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By Jennifer A. Frontera First Online: 30 March 2020 The INTERACT2 and ATACH-II trials, both large, international, multi-center, randomized-controlled trials, evaluated the benefits of early aggressive blood pressure control following spontaneous intracerebral hemorrhage (ICH) [1, 2]. While the INTERACT2 trial narrowly missed statistical significance on its primary outcome (modified Rankin [mRS] score of 3–6 at 90 days), a prespecified ordinal analysis of the mRS did demonstrate significantly better outcomes when blood pressure was aggressively lowered to a target systolic blood pressure (SBP) < 140 mmHg and no differences in serious adverse events ...
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By Tia Chakraborty & Eelco Wijdicks First Online: 30 March 2020 Introduction There are a myriad of complications of aneurysmal subarachnoid hemorrhage (SAH). Systemic effects include hyponatremia, stunned myocardium (takotsubo cardiomyopathy), pulmonary edema, deep venous thrombosis, and anemia. Lesser known complications involving the gastrointestinal tract including bleeding, reduced contractility, and increased permeability have been observed following acute brain injury [ 1 , 2 , 3 ]. We describe a case of a patient with aneurysmal SAH who developed mesenteric ischemia and pneumatosis intestinalis (PI) and discuss potential pathogenic ...
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By Roland Faigle First Online: 30 March 2020 Inequities in healthcare quality and outcomes are pervasive in the USA. Geographic location has been increasingly recognized as an important, and arguably modifiable, determinant of health. Approximately 15–20% of the US population live in rural areas. People living in rural communities generally have poorer health compared to urban dwellers, in part due to differences in access to high-quality care [1, 2]. In this issue of Neurocritical Care, Otite et al. [3] leverage administrative data from the 2004–2014 Nationwide Inpatient Sample (National Inpatient Sample) to examine rural–urban differences in in-hospital ...
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By Fadar Oliver Otite, Emmanuel Oladele Akano, Emmanuel Akintoye, Priyank Khandelwal, Amer M. Malik, Seemant Chaturvedi & Jonathan Rosand First Online: 30 March 2020 Objectives To compare in-hospital mortality between intracerebral hemorrhage (ICH) patients in rural hospitals to those in urban hospitals of the USA. Methods We used the National Inpatient Sample to retrospectively identify all cases of ICH in the USA over the period 2004–2014. We used multivariable-adjusted models to compare odds of mortality between rural and urban hospitals. Joinpoint regression was used to evaluate trends in age- and sex-adjusted mortality in rural and urban ...
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By Aaron M. Cook, G. Morgan Jones, Gregory W. J. Hawryluk, Patrick Mailloux, Diane McLaughlin, Alexander Papangelou, Sophie Samuel, Sheri Tokumaru, Chitra Venkatasubramanian, Christopher Zacko, Lara L. Zimmermann, Karen Hirsch & Lori Shutter First Online: 29 March 2020 Background Acute treatment of cerebral edema and elevated intracranial pressure is a common issue in patients with neurological injury. Practical recommendations regarding selection and monitoring of therapies for initial management of cerebral edema for optimal efficacy and safety are generally lacking. This guideline evaluates the role of hyperosmolar agents (mannitol, HTS), corticosteroids, ...
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By Ilari Rautalin & Miikka Korja First Online: 26 March 2020 One-fourth of people with aneurysmal subarachnoid hemorrhage (SAH) die from the bleed suddenly in emergency rooms or before reaching hospital [1]. Unless medicolegal or medical autopsies are systematically performed to all sudden deaths, these SAH deaths are almost invariably classified as sudden cardiac deaths. The first observable symptom of sudden SAH death is loss of consciousness (LOC), which is also a common presenting symptom of non-fatal SAH. The pathophysiology of LOC at the time of aneurysm rupture is controversial. However, similar to sudden SAH deaths, the etiology of LOC in ...
