Neurocritical Care最新文献

{"title":"Dynamic Impact of Leptomeningeal Collateral Status for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke with Endovascular Treatment: A Prospective Study.","authors":"Xin Jiang, Tingting Guo, Yidie Lin, Yanbo Li, Yaowen Hu, Xin He, Ning Chen, Muke Zhou, Jian Guo","doi":"10.1007/s12028-025-02312-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02312-2","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhagic transformation (HT) remains a common and serious complication after endovascular treatment (EVT) for acute ischemic stroke (AIS). Limited data exist on how dynamic status of leptomeningeal collaterals influence HT in AIS. This study aims to investigate the impact of dynamic status of leptomeningeal collaterals on postoperative HT in patients with AIS undergoing EVT.</p><p><strong>Methods: </strong>A prospective cohort study was performed between January 2019 and June 2023. Only patients with middle cerebral artery occlusion who received EVT were included. Preoperative leptomeningeal collaterals were evaluated using the regional leptomeningeal collateral (rLMC) score, and postoperative collaterals were assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology score.</p><p><strong>Results: </strong>A total of 342 patients with middle cerebral artery occlusion were included in this study. Multivariate analysis demonstrated that patients with good rLMC scores (˃ 10) experienced fewer HT events compared with those with poor rLMC scores (≤ 10) (adjusted odds ratio [aOR] 0.46, 95% confidence interval [CI] 0.28-0.76, P = 0.002). Further subgroup analysis based on intravenous thrombolysis showed that good leptomeningeal collaterals were significantly associated with reduced risk of HT in patients receiving bridging therapy (aOR 0.12, 95% CI 0.03-0.38, p < 0.001). Among 75 patients with incomplete recanalization, analysis of collateral changes indicated that patients with consistently good preoperative and postoperative collateral had the lowest risk of HT (aOR 0.19, 95% CI 0.04-0.95, P = 0.043). However, no significant correlation was detected between symptomatic intracranial hemorrhage and preoperative and postoperative collateral or its dynamic evolution.</p><p><strong>Conclusions: </strong>Good preoperative leptomeningeal collateral status is associated with reduced risk of HT and better 90-day functional outcomes after EVT, possibly due to its role in maintaining cerebral perfusion and slowing infarct growth. Although our findings suggest that collateral-dependent infarct growth may be a potential mechanism for HT and unfavorable outcomes, this hypothesis requires further investigation.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554011","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":"Risk Factors for Early Poor Outcomes in In-hospital Intracranial Hemorrhage: A Retrospective Cohort Study.","authors":"Tian Qu, Shengde Li, Xiang Zhou, Qi Miao, Jun Ni, Bin Peng","doi":"10.1007/s12028-025-02306-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02306-0","url":null,"abstract":"<p><strong>Background: </strong>Compared to in-hospital ischemic stroke, the prognosis of in-hospital intracranial hemorrhage (IH-ICH) remains poorly understood. We aimed to analyze the risk factors for early poor outcomes and propose a novel predictive nomogram for in-hospital ICH.</p><p><strong>Methods: </strong>We retrospectively analyzed data of patients with in-hospital ICH treated in our hospital between 2014 and 2022. Baseline demographics, comorbidities, clinical characteristics, and outcomes were collected. The early poor outcome was defined as in-hospital death or discharge against medical advice. Univariate and multivariate logistic regressions were used to identify the risk factors and then construct a nomogram. The nomogram was compared with the ICH score in terms of predictive ability.