Neurocritical Care最新文献

{"title":"The Culprit Behind a Fading Young Man.","authors":"Songsong Luo, Xiaoyuan Shen, Jiawei Lai, Yuan Gao","doi":"10.1007/s12028-026-02701-1","DOIUrl":"https://doi.org/10.1007/s12028-026-02701-1","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224671","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":"Correction: Prevention of Shivering During Therapeutic Temperature Modulation: The Columbia Anti-Shivering Protocol.","authors":"H Alex Choi, Sang-Bae Ko, Mary Presciutti, Luis Fernandez, Amanda M Carpenter, Christine Lesch, Emily Gilmore, Rishi Malhotra, Stephan A Mayer, Kiwon Lee, Jan Claassen, J Michael Schmidt, Neeraj Badjatia","doi":"10.1007/s12028-026-02696-9","DOIUrl":"https://doi.org/10.1007/s12028-026-02696-9","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224697","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":"Electroacupuncture Ameliorating Cerebral I/R-Induced Inflammatory Response through the TLR/TRAF6/NF-κB Pathway.","authors":"Ye-Ting Chen, Yi-Si Shan, Shen-Nan Zhao, Wen-Ping Cao, Jian-Feng Pu","doi":"10.1007/s12028-026-02680-3","DOIUrl":"https://doi.org/10.1007/s12028-026-02680-3","url":null,"abstract":"<p><strong>Background: </strong>The inflammatory response plays a crucial role in cerebral ischemia/reperfusion (I/R) injury and may offer a new therapeutic approach for stroke. Electroacupuncture has shown potential in treating cerebral ischemia/reperfusion injury.</p><p><strong>Methodology: </strong>Male Sprague-Dawley rats were randomly assigned to four groups: the sham group, middle cerebral artery occlusion/reperfusion (MCAO/R) group, sham electroacupuncture (SEA) group, and electroacupuncture (EA) group. The SEA and EA groups received 30 min of treatment after 60 min of ischemia. Body weight was measured before and 24 h after the MCAO/R procedure. Neurological function and infarct volume were assessed 24 h after the MCAO/R procedure. Protein and messenger RNA (mRNA) expression levels of TLR4, TLR9, TRAF6, and NF-κB were evaluated using western blot and reverse-transcription polymerase chain reaction (RT-PCR). The mRNA and protein expression of inflammatory markers was assessed using RT-PCR and enzyme-linked immunosorbent assay (ELISA).</p><p><strong>Results: </strong>Compared with the MCAO/R group, the EA group exhibited improved neurological function, reduced infarct volume, and down-regulated expression of TLR4, TLR9, TRAF6, and NF-κB. Additionally, in the EA group, the mRNA and protein expression of proinflammatory cytokines (TNF-α, IL-6, and IL-1β) were decreased, while the expression of the anti-inflammatory cytokine (IL-10) was increased.</p><p><strong>Conclusions: </strong>Electroacupuncture exerts a neuroprotective effect on MCAO/R, potentially through the modulation of the TLR4, TLR9, TRAF6, and NF-κB pathways. This treatment may reduce the cerebral I/R-induced inflammatory response by influencing the TLR/TRAF/NF-κB signaling pathway.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207622","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":"Response to: Intracerebral Hemorrhage and Vasospasm After Aneurysmal Rupture: Association or Confounding by Aneurysm Location.","authors":"Rajat Dhar, Nada Babtain","doi":"10.1007/s12028-026-02686-x","DOIUrl":"https://doi.org/10.1007/s12028-026-02686-x","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195741","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":"Intracerebral Hemorrhage and Vasospasm After Aneurysmal Rupture: Association or Confounding by Aneurysm Location?","authors":"Hongwu Qi","doi":"10.1007/s12028-026-02685-y","DOIUrl":"https://doi.org/10.1007/s12028-026-02685-y","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195758","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":"LI60 and Hematoma Expansion in Intracerebral Hemorrhage: Statistical Artefact or Novel Biology?","authors":"Shingo Kawashima, Atsushi Kobayashi, Wakana Kawashima, Masahiko Ohashi, Hiroyuki Kinoshita","doi":"10.1007/s12028-026-02681-2","DOIUrl":"https://doi.org/10.1007/s12028-026-02681-2","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195705","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":"Neurogenic Cerebral Edema: Proposed Mechanism for Vasogenic Cerebral Edema.","authors":"Siddharth Srinivasan, Mithun Sattur, Kautilya Patel, Daryl R Gress","doi":"10.1007/s12028-026-02684-z","DOIUrl":"https://doi.org/10.1007/s12028-026-02684-z","url":null,"abstract":"<p><p>Global cerebral edema (GCE) is a frequent and devastating manifestation of early brain injury after aneurysmal subarachnoid hemorrhage (aSAH), yet its exact inciting biology and sequence of events remain incompletely explained. In this viewpoint, we propose neurogenic cerebral edema (NCE) as a mechanistic hypothesis for vasogenic edema after aSAH, in which autonomic disequilibrium may amplify blood-brain barrier permeability within otherwise mixed