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By Qi Li, Rui Li, Li-Bo Zhao, Xiao-Min Yang, Wen-Song Yang, Lan Deng, Xin-Ni Lv, Guo-Feng Wu, Zhou-Ping Tang, Miao Wei, Yi-Neng Zheng, Fa-Jin Lv, Xiao-Chuan Sun, Joshua N. Goldstein & Peng Xie First Online: 26 March 2020 Background/Objectives The objective of this study is to propose a definition of intraventricular hemorrhage (IVH) growth and to investigate whether IVH growth is associated with ICH expansion and functional outcome. Methods We performed a prospective observational study of ICH patients between July 2011 and March 2017 in a tertiary hospital. Patients were included if they had a baseline CT scan within 6 h after onset of symptoms ...
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By Sami Ullah, Ronny Beer, Uwe Fuhr, Max Taubert, Markus Zeitlinger, Alexander Kratzer, Christoph Dorn, Usman Arshad, Mario Kofler & Raimund Helbok First Online: 26 March 2020 Background The broad antibacterial spectrum of piperacillin/tazobactam makes the combination suitable for the treatment of nosocomial bacterial central nervous system (CNS) infections. As limited data are available regarding piperacillin CNS exposure in patients without or with low-grade inflammation, a clinical study was conducted (1) to quantify CNS exposure of piperacillin by cerebral microdialysis and (2) to evaluate different dosing regimens in order to improve probability ...
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By Andrea Loggini, Victor J. Del Brutto, Faten El Ammar, Zachary B. Bulwa, Faddi Saleh Velez, Cedric McKoy, Raisa C. Martinez, James Brorson, Fernando D. Goldenberg & Agnieszka A. Ardelt First Online: 24 March 2020 Background Intracranial hemorrhage (ICH) may occur in patients admitted to the hospital for unrelated medical conditions, resulting in prolonged hospitalization and worse prognosis. We aim to assess the clinical presentation and outcomes of in-hospital ICH compared to patients with ICH presenting from the community. Methods We conducted a retrospective analysis of all acute stroke alerts diagnosed with ICH in an urban academic hospital ...
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By Andrés Gempeler, Eduardo Orrego-González, Andrés Hernandez-Casanas, Andrés M. Castro, Juan D. Aristizabal-Mayor & Jorge H. Mejia-Mantilla First Online: 23 March 2020 Background Literature on diabetes insipidus (DI) after severe traumatic brain injury (TBI) is scarce. Some studies have reported varying frequencies of DI and have showed its association with increased mortality, suggesting it as a marker of poor outcome. This knowledge gap in the acute care consequences of DI in severe TBI patients led us to conceive this study, aimed at identifying risk factors and quantifying the effect of DI on short-term functional outcomes and mortality. ...
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By Shane W. English First Online: 20 March 2020 Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating form of stroke that affects a particularly young and often otherwise healthy population. It is associated with significant morbidity and premature mortality with a typical hospitalization for survivors that is protracted and requires specialized care [1, 2]. SAH is a common neurological reason for intensive care unit admission [3], which itself is resource-intense and a significant driver of hospital cost [4]. These collectively contribute to the substantial burden associated with this disease—similar in magnitude to the much more common ischemic ...
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By Judith von Hofen-Hohloch, Carolin Awissus, Marie Michèle Fischer, Dominik Michalski, Jost-Julian Rumpf & Joseph Classen First Online: 20 March 2020 Background/Objective Delirium is a common complication in critically ill patients with a negative impact on hospital length of stay, morbidity, and mortality. Little is known on how neurological deficits affect the outcome of commonly used delirium screening tools such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) in neurocritical care patients. Methods Over a period of 1 month, all patients admitted to a neurocritical ...
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New England Journal of Medicine (03/19/20) 382:1177-1179  doi: 10.1056/NEJMp2005689 Zou, Lirong; Ruan, Feng; Huang, Mingxing; et al. https://www.nejm.org/doi/full/10.1056/NEJMc2001737 The viral nucleic acid shedding pattern of patients infected with SARS-CoV-2, the novel coronavirus that is spreading worldwide, is similar to that of patients infected with influenza, according to a new analysis out of China. The pattern appears different from SARS-CoV, a global epidemic that caused more than 8,000 infections worldwide in 2002-2003. In a letter to the editor, researchers report they monitored SARS-CoV-2 viral loads in upper respiratory specimens taken ...
