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Source: Neurocritical Care

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Total 235 results found since Jan 2013.

Relationship Between Body Temperature and Early Neurological Deterioration after Endovascular Thrombectomy for Acute Ischemic Stroke with Large Vessel Occlusion
ConclusionsIn summary, there is a J-shaped association between the maximum body temperature within 24  h after EVT and END. Moreover, the risk of END differed according to the timing of fever onset.
Source: Neurocritical Care - January 3, 2022 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

Barriers to Surrogate Application of Patient Values in Medical Decisions in Acute Stroke: Qualitative Study in a Biethnic Community
ConclusionsStroke surrogate decision-makers may benefit from (1) continued efforts to make advance care planning more common and more relevant, (2) assistance in how to apply their knowledge of patient values to actual treatment decisions, and (3) psychosocial support to reduce emotional burden. Barriers to surrogate application of patient values were generally similar in MA and NHW participants, though the possibility of greater guilt or burden among MA surrogates warrants further investigation and confirmation.
Source: Neurocritical Care - May 2, 2023 Category: Neurology Source Type: research

The Change in Fibrinogen is Associated with Outcome in Patients with Acute Ischemic Stroke Treated with Endovascular Thrombectomy
ConclusionsIn patients with endovascular thrombectomy, hyperfibrinogenemia on admission was associated with poor functional outcomes at 3  months, whereas Δfibrinogen was associated with poor 3-month outcomes in a possible U-shaped manner.
Source: Neurocritical Care - June 14, 2023 Category: Neurology Source Type: research

Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting
Conclusion Hemodynamic management of patients with cerebrovascular injuries, based on targeted thresholds in the NSICU, yielded optimal control of SBP in only 28 % of our patients (within parameters ≥90 % of time).
Source: Neurocritical Care - April 21, 2015 Category: Neurology Source Type: research

TURN Score Predicts 90-day Outcome in Acute Ischemic Stroke Patients After IV Thrombolysis
Conclusions TURN predicted 90-day outcome with comparable or better accuracy compared to several existing clinical scores.
Source: Neurocritical Care - June 2, 2015 Category: Neurology Source Type: research

Noninvasive Neuromonitoring: Current Utility in Subarachnoid Hemorrhage, Traumatic Brain Injury, and Stroke
AbstractNoninvasive neuromonitoring is increasingly being used to monitor the course of primary brain injury and limit secondary brain damage of patients in the neurocritical care unit. Proposed advantages over invasive neuromonitoring methods include a lower risk of infection and bleeding, no need for surgical installation, mobility and portability of some devices, and safety. The question, however, is whether noninvasive neuromonitoring is practical and trustworthy enough already. We searched the recent literature and reviewed English-language studies on noninvasive neuromonitoring in subarachnoid hemorrhage, traumatic b...
Source: Neurocritical Care - December 20, 2016 Category: Neurology Source Type: research

Stroke and Craniectomy
AbstractNeurosurgical involvement in the care of major stroke complications has yielded striking results in the subtentorial region but equivocal outcomes in the supratentorial compartment. Most neurosurgeons want to see some degree of deterioration before proceeding; thus, timing will be debated. Viewpoints have changed over the years regarding surgical or medical intervention, but in many patients the procedure has not produced a definitive change in outcome other than preventing death from terminal brainstem shift. The introduction of craniectomy (and craniotomy) to treat swollen ischemic brain or intracranial hemorrhag...
Source: Neurocritical Care - December 22, 2017 Category: Neurology Source Type: research

Early Manipulation of Arterial Blood Pressure in Acute Ischemic Stroke (MAPAS): Results of a Randomized Controlled Trial
ConclusionsGood outcome in 90  days was not significantly different among the 3 blood pressure ranges. After logistic regression analysis, the odds of having good outcome was greater in Group 2 (SBP 161–180 mmHg). SICH occurred more frequently in Group 3 (181–200 mmHg).
Source: Neurocritical Care - November 20, 2018 Category: Neurology Source Type: research

What is the Role of Hyperosmolar Therapy in Hemispheric Stroke Patients?
AbstractThe role of hyperosmolar therapy (HT) in large hemispheric ischemic or hemorrhagic strokes remains a controversial issue. Past and current stroke guidelines state that it represents a reasonable therapeutic measure for patients with either neurological deterioration or intracranial pressure (ICP) elevations documented by ICP monitoring. However, the lack of evidence for a clear effect of this therapy on radiological tissue shifts and clinical outcomes produces uncertainty with respect to the appropriateness of its implementation and duration in the context of radiological mass effect without clinical correlates of ...
Source: Neurocritical Care - March 19, 2020 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

Deferred Consent in an Acute Stroke Trial from a Patient, Proxy, and Physician Perspective: A Cross-Sectional Survey
ConclusionsA large majority of the surveyed patients and proxies and a somewhat smaller majority of the surveyed physicians agreed with deferred consent in the ULTRA trial. Deferred consent may enable acute care trials in an acceptable manner without decreasing trust in medicine. Future research should investigate factors facilitating the responsible use of deferred consent, such as in-depth interviews, to study the minority of participants who agreed with deferred consent but still preferred immediate informed consent.
Source: Neurocritical Care - October 5, 2021 Category: Neurology Source Type: research

Augmented Renal Clearance in Patients with Acute Ischemic Stroke: A Prospective Observational Study
ConclusionsARC appears to manifest in patients with AIS inconsistently. Patients experiencing ARC were associated with nonsignificantly shorter ICU length of stay.
Source: Neurocritical Care - August 3, 2022 Category: Neurology Source Type: research

Andexanet-Alfa-Associated Heparin Resistance in the Context of Hemorrhagic Stroke
ConclusionsAlthough well known to hematologists, the phenomenon is underrecognized among stroke clinicians. However, patients with intracranial hemorrhage frequently undergo endovascular or surgical interventions that require periprocedural administration of heparin.
Source: Neurocritical Care - August 5, 2022 Category: Neurology Source Type: research

Albumin-Induced Neuroprotection in Focal Cerebral Ischemia in the ALIAS Trial: Does Severity, Mechanism, and Time of Infusion Matter?
ConclusionA trend for benefit is noted in ischemic stroke patients with large cardioembolic stroke (NIHSS  ≥15) when high-dose albumin was initiated within 2 h, suggesting that certain ischemic stroke subgroups of patients most representative of preclinical settings may benefit from such a treatment. Additional clinical trials maybe needed to stratify subjects and treatment assignments according to NIHSS severity and timely randomization to evaluate this concept further.
Source: Neurocritical Care - April 24, 2017 Category: Neurology Source Type: research