Neurocritical Care最新文献

{"title":"Correction: Predisposing Factors of Progression from Refractory Status Epilepticus to Super-Refractory Status Epilepticus in ICU-Admitted Patients: Multicenter Retrospective Cohort Study in a Resource-Limited Setting.","authors":"Dannys Rivero Rodríguez, Telmo Fernandez, Daniela DiCapua Sacoto, Yanelis Pernas Sanchez, María Isabel Morales-Casado, Nelson Maldonado, Graham Pluck","doi":"10.1007/s12028-025-02232-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02232-1","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhibition of C3a/C3aR by SB290157 Attenuates Neuroinflammation via PKC/P38/NLRP3 Signaling Pathway After Intracerebral Hemorrhage.","authors":"Dongqing Qi, Pengju Wei, Yuhui Cui, Cameron Lenahan, Xiaogen Tao, Peng Jin","doi":"10.1007/s12028-025-02226-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02226-z","url":null,"abstract":"<p><strong>Background: </strong>The C3a/C3aR axis has been shown to play an important role in a variety of neurological diseases. The aim of this study was to investigate the effects of the C3aR antagonist SB290157 on neuroinflammation in a mouse model of intracerebral hemorrhage (ICH) and the mechanism of the protein kinase C (PKC)/P38/NLRP3 signaling pathway in C3aR-mediated neuroinflammation.</p><p><strong>Methods: </strong>A total of 276 CD-1 mice were randomly assigned to different experimental groups. The ICH model was constructed by injecting autologous blood into the right basal ganglia, and SB290157 was administered intraperitoneally after 1 h. C3a (an endogenous ligand for C3aR), PMA (a specific PKC activator), and C3aR small interfering RNA (siRNA) were chosen to elucidate the underlying mechanisms. Western blots, immunofluorescence staining, Nissl staining, neurobehavioral tests, and brain water content tests were also performed.</p><p><strong>Results: </strong>C3aR was mainly expressed on microglia. The expression of C3a and C3aR was upregulated in the right hemisphere of the brain after ICH. Intraperitoneal injection of SB291057 improves short-term and long-term behavioral deficits, attenuates brain edema, and reduces the number of activated microglia and neutrophil infiltration after ICH and downregulates the expression of phosphorylated PKC, phosphorylated P38, and NLRP3, as well as tumor necrosis factor-α, interleukin-6 (IL-6), and IL-1β. Administration of C3aR siRNA and the C3aR endogenous agonist C3a reversed the protective effect of SB290157. In addition, selective activation of PKC/P38/NLRP3 signaling also attenuated the antiinflammatory effects of SB290157 after ICH.</p><p><strong>Conclusions: </strong>This study demonstrates that SB290157 inhibits neuroinflammation and improves short-term and long-term neurological function after ICH in mice, at least in part through regulation of the C3aR/PKC/P38/NLRP3 signaling pathway. Targeting C3aR to inhibit NLRP3-dependent neuroinflammation may provide a promising therapeutic approach for treating ICH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulant Therapy for Cerebral Venous Sinus Thrombosis: A Propensity Score Matching Study and Inverse Probability Weighting.","authors":"Kai Liu, Mengmeng Zhang, Jiawei Zhao, Qinqin Dai, Yuan Gao, Shen Li, Lu Zhao, Yuming Xu, Bo Song","doi":"10.1007/s12028-025-02225-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02225-0","url":null,"abstract":"<p><strong>Background: </strong>New oral anticoagulants (NOACs) offer potential advantages for patients with cerebral venous sinus thrombosis (CVST). There is a lack of evidence to evaluate the efficacy and safety of NOACs in CVST. The purpose of this study was to compare the benefit and safety between NOACs and warfarin in patients with CVST.</p><p><strong>Methods: </strong>We performed a single-center prospective analysis including patients with CVST from the First Affiliated Hospital of Zhengzhou University between January 1, 2018, and December 31, 2021. The primary outcome was recurrent thrombotic events during the 6-month follow-up. Secondary outcomes included the modified Rankin scale (mRS) score, bleeding events, death, and cerebral venous recanalization during anticoagulant therapy. Propensity score matching (PSM) and inverse probability weighting (IPTW) were utilized to balance covariates between groups and mitigate selection bias in our study.</p><p><strong>Results: </strong>A total of 650 patients were identified. NOACs were used in 184 patients, and warfarin was used in 466 patients. Baseline characteristics were balanced between groups after IPTW or PSM. After 1:2 and 1:3 PSM, there were statistically significant differences between the two groups in death (2.2% vs. 8.0%, P = 0.014) and in mRS scores ≤ 2 (95. 1% vs. 88.7%, P = 0.020) in all patients. But there were no statistically significant differences between the two groups in recurrent CVST (odds ratio [OR] 0.543; 95% confidence interval [CI] 0.258-1.143; P = 0. 108), bleeding events (OR 0.823; 95% CI 0.074-9.143; P = 0.874), and partial/complete recanalization (OR 0.980; 95% CI 0.546-1.760; P = 0.946) in all patients. Similarly, there were no significant differences in patients who received anticoagulation therapy and in patients who received endovascular therapy plus anticoagulation therapy regarding any of the clinical outcomes. These results remained similar after IPTW analysis.</p><p><strong>Conclusions: </strong>Our study demonstrates that the use of NOACs in CVST has similar efficacy and safety compared to warfarin treatment. NOACs treatment may improve the clinical prognosis in patients with CVST.