Dialysis is Associated with Worsening Cerebral Edema and Outcomes in Intracerebral Hemorrhage
AbstractBackground/ObjectivesWe postulated that renal replacement therapy (RRT) in ICH patients with advanced chronic kidney disease (CKD) is associated with increased frequency and size of perihematomal edema (PHE) expansion and worse patient outcomes.MethodsThe Get With the Guidelines-Stroke Registry was queried for all patients admitted with ICH (N = 1089). Secondary causes, brainstem ICH, and initial HV 
Source: Neurocritical Care - January 5, 2021 Category: Neurology Source Type: research

Pterygopalatine Fossa Blockade as Novel, Narcotic-Sparing Treatment for Headache in Patients with Spontaneous Subarachnoid Hemorrhage
ConclusionsPPF blockade might constitute a promising opioid-sparing therapeutic strategy for the management of post-SAH headache that merits further prospective controlled randomized studies. (Source: Neurocritical Care)
Source: Neurocritical Care - January 5, 2021 Category: Neurology Source Type: research

The Association Between Arterial Oxygen Level and Outcome in Neurocritically Ill Patients is not Affected by Blood Pressure
We examined whether the association between PaO2 and mortality is different in patients with low compared to normal and high mean arterial pressure (MAP) in patients after various types of brain injury.MethodsWe screened the Finnish Intensive Care Consortium database for mechanically ventilated adult ( ≥ 18) brain injury patients treated in several tertiary intensive care units (ICUs) between 2003 and 2013. Admission diagnoses included traumatic brain injury, cardiac arrest, subarachnoid and intracranial hemorrhage, and acute ischemic stroke. The primary exposures of interest were PaO2 (recorded in connection wit...
Source: Neurocritical Care - January 5, 2021 Category: Neurology Source Type: research

Biofluid Biomarkers in Traumatic Brain Injury: A Systematic Scoping Review
AbstractEmerging evidence suggests that biofluid-based biomarkers have diagnostic and prognostic potential in traumatic brain injuries (TBI). However, owing to the lack of a conceptual framework or comprehensive review, it is difficult to visualize the breadth of materials that might be available. We conducted a systematic scoping review to map and categorize the evidence regarding biofluid-based biochemical markers of TBI. A comprehensive search was undertaken in January 2019. Of 25,354 records identified through the literature search, 1036 original human studies were included. Five hundred forty biofluid biomarkers were ...
Source: Neurocritical Care - January 5, 2021 Category: Neurology Source Type: research

Targeted Temperature Management Suppresses Hypoxia-Inducible Factor-1 α and Vascular Endothelial Growth Factor Expression in a Pig Model of Cardiac Arrest
AbstractBackgroundThe hypoxia-inducible factor-1 α (HIF-1α)/vascular endothelial growth factor (VEGF)/VEGF receptor subtype 2 (VEGFR-2) pathway has been implicated in ischemia/reperfusion injury. The aim of this study was to clarify whether whole-body hypothermic targeted temperature management (HTTM) inhibits the HIF-1α/VEGF/VEGFR-2 pathway in a swine model of cardiac arrest (CA) and cardiopulmonary resuscitation (CPR).MethodsTwenty-four domestic male Beijing Landrace pigs were used in this study. CA was electrically induced with ventricular fibrillation and left untreated for 8  min. Return of spon...
Source: Neurocritical Care - January 5, 2021 Category: Neurology Source Type: research

Failure Mode and Effect Analysis: Engineering Safer Neurocritical Care Transitions
We describe the conceptual basis for and specific use-case example for each formal step of the FMEA process. We assembled a multi-disciplinary team, developed a process map of all components required for successful transfer, and identified “failure modes” or errors that hinder completion of each subprocess. A risk or hazard analysis was conducted for each failure mode, and ones of highest impact on patient safety and outcomes were identified and prioritized for implementation. Interventions were then developed and implemented into an action plan to redesign the process. Importantly, a comprehensive evaluation m...
Source: Neurocritical Care - January 5, 2021 Category: Neurology Source Type: research

Advanced Bio-signal Analytics for Continuous Bedside Monitoring of Aneurysmal Subarachnoid Hemorrhage: The Future
(Source: Neurocritical Care)
Source: Neurocritical Care - January 5, 2021 Category: Neurology Source Type: research

Alcohol Withdrawal Syndrome in Neurocritical Care Unit: Nicotine Replacement Therapy and Thiamine Deficiency
(Source: Neurocritical Care)
Source: Neurocritical Care - January 5, 2021 Category: Neurology Source Type: research

Automated Pupillometry Identifies Absence of Intracranial Pressure Elevation in Intracerebral Hemorrhage Patients
AbstractIntroductionAlthough automated pupillometry is increasingly used in critical care settings, predictive value of automatically assessed pupillary parameters during different intracranial pressure (ICP) levels and possible clinical implications are unestablished.MethodsThis retrospective cohort study at the neurocritical care unit of the University of Erlangen-Nuremberg (2016 –2018) included 23 nontraumatic supratentorial (intracerebral hemorrhage) ICH patients without signs of abnormal pupillary function by manual assessment, i.e., absent light reflex. We assessed ICP levels by an external ventricular drain si...
Source: Neurocritical Care - December 24, 2020 Category: Neurology Source Type: research

