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Yang P, Zhang Y, Zhang L, et al. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. N Engl J Med . 2020 May 21;382(21):1981-93. Reviewed by Wazim Mohamed, MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Background/Methods As thrombectomy has become the mainstay of treatment for large vessel occlusion strokes, the additional benefit offered by thrombolytics has come into question. Thrombolysis with alteplase may aid in early reperfusion prior to thrombectomy and may have a role in dissolving distal thrombi post-thrombectomy ...
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By Thomas D. Bernier, PharmD; and Michael Schontz, PharmD, BCPS, BCCCP Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of all strokes, and due to a multitude of complications, patients are at exceptional risk of mortality and morbidity. 1 The incidence of aSAH is geographically diverse varying between 2 and 16.5 per 100,000 hospitalized adults globally. 2 Patients are at risk of multifactorial mortality and morbidity in aSAH, as patients can experience rebleeding, hydrocephalus, seizures, infections and notably delayed cerebral ischemia (DCI). 3 DCI occurs in approximately one-third of patients following aneurysmal rupture, typically presenting ...
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By Michael J. Erdman First Online: 15 September 2020 This comment refers to the article available at https://doi.org/10.1007/s12028-020-01035-w. Acute encephalopathy (AE), defined as either delirium or depressed level of consciousness, is common in the intensive care unit (ICU) [1, 2]. The exact cause can be hard to determine and may often be a combination of medications, acute disease processes, metabolic derangements, and unknown causes [3]. Recent literature has sought to identify what interventions and processes place patients at a high risk of AE. Numerous medications commonly used in the intensive care unit have been associated with AE or changes ...
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By Dale Ding First Online: 15 September 2020 In this article, Wanbing et al. performed a single-center, retrospective cohort study to identify predictors of postoperative CSF outflow following craniopuncture for spontaneous intracerebral hemorrhage (ICH) with intraventricular hemorrhage (IVH) [13]. The study cohort comprised 125 patients who underwent 189 craniopuncture procedures, and CSF outflow was achieved in 40% of craniopunctures. Based on their analysis, the authors found that a mean hematoma radiodensity ≤ 59 Hounsfield units (HU) on computed tomography (CT), intrahematomal placement of the craniopuncture needle tip approximately 22–34 mm from ...
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By Roman Mounier, Natacha Kapandji, Guillaume Gricourt, David Lobo, Christophe Rodriguez, Stéphanie Pons, Chakib Djediat, Paul-Louis Woerther, Vincent Mellano, Bouziane Aït-Mamar, Vanessa Demontant, Biba Nebbad, Yann Senova, Melissa Arnaud, Fabrice Cook, Gilles Dhonneur & David Lebeaux Online First: 15 September 2020 Objectives Cerebral infections related to the presence of an intraparenchymal intracranial pressure transducer (ICPT) are rare. We assessed the incidence of ICPT-related infections and colonization using culture, molecular biology, and electron microscopy. Methods All consecutive patients in a neurosurgical intensive care unit who ...
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Anna Lindner, Verena Rass, Bogdan-Andrei Ianosi, Alois J. Schiefecker, Mario Kofler, Paul Rhomberg, Bettina Pfausler, Ronny Beer, Erich Schmutzhard, Claudius Thomé & Raimund Helbok First Online: 11 September 2020 Background/objective Monitoring of brain tissue oxygen tension (P bt O 2 ) provides insight into brain pathophysiology after intracerebral hemorrhage (ICH). Integration of probe location is recommended to optimize data interpretation. So far, little is known about the importance of PbtO2 catheter location in ICH patients. Methods We prospectively included 40 ICH patients after hematoma evacuation (HE) who required PbtO2-monitoring. PbtO2-probe ...
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By Thibaud Crespy, Maxime Durost, Pierre Fricault, Benjamin Lemasson, Pierre Bouzat, Emmanuel L. Barbier & Jean-François Payen  First Online: 09 September 2020 Background There has been growing interest in the use of hypertonic sodium lactate (HSL) solution following traumatic brain injury (TBI) in humans. However, little is known about the effects of HSL on functional deficits with respect to the hyperosmotic nature of HSL. Methods We have compared the effects of HSL solution and isotonic saline solution using sensorimotor and cognitive tests for 14 days post-trauma in animals. Thirty minutes after trauma (impact-acceleration model), anesthetized ...
