Neurocritical Care最新文献

{"title":"Hematocrit-to-Hemoglobin Ratio as a Novel Independent Predictor for In-Hospital Mortality and Delayed Cerebral Ischemia in Critically Ill Patients with Aneurysmal Subarachnoid Hemorrhage Requiring Neurosurgical or Endovascular Treatment: A Retrospective Analysis.","authors":"Emanuel Moisa, Georgeana Tuculeanu, Liliana Mirea, Claudia Mihail, Stefanita Dima, Liviu Ioan Serban, Dan Corneci, Federico Bilotta, Silvius Ioan Negoita","doi":"10.1007/s12028-025-02395-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02395-x","url":null,"abstract":"<p><strong>Background: </strong>Substantial research has been dedicated to new prognostication tools in aneurysmal subarachnoid hemorrhage (aSAH), with a recent focus on laboratory parameters. Our study investigates the predictive value of a new hematological index, the hematocrit-to-hemoglobin (Ht-to-Hb) ratio, for mortality and delayed cerebral ischemia (DCI).</p><p><strong>Methods: </strong>This is a retrospective, single-center, observational study on 78 adult critically ill patients with aSAH. We collected data from the electronic and written records, including demographic and clinical data, therapeutic measures, and intensive care unit and hospital length of stay. The primary outcome was in-hospital mortality, whereas the secondary outcome was DCI development. After descriptive analysis was performed, the Ht-to-Hb ratio was tested as a predictor for the primary and secondary outcomes. Firstly, we conducted a receiver operating characteristic analysis, and cutoff values were identified using the Youden index. Further, in-hospital mortality and DCI probability were evaluated using the log rank test. Cox proportional hazards regression was conducted to test the independent predictive value of the Ht-to-Hb ratio for the aforementioned outcomes.</p><p><strong>Results: </strong>Mortality during hospitalization was 25.54%, whereas DCI frequency was 42.3%. The Ht-to-Hb ratio had areas under the receiver operating characteristic curve for death prediction and DCI of 0.85 and 0.734, respectively. Values greater than the cutoff value for mortality, 3.069, were independently associated with the primary outcome in the multivariable analysis (hazard ratio [HR] 4.64, 95% confidence interval [CI] 1.08-19.98, p = 0.039). For DCI, the cutoff value identified was 3.007. Ht-to-Hb ratios > 3.007 were an independent risk factor for DCI in the multivariable analysis (HR 3.86, 95% CI 1.43-10.4, p = 0.008).</p><p><strong>Conclusions: </strong>The present study proposes a new prognostic index for mortality and DCI in aSAH: the Ht-to-Hb ratio. This marker could act as a surrogate for blood viscosity, uncovering the importance of blood rheology in aSAH pathogenesis.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368366","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":"Systemic Metabolic Alterations After Aneurysmal Subarachnoid Hemorrhage: A Plasma Metabolomics Approach.","authors":"Bosco Seong Kyu Yang, Jude P J Savarraj, Hua Chen, Sarah N Hinds, Glenda L Torres, Alice S Ryan, Folefac D Atem, Philip L Lorenzi, Xuefang S Ren, Louise D McCullough, Neeraj Badjatia, Huimahn A Choi, Aaron M Gusdon","doi":"10.1007/s12028-025-02392-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02392-0","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) causes systemic changes that contribute to delayed cerebral ischemia (DCI). Systemic metabolomic profiles following aSAH were characterized and examined for their ability to predict outcomes.</p><p><strong>Methods: </strong>Blood samples prospectively collected within 24 h (T1) of admission and 7 days (T2) post ictus from patients with aSAH at two tertiary care centers were retrospectively analyzed. Samples from healthy individuals and patients with nonneurologic critical illness served as controls. A validated external analysis platform was used to perform untargeted metabolomics. Clinical data were prospectively collected and adjudicated. Bioinformatics analyses were conducted to identify metabolomic profiles defining each group and delineating relevant metabolic pathways. Machine learning (ML) models for outcome prediction were developed, incorporating key metabolites.</p><p><strong>Results: </strong>A total of 70 subjects with aSAH, 30 healthy controls, and 17 sick controls were included. Groups were matched among key clinical variables. DCI occurred in 36% of subjects with aSAH, and poor functional outcome occurred in 70% at discharge. Metabolomic profiles readily discriminated the groups. aSAH subjects demonstrated mobilization of lipid metabolites, with increased levels of free fatty acids, monoacylglycerols, and diacylglycerols compared with control groups (average 1.8-fold increase; q < 0.05). Circulating amino acid-derived metabolites were significantly decreased, showing an average 30% reduction (q < 0.05), consistent with increased catabolism. DCI was associated with increased sphingolipids (2.1-fold) and decreased acylcarnitines (1.9-fold) and S-adenosylhomocysteine (1.2-fold) at T1 (p < 0.05). Decreased lysophospholipids (1.4-fold) and acylcarnitines (1.5-fold) were associated with poor outcomes (p < 0.05). Incorporating metabolites into ML models improved prediction of DCI compared with clinical variables alone (elastic net linear regression p < 0.01, extreme gradient boosting p = 0.016).