Neurocritical Care最新文献

{"title":"Challenges with Formulating Accurate Prognosis for Patients with Severe Acute Brain Injury.","authors":"Lourdes R Carhuapoma, David Y Hwang","doi":"10.1007/s12028-024-02170-4","DOIUrl":"10.1007/s12028-024-02170-4","url":null,"abstract":"<p><p>Prognostication is fundamental to determining the intensity of care offered for many critically ill patients with severe acute brain injury (SABI). Inherent uncertainties linked to predicting outcomes for patients with SABI primarily arise from a lack of complete data regarding the natural disease/injury progression that follows various forms of SABI, stemming from early withdrawal of life-sustaining treatment. This potential bias has led to limitations in using outcome data associated with clinical grading scales and a risk of perpetuating high mortality following SABI, leading to self-fulfilling prophecies. The aims of this article are to (1) review contemporary prognostication practices among clinicians for patients with SABI, (2) discuss inherent challenges in prognosticating outcomes following SABI, (3) summarize statements and guidelines from professional societies regarding SABI prognostication, and (4) identify directions for future research in prognostication after SABI.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"772-779"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770703","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 History of Treating Cerebral Abscesses: Sir William Macewen's Optimism.","authors":"Eelco F M Wijdicks","doi":"10.1007/s12028-024-02162-4","DOIUrl":"10.1007/s12028-024-02162-4","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"1118-1121"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770722","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":"Point-of-Care Ultrasound and Critical Care Ultrasound use Among Providers in Neurocritical Units: A National Survey.","authors":"Melvin Parasram, Shamelia Y Loiseau, Thanujaa Subramaniam, Neha S Dangayach, Aarti Sarwal, Judy H Ch'ang","doi":"10.1007/s12028-024-02174-0","DOIUrl":"10.1007/s12028-024-02174-0","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS)/critical care ultrasound (CCU) use in medical and surgical intensive care units has surged over the last few decades. It is unclear if this has similarly translated in neurocritical care (NCC) units. We designed a survey to describe the current state of POCUS/CCU use and training among NCC providers.</p><p><strong>Methods: </strong>An online 13-question survey was distributed nationally through newsletters and social media after endorsement by the Neurocritical Care Society. Participation was voluntary, and responses were anonymous. The survey queried respondent demographics, training, clinical use, confidence in POCUS/CCU, and barriers to POCUS/CCU use.</p><p><strong>Results: </strong>Overall, 119 NCC providers responded to the survey. Most respondents were attending neurointensivists (52.1%) and had completed neurology residency training (62.2%). Approximately 23% of respondents did not have training in POCUS/CCU, and 71% of respondents had not completed POCUS/CCU board-certified training. Fifty-five percent of respondents used POCUS/CCU in their practice frequently, and 37% used it rarely on a weekly basis. Thirty-six percent and 42% of respondents felt moderately skilled at acquiring and interpreting POCUS/CCU images, respectively. Ultrasound guidance for procedures was the most common technique used by respondents. Most respondents felt that using ultrasound for volume status, procedural guidance, and evaluation of shock influenced clinical decision-making. Lack of confidence in interpreting data/imaging and comfort in performing POCUS/CCU were the most common barriers to ultrasound use. Respondents agreed with incorporation of POCUS/CCU training in NCC fellowship milestones and creating resources for credentialing providers in POCUS/CCU to increase use of POCUS/CCU in NCC.</p><p><strong>Conclusions: </strong>This national survey indicated that POCUS/CCU is moderately used among NCC providers. However, more formalized and robust training in POCUS/CCU is needed for trainees and practitioners in NCC to enhance comfortability with using ultrasound for clinical assessments.