</p><p><strong>Results: </strong>A total of 196 patients were included; the median age was 57.0 (interquartile range 40.0-67.0) years, and 84 (49.7%) patients were male. Among the cohort, 135 patients had intraparenchymal hemorrhage, 27 had subarachnoid hemorrhage, 1 had intraventricular hemorrhage, 5 had subdural hemorrhage, and 1 had epidural hemorrhage. Overall, 96 (56.8%) patients developed an early poor outcome. Multivariate logistic regression identified prior spontaneous extracranial hemorrhage (ECH), baseline modified Rankin Scale (mRS) score ≥ 4, baseline Glasgow Coma Scale (GCS) score ≤ 8, and systemic disease etiology as independent risk factors for early poor outcomes. The IH-ICH nomogram, developed based on these risk factors, had good calibration and superior predictive performance compared to the conventional ICH score (area under the receiver operating characteristic curve 0.894 vs. 0.743, p < 0.001). Besides, the decision curve analysis curves revealed greater positive net benefit of the model than the ICH score.</p><p><strong>Conclusions: </strong>Patients with prior ECH, severe coma (GCS score ≤ 8), poor functional status (mRS score ≥ 4), and systemic disease etiology face a significant risk of early poor outcomes. The IH-ICH nomogram incorporating these factors offers a promising tool for identifying high-risk patients with in-hospital ICH, thereby contributing to improved patient care and resource allocation in neurology and critical care settings.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541469","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":"Fast and Slow Recovery of Consciousness Following Traumatic Brain Injury.","authors":"Sujith Swarna, Jordan R Saadon, Jermaine Robertson, Vaibhav Vagal, Nathaniel A Cleri, Kurt Butler, Xi Cheng, Yindong Hua, Seyed Morsal Mosallami Aghili, Chiemeka Uwakwe, Jason Zhang, Xuwen Zheng, Aniket Singh, Cassie Wang, Thomas Hagan, Chuan Huang, Petar M Djurić, Charles B Mikell, Sima Mofakham","doi":"10.1007/s12028-025-02304-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02304-2","url":null,"abstract":"<p><strong>Background: </strong>Consciousness recovery after severe traumatic brain injury (sTBI) can take minutes to years. Despite this variability, we hypothesized that we could identify subgroups with distinct temporal recovery trajectories and that these subgroups would have distinct clinical features.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study to analyze recovery trajectories for patients with sTBI (Glasgow Coma Scale [GCS] score ≤ 8) admitted to Stony Brook University Hospital from 2010 to 2019. Patients meeting our criteria for recovery (GCS score ≥ 13) were classified into cohorts using the slopes of their recovery trajectories. We then characterized these groups by their clinical features, neuroimaging, and electroencephalography (EEG).</p><p><strong>Results: </strong>A total of 501 patients with sTBI (348 men, mean age 51 years) were included in this study. Of these, 299 recovered. After analyzing their recovery rates, two distinct groups emerged, (1) fast recovery (n = 215) and (2) slow recovery (n = 84), with a median recovery time of 6 (interquartile range [IQR] 2-12) vs. 33 (IQR 27-44.75) days. Slow recovery patients had higher Injury Severity Scores (median 30 [IQR 25-41.75] vs. 24 [IQR 16-30]; 95% confidence interval [CI] 4.4495-10.6105; P < 0.001), more thalamic injury on neuroimaging (normalized volume [voxels] - 0.664 vs. 1.74; R² = 0.781; P < 0.016), and impaired interhemispheric connectivity on EEG (phase-locking value 0.35 vs. 0.44; 95% CI 0.055-0.14; P < 0.001).</p><p><strong>Conclusions: </strong>Recovery after sTBI falls into two broad categories, distinguishable by injury severity, thalamic injury, and disrupted interhemispheric connectivity. This model accounts for heterogeneity in TBI outcomes and represents progress toward identifying targets for future neuromodulatory therapeutic development.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512184","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":"Impact of Hemorrhage Extent on External Ventricular Drain-Associated Infections in Aneurysmal Subarachnoid Hemorrhage.","authors":"Florian Ebel, Emilia Westarp, Matteo Poretti, Matthias von Rotz, Simon Stohler, Raymond Chen, Raphael Guzman, Maja Weisser, Sarah Tschudin-Sutter, Luigi Mariani, Michel Roethlisberger","doi":"10.1007/s12028-025-02310-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02310-4","url":null,"abstract":"<p><strong>Background: </strong>External ventricular drain (EVD)-associated infections (EVDAI) remain a relevant complication of acute hydrocephalus treatment following aneurysmal subarachnoid hemorrhage (aSAH). Whether radiological quantity and anatomical distribution of subarachnoid and ventricular blood impact EVDAI rates has not been thoroughly studied to date.