</p><p><strong>Conclusions: </strong>Profound metabolic shifts occur after aSAH, with characteristic increases in lipid and decreases in amino acid metabolite levels. This sentence should read: 'Key lipid metabolites (sphingolipids, lysophospholipids, and acylcarnitines) associated with outcomes provide insight into the pathophysiological changes driving secondary complications after aSAH. These metabolites may be useful biomarkers to improve prognostication and personalize aSAH care.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355353","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":"Resource Utilization After Mechanical Thrombectomy: Is ICU Care Required for All Patients?","authors":"Lindsey J Krawchuk, Amanda M Crooks, Rachel K Do, William J Powers, James P Ho, Dena M Williams","doi":"10.1007/s12028-025-02384-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02384-0","url":null,"abstract":"<p><strong>Background: </strong>Mechanical thrombectomy (MT) is the standard of care for qualifying patients with acute ischemic stroke (AIS). Minimal postprocedural guidelines often result in patients being admitted to the intensive care unit (ICU) for 24 h, even if they did not receive intravenous thrombolysis (IVT). Whether or not these patients consistently use ICU resources has not been well studied. This study aims to assess the use of ICU resources in post-thrombectomy patients who did not receive IVT.</p><p><strong>Methods: </strong>A single-center retrospective chart review was performed for all patients with AIS who were at least 18 years old and received MT from 2015 to 2022. Patients who received IVT or required ICU-level resources before MT were excluded. ICU-level resources were defined as advanced respiratory support (ARS), neurosurgical intervention, ICU-level infusions (e.g., hypertonic saline, vasoactive, sedating), or interventions requiring ICU-level nursing care. We collected data on patient demographics, stroke characteristics, and the use of ICU-level resources up to 24 h after MT. A multivariate logistic regression model was used to determine the factors associated with ICU resource use.</p><p><strong>Results: </strong>A total of 239 patients met the inclusion criteria. The median admission National Institute of Health Stroke Scale score was 16. Of these patients, 128 (53.6%) did not require ICU resources in the first 24 h, and 111 (46.4%) did. Vasoactive infusions and ARS were the most used resources (n = 86 [77.4%] and n = 55 [49.5%]). Vasoactive infusions and ARS started during MT were the only statistically significant variables associated with the use of ICU-level resources in the 24 h postprocedure (odds ratio [OR] 2.92, p < 0.001; and OR 2.33, p = 0.009).</p><p><strong>Conclusions: </strong>Most patients who did not receive IVT do not require ICU resources in the first 24 h after MT. Multivariate analysis revealed the only statistically significant factors predicting the need for ICU resources was the use of ARS and vasoactive infusions during MT. These results suggest it may be reasonable to reexamine current monitoring paradigms.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355344","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":"Spinal Cord Blood Flow, Metabolism, and Neurological Outcome in Patients with Acute, Severe Traumatic Spinal Cord Injuries.","authors":"Hasan Asif, Ellaine Boseta, Argyro Zoumprouli, Marios C Papadopoulos, Samira Saadoun","doi":"10.1007/s12028-025-02385-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02385-z","url":null,"abstract":"<p><strong>Background: </strong>We characterized, in patients with severe acute traumatic spinal cord injuries, the relationships between intraoperative spinal cord blood flow (SCBF) and postoperative injury-site metabolism and physiology, preoperative magnetic resonance imaging (MRI) features, and neurological outcome.</p><p><strong>Methods: </strong>Twenty-six adults with severe, acute traumatic spinal cord injuries (American Spinal Injury Association Impairment Scale, grades A-C) had surgery within 72 h of injury. All had preoperative spine MRI and intraoperative laser speckle contrast imaging of SCBF. For four days after operation, we monitored from the injury site, intraspinal pressure (ISP), and spinal cord perfusion pressure (SCPP) as well as tissue metabolism with surface microdialysis.