Neurocritical Care最新文献

{"title":"Effects of 'Head Up' Prone Position on Transcranial Color Doppler-Based Estimators of Intracranial Pressure in Moderate to Severe Acute Respiratory Distress Syndrome Without Brain Injury: A Cross-Over, Longitudinal, Physiological Study.","authors":"Domenico Junior Brunetti, Francesca Leonardis, Francesca Frisardi, Mario Dauri, Cristian Deana, Raffaele Aspide, Gianmaria Cammarota, Luigi Pisani, Rossella Adorno, Roberto Polidoro, Marco Tiseo, Paola Giuseppina Sergi, Luigi Vetrugno, Luciana Mascia, Daniele Guerino Biasucci","doi":"10.1007/s12028-025-02240-1","DOIUrl":"10.1007/s12028-025-02240-1","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning is recommended in acute respiratory distress syndrome (ARDS) to ensure adequate gas exchange. However, it may lead to an increase in intracranial pressure (ICP), mostly due to a reduction of venous return from the brain. ICP can be noninvasively estimated with transcranial color-coded Doppler (TCCD) using methods based on the relationships between the pulsatility index (PI) and ICP or methods based on the estimate of cerebral perfusion pressure (eCPP) and estimate of ICP (eICP). This study was aimed at assessing the effects of a 30° reverse Trendelenburg ('head up') prone position on two noninvasive estimators of ICP (eICP and PI).</p><p><strong>Methods: </strong>This is a cross-over, longitudinal, physiological study conducted on a cohort of adult patients fulfilling Berlin definition criteria for moderate to severe ARDS without brain injury but with clinical indication to prone positioning. We registered TCCD parameters of cerebral hemodynamic and systemic hemodynamic parameters, blood gas exchange data, and respiratory mechanics parameters in a horizonal supine position, in a 30° semirecumbent supine position, in the standard prone position, and, finally, in the 30° 'head up' prone position, obtained by tilting the entire bed to a reverse Trendelenburg position. One-way repeated measures analysis of variance was used to analyze data.</p><p><strong>Results: </strong>In 20 patients included, switching from a supine position to the standard prone position resulted in a significant increase in mean ± SD PI (from 0.99 ± 0.22 to 1.29 ± 0.25, p < 0.01) and eICP (from 12.5 ± 3.8 to 17.5 ± 4.1, p < 0.01), whereas moving from this latter position to the 'head up' prone position resulted in a decrease in the mean ± SD PI (from 1.29 ± 0.25 to 1.0 ± 0.23, p < 0.01). Hemodynamic and respiratory mechanics parameters did not differ.</p><p><strong>Conclusions: </strong>The 30° 'head up' prone position may limit the increase in PI in moderate to severe ARDS without brain injury. As a noninvasive estimator of ICP, PI may allow detection of changes in ICP when moving from the 'head up' semirecumbent supine position to the standard prone position and from this latter position to the 'head up' prone position.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"446-457"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710779","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":"Clinical Consequences of Disproportionate Free Valproate Elevation in Critically Ill Adult Patients: A Multicenter Retrospective Cohort Study.","authors":"Andrew J Webb, David J Gagnon, Caitlin S Brown, Richard R Riker, Natasha D Lopez, Melanie Z Goodberlet, Michael J Schontz, Kaylee K Marino, Sahar F Zafar, Eric S Rosenthal","doi":"10.1007/s12028-025-02243-y","DOIUrl":"10.1007/s12028-025-02243-y","url":null,"abstract":"<p><strong>Background: </strong>Valproate has a narrow therapeutic index and unpredictable protein binding, and critically ill patients may experience unexpectedly elevated free concentrations. We sought to identify the clinical consequences and determinants of disproportionate free valproate concentration elevation in critically ill adults.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study conducted at two academic medical centers from December 2015 to December 2023. Adult patients admitted to an intensive care unit who were receiving valproate and had concurrent total and free valproate concentrations measured were eligible for inclusion. We examined whether valproate concentrations were independently associated with adverse effects (AEs), including thrombocytopenia, hepatotoxicity, hyperammonemia, and pancreatic injury. Secondarily, determinants of disproportionate free valproate elevation, defined as a free valproate concentration that was greater than expected and out of proportion to the total concentration (e.g., free valproate above reference range but total valproate below reference range), were also identified.</p><p><strong>Results: </strong>A total of 311 patients (mean age 58 [SD ± 17] years, 36% female, 31% non-White, and 29% on valproate prior to admission) with 550 concurrent free valproate and total valproate pairs were included. The median total valproate concentration was 46 μg/mL (interquartile range [IQR] 34-63), and the median free valproate concentration was 17 μg/mL (IQR 11-23); the median free fraction was 35% (IQR 25-63%). Disproportionate free valproate elevation was observed in 462 (84%) samples. Each 2.5-μg/mL increase in free valproate concentration was associated with thrombocytopenia (adjusted odds ratio [aOR] 1.15, 95% confidence interval [CI] 1.05-1.26) and hepatotoxicity (aOR 1.11, 95% CI 1.05-1.18). Albumin concentration (aOR 0.17, 95% CI 0.08-0.36), blood urea nitrogen (aOR 1.36, 95% CI 1.09-1.70), and propofol exposure (aOR 3.06, 95% CI 1.38-6.79) were associated with disproportionate free valproate elevation.