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of EEG Findings in Patients with Acute Brain Injury.","authors":"Jackson A Narrett, MarieElena Byrnes, Emily Gilmore, Lawrence J Hirsch, Vineet Punia, Adithya Sivaraju","doi":"10.1007/s12028-025-02227-y","DOIUrl":"10.1007/s12028-025-02227-y","url":null,"abstract":"<p><strong>Background: </strong>Increasing use of continuous electroencephalography (cEEG) provides the opportunity to observe temporal trends in EEG patterns during the acute phase of brain injury. These trends have not been extensively documented.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of patients undergoing cEEG between January 1st and June 30th, 2019, at two academic medical centers. Only patients with acute brain injury having electrographic or electroclinical seizures or epileptic EEG findings on day 1 of monitoring and ≥ 2 calendar days of cEEG were included. The temporal evolution of EEG patterns was depicted as a heatmap.</p><p><strong>Results: </strong>Of 1356 screened patients, 101 met the study criteria. Clinical acute symptomatic seizures occurred in 30 patients (29.7%) prior to EEG. The median number of days of cEEG was 4 (interquartile range 3-6 days). Among patients with electrographic seizures, status epilepticus, generalized periodic discharges, or sporadic epileptiform discharges, 24.6% had improvement and 54.1% had resolution of epileptic EEG findings by the final day of monitoring. In contrast, 65% of patients with lateralized periodic discharges or lateralized rhythmic delta activity persisted or worsened. Overall, 61.4% (62/101) of patients showed either improvement (19.8%) or resolution (41.6%) of their EEG findings prior to hospital discharge. Of the 36 patients with follow-up EEGs at a median of 4.5 (interquartile range 3-8) months after admission for acute brain injury, 83% (30/36) showed either improvement (1/36; 2.7%) or resolution (29/36; 80.6%).</p><p><strong>Conclusions: </strong>In patients with acute brain injury, we observed a trend over time toward the normalization of most epileptiform patterns, except for lateralized periodic discharges and lateralized rhythmic delta activity. The clinical significance of this trend as it relates to antiseizure medication treatment and neurologic outcomes warrants further investigation in an independent cohort.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility and Value of Movement Recording with Combined EEG-EMG Monitoring in the Intensive Care Unit.","authors":"Julie Lévi-Strauss, Clémence Marois, Yulia Worbe, Laurine Bedoucha, Raouf Benchikh Lehocine, Benjamin Rohaut, Nicolas Weiss, Sophie Demeret, Emmanuelle Apartis, Virginie Lambrecq","doi":"10.1007/s12028-025-02230-3","DOIUrl":"10.1007/s12028-025-02230-3","url":null,"abstract":"<p><p>Continuous electroencephalographic (EEG) monitoring has become a standard of care in several contexts in the intensive care unit (ICU), especially for the management of refractory status epilepticus. ICU patients often present movement disorders that may be of epileptic or nonepileptic origin, and their correct identification is crucial for the diagnostic and therapeutic process. Video analysis is often insufficient to precisely detect or characterize movement disorders and the ICU environment is prone to many artifacts. Combined EEG electromyogram (EMG) monitoring can enhance the detection of epileptic seizures with subtle motor expression and help identify nonepileptic movement disorders, such as postanoxic myoclonus, dystonia, or tremor. We will review the various scenarios in which combined EEG-EMG monitoring is useful in routine ICU practice. We also provide a practical guide for easily placing surface EMG electrodes during continuous EEG recording, along with clinical examples to illustrate the significance of this combined approach.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative General Anesthesia at Terminal Extubation: \"Go Gentle into that Good Night\".","authors":"Christos Lazaridis","doi":"10.1007/s12028-025-02228-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02228-x","url":null,"abstract":"<p><p>Withdrawal of life-sustaining treatments in the intensive care unit most often culminates into the discontinuation of mechanical ventilation and removal of the endotracheal tube or \"terminal extubation.\" Standards of practice call for the appropriate use of analgesia and sedation before, during and after extubation with an explicit goal to relieve suffering but not to hasten death. Patients subjected to this procedure are exposed to variable pharmacologic agents, modes, and doses, without any knowledge or monitoring of what these patients are experiencing. This practice seems to rest on contestable assumptions regarding the reliability of bedside examination, the experiential states of unresponsive patients, and the scope of the doctrine of double effect; instead, I argue for palliative general anesthesia in order to safeguard against potential suffering at the end of life. I employ philosophical notions of harm to justify the normative status of palliative anesthesia, in conjunction with contemporary evidence as it relates to the phenomena of covert consciousness and cognitive-motor dissociation. If this analysis is correct, then it may serve as a valid challenge toward current practice without having engaged into controversial debates over the soundness of the doctrine of double effect, or euthanasia. Primun non nocere offers the strongest justification for general anesthesia when terminal extubation is planned.