</p><p><strong>Results: </strong>We observed three intraoperative SCBF patterns: necrosis-penumbra SCBF (SCBF-necr) in 34.6% of patients, patchy-perfusion SCBF (SCBF-patchy) in 38.5% of patients, and hyperperfusion SCBF (SCBF-hyper) in 26.9% of patients. On preoperative MRI, SCBF-necr was associated with higher Brain and Spinal Injury Center MRI score versus SCBF-patchy or SCBF-hyper (median 4 vs. 2 or 2.5). SCBF-necr was associated with higher postoperative ISP, lower postoperative SCPP, and more deranged postoperative injury-site metabolism (lower glucose; higher lactate, glutamate, and glycerol) than SCBF-patchy or SCBF-hyper, with little difference between SCBF-patchy and SCBF-hyper. Machine learning analysis of physiological-metabolic data considered as seven-dimensional vectors (ISP, SCPP, glucose, pyruvate, lactate, glutamate, and glycerol) accurately distinguished between the three SCBF patterns with an area under the curve of 0.85-0.95. The seven-dimensional physiological-metabolic vectors were segregated as SCBF-necr, SCBF-patchy, and SCBF-hyper in Kohonen self-organizing maps. SCBF-patchy was associated with greater improvement in motor score than SCBF-necr or SCBF-hyper (35.3 vs. 5.2 or 2.2), independent of admission American Spinal Injury Association Impairment Scale grade.</p><p><strong>Conclusions: </strong>Our findings challenge the prevailing concept in the field, derived from animal experiments, that spinal cord injury causes necrosis at the injury site with surrounding penumbra. In humans, spinal cord injury causes three abnormal SCBF patterns detected intraoperatively, with distinct postoperative physiological-metabolic signatures, preoperative MRI characteristics, and neurological outcomes.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346309","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":"Early Markers of Systemic Inflammation are not Related to Pain Burden After Aneurysmal Subarachnoid Hemorrhage: A Multicenter Observational Study.","authors":"Adam Kardon, Haoyu Ren, Emily Gerard, Daniela Pomar-Forero, Ralisa Pop, Bakhtawar Ahmad, Prajwal Ciryam, Gunjan Parikh, Neeraj Badjatia, Carolina B Maciel, Katharina M Busl, Chixiang Chen, Nicholas A Morris","doi":"10.1007/s12028-025-02396-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02396-w","url":null,"abstract":"<p><strong>Background: </strong>Headache is nearly ubiquitous in the immediate aftermath of nontraumatic, aneurysmal pattern subarachnoid hemorrhage (SAH); however, pain experiences vary significantly throughout the intensive care unit (ICU) course across patients and may challenge the establishment of effective analgesic treatment. Acute abortive management often relies on opioids. The pathophysiologic factors driving persistent pain after SAH are likely related to the inflammatory response to blood-brain barrier breakdown and heme degradation. Scarce data on predictors for a course of refractory headache preclude the ability to risk stratify and identify patients who could benefit from targeted, opioid-sparing pain management strategies. We aimed to identify clinical and laboratory predictors of a persistently high pain burden during the ICU course.</p><p><strong>Methods: </strong>We performed a retrospective, multicenter observational study in patients with SAH. Pain scores were abstracted from the electronic health record. Study participants were divided into quartiles based on the average burden of daily pain, and predictors of pain burden were identified by univariate analysis and ordinal logistic regression. We performed a sensitivity analysis restricted to patients able to verbally report pain scores in the ICU.</p><p><strong>Results: </strong>Of the 523 patients in the final analysis, the mean age was 55 years, 352 (67%) were female, the median Hunt-Hess score was 3 (interquartile range 2-3), and 465 (89%) had a modified Fisher score of 3 or 4. Older age was associated with lower ICU pain burden (odds ratio 1.01, 95% confidence interval 1.01-1.03). Chronic opioid use (odds ratio 0.59, 95% confidence interval 0.38-0.90) was associated with a higher ICU pain burden. Conversely, blood inflammatory biomarkers were not associated with high ICU pain burden in the univariate or multivariate analysis. The results were similar among the subgroup of patients able to verbally report pain scores throughout admission.</p><p><strong>Conclusions: </strong>In this multicenter study, young age and chronic opioid use are associated with higher ICU pain burden, whereas inflammatory blood biomarkers lack an association. Further study is required to elucidate the biological pathways and psychosocial determinants of protracted pain after aneurysmal SAH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346323","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":"Letter to the Editor: Impact of Microcirculatory Dysfunction on Persistent Global Cerebral Edema After Aneurysmal Subarachnoid Hemorrhage: An Age-Stratified Analysis.","authors":"Hamida Memon, Hafsa Shuja, Umer Wamiq","doi":"10.1007/s12028-025-02397-9","DOIUrl":"https://doi.org/10.1007/s12028-025-02397-9","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293186","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":"Quantitative EEG Markers of Elevated Intracranial Pressure in a Case of Carcinomatous Meningitis.","authors":"Cody L Nathan, Diamond A Dominguez, Elizabeth