</p><p><strong>Methods: </strong>This was a retrospective (2009-2023) analysis of patients with aSAH undergoing emergency ventriculostomy. Univariable and multivariable logistic regression analyses were used to assess the association between the Barrow Neurological Institute (BNI) grading scale for subarachnoid hemorrhage and the intraventricular hemorrhage (IVH) score for extent and anatomical distribution of intracerebral bleeding with EVDAI risk. Cox regression analysis was employed to investigate the relationship between hemorrhage extent and the timing of EVDAI onset.</p><p><strong>Results: </strong>One hundred and ninety-four patients with aSAH received 228 EVDs with a total of cumulative 2,258 EVD days. Overall EVDAI rates were 14% (27/194) per patient and 12% (27/228) per EVD. EVDAI was associated with a larger subarachnoid blood clot (BNI grade 4; odds ratio 6.66, 95% confidence interval 2.04-21.68; p = 0.002) and higher IVH scores (odds ratio 1.33, 95% confidence interval 1.05-1.69; p = 0.02). Intracerebral hemorrhage was more frequently localized in the posterior fossa in the EVDAI group (20% vs. 0%, p = 0.004). Multivariable analysis confirmed a positive independent correlation with larger blood clots. Cox regression demonstrated earlier EVDAI onset in association with higher BNI grades and IVH scores.</p><p><strong>Conclusions: </strong>Both the quantity and radiological distribution of subarachnoid and ventricular blood positively correlate with EVD-associated nosocomial meningitis, eventually accelerating an earlier infection onset. These findings should help guide future research on EVDAI prevention in patients with aSAH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507083","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":"Cerebrospinal Fluid Heparin-Binding Protein Improves the Evaluation of Functional Outcomes in Postcraniotomy Meningitis and Ventriculitis.","authors":"Yueyue Kong, Dawei Zhou, Yi Ye, Zhimin Li, Guangzhi Shi","doi":"10.1007/s12028-025-02224-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02224-1","url":null,"abstract":"<p><strong>Background: </strong>The research aimed to explore the role of cerebrospinal fluid heparin-binding protein in estimating the functional outcomes among patients with postcraniotomy meningitis or ventriculitis.</p><p><strong>Methods: </strong>Adult patients with meningitis or ventriculitis following craniotomy were eligible for this prospective observational cohort study conducted in the intensive care unit of a tertiary referral academic medical center. Patients were dichotomized by the Glasgow Outcome Scale score as good (4-5) and adverse functional outcome group (1-3) at hospital discharge. Heparin-binding protein, procalcitonin, white blood cell count, glucose, protein, and lactate in cerebrospinal fluid were tested at enrollment and on the 3rd to 5th day of antibiotherapy.</p><p><strong>Results: </strong>Among 246 suspected participants, 139 with postcraniotomy meningitis or ventriculitis were enrolled in the final analysis, including 82 with good and 57 with adverse functional outcomes. Patients with adverse functional outcomes had significantly higher levels of heparin-binding protein than those with good functional outcomes. The protein descended significantly in patients with good functional outcomes on the 3rd to 5th day of antimicrobial treatment compared with baseline (29 [9-92] ng/mL vs. 136 [85-187] ng/mL). It was the only biomarker that remained high in the adverse functional outcome group on the 3rd to 5th day of treatment (209 [136-222] ng/mL vs. 170 [129-200] ng/mL at baseline). Heparin-binding protein achieved the highest area under the receiver operating characteristic curve of 0.86 (95% confidence interval 0.78-0.93) in recognizing patients with adverse functional outcomes. It was significantly associated with patient functional outcomes with an adjusted odds ratio of 1.02 (1.00-1.03), p = 0.01.</p><p><strong>Conclusions: </strong>Cerebrospinal fluid heparin-binding protein is a more accurate candidate biomarker in evaluating functional outcomes among patients with postcraniotomy meningitis and ventriculitis. Monitoring its kinetics helps to estimate antibacterial therapeutic efficacies.