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Delay in Diagnosis of Basilar Artery Stroke
Conclusions Our results suggest that both pre-hospital and in-hospital processes cause substantial, clinically significant delays in the diagnosis of BA stroke.
Source: Neurocritical Care - October 26, 2015 Category: Neurology Source Type: research

Non-invasive Monitoring of Dynamic Cerebrovascular Autoregulation Using Near Infrared Spectroscopy and the Finometer Photoplethysmograph
Conclusions The results suggest that dynamic cerebrovascular autoregulation can be continuously assessed entirely non-invasively using nTOx. This allows for autoregulation assessment using spontaneous blood pressure fluctuations in conditions where iABP is not routinely monitored. The nABPOPT might deviate from iABPOPT, likely because of discordance between absolute nABP and iABP readings.
Source: Neurocritical Care - October 21, 2015 Category: Neurology Source Type: research

CSF Volumetric Analysis for Quantification of Cerebral Edema After Hemispheric Infarction
Conclusions Volumetric CSF analysis reliably quantifies CED and distinguishes those with malignant edema and MLS from those with a more benign course after LHI. ∆CSF may provide an earlier and more sensitive indicator of edema severity across a broader dynamic range than MLS.
Source: Neurocritical Care - October 5, 2015 Category: Neurology Source Type: research

Emergency Neurological Life Support: Acute Ischemic Stroke
Abstract Acute ischemic stroke is a neurological emergency that can be treated with time-sensitive interventions, including intravenous thrombolysis and endovascular approaches. Extensive study has demonstrated that rapid assessment and treatment are essential for improving neurological outcome. For this reason, acute ischemic stroke was chosen as an Emergency Neurological Life Support protocol. The protocol focuses on the first hour following the onset of neurological deficit.
Source: Neurocritical Care - October 5, 2015 Category: Neurology Source Type: research

Emergency Neurological Life Support: Intracerebral Hemorrhage
Abstract Intracerebral hemorrhage (ICH) is a subset of stroke due to bleeding within the parenchyma of the brain. It is potentially lethal, and survival depends on ensuring an adequate airway, reversal of coagulopathy, and proper diagnosis. ICH was chosen as an Emergency Neurological Life Support protocol because intervention within the first critical hour may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently.
Source: Neurocritical Care - October 5, 2015 Category: Neurology Source Type: research

Glyburide Advantage in Malignant Edema and Stroke (GAMES-RP) Trial: Rationale and Design
Conclusions GAMES-RP was designed to provide critical information regarding glyburide for injection in patients with large hemispheric stroke and will inform the design of future studies.
Source: Neurocritical Care - August 12, 2015 Category: Neurology Source Type: research

Mandatory Intensivist Management Decreases Length of Stay, Facilitates an Increase in Admissions and Minimizes Closure of a Neurocritical Care Unit
Conclusions Implementation of mandatory intensivist management in the NCC unit decreased LOS, increased admissions, and decreased service line closure rates, while maintaining patient care.
Source: Neurocritical Care - July 25, 2015 Category: Neurology Source Type: research

Adverse Outcomes After Initial Non-surgical Management of Subdural Hematoma: A Population-Based Study
Conclusions Approximately one in eight patients with a conservatively managed SDH was readmitted with SDH within 90 days. A substantial proportion of these readmissions involved surgical hematoma evacuation. These outcomes occurred significantly more often after nontraumatic as compared to traumatic SDH.
Source: Neurocritical Care - July 10, 2015 Category: Neurology Source Type: research

The Role of Osmotic Therapy in Hemispheric Stroke
Conclusion Our results suggest that patients with moderate size hemispheric infarcts on presentation and those who do not require OT within the first 24 h of stroke may survive until discharge with medical management alone. Black race was also associated with conservative management failure, a finding that may reflect a cultural preference toward aggressive management. Further prospective studies are needed to better establish the utility of medical management of hemispheric edema in the setting of moderate size hemispheric infarcts.
Source: Neurocritical Care - July 1, 2015 Category: Neurology Source Type: research

Prognostic and Mechanistic Factors Characterizing Seizure-Associated Crossed Cerebellar Diaschisis
Conclusions Collectively, these observations indicate that imaging findings of persistent cerebral restricted diffusion and cytotoxic edema in the subacute post-ictal period may predict irreversible neuronal injury and poor long-term outcome—even when accompanied by evidence of cortical hyperperfusion and recovery of second- and third-order neurons along the involved circuit.
Source: Neurocritical Care - June 11, 2015 Category: Neurology Source Type: research

Complications Associated with Decompressive Craniectomy: A Systematic Review
Abstract Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all re...
Source: Neurocritical Care - June 2, 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

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: A Simple Predictor of Symptomatic Intracerebral Hemorrhage After IV Thrombolysis
Conclusions We developed a new score for predicting sICH after IV thrombolysis. Our score is simple and with acceptable accuracy, making it ideal for use in the hyperacute stroke setting.
Source: Neurocritical Care - April 13, 2015 Category: Neurology Source Type: research

Comparison of 8 Scores for predicting Symptomatic Intracerebral Hemorrhage after IV Thrombolysis
Conclusions Three scores showed good agreement with sICH: DRAGON, Stroke-TPI, and HAT with odds ratios substantially greater than 1. Stroke-TPI and HAT additionally benefited from low computational complexity and therefore performed best overall. Our results demonstrate the utility of clinical scores as predictors of sICH in acute ischemic stroke patients undergoing IV thrombolytic therapy.
Source: Neurocritical Care - March 18, 2015 Category: Neurology Source Type: research

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