Gerard","doi":"10.1007/s12028-025-02372-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02372-4","url":null,"abstract":"<p><p>We present the case of a 69-year-old woman with acute myeloid leukemia with recurrent transient events characterized by loss of awareness and generalized shaking. The events were initially diagnosed as seizures based on semiology but persisted despite antiseizure medications. The events were recorded using continuous video electroencephalography (EEG) with no epileptiform correlate. However, pertinent changes included diffuse attenuation of fast activity, increase in delta activity, and subsequent attenuation of faster frequencies. Quantitative EEG detected a decrease in fast activity, alpha-delta ratio, and amplitude-integrated EEG. The transient events and EEG findings in the setting of known cancer history raised concern for carcinomatous meningitis despite unremarkable brain imaging. Lumbar puncture showed an elevated opening pressure and cytology confirmed a myeloid blast population consistent with acute myeloid leukemia. The events resolved with serial lumbar punctures supporting the fact that the events were likely secondary to transient elevations in intracerebral pressure. In summary, video EEG with quantitative EEG analysis is a sensitive, non-invasive way to confirm transient elevated intracranial pressure and rule out epileptic activity. This constellation of cancer, clinical symptoms and EEG findings should increase suspicion of carcinomatous meningitis.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286525","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":"Exploring the Role of Alpha Lipoic Acid in the Treatment of Traumatic Brain Injury: Pathways and Perspectives.","authors":"Mazyar Ataei, Amirreza Peyrovinasab, Moloud Saleh, Hedieh Sadat Shamsnia, Leila Mohaghegh Shalmani, Amir Hossein Abdolghaffari","doi":"10.1007/s12028-025-02383-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02383-1","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is known to be a critical health challenge with a significant number of hospital admissions. In addition to the primary injury and its complications, the secondary phase of the injury also causes numerous health issues. Neuroinflammation, oxidative stress (OS), and neuronal cell death are among the main outcomes of secondary injury. Although so far there are no drugs approved by the Food and Drug Administration for TBI's pharmacological treatment, numerous pharmaceutical compounds have been studied to help patients. Alpha lipoic acid (ALA), as a potent antioxidant agent, has been investigated for a considerable period.</p><p><strong>Methods: </strong>Eligible original studies written in English on the effects of ALA in TBI were collected from PubMed, Embase, Scopus, Web of Science, and Google Scholar for clinical, in vivo, and in vitro studies.</p><p><strong>Results: </strong>ALA is able to enter the blood-brain barrier due to its distinctive combination of hydrophilic and hydrophobic characteristics, enabling it to directly affect brain regions. It acts as a cofactor for enzymes in mitochondria, helping in oxidative carboxylation and replenishing other antioxidants like glutathione. This improves the glutathione/glutathione disulfide ratio during cellular stress, hence reducing cell death. In addition, ALA regulates oxidative, inflammatory, and apoptotic pathways by controlling the activity of caspase 3, caspase 9, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), and inflammatory proteins, including tumor necrosis factor and inducible nitric oxide synthase. These methods highlight the potential of ALA in decreasing neuronal damage and OS in brain-related illnesses, including TBI.</p><p><strong>Conclusions: </strong>Based on this review, it can be concluded that ALA can potentially be administered as a therapeutic option for patients with TBI. However, more studies and trials are required to adjust the optimum dosing of ALA for the treatment of patients.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286542","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":"Efficacy and Predictors of Success of External Ventricular Drainage for the Management of Traumatic Intracranial Hypertension: A Retrospective Multicenter Cohort Study.","authors":"Jean-Denis Moyer, Benjamin Cohen, Marie Werner, Vincent Legros, Thomas Leperlier, Mathieu Willig, Thomas Gaberel, Gueorgui Iakovlev, Caroline Jeantrelle, Jean Pasqueron, Thomas Clavier, Pauline Ponsin, Clément Gakuba, Benoit Champigneulle","doi":"10.1007/s12028-025-02394-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02394-y","url":null,"abstract":"<p><strong>Background: </strong>External ventricular drainage (EVD) is commonly used to manage elevated intracranial pressure (ICP) following traumatic brain injury (TBI). However, evidence supporting its effectiveness in this context remains limited. This study aimed to evaluate the effectiveness of EVD in controlling elevated ICP and to identify clinical and radiological factors associated with its success.