</p><p><strong>Conclusions: </strong>Elevated free valproate concentrations were associated with hepatotoxicity and thrombocytopenia; free valproate concentrations should be directly measured in critically ill patients because it is underrepresented by total valproate. Most critically ill patients are at risk, especially those with hypoalbuminemia, uremia, and propofol exposure.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"472-483"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Communicating with Families after Severe Acute Brain Injury.","authors":"Adeline L Goss, Claire J Creutzfeldt","doi":"10.1007/s12028-025-02252-x","DOIUrl":"10.1007/s12028-025-02252-x","url":null,"abstract":"<p><p>Communicating with patients and families after severe acute brain injury (SABI) is often considered an art, but the science of communication in SABI is advancing. Recent research demonstrates how surrogates perceive various styles of prognostic language in SABI, provides insight on factors that influence prognostic discordance between surrogate decision-makers and clinicians, and identifies sources of bias in prognostic communication and shared decision-making. In this article for Neurocritical Care's topical collection on palliative care, we review this latest research, offer strategies to approach difficult communication tasks with insufficient evidence to guide practice, and discuss ethical issues relevant to decision-making for this patient population.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"671-681"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045283","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":"Different Responses to Blood Pressure Reduction in Lobar and Deep Intracerebral Hemorrhage.","authors":"Santiago Clocchiatti-Tuozzo, Cyprien A Rivier, Adnan I Qureshi, Daniela Renedo, Shufan Huo, Charles Matouk, Nils Petersen, Adam de Havenon, Kevin N Sheth, Alejandro A Rabinstein, Guido J Falcone, Maximiliano A Hawkes","doi":"10.1007/s12028-025-02269-2","DOIUrl":"10.1007/s12028-025-02269-2","url":null,"abstract":"<p><strong>Background: </strong>Intensive blood pressure (BP) reduction may benefit patients with acute intracerebral hemorrhage (ICH), but it is unknown if those benefits apply equally to patients with lobar and deep ICH. Our objective was to assess the impact of intensive BP reduction on hematoma expansion (HE), 90-day functional outcomes, and renal adverse events (RAEs) in patients with deep ICH compared with those with lobar ICH.</p><p><strong>Methods: </strong>This was an exploratory, post hoc analysis of the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-2) randomized clinical trial, which investigated the efficacy of intensive BP reduction (110-139 mm Hg systolic BP) versus standard (140-179 mm Hg systolic BP) reduction 4.5 h after acute spontaneous ICH. Our end points of interest were HE (> 6 mL increase in hematoma volume between baseline and 24 h), 90-day functional outcome (modified Rankin Scale score 0-3 vs. 4-6), and RAEs.</p><p><strong>Results: </strong>Of 1000 ATACH-2 participants, only 875 participants (87.5%) with complete neuroimaging data were included (778 [89%] deep and 97 [11%] lobar, mean age of 62 years, 62% male). Multivariable logistic regressions results showed that intensive BP reduction decreased the risk of HE (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.38-0.93; p = 0.024) and increased the risk of RAE (OR 2.42, 95% CI 1.29-4.72; p = 0.007) in deep ICH, whereas in lobar ICH results were nonsignificant for HE (OR 0.91, 95% CI 0.34-2.41; p = 0.9). Intensive BP reduction was not significantly associated with 90-day unfavorable functional outcome in either deep (OR 1.03, 95% CI 0.71-1.51; p = 0.9) or lobar (OR 0.97, 95% CI 0.31-2.95; p = 0.9) ICH.</p><p><strong>Conclusions: </strong>In this exploratory analysis of the ATACH-2 study, intensive BP reduction was associated with reduced risk of HE and increased risk of RAE in deep but not lobar ICH. These results emphasize the need for a better understanding of the biological differences in ICH, which may have therapeutic implications.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"607-615"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064169","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":"Commentary: Invasive and Noninvasive Intracranial Pressure Pulse Waveform in Neurocritical Care Patients with Different Cranium Integrity.","authors":"Shraddha Mainali","doi":"10.1007/s12028-025-02381-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02381-3","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207058","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":"NeuroICU FastTrack: Rapid Disposition of Patients with Intracerebral Hemorrhage from the Emergency Department to Neuro-ICU.","authors":"Nicolle W Davis, Jeannette M Hester, Brandon Allen, Christina Wilson, Anna Khanna, Ashley E Magnuson, Teng J Peng, Katharina M Busl, Amita Singh","doi":"10.1007/s12028-025-02247-8","DOIUrl":"10.1007/s12028-025-02247-8","url":null,"abstract":"<p><strong>Background: </strong>Emergency department length of stay (EDLOS) directly impacts outcomes of critically ill patients, with the risk of in-hospital mortality increasing by nearly 40% when an intensive care unit (ICU) bed is delayed beyond 4 h. Patients with intracerebral hemorrhage (ICH) suffer from worse functional outcomes and higher mortality when EDLOS exceeds 5 h, even for EDLOS exceeding just 1 h. Our goal was to implement an expedited triage pathway to reduce EDLOS of patients with ICH to less than 3 h and evaluate for downstream reduced morbidity and mortality.