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Initial Conservative Management of Severe Hemispheric Stroke Reduces Decompressive Craniectomy Rates
Conclusions Delayed DC for hemispheric stroke patients managed under protocol in the neurocritical care unit is a safe alternative to early, prophylactic DC for adults with severe hemispheric stroke. This strategy reduced DC rates by 60 % without an excess of death or survival with severe disabilities.
Source: Neurocritical Care - April 20, 2016 Category: Neurology Source Type: research

Emergency Free-Hand Bedside Catheter Evacuation of Large Intracerebral Hematomas Following Thrombolysis for Ischemic Stroke: A Case Series
ConclusionsEmergency free-hand bedside catheter aspiration is a reasonable option for hematoma evacuation in large thrombolysis-associated sICH when performed by experienced neurosurgeons. Larger studies would help in determining the generalizability of our findings to other centers and assessing their impact on functional outcome.
Source: Neurocritical Care - December 2, 2019 Category: Neurology Source Type: research

Early Prediction of Malignant Edema After Successful Recanalization in Patients with Acute Ischemic Stroke
ConclusionsThe extent of postinterventional cerebral hyperdensities on postinterventional non-contrast-enhanced CT was associated with malignant brain edema. The Hyperdensity on CT Score could be used to predict malignant brain edema regardless of the component of postinterventional cerebral hyperdensities.
Source: Neurocritical Care - November 8, 2021 Category: Neurology Source Type: research

Natural Language Processing of Radiology Reports to Detect Complications of Ischemic Stroke
ConclusionsOur study demonstrates robust performance and external validity of a core NLP tool kit for identifying both categorical and continuous outcomes of ischemic stroke from unstructured radiographic text data. Medically tailored NLP methods have multiple important big data applications, including scalable electronic phenotyping, augmentation of clinical risk prediction models, and facilitation of automatic alert systems in the hospital setting.
Source: Neurocritical Care - May 9, 2022 Category: Neurology Source Type: research

The Routine Follow-up Head CT: Is it Still a Necessary Step in the Thrombolysis Pathway?
ConclusionsThe 24-h head CT scan does not change management for most patients, particularly those with low National Institutes of Health Stroke Scale scores who do not undergo MT. Consideration should be given to removing routine follow-up imaging from postthrombolysis protocols in favor of an examination-based approach.
Source: Neurocritical Care - September 27, 2021 Category: Neurology Source Type: research

Causes, Predictors, and Timing of Early Neurological Deterioration and Symptomatic Intracranial Hemorrhage After Administration of IV tPA
ConclusionsIn this study, only a small proportion suffered from either sICH and/or END, typically within 12  h of tPA administration. These findings may support earlier deescalation of higher acuity monitoring in clinically stable post-IV tPA patients without large vessel occlusion.
Source: Neurocritical Care - July 6, 2021 Category: Neurology Source Type: research

Acute Posterior Cranial Fossa Hemorrhage—Is Surgical Decompression Better than Expectant Medical Management?
Conclusions SDC following PCFH was associated with a reduction in mortality compared to expectant MT with or without EVD insertion. A high-quality multicenter randomized control trial is required to evaluate the superiority of SDC for PCFH.
Source: Neurocritical Care - April 11, 2016 Category: Neurology Source Type: research

Acute Posterior Cranial Fossa Hemorrhage —Is Surgical Decompression Better than Expectant Medical Management?
ConclusionsSDC following PCFH was associated with a reduction in mortality compared to expectant MT with or without EVD insertion. A high-quality multicenter randomized control trial is required to evaluate the superiority of SDC for PCFH.
Source: Neurocritical Care - November 30, 2016 Category: Neurology Source Type: research

The Role of Serum Calcium Level in Intracerebral Hemorrhage Hematoma Expansion: Is There Any?
AbstractSpontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke, with a high rate of mortality and morbidity. Even with the best current medical or surgical interventions, outcomes remain poor. The location and initial hematoma volume are strong predictors of mortality. Hematoma expansion (HE) is a further marker of poor prognosis that may be at least partly preventable. Several risk factors for HE have been identified, including baseline ICH volume, anticoagulation, and computed tomography angiography spot signs. Recent studies have shown the correlation of serum calcium (Ca++) levels on admission with ...
Source: Neurocritical Care - June 27, 2018 Category: Neurology Source Type: research

External Validation of Hematoma Expansion Scores in Spontaneous Intracerebral Hemorrhage in an Asian Patient Cohort
ConclusionsTo our knowledge, this is the first study to validate HE scores, namely PREDICT, 9-Point and BRAIN, in a multi-ethnic Asian ICH patient population. The PREDICT score was the best performing model in our study cohort, based on the performance metrics employed in this study. Our findings also showed support for CT angiography spot sign as a predictor of outcome after ICH. Although the models assessed are sufficient for risk stratification, the discrimination and calibration are at best moderate and could be improved.
Source: Neurocritical Care - October 30, 2018 Category: Neurology Source Type: research

Relationship of White Matter Lesions with Intracerebral Hemorrhage Expansion and Functional Outcome: MISTIE II and CLEAR III
ConclusionsConcomitant WML does not increase the odds for HE in patients with ICH but increases the odds for poor functional outcome.Clinical Trial Registrationhttp://www.clinicaltrials.gov trial-identifiers: NCT00224770 and NCT00784134.
Source: Neurocritical Care - February 4, 2020 Category: Neurology Source Type: research

Efficacy of 4-Factor Prothrombin Complex Concentrates in Factor Xa Inhibitor-Associated Intracranial Bleeding
Conclusion4FPCC appears to be an effective and safe option for FXaI-associated ICB with outcomes comparable to andexanet alfa. A formal prospective evaluation of this strategy versus andexanet alpha including cost analysis is warranted.
Source: Neurocritical Care - May 18, 2020 Category: Neurology Source Type: research

Size-Related Differences in Computed Tomography Markers of Hematoma Expansion in Acute Intracerebral Hemorrhage
ConclusionsThe prevalence of NCCT markers and their association with HE differed according to hematoma volume. Quantitative hematoma density was associated with HE, regardless of hematoma size.
Source: Neurocritical Care - September 29, 2021 Category: Neurology Source Type: research

Association Between Hyperacute Blood Pressure Variability and Hematoma Expansion After Intracerebral Hemorrhage: Secondary Analysis of the FAST-MAG Database
ConclusionsHigher BPV was not found to be associated with occurrence of HE in the hyperacute or the acute period of spontaneous ICH. Further study is needed to determine the relationship.
Source: Neurocritical Care - December 5, 2022 Category: Neurology Source Type: research

Neuromonitoring During ECMO Support in Children
AbstractExtracorporeal membrane oxygenation is a potentially lifesaving intervention for children with severe cardiac or respiratory failure. It is used with increasing frequency and in increasingly more complex and severe diseases. Neurological injuries are important causes of morbidity and mortality in children treated with extracorporeal membrane oxygenation and include ischemic stroke, intracranial hemorrhage, hypoxic-ischemic injury, and seizures. In this review, we discuss the epidemiology and pathophysiology of neurological injury in patients supported with extracorporeal membrane oxygenation, and we review the curr...
Source: Neurocritical Care - January 31, 2023 Category: Neurology Source Type: research