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507082","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":"Development and Validation of Machine Learning Models for Predicting 7-Day Mortality in Critically Ill Patients with Traumatic Spinal Cord Injury: A Multicenter Retrospective Study.","authors":"Yixi Wang, Xinkai Luo, Jingjie Wang, Wenzhe Li, Jian Cui, Yuqian Li","doi":"10.1007/s12028-025-02308-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02308-y","url":null,"abstract":"<p><strong>Background: </strong>Traumatic spinal cord injury (TSCI), a severe central nervous system injury, despite treatment advances, critically ill patients with TSCI face high short-term mortality. This study leverages machine learning to integrate standard intensive care unit (ICU) indicators, identifying 7-day high-mortality risk patients with TSCI to optimize treatment.</p><p><strong>Methods: </strong>Using critically ill patients with TSCI data from the Medical Information Mart for Intensive Care 2.2 database, this study employs the Boruta and LASSO regression algorithms to identify key features, developing a 7-day mortality risk prediction model in critically ill patients with TSCI using ten machine learning algorithms including Adaptive Boosting, Categorical Boosting, Gradient Boosting Machine, k-Nearest Neighbors, Light Gradient Boosting Machine, Logistic Regression, Neural Network, Random Forest (RF), Support Vector Machine, and Extreme Gradient Boosting. Model Performance is evaluated via receiver operating characteristic curves, calibration curves, decision curve analysis, accuracy, sensitivity, specificity, precision, and F1 score, whereas Shapley Additive Explanations ensure model interpretability. External validation with ICU data from the First Affiliated Hospital of Xinjiang Medical University further assesses the model's generalizability.</p><p><strong>Results: </strong>This study, collecting data from 261 and 45 critically ill patients with TSCI from the Medical Information Mart for Intensive Care database and the First Affiliated Hospital of Xinjiang Medical University's ICU, respectively, identified ten key features for model development, in which the RF model consistently outperformed others across raw and Synthetic Minority Over-sampling Technique-balanced synthetic datasets in receiver operating characteristic curves, calibration curves, decision curve analysis, and performance metrics. Shapley Additive Explanation analysis highlighted minimum body temperature, lowest systolic blood pressure, and Charlson Comorbidity Index as critical predictors in the RF model. External validation initially demonstrated the model's robustness and clinical applicability, leading to an online calculator that enables clinicians to estimate the 7-day survival probability of critically ill patients with TSCI.</p><p><strong>Conclusions: </strong>The RF model exhibits favorable performance in predicting 7-day mortality risk among critically ill patients with TSCI, indicating its potential utility in supporting clinical decision-making.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497537","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":"Near-Infrared Spectroscopy to Assess Covert Volitional Brain Activity in Intensive Care.","authors":"Pardis Zarifkar, Matthew Kolisnyk, Marwan H Othman, Melika Hassani, Karen Irgens Tanderup Hansen, Morten Hylander Møller, Kirsten Møller, Christine Sølling, Jens Christian Nilsson, Sigurdur Thor Sigurdsson, Michael E Benros, Jack de Jeu, Karnig Kazazian, John Hauerberg, Kåre Fugleholm, Peter F Birkeland, Tobias S Andersen, Jesper Kjaergaard, Daniel Kondziella","doi":"10.1007/s12028-025-02301-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02301-5","url":null,"abstract":"<p><strong>Background: </strong>Detecting covert consciousness in unresponsive patients is challenging. Although functional magnetic resonance imaging and advanced electroencephalography paradigms can identify volitional brain activity, the limited accessibility of these technologies necessitates alternative approaches. Functional near-infrared spectroscopy may provide a portable solution in the intensive care unit. We assessed the feasibility of functional near-infrared spectroscopy with verbal motor commands to detect volitional brain activity in acute disorders of consciousness (DoC).</p><p><strong>Methods: </strong>Functional near-infrared spectroscopy recordings and clinical assessments were obtained from 50 patients with DoC with acute brain injury, with data analyzed post hoc and visually at the bedside. Twenty healthy volunteers served as controls.