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients with ICH evaluated in the emergency department (ED) at an academic comprehensive stroke center between January 1, 2022, and June 30, 2023. Univariate and multivariate logistic regression analyses were conducted to investigate the association between the NeuroICU FastTrack intervention with EDLOS less than 3 h and the rate of in-hospital mortality.</p><p><strong>Results: </strong>A total of 234 patients with ICH arrived to the ED and were admitted to the neuro-ICU. Post implementation, there was a statistically significant decrease in EDLOS from an average of 6.6 h to 4 h (p < 0.001) and a significant decrease in patient mortality (p = 0.006). There was also a reduction in mortality to 9.3% (p = 0.006) compared to a preintervention mortality rate of 22.9%. Additionally, the morbidity outcome (mRS of 0-2) remained relatively constant in both groups preintervention (23%) to post intervention (28%).</p><p><strong>Conclusions: </strong>Consistent with prior published evidence and National Institute of Neurological Disorders and Stroke recommendations, a shorter EDLOS significantly decreased mortality, but there was no difference in morbidity in our population. The NeuroICU FastTrack process expedited critically ill ICH patient throughput from the ED to the ICU, enhanced bed availability through streamlined procedures, and improved patient outcomes.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"504-511"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012205","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":"Acute Abnormalities Identified on Brain Magnetic Resonance Imaging in Patients with Sepsis.","authors":"Toru Hosokawa, Kosaku Kinoshita, Shingo Ihara, Katsuhiro Nakagawa, Umefumi Iguchi, Tomokazu Mutoh, Nami Sawada, Tsukasa Kuwana, Junko Yamaguchi, Atsushi Sakurai","doi":"10.1007/s12028-025-02235-y","DOIUrl":"10.1007/s12028-025-02235-y","url":null,"abstract":"<p><strong>Background: </strong>Sepsis often codevelops with brain damage, and the mechanisms underlying sepsis-related brain damage have been elucidated. However, only a few studies have reported the diagnostic imaging assessments for brain damage in sepsis. Therefore, in this study, we analyzed the brain magnetic resonance (MR) imaging (MRI) findings of patients with sepsis.</p><p><strong>Methods: </strong>This single-center prospective observational study included 71 patients with sepsis who underwent brain MRI, regardless of the presence or absence of shocks and acute neurological abnormalities. The MR images were classified according to the presence or absence of acute cerebral ischemia and leukoencephalopathy, with normal findings indicating neither condition.</p><p><strong>Results: </strong>The MR images of 18 patients (25.3%) showed acute cerebral ischemia and leukoencephalopathy. Furthermore, 44 patients (62.0%) had only leukoencephalopathy. In terms of patient demographic characteristics and neurological outcomes, significant differences were noted among patients with acute cerebral ischemia findings, those with leukoencephalopathy findings, and those with neither. There were significant differences in age (P = 0.0296), neurological findings (P = 0.0057), number of days in the intensive care unit (P = 0.0239), acute disseminated intravascular coagulation score during hospitalization (P = 0.0363), and the Katz index at discharge or transfer (P = 0.0020) among these groups.</p><p><strong>Conclusions: </strong>Among patients with sepsis, 25.3% showed acute cerebral ischemia findings on brain MRI, regardless of illness severity, including hypoxia and hypotension, and presence of shock. Abnormal MRI findings were also observed in patients without acute brain dysfunction. Importantly, abnormal brain MRI findings were associated with worse neurological outcomes.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"437-445"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033796","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":"Cryptogenic Encephalitis: The New Abnormal.","authors":"Chiara Risso, Romain Sonneville","doi":"10.1007/s12028-025-02289-y","DOIUrl":"10.1007/s12028-025-02289-y","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"378-381"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181117","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":"Real-World Antiseizure Medication Prophylaxis and Outcomes in Hospitalized Adults with Acute Brain Injuries.","authors":"David Cheng, Marta Bento Fernandes, M Brandon Westover, Lidia Moura, Sahar F Zafar","doi":"10.1007/s12028-025-02345-7","DOIUrl":"https://doi.org/10.1007/s12028-025-02345-7","url":null,"abstract":"<p><strong>Background: </strong>There is low-quality evidence for antiseizure medication (ASM) prophylaxis in acute brain injuries. We examined ASM prophylaxis patterns and explored the association with hospital outcomes in acute brain injury.