cellular, ionic, and vasogenic edema. We integrate evidence that aSAH perturbs the central autonomic network, producing a sympathetic catecholamine surge that can coexist with parasympathetic system activation. This autonomic disequilibrium may indirectly amplify established neurovascular-unit injury pathways, including sulfonylurea receptor 1 (SUR1)-transient receptor potential melastatin 4 (TRPM4) upregulation and tight-junction dysfunction, thereby increasing the vasogenic component of early cerebral edema. We further highlight a pathophysiological parallel with neurogenic pulmonary edema, wherein neurally mediated hemodynamic and permeability forces culminate in protein-rich extravasation across an endothelial barrier. An analogous process in the brain provides a coherent framework for blood-brain barrier (BBB) breakdown and diffuse edema after aSAH. To illustrate the imaging pattern motivating prospective testing, we present a patient with poor-grade aSAH with malignant edema and diffusely elevated apparent diffusion coefficient values. Because autonomic measurements and direct BBB permeability assessment were not obtained, this case illustrates a vasogenic component but does not establish a neurogenic etiology. Our premise is that both arms of autonomic control must be considered. This hypothesis also emphasizes the need for prospective validation using BBB permeability imaging and translational autonomic biomarkers.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195754","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":"Diagnostic and Prognostic Value of Sonographic Optic Nerve Sheath Diameter in Patients with Ischemic Stroke or Hypertensive Intracerebral Hemorrhage.","authors":"Hisham Alasar, Abdallah Kandeel, Mohamed Hamdi, Alshaimaa M Aboul Fotooh, Farid Amin, Mohamed Abdeltawab, Mahmoud Kenawy","doi":"10.1007/s12028-026-02697-8","DOIUrl":"https://doi.org/10.1007/s12028-026-02697-8","url":null,"abstract":"<p><strong>Background: </strong>Elevated intracranial pressure (ICP) is a critical complication in nontraumatic brain injury, yet invasive monitoring carries significant risks, and noninvasive alternatives remain undervalidated. Optic nerve sheath diameter (ONSD) ultrasonography represents a promising bedside technique, but data in nontraumatic populations are limited. This study evaluated the diagnostic and prognostic value of ONSD in neurocritical patients with ischemic stroke or hypertensive intracerebral hemorrhage.</p><p><strong>Methods: </strong>This prospective observational cohort study enrolled 100 neurocritical intensive care unit (ICU) patients with acute nontraumatic brain injury [ischemic stroke or hypertensive intracerebral hemorrhage; Glasgow Coma Scale (GCS) < 9] who underwent admission computed tomography (CT) and bedside ONSD ultrasonography. Sixty age- and sex-matched healthy volunteers were enrolled exclusively to provide descriptive reference values for physiological ONSD and were not included in the primary diagnostic or prognostic analyses. CT-based radiologic ICP surrogates were the reference standard. Exploratory analyses evaluated inter-eye variability, adjusted models, and in-hospital survival.</p><p><strong>Results: </strong>ONSD increased stepwise across healthy controls, patients with negative CT, and patients with positive CT (4.62 ± 0.33, 5.52 ± 0.51, and 6.50 ± 0.51 mm, respectively). Among neurocritical patients, a cohort-derived cutoff of ≥ 6.00 mm yielded 86.7% sensitivity, 85.0% specificity, 89.7% positive predictive value, 81.0% negative predictive value, 86.0% accuracy, and 0.901 area under the curve (AUC). Above-threshold ONSD remained independently associated with CT-positive elevated ICP after adjustment for age, body mass index (BMI), GCS, and systolic blood pressure (SBP) in exploratory multivariable analysis. Exploratory survival analysis showed significantly higher in-hospital mortality in patients with ONSD above the cohort-derived threshold (log-rank p = 4.77 × 10^-13).</p><p><strong>Conclusions: </strong>Bedside ultrasonographic ONSD measurement appears clinically useful for early triage and longitudinal bedside surveillance in neurocritical patients with ischemic stroke or hypertensive intracerebral hemorrhage, particularly when invasive monitoring is unavailable or delayed.