</p><p><strong>Results: </strong>After quality control, data from 19 controls and 36 patients were analyzed. Cortical activation was detected in 18 (96%) controls and 16 (44%) patients. Among 13 minimally conscious patients, volitional activity was found in 8 (62%), whereas 8 (35%) of 23 clinically unresponsive patients showed activation. Volitional brain activity in the latter was associated with higher odds of command following within a week, although it was not statistically significant (odds ratio 3.1, 95% confidence interval 0.7-15.8; p = 0.14). Visual bedside analysis showed high specificity (90%) but moderate agreement (κ = 0.4) with post hoc computational analysis.</p><p><strong>Conclusions: </strong>Functional near-infrared spectroscopy with motor commands can detect volitional brain activity in acute DoC, although data quality issues remain a limitation.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476117","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":"Treatment, Diagnostic Approach, and Long-Term Outcomes of Lance-Adams Syndrome.","authors":"Helena Xeros, Amra Sakusic, Jennifer E Fugate, Maximiliano A Hawkes, Eelco F M Wijdicks, Alejandro A Rabinstein, Sherri A Braksick","doi":"10.1007/s12028-025-02307-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02307-z","url":null,"abstract":"<p><strong>Background: </strong>Lance-Adams syndrome (LAS) is a rare neurological complication following cardiopulmonary resuscitation. Patients present with action myoclonus within days to months after awakening. There is no established first-line treatment. The objectives of this study were to describe treatments, diagnostic approaches, and long-term clinical outcomes for LAS.</p><p><strong>Methods: </strong>We performed a retrospective review of patients seen at three tertiary referral hospitals. An electronic database was used to identify all patients diagnosed with LAS from January 1, 2010, to June 30, 2022. Demographics, diagnostics, treatments, and long-term clinical outcomes were extracted. Descriptive statistics were completed to summarize treatments, diagnostics, and clinical outcomes, which were assessed by Cerebral Performance Category (CPC) at 6 months. Symptom control was defined as minimal or no residual myoclonus causing functional impairment on activities of daily living.</p><p><strong>Results: </strong>Thirty-nine patients met inclusion criteria. A total of 25 patients were diagnosed with LAS during the acute hospitalization after their cardiac arrest, and the rest were diagnosed in the outpatient setting. The most common initial treatment was levetiracetam (n = 26; 67%) followed by valproic acid (n = 4; 10.3%). Most patients initially treated with levetiracetam (n = 22; 85%) or valproic acid (n = 4; 100%) had symptom improvement. Most patients (n = 28; 72%) required a second medication. The most common second-line agent was a benzodiazepine (n = 13; 48%). Thirty-three patients (85%) had improvement of the myoclonus over time. Thirty (77%) were able to achieve symptom control. The median time to achieve symptom control for patients diagnosed in the inpatient setting was 70 days. At the 6-month follow-up, 8 patients (23%) achieved a CPC score of 1, whereas 11 patients (30%) had a CPC score of 2. Thirteen patients (33%) attempted to wean off their medications, of which six patients (46%) were successful.</p><p><strong>Conclusions: </strong>Most patients with LAS experienced improvement of their myoclonus while being treated with levetiracetam, valproic acid, or benzodiazepines, although multiple medications and long-term treatment were often used. Half the patients attained favorable functional outcomes at 6 months.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476118","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":"In vivo Testing of the Pressio Intracranial Pressure Monitor.","authors":"Laurent Gergelé, Jérémy Mallard, Clément Magand, Kevin Lagarde, Russel Chabanne, Jérôme Morel, Jean François Payen, Yoann Launey","doi":"10.1007/s12028-025-02303-3","DOIUrl":"10.1007/s12028-025-02303-3","url":null,"abstract":"<p><strong>Background: </strong>Measuring reliable intracranial pressure (ICP) is critical for patients with acute brain injuries. The aim of this study was to evaluate zero drift of the intraparenchymal strain gauge Pressio transducer (Sophysa, Orsay, France) in clinical conditions.