</p><p><strong>Methods: </strong>A multicenter retrospective cohort study was conducted between January 1, 2019, and December 31, 2022, across nine regional trauma centers in France participating in the Traumabase registry. All patients with TBI with intracranial hypertension despite maximal medical therapy and treated with EVD were included. EVD success was defined as an effective control of ICP avoiding the use of any third-tier therapy or avoiding a decision to withdraw life-sustaining treatment due to both refractory intracranial hypertension and severity of brain injury lesions.</p><p><strong>Results: </strong>A cohort of 176 patients with TBI treated with EVD was included. Among these patients, 88 (50%) achieved sustained control of ICP after EVD, with few complications reported (health care-associated ventriculitis: 3%, significant hematoma [> 1 cm] on EVD path: 3%). In the multivariate analysis, sedation with a combination of sedative drugs (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.12-0.62, p = 0.002), obliterated basal cisterns on the brain computed tomography scan prior to EVD placement (OR 0.07; 95% CI 0.00-0.39, p = 0.013), and severity of chest trauma (OR 0.79; 95% CI 0.64-0.99, p = 0.039) were factors associated with poor likelihood of EVD success. Conversely, EVD placement occurring more than 24 h after admission was independently associated with success (OR 3.07; 95% CI 1.41-7.01, p = 0.006).</p><p><strong>Conclusions: </strong>In this multicenter cohort of patients with TBI with refractory intracranial hypertension, EVD effectively controlled ICP in half of the cases. The effectiveness of EVD appears to depend on clinical and radiological markers of severity of traumatic intracranial hypertension.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258648","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":"Infratentorial Pressure Monitoring in Cerebellar Stroke: Feasibility and Prognostic Utility.","authors":"Sae-Yeon Won, Eva Herrmann, Anne Neumeister, Jonas Hagemeier, Daniel Dubinski, Alhalabi T Obada, Bedjan Behmanesh, Joshua D Bernstock, Thomas M Freiman, Olaf Lademann, Artem Rafaelian, Jens-Christian Schewe, Alexander Storch, Andreas W Unterberg, Johannes Walter, Matthias Wittstock, Nazife Dinc, Florian Gessler","doi":"10.1007/s12028-025-02391-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02391-1","url":null,"abstract":"<p><strong>Background: </strong>Although supratentorial intracranial pressure (ICP) monitoring represents the current standard in neurocritical care, its validity for assessing infratentorial pathologies remains uncertain. This multicenter, prospective study aimd to (1) evaluate the feasibility and clinical utility of infratentorial ICP monitoring in acute posterior fossa pathologies and (2) develop a prognostic model for functional outcomes based on infratentorial pressure dynamics.</p><p><strong>Methods: </strong>We conducted a prospective cohort study across three tertiary neurovascular centers in Germany (2021-2024), enrolling 35 consecutive patients with cerebellar stroke requiring surgical decompression and external ventricular drainage. All participants underwent simultaneous supratentorial and infratentorial ICP monitoring for seven posteroperative days. Functional outcomes were assessed using the modified Rankin scale at discharge and at six-month follow-up (FU). The primary end point was the comparison of ICP gradients between compartments; secondary analyses evaluated the association between infratentorial ICP and functional outcomes.</p><p><strong>Results: </strong>The mean infratentorial ICP was significantly higher than the supratentorial ICP (11.9 mm Hg [95% confidence interval (CI) 10.5-13.3] vs. 8.8 mm Hg [95% CI 7.4-10.1], P < 0.001). Patients with unfavorable outcomes had significantly higher infratentorial ICP values compared with those with favorable outcomes at FU (13.1 mm Hg [95% CI 11.1-15.1] vs. 9.5 mm Hg [95% CI 6.8-12.1], P = 0.042). Multivariate logistic regression analysis identified a novel scoring system-calculated as patient age (years) plus four times the mean infratentorial ICP (mm Hg)-as a significant predictor of unfavorable outcomes at both discharge and FU (P < 0.001 and P = 0.001, respectively), with area under the curve (AUC) values of 0.88 and 0.89. A cutoff value of 115 was established to predicting unfavorable outcomes at FU.</p><p><strong>Conclusions: </strong>This study establishes that infratentorial ICP monitoring (1) reveals clinically significant pressure gradients undetctable by supratentorial measurement alone, (2) provides superior prognostic information compared with conventional monitoring, and (3) can be safely implemented with 94% technical success rate. These findings advocate for the integration of infratentorial ICP assessment into the neurocritical care paradigm for posterior fossa pathologies.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145258610","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}