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New England Journal of Medicine (03/23/20) doi: 10.1056/NEJMp2005689 Truog, Robert D.; Mitchell, Christine; and Daley, George Q. https://www.nejm.org/doi/full/10.1056/NEJMp2005689   As the COVID-19 epidemic leads to serious shortages of some medical products and devices in the United States, mechanical ventilation is the “most problematic,” say experts. Based on estimates from the Centers for Disease Control and Prevention and data from the experience in Italy, “the number of patients needing ventilation could range between 1.4 and 31 patients per ventilator,” write Robert D. Truog, MD, of Harvard Medical School in Boston, and colleagues. To help ...
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Title: Faculty/Neurocritical Care Specialist Company: Wayne State University Department: Neurology Position: Clinical Assistant Professor Expertise: Neurocritical Care Region: Detroit Salary Range: Salary commensurate with credentials Description: Neurocritical Care Specialist, Clinical Assistant Professor in the Department of Neurology at Wayne State University School of Medicine Department of Neurology at Wayne State University seeks a physician who is subspecialized in Neurocritical Care. Our NICU is located in Detroit Receiving Hospital, a Level I trauma center and primary stroke center in Detroit. The NICU team provides high quality ...
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Advocate Aurora Health is the market leader in Neurosciences in the Chicagoland area with a system platform of over 100 neuroscience physicians and advanced practice clinicians. We are recruiting a Neuro Intensivist at Advocate Christ Medical Center providing the highest level of neurological care in a patient centered environment for the dedicated Neuro Intensive Care Unit. Designated Comprehensive Stroke Center 24/7 Neuroendovascular coverage Collaborative efforts between Neurosurgery, Interventional Neuroradiology, Critical Care Medicine, Neuro-Rehabilitation and Trauma Services 24/7 Telestroke Coverage Full-time is considered one hundred forty ...
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By Alberto Hernandez, MD, PhD, DESA, Director, Anaesthesia & ICU, Grupo Policlinica, Ibiza, Spain; and Peter J. Papadakos, MD, FCCM, FAARC. Director, Critical Care Medicine, Professor Anesthesia, Surgery, Neurology and Neurosurgery, University of Rochester, New York, US.   These days, there are multiple papers emerging daily about COVID-19 management, protocols, guidelines, etc. Many research protocols are in play, but c urrent management of COVID-19 still remains supportive .   We were intially told the virus would only seriously affect older people; however, in Spain, we are seeing young people — many in their 30s — rapidly deteriorating, requiring ...
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By Lauren Koffman DO, MS Months ago, I had plans for a weekend trip with a friend, and despite my multiple reassurances, she cancelled. She had family and friends in China and had deep concerns about the COVID-19 situation evolving. She would tell me about the horrific scenes unfolding as hospitals were overwhelmed and under prepared.  Thinking back two or three months ago, the virus and its casualties on another continent felt like an isolated health crisis. Now, not much time has passed, and COVID-19 is here.  While we as intensivists are used to a world of critically ill patients, this feels different. It could be the uncertainty of waiting for ...
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By Chitra Venkatasubramanian, MBBS, MD, MS, FNCS; George Lopez, MD, PhD; and Sarah Peacock, DPN  We are in unprecedented times with the COVID-19 pandemic. Quarantines, lockdowns and shelter-in-home are the buzzwords, and schools have switched to continuing education using online curriculums.  At NCS, we are not far behind. In fact, the idea for live online Emergency Neurological Life Support (ENLS) lectures germinated in 2019 as we recognized the increasing demand for ENLS worldwide and the need to deliver high-quality educational content in a standardized fashion by leveraging online platforms.  The objectives of the webinars are trifold: Deliver ...
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By Peter J. Papadakos, MD, FCCM, FAARC As an individual who studies the effect of technology on the practice of medicine, one of the most amazing aspects of this terrible pandemic is how the medical community around the world has joined together as one to share protocols, guidelines and disaster plans with each other. I have a broad network of colleagues in both trauma critical care and neurocritical care, and it’s been outstanding how rapidly we all joined together via e-mail, WhatsApp forums, Zoom conferences and others to share our patient care experiences.  We circle the globe from every U.S. state, Canada, South America, China, Japan Korea, Italy, Spain ...
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