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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

Clostridium septicum Pneumocephalus
Conclusions Clostridium septicum is an uncommon and often fatal cause of nontraumatic pneumocephalus. This underscores the need for a high index of clinical suspicion in cases with unexplained pneumocephalus, as early diagnosis remains the key to survival. In survivors of C. septicum infection, subsequent colonoscopy should be considered to exclude undiagnosed or occult gastrointestinal malignancy.
Source: Neurocritical Care - March 31, 2016 Category: Neurology Source Type: research

Mucor Thrombus
Conclusions The endovascular placement of an expandable stent in the setting of angioinvasive mucormycosis restored good cerebral blood flow in a proximal internal carotid artery occlusion. The patient’s aphasia resolved following this intervention. Artifacts of CT angiography may result in the overestimation of acute arterial occlusions. Endovascular carotid stenting may be a palliative measure in the setting of angioinvasive rhino-cerebro-orbital mucormycosis.
Source: Neurocritical Care - March 31, 2016 Category: Neurology Source Type: research

Severe Cerebral Venous and Sinus Thrombosis: Clinical Course, Imaging Correlates, and Prognosis
Conclusion The outcome of severe CVT is almost equally divided between severe impairment or death and survival with no or only mild handicap. Specifically, space-occupying mass effect and associated neurologic deterioration seem to determine a poor outcome. Therefore, early detection and treatment of mass effect should be the focus of critical care.
Source: Neurocritical Care - March 20, 2016 Category: Neurology Source Type: research

A Propensity Score-Matched Study of the Use of Non-steroidal Anti-inflammatory Agents Following Aneurysmal Subarachnoid Hemorrhage
Conclusions Inflammation may play a crucial role in the poor outcomes after SAH, and that NSAIDs may be a useful therapeutic option, once validated by larger prospective studies.
Source: Neurocritical Care - March 20, 2016 Category: Neurology Source Type: research

Headache and Its Approach in Today’s NeuroIntensive Care Unit
Abstract Headache is a very common symptom in the neurointensive care unit (neuroICU). While headache in the neuroICU can be caused by worsening of a pre-existing primary headache disorder, most are secondary to another condition. Additionally, headache can be the presenting symptom of a number of conditions requiring prompt recognition and treatment including subarachnoid hemorrhage, ischemic and hemorrhagic stroke, central nervous system infection, pituitary apoplexy, and cerebral vasoconstriction. The neuroICU also has a unique postoperative population in which postcraniectomy and postcraniotomy headache, posti...
Source: Neurocritical Care - March 20, 2016 Category: Neurology Source Type: research

Vancomycin Pharmacokinetic Parameters in Patients with Hemorrhagic Stroke
Conclusions Patients with hemorrhagic stroke exhibited pharmacokinetic alterations favoring increased elimination of vancomycin when compared to predicted pharmacokinetic parameters based on population data. This may result in underexposure to vancomycin, leading to treatment failure and other medical complications.
Source: Neurocritical Care - March 4, 2016 Category: Neurology Source Type: research

Non-invasive Monitoring of Intracranial Pressure Using Transcranial Doppler Ultrasonography: Is It Possible?
Abstract Although intracranial pressure (ICP) is essential to guide management of patients suffering from acute brain diseases, this signal is often neglected outside the neurocritical care environment. This is mainly attributed to the intrinsic risks of the available invasive techniques, which have prevented ICP monitoring in many conditions affecting the intracranial homeostasis, from mild traumatic brain injury to liver encephalopathy. In such scenario, methods for non-invasive monitoring of ICP (nICP) could improve clinical management of these conditions. A review of the literature was performed on PUBMED ...
Source: Neurocritical Care - March 3, 2016 Category: Neurology Source Type: research

Systemic Inflammatory Response Syndrome and Outcomes in Intracerebral Hemorrhage
Conclusion We observed that approximately 20 % of patients with ICH develop SIRS, and that patients with SIRS were at increased risk of having poor functional outcome at discharge.
Source: Neurocritical Care - February 26, 2016 Category: Neurology Source Type: research

Risk of Venous Thromboembolism in Patients with Large Hemispheric Infarction Undergoing Decompressive Hemicraniectomy
Conclusions The rate of DVT and PE is remarkably high in patients with large hemispheric infarction undergoing decompressive hemicraniectomy despite prophylactic measures. We recommend routine screening for DVT in this population. Interventions beyond the standard prophylactic measures may be necessary in this high-risk group.
Source: Neurocritical Care - February 19, 2016 Category: Neurology Source Type: research

Predictors of Extubation Success in Patients with Posterior Fossa Strokes
Conclusions In posterior fossa stroke patients with a GCS ≤ 6 at the time of intubation and who remain intubated for more than 1 week, extubation is less likely to be successful, and tracheostomy should be considered.
Source: Neurocritical Care - February 17, 2016 Category: Neurology Source Type: research

The SETscore to Predict Tracheostomy Need in Cerebrovascular Neurocritical Care Patients
Conclusions Based on this monocentric study, the SETscore seems to be a valid tool to indicate prolonged NICU-LOS and VT, as well as TT need in cerebrovascular NICU patients. Confirmation of these results in larger cohorts with various settings may help to develop the SETscore as a decisive tool on primary TT early in time to avoid extubation failure.
Source: Neurocritical Care - February 2, 2016 Category: Neurology Source Type: research

Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage
Conclusions This guideline provides timely, evidence-based reversal strategies to assist practitioners in the care of patients with antithrombotic-associated intracranial hemorrhage.
Source: Neurocritical Care - December 29, 2015 Category: Neurology Source Type: research

Dynamic Autoregulatory Response After Aneurysmal Subarachnoid Hemorrhage and Its Relation to Angiographic Vasospasm and Clinical Outcome
Conclusions Early deterioration of CA significantly correlates with unfavorable clinical outcome and severity of angiographic vasospasm. Dynamic CA measurements might represent an important tool in stratifying therapy guidelines in patients after SAH.
Source: Neurocritical Care - November 6, 2015 Category: Neurology Source Type: research

The Role of FEIBA in Reversing Novel Oral Anticoagulants in Intracerebral Hemorrhage
Conclusion In this small case series, reversal of NOAC with FEIBA was not associated with ICH expansion or any thrombotic or hemorrhagic complications.
Source: Neurocritical Care - November 6, 2015 Category: Neurology Source Type: research

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