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perihematomal Edema in Minimally Invasive Surgery for Spontaneous Cerebellar Hemorrhage: Prognostic Clue or Red Herring?","authors":"Anil Ramineni, Joseph D Burns","doi":"10.1007/s12028-025-02220-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02220-5","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Significance of Preoperative Perihematomal Edema in Spontaneous Cerebellar Hemorrhage After Minimally Invasive Surgery.","authors":"Haixiao Liu, Dongbo Li, Yaning Cai, Longlong Zheng, Zhijun Tan, Feng Liu, Fei Gao, Hui Zhang, Yong Du, Gaoyang Zhou, Feifei Sun, Ruixi Fan, Ping Wang, Lei Wang, Shunnan Ge, Tianzhi Zhao, Tao Zhang, Rongjun Zhang, Guoqiang Xie, Yan Qu, Wei Guo","doi":"10.1007/s12028-025-02221-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02221-4","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery (MIS), including endoscopic evacuation and minimally invasive catheter (MIC) evacuation, has been widely used in patients with spontaneous cerebellar hemorrhage (SCH). However, the long-term prognosis varies widely. Herein, a case-control study nested within a multicenter cohort was conducted to explore the risk factors for unfavorable prognosis in patients with SCH after MIS.</p><p><strong>Methods: </strong>The data on medical history, perioperative computed tomography scans, and 6-month prognosis of the observed patients were collected. A comparison of these variables between patients with favorable outcomes (modified Rankin Scale score ≤ 3) and those with unfavorable outcomes (modified Rankin Scale score ≥ 4) was conducted to investigate prognostic predictors.</p><p><strong>Results: </strong>Eighty patients from four clinical centers were enrolled in the present study. Four factors including advanced age, MIC evacuation, large postoperative perihematomal edema (PHE), and large preoperative PHE were identified as independent risk factors for 6 month unfavorable neurological outcome. Subsequent analysis demonstrated that preoperative PHE serves as a reliable predictor of unfavorable neurological outcome at 6 months (area under the curve = 0.849). Based on restricted cubic spline analysis, patients were subsequently stratified into a large preoperative PHE (≥ 10 ml) subgroup and a small preoperative PHE (< 10 ml) subgroup. The incidence of unfavorable outcomes in the large preoperative PHE subgroup (47.4%) was significantly higher than that in the small preoperative PHE subgroup (2.4%).</p><p><strong>Conclusions: </strong>Advanced age, MIC evacuation, large preoperative PHE, and postoperative PHE are independent factors associated with unfavorable outcome in patients with SCH who underwent MIS. Significantly, the large preoperative PHE is an independent predictor for unfavorable long-term neurological outcome, particularly when the preoperative PHE is ≥ 10 ml.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Approaches to Clinical Prognostication After Cardiac Arrest: Principles and Uncertainty.","authors":"Michael S Wolf, Mayur B Patel, E Wesley Ely","doi":"10.1007/s12028-025-02223-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02223-2","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"System for Predicting Neurological Outcomes Following Cardiac Arrest Based on Clinical Predictors Using a Machine Learning Method: The Neurological Outcomes After Cardiac Arrest Method.","authors":"Tae Jung Kim, Jungyo Suh, Soo-Hyun Park, Youngjoon Kim, Sang-Bae Ko","doi":"10.1007/s12028-025-02222-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02222-3","url":null,"abstract":"<p><strong>Background: </strong>A multimodal approach may prove effective for predicting clinical outcomes following cardiac arrest (CA). We aimed to develop a practical predictive model that incorporates clinical factors related to CA and multiple prognostic tests using machine learning methods.</p><p><strong>Methods: </strong>The neurological outcomes after CA (NOCA) method for predicting poor outcomes were developed using data from 390 patients with CA between May 2018 and June 2023. The outcome was poor neurological outcome, defined as a Cerebral Performance Category score of 3-5 at discharge. We analyzed 31 variables describing the circumstances at CA, demographics, comorbidities, and prognostic studies. The prognostic method was developed based on an extreme gradient-boosting algorithm with threefold cross-validation and hyperparameter optimization. The performance of the predictive model was evaluated using the receiver operating characteristic curve analysis and calculating the area under the curve (AUC).</p><p><strong>Results: </strong>Of the 390 total patients (mean age 64.2 years; 71.3% male), 235 (60.3%) experienced poor outcomes at discharge. We selected variables to predict poor neurological outcomes using least absolute shrinkage and selection operator regression. The Glasgow Coma Scale-M (best motor response), electroencephalographic features, the neurological pupil index, time from CA to return of spontaneous circulation, and brain imaging were found to be important key parameters in the NOCA score. The AUC of the NOCA method was 0.965 (95% confidence interval 0.941-0.976).</p><p><strong>Conclusions: </strong>The NOCA score represents a simple method for predicting neurological outcomes, with good performance in patients with CA, using a machine learning analysis that incorporates widely available variables.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}