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By Benjamin E. Zusman, Patrick M. Kochanek, Zachary S. Bailey, Lai Yee Leung, Vincent A. Vagni, David O. Okonkwo, Ava M. Puccio, Lori A. Shutter, Keri L. Janesko-Feldman, Janice S. Gilsdorf, Deborah A. Shear & Ruchira M. Jha First Online: 04 September 2020 Background Despite increasing use in hemorrhagic shock (HS), whole blood (WB) resuscitation for polytrauma with traumatic brain injury (TBI) is largely unexplored. Current TBI guidelines recommend crystalloid for prehospital resuscitation. Although WB outperforms lactated Ringer’s (LR) in increasing mean arterial pressure (MAP) in TBI + HS models, effects on brain tissue oxygenation (PbtO2), and ...
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By Beiyuan Zhang, Qin Gu, Xiancheng Chen, Yong You, Ming Chen, Yajun Qian, Yan Chen & Wenkui Yu First Online: 02 September 2020 Background Endoplasmic reticulum stress (ERS) plays a vital role in mediating apoptosis in the brain following cardiac arrest (CA). Studies have shown that therapeutic hypothermia (TH) provides neuroprotection through anti-apoptosis; however, the effects of temperature variability in TH on the brain remain unclear. In this study, we investigated the different effects of temperature variability through extracorporeal membrane oxygenation on apoptosis and ERS in the brain following CA. Methods Eighteen male domestic pigs ...
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Title: Two Neurocritical Care Intensivitist Positions Company: Mount Sinai Health System / NYC Health + Hospitals Department: Neurocritical Care / Neurosurgery / Neurology Position: Medical Director of NSICU & Clinician-Researcher Expertise: Neurotrauma, teaching, research, grand funding Region: New York City / Queens Description: The Mount Sinai Health System is recruiting for two dynamic, collaborative neurointensivists to join our current team of seven. Candidates must have completed a fellowship in Neurocritical Care and be board certified/eligible. This is a transformational opportunity for highly motivated junior faculty as well ...
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Date Begin: 10/01/2020 Title: Neurocritical Care Advanced Practitioner (PA/NP) Company: Lehigh Valley Hospital Network Department: Neurosciences ICU Region: PA Description: At Lehigh Valley Health Network (LVHN), we continually go the extra mile to fulfill our mission to heal, comfort and care for the people of our community. Each one of our 18,000 colleagues contributes to this mission and helps make the Lehigh Valley and all communities we serve healthier – and better – places in which to live. Our health care professionals provide amazing care every day! At Lehigh Valley Health Network, you can provide community care and impact lives of your ...
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The Neurocritical Care Society (NCS) is proud to launch the September 2020 issue of Currents , featuring a compilation of content published on Currents throughout this extraordinary year.  This special annual issue reflects on how neurocritical care professionals have addressed COVID-19, while sharing how our Society and the field will embrace the future. This content provides a mere snapshot of the work our community has done during the pandemic, and we are immensely proud to showcase it in this issue.  Currents highlights innovative ideas and perspectives from multidisciplinary neurocritical care clinicians, and we welcome you to share your insight ...
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By Franziska Staub-Bartelt, Jasper Hans van Lieshout, Thomas Beez, Rainer Kram, Daniel Hänggi & Kerim Beseoglu  First Online: 26 August 2020 The original article can be found online at https://doi.org/10.1007/s12028-020-01054-7. Correction to: Neurocrit Care https://doi.org/10.1007/s12028-020-01054-7 The original article has been updated: The author name Kerim Beseoglu has been corrected and the details given in this correction are correct. Author information Affiliations Department of Neurosurgery, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany Franziska Staub-Bartelt, Jasper Hans van Lieshout, ...