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149195720","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":"Artificial Intelligence for Early Prediction of Intracranial Hypertension: From Single-Centre Development to Multicentre Validation.","authors":"Peter Galos, Ludvig Hult, Giuseppe Citerio, Anders Lewén, Anders Hånell, Thomas B Schön, Per Enblad","doi":"10.1007/s12028-026-02633-w","DOIUrl":"https://doi.org/10.1007/s12028-026-02633-w","url":null,"abstract":"<p><strong>Background: </strong>Raised intracranial pressure is one of the most severe secondary insults after traumatic brain injury. Recognising physiological patterns before they progress to dangerous intracranial pressure elevations could enable preventive rather than reactive interventions. In our previous Uppsala single-centre study, an XGBoost machine learning model showed high discriminative performance for prediction of imminent intracranial pressure insults. The model identifies short-term physiological trajectories associated with imminent threshold crossing rather than predicting independent future clinical events. Whether these results are generalisable across centres is unknown. The aim was therefore to evaluate whether the XGBoost model trained on an Uppsala dataset maintains similar performance when applied to a multicentre TBI cohort - The CENTER-TBI High-Resolution ICU cohort.</p><p><strong>Methods: </strong>The XGBoost model trained on the Uppsala high frequency traumatic brain injury cohort was externally validated using data from the multicentre CENTER-TBI cohort. Minute-level averages of intracranial pressure and invasive arterial blood pressure were used to predict the onset of an intracranial pressure insult within 30 min on the basis of a 4h historical window. A bidirectional validation design was applied and performance was assessed using multiple metrics.</p><p><strong>Results: </strong>The cohorts comprised 602 patients from Uppsala and 255 patients from the CENTER-TBI database. When trained on the Uppsala cohort and tested on CENTER-TBI, the model achieved an area under the receiver operating characteristic curve (AUROC) of 97.4%, sensitivity of 93.8%, and specificity of 98.6%. Training on CENTER-TBI and testing on the Uppsala dataset yielded an AUROC of 96.1%, sensitivity of 81.2%, and specificity of 98.7%. Balanced accuracy exceeded 88% in both validation directions.</p><p><strong>Conclusions: </strong>The XGBoost model retained high performance under external multicentre validation, indicating that pre-insult physiological patterns preceding increased intracranial pressure are shared across cohorts. Differences in sensitivity between validation directions were observed and may reflect cohort characteristics or dataset size. These findings support the need for local evaluation before clinical implementation.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183605","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":"Optimal Transfusion Thresholds in Patients with Acute Brain Injury: A Bayesian Network Meta-analysis of Randomized Controlled Trials.","authors":"Xing Wang, Wei Fu, Wuqian Chen, Lu Ma, Chao You","doi":"10.1007/s12028-026-02674-1","DOIUrl":"https://doi.org/10.1007/s12028-026-02674-1","url":null,"abstract":"<p><strong>Background: </strong>The optimal transfusion threshold for acute brain injury (ABI) remains uncertain. Previous studies comparing liberal and restrictive transfusion strategies have yielded inconsistent findings. Therefore, we performed a Bayesian network meta-analysis to compare the effectiveness and safety of different transfusion thresholds in patients with ABI.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Medical Literature Analysis and Retrieval System Online (MEDLINE), and the Cochrane Library was performed to identify randomized controlled trials (RCTs) comparing red blood cell transfusion thresholds in patients with ABI. The primary outcomes were mortality and unfavorable functional outcome. Risk ratios (RRs) with 95% credible intervals (CrIs) were estimated from the Bayesian network meta-analysis, and treatment rankings were assessed using the surface under the cumulative ranking curve (SUCRA).</p><p><strong>Results: </strong>Six RCTs involving 2599 patients were included. Four transfusion thresholds were evaluated (hemoglobin levels of 7, 8, 9, and 10 g/dL). Compared with a transfusion threshold of 7 g/dL, a threshold of 9 g/dL was associated with a lower risk of unfavorable functional outcome (RR 0.86, 95% CrI 0.78-0.94; direct evidence from two trials). Compared with 8 g/dL, the estimated effect favored a 9 g/dL threshold, but the evidence was indirect and did not reach statistical significance (RR 0.79, 95% CrI 0.63-1.00). No clear differences in adverse events were observed across the evaluated thresholds. The 9 g/dL threshold ranked highest according to SUCRA values for both mortality and neurological outcomes. Meta-regression analysis suggested that baseline hemoglobin level may represent a potential source of heterogeneity in the effect of liberal transfusion strategies on functional outcomes.</p><p><strong>Conclusions: </strong>Among the evaluated transfusion thresholds, a threshold of 9 g/dL ranked most favorably for functional outcome and was associated with a lower risk of unfavorable functional outcome than 7 g/dL, without clear differences in mortality, infectious complications, or thromboembolic events.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165772","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}