</p><p><strong>Methods: </strong>A prospective observational multicenter study was conducted in four French intensive care units of university hospitals. Patients with acute brain injuries were included if they needed ICP measurement using the Pressio transducer. The zero drift was measured at the explantation of the sensor. ICP-related adverse events were also collected.</p><p><strong>Results: </strong>Between January 1, 2018, and March 31, 2020, 235 patients were included in this study for a monitoring time of 2,180 days. The zero drift assessment was determined in 223 transducers (95%). The median duration of ICP monitoring was 8 days (interquartile range [IQR] 4 to 13 days). The median zero drift was 1 mm Hg (IQR 1 to 3 mm Hg), and a weak correlation was observed between the duration of ICP monitoring and zero drift (ρ = 0.141; P = 0.0357), which lacks clinical significance. Zero drifts higher than 5 mm Hg were found in 10% of transducers. Four patients (1.8%) had ICP-related hematomas, with no clinical impact, and none had ICP-related brain infection. Failures or technical dysfunctions of the monitoring were found in six patients (2.6%).</p><p><strong>Conclusions: </strong>The Pressio catheter from the Sophysa system exhibited a minor zero drift after a median monitoring period of 8 days. The transducer's precision was comparable to that of other ICP devices using strain gauge technology.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336758","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":"Ability of a Composite Brain Magnetic Resonance Imaging Score to Predict Neurologic Outcomes in Survivors of Out-Of-Hospital Cardiac Arrest.","authors":"Thuhien Nguyen, Nicolas Poilvert, Victor Lin, Hope Opara, Nassim Matin, Arielle P Davis, Breana L Taylor, Catherine R Counts, Penelope Chung Thomas, Monisha Sharma, James A Town, Sarah Wahlster, Nicholas J Johnson","doi":"10.1007/s12028-025-02295-0","DOIUrl":"10.1007/s12028-025-02295-0","url":null,"abstract":"<p><strong>Background: </strong>Brain magnetic resonance imaging (MRI) has been investigated as a neuroprognostication (NP) test after out-of-hospital cardiac arrest (OHCA); however, most studies have focused on predicting poor neurologic outcomes or death.</p><p><strong>Methods: </strong>We examined the ability of a composite brain MRI score (\"NP score\") to predict neurologic outcomes in an OHCA cohort (2017-2023) who underwent brain MRI within 2-7 days post arrest and survived to hospital discharge. NP scores (range 0-214) were calculated from diffusion weighted imaging and fluid attenuated inversion recovery signals in prespecified neuroanatomical regions. We categorized neurologic outcomes as \"independent\" (Cerebral Performance Categories [CPC] 1-2), \"dependent\" (CPC 3), and \"vegetative state\" (CPC 4). We conducted correlation analyses and used computational modeling for probabilities to identify transition points between the outcome categories.</p><p><strong>Results: </strong>Forty-two OHCA survivors were included (median age 47 years; 74% male, 43% shockable rhythm; 88% underwent targeted temperature management). At hospital discharge, 50% (n = 21) had recovered to independent, 24% (n = 10) were dependent, and 26% (n = 11) remained in a vegetative state. MRIs were obtained at a median of 4 days post arrest, (interquartile range 3-5). NP scores (range 0-136, median 11.5, interquartile range 0-41.5, intraclass correlation coefficient 0.89) strongly correlated with CPC (r_s = 0.69, p < 0.001) and were significantly different between CPC groups (p < 0.001); thresholds of 15 and 54 were identified as transition points between independent-dependent and dependent-vegetative state, respectively. Among survivors with bilaterally intact somatosensory evoked potentials, median NP scores were 0, 29, 68.5 for independent, dependent, and vegetative state patients, respectively.</p><p><strong>Conclusions: </strong>Quantitative brain MRI-based scoring may predict neurologic outcomes at discharge among OHCA survivors. External validation in larger prospective multicenter cohorts, assessment of long-term outcomes, and examination of the score in deceased patients are needed to establish the prognostic value and address concerns about generalizability.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333609","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}