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By Małgorzata M. Miller, Katarina Dakay, Nils Henninger, Yunis Mayasi, Ali Mahta, Aleksandra Yakhkind, Anas Hannoun, Bradford B. Thompson, Linda C. Wendell & Raphael Carandang First Online: 26 August 2020 Background and Purpose Current guidelines do not support the routine use of corticosteroids in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, corticosteroids use in aSAH has been practiced at some centers by convention. The aim of the study was to determine the incidence of hydrocephalus requiring ventriculoperitoneal shunt (VPS) placement as well as functional outcome on discharge and adverse events attributed to corticosteroids ...
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By Alexandra Kvernland, Arooshi Kumar, Shadi Yaghi, Eytan Raz, Jennifer Frontera, Ariane Lewis, Barry Czeisler, D. Ethan Kahn, Ting Zhou, Koto Ishida, Jose Torres, Howard A. Riina, Maksim Shapiro, Erez Nossek, Peter K. Nelson, Omar Tanweer, David Gordon, Rajan Jain, Seena Dehkharghani, Nils Henninger, Adam de Havenon, Brian Mac Grory, Aaron Lord & Kara Melmed First Online: 24 August 2020 Background and Purpose While the thrombotic complications of COVID-19 have been well described, there are limited data on clinically significant bleeding complications including hemorrhagic stroke. The clinical characteristics, underlying stroke mechanism, and outcomes ...
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By Anselmo Caricato, Eleonora Ioannoni & Camilla Gelormini First Online: 20 August 2020 A 32-year-old female was admitted in Neuro Intensive Care of Policlinico “A. Gemelli” in Rome after bleeding from artero-venous malformation and ventriculostomy. After 6 days, the patient was awake (Glasgow Coma Scale (GCS) 14;E4,V4,M6), and external ventricular drainage was removed. Two days after, she deteriorated (GCS 11;E3,V3,M5); a brain sonography was performed by a neuro-intensive care unit (ICU) resident, and the exam was considered normal. According to our policy for residents training, echography was immediately repeated by an expert neurosonologist (Anselmo ...
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By Wanbing Jia, Biao Zhao, Jinghua Du, Guofeng Wu & Tingzhong Wang First Online: 27 August 2020 Background Surgeries for intracerebral hemorrhage (ICH) remain controversial. Our previous study found that postoperative cerebrospinal fluid (CSF) outflow was associated with high hematoma evacuation efficiency in ICH cases with intraventricular involvement (ICHV) treated with minimally invasive craniopuncture (MIC). This study was designed to identify factors that predict postoperative CSF outflow and the specific subtype of ICHV that may benefit from MIC. Methods A total of 189 MIC needles applied to 125 ICHV patients were retrospectively analyzed. ...
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By Isabel Fragata, Alejandro Bustamante, Ana Penalba, Patrícia Ferreira, Ana Paiva Nunes, Patrícia Canhão & Joan Montaner First Online: 20 August 2020 Background Early cerebral hypoperfusion and ischemia occur after subarachnoid hemorrhage (SAH) and influence clinical prognosis. Pathophysiological mechanisms possibly involve inflammatory mediators. TNF-α has been associated with complications and prognosis after SAH. We investigated the relation of perfusion parameters and ischemic lesions, with levels of TNF-α main receptor, TNF-R1, after SAH, and their association with prognosis. Methods We included consecutive SAH patients admitted within the ...
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Title: Neurocritical Care Physician (Neurointensivist) Company: Southern California Permanente Medical Group Region: Southern California Description: I am a PERMANENTE PHYSICIAN. A skilled practitioner who seeks to create high-quality outcomes through integrated care. At the Southern California Permanente Medical Group (SCPMG), a physician-led partnership organization with a patient-centered and evidence-based approach to medicine, we believe in giving every member of our community the opportunity to live a happy, healthy life. From the physicians we employ to the patients we serve, our mission is to provide a level of care and support that enables ...
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Date Begin: 10/01/2020 Title: Clinical Assistant Professor Company: Univ of Florida, Jacksonville Department: Neurology Position: Neurointensivist Expertise: Neurocritical Care Region: Southeast Description: UF Health Neurology in Jacksonville, Florida, offers comprehensive care for brain and nerve disorders. The department includes a nationally recognized team of faculty neurologists of the   University of Florida Department of Neurology   who are part of the multidisciplinary   UF Health Neuroscience Institute . By participating in numerous national and international research projects and investing in the most sophisticated technology ...
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