</p><p><strong>Methods: </strong> We analyzed the PINC AI Healthcare Database with data from more than 1,400 US hospitals. We included adults aged ≥ 18 years admitted for at least 2 days with acute brain injury (International Classification of Diseases codes for ischemic stroke [IS], hemorrhagic stroke [HS], and traumatic brain injury [TBI]) and excluded potential prevalent users and patients with epilepsy/seizures. Index date was the second day of admission. The ASM prophylaxis cohort received levetiracetam or phenytoin on the index date; the control cohort did not receive any ASM on the index date. Outcomes were time-to-mortality and time-to-home discharge.</p><p><strong>Results: </strong>In total, 739,213 patients were eligible: 568,254 with IS, 86,842 with HS, and 84,117 with TBI. ASM prophylaxis was prescribed in 10,959/568,254 (2%) patients with IS, 31,970/86,842 (37%) patients with HS, and 38,331/84,117 (46%) patients with TBI. Patients on prophylaxis more frequently received mechanical ventilation, craniectomies/craniotomies, vasopressors, and anesthetics. After adjusting for markers of illness severity, prophylaxis was associated with mortality (IS: hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.89-2.16; HS: HR 0.83; 95% CI 0.79-0.87; TBI: HR 0.97, 95% CI 0.89-1.06). Prophylaxis was associated with lower home discharge (IS: HR 0.40, 95% CI 0.37-0.42; HS: HR 0.61, 95% CI 0.58-0.64; TBI: HR 0.69, 95% CI 0.68-0.72). Across all acute brain injuries, mechanical ventilation exhibited strong association with outcomes.</p><p><strong>Conclusions: </strong>Antiseizure medication prophylaxis was higher in TBI and HS compared with IS. Markers of illness severity (e.g., mechanical ventilation, neurosurgical procedures) were associated with more frequent prophylaxis. Prophylaxis exhibited differential associations with mortality (higher in IS, lower in HS and TBI). Prophylaxis was associated with lower home discharge across all acute brain injuries. We hypothesize that neurologic severity and critical illness severity are primary drivers of outcomes. However, the independent association of ASMs with outcomes warrants further investigation.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207027","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":"The Impact of Paroxysmal Sympathetic Hyperactivity on Prognosis in Patients with Severe Intracerebral Hemorrhage.","authors":"Fan Yang, Guang Feng, Bingsha Han, Jingzhou Li, Jinsong Chen","doi":"10.1007/s12028-025-02258-5","DOIUrl":"10.1007/s12028-025-02258-5","url":null,"abstract":"<p><strong>Background: </strong>Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodes of excessive sympathetic activity and is associated with poor outcomes in brain injuries, yet its impact on severe intracerebral hemorrhage (ICH) remains unclear. This study investigates the association between PSH and clinical outcomes in patients with severe ICH.</p><p><strong>Methods: </strong>We conducted a prospective observational cohort study of patients with severe ICH from January 2018 to December 2022. Severe ICH was defined as ICH with a Glasgow Coma Scale score ≤ 8 on admission, indicating significant neurological impairment. Patients were assessed for PSH using the PSH-Assessment Measure, and categorized into probable, possible, and unlikely PSH groups. Propensity score matching was used to adjust for baseline differences among three groups. The primary outcome was the 90-day mortality rate. Secondary outcomes included a favorable functional outcome at 90 days, defined by a modified Rankin Scale score of 0-2. Statistical analyses were performed using Cox proportional hazards regression and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>After propensity score matching, 177 patients (59 in each group) were analyzed. The 90-day mortality rate was significantly higher (P < 0.01) in the probable PSH group (67.8%), compared with possible (47.5%) and unlikely PSH groups (35.6%). The Kaplan-Meier survival curve further illustrates a significantly increased risk of 90-day mortality in the probable PSH group (Log rank test P < 0.01). Multivariate Cox proportional hazards regression analysis confirmed that, after adjusting for confounders, the presence of probable PSH (hazard ratio 3.86, 95% confidence interval 2.17-6.87; P < 0.01) was independently associated with a higher risk of 90-day mortality. Functional outcomes at 90 days were poorer in the probable PSH group.</p><p><strong>Conclusions: </strong>Probable PSH is significantly associated with worse outcomes in severe ICH, underscoring the importance of early recognition and targeted management strategies.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"590-597"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064187","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}