Individualized Brain Tissue Oxygen-Monitoring Probe Placement Helps to Guide Therapy and Optimizes Outcome in Neurocritical Care
ConclusionCT-guided probe insertion is a reliable and easy technique to place a ptO2 probe in a particular area of interest in patients with potentially reduced cerebral oxygen supply. By adjusting treatment aggressively according to this individualized monitoring data, clinical outcome may improve. (Source: Neurocritical Care)
Source: Neurocritical Care - December 16, 2020 Category: Neurology Source Type: research

Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis
ConclusionConsideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management. (Source: Neurocritical Care)
Source: Neurocritical Care - December 11, 2020 Category: Neurology Source Type: research

Treatment of Delayed Cerebral Ischemia in Good-Grade Subarachnoid Hemorrhage: Any Role for Invasive Neuromonitoring?
ConclusionsA considerable number of patients with good-grade SAH experiences secondary deterioration rendering them neurologically not assessable. In our cohort, the introduction of INM to guide DCI treatment in patients with secondary deterioration increased the rate of good recovery after 12  months. Additionally, a significant reduction of CT scans and infarction load was recorded, which may have an underestimated impact on quality of life and more subtle neuropsychological deficits common after SAH. (Source: Neurocritical Care)
Source: Neurocritical Care - December 10, 2020 Category: Neurology Source Type: research

Clinicians ’ Perceptions of the Appropriateness of Neurocritical Care for Patients with Spontaneous Intracerebral Hemorrhage (ICH): A Qualitative Study
ConclusionsCaring for severely affected ICH patients in need of neurocritical care is challenging, particularly with frail elderly patients. Awareness of the challenges could facilitate interventions to improve decision-making for this group of stroke patients and their families, as well as measures to reduce the distress on clinicians who care for this patient group. Our findings highlight the need for effective interdisciplinary shared decision making involving the family, taking into account patients ’ previously expressed values and preferences and incorporating these into bespoke care planning. (Source: Neurocritical Care)
Source: Neurocritical Care - December 2, 2020 Category: Neurology Source Type: research

How Does the Brain Die After a Massive Posterior Fossa Lesion?
(Source: Neurocritical Care)
Source: Neurocritical Care - December 2, 2020 Category: Neurology Source Type: research

Ventriculostomy Without Decompressive Suboccipital Craniectomy for a Devastating Posterior Fossa Mass Lesion: Doing “Everything” for the Family
(Source: Neurocritical Care)
Source: Neurocritical Care - December 2, 2020 Category: Neurology Source Type: research

Response
(Source: Neurocritical Care)
Source: Neurocritical Care - December 1, 2020 Category: Neurology Source Type: research

Intracranial Reserve in Ischemic Stroke: Is the Skull Half-Full or Half-Empty?
(Source: Neurocritical Care)
Source: Neurocritical Care - December 1, 2020 Category: Neurology Source Type: research

The Authors Reply: Correlation Between Ultrasonographic Optic Nerve Sheath Diameter and Intracranial Pressure in Patients with Aneurysmal Subarachnoid Hemorrhage
(Source: Neurocritical Care)
Source: Neurocritical Care - December 1, 2020 Category: Neurology Source Type: research

Hemodynamic Changes Associated with Lateralized Periodic Discharges: A Near-Infrared Spectroscopy and Continuous EEG Study
ConclusionsThis study demonstrates an increased cerebral SO2 in the hemisphere with LPDs, and decreased SO2 and O2Hb when the frequency of LPDs increases. The findings indicate that LPDs increase oxygen demand on the ipsilateral hemisphere. We infer that a threshold of LPDs frequency might exit, when the cerebral oxygen demand begins to supersede the ability of delivery, and saturation decreases. (Source: Neurocritical Care)
Source: Neurocritical Care - December 1, 2020 Category: Neurology Source Type: research

New Approaches to Critical Illness Polyneuromyopathy: High-Resolution Neuromuscular Ultrasound Characteristics and Cytokine Profiling
ConclusionsExploratory neuromuscular ultrasound and cytokine analyses showed signs of inflammation like macrophage and monocyte activation at the peak of CIPNM followed by a systemic immune response parallel to axonal damage. This underlines the role of both axonal damage and inflammation in pathogenesis of CIPNM. (Source: Neurocritical Care)
Source: Neurocritical Care - November 24, 2020 Category: Neurology Source Type: research

Inactivated Four-Factor Prothrombin Complex Concentrate Dosing Practices for Reversal of Warfarin-Related Intracranial Hemorrhage
ConclusionsMost patients received single doses of I4F-PCC, with adjunctive reversal agents and rounding doses to vial size. The time difference from baseline INR to factor product administration is a potential opportunity for process improvement in the management of warfarin-related ICH. (Source: Neurocritical Care)
Source: Neurocritical Care - November 20, 2020 Category: Neurology Source Type: research