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"976-984"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847018","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":"Fatal Grade V Immune Effector Cell-Associated Neurotoxicity Syndrome After Chimeric Antigen Receptor T Cell Therapy Leading to Brain Death.","authors":"Maxime Touron, Justine Decroocq, Sarah Benghanem","doi":"10.1007/s12028-025-02231-2","DOIUrl":"10.1007/s12028-025-02231-2","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"1124-1125"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657872","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":"Contralateral Neurovascular Coupling in Patients with Ischemic Stroke After Endovascular Thrombectomy.","authors":"Zhe Zhang, Shafiul Hasan, Ofer Sadan, Eric S Rosenthal, Yuehua Pu, Zhixuan Wen, Changgeng Fang, Xin Liu, Wanying Duan, Liping Liu, Ran Xiao, Xiao Hu","doi":"10.1007/s12028-024-02178-w","DOIUrl":"10.1007/s12028-024-02178-w","url":null,"abstract":"<p><strong>Background: </strong>Neurovascular coupling (NVC) refers to the process of aligning cerebral blood flow with neuronal metabolic demand. This study explores the potential of contralateral NVC-linking neural electrical activity on the stroke side with cerebral blood flow velocity (CBFV) on the contralesional side-as a marker of physiological function of the brain. Our aim was to examine the association between contralateral NVC and neurological outcomes in patients with ischemic stroke following endovascular thrombectomy.</p><p><strong>Methods: </strong>We concurrently recorded the CBFVs of the middle cerebral arteries and electroencephalographic (EEG) signals of patients after endovascular thrombectomy. We employed phase-amplitude cross-frequency coupling to quantify the contralateral coupling between EEG activity on the stroke side and CBFV on the contralesional side. Key neurological outcomes were measured, including changes in National Institute of Health Stroke Scale (NIHSS) scores, infarct volume progression over 7 days, and modified Rankin Scale scores at 90 days.</p><p><strong>Results: </strong>A total of 52 study participants were enrolled in our study (mean age 61.5 ± 10.4 years; 90.4% male; median preprocedural NIHSS score 14 [interquartile range 10-17]). We successfully computed contralateral NVC in 48 study participants. A significant association emerged between contralateral coupling and improvements in NIHSS scores over 7 days (theta band, P = 0.030) and in infarct volume progression (delta band, P = 0.001; theta band, P = 0.013). Stronger contralateral NVC in the delta and theta bands correlated with better outcomes at 90 days (adjusted odds ratio for delta 7.53 [95% confidence interval 1.13-50.30], P = 0.037; adjusted odds ratio for theta 6.36 [95% confidence interval 1.09-37.01], P = 0.039).</p><p><strong>Conclusions: </strong>A better contralateral coupling between stroke-side EEG and contralesional CBFV is associated with favorable neurological outcomes, suggesting that contralateral NVC analysis may aid in assessing brain function after recanalization. Replication with a deeper understanding of the mechanisms is needed before clinical translation.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"996-1006"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952359","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":"Evolution of Magnetic Resonance Imaging on Severe Contrast-Induced Encephalopathy.","authors":"Mei Gu, Haoqi Huang, Tian Qiu, Yitao He","doi":"10.1007/s12028-024-02132-w","DOIUrl":"10.1007/s12028-024-02132-w","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"1122-1123"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308205","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: Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Goals-of-Care and Family/Surrogate Decision-Maker Data.","authors":"Matthew N Jaffa, Hannah L Kirsch, Claire J Creutzfeldt, Mary Guanci, David Y Hwang, Darlene LeTavec, Dea Mahanes, Girija Natarajan, Alexis Steinberg, Darin B Zahuranec, Susanne Muehlschlegel","doi":"10.1007/s12028-024-02098-9","DOIUrl":"10.1007/s12028-024-02098-9","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"1130-1131"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470847","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":"A Survey of Surrogates and Health Care Professionals Indicates Support of Cognitive Motor Dissociation-Assisted Prognostication.","authors":"Gregory A Heinonen, Jerina C Carmona, Lauren Grobois, Lucie S Kruger, Angela Velazquez, Athina Vrosgou, Vedant B Kansara, Qi Shen, Satoshi Egawa, Lizbeth Cespedes, Mariam Yazdi, Danielle Bass, Ana Bolanos Saavedra, Daniel Samano, Shivani Ghoshal, David Roh, Sachin Agarwal, Soojin Park, Ayham Alkhachroum, Lydia Dugdale, Jan Claassen","doi":"10.1007/s12028-024-02145-5","DOIUrl":"10.1007/s12028-024-02145-5","url":null,"abstract":"<p><strong>Background: </strong>Prognostication of patients with acute disorders of consciousness is imprecise but more accurate technology-supported predictions, such as cognitive motor dissociation (CMD), are emerging. CMD refers to the detection of willful brain activation following motor commands using functional magnetic resonance imaging or machine learning-supported analysis of the electroencephalogram in clinically unresponsive patients. CMD is associated with long-term recovery, but acceptance by surrogates and health care professionals is uncertain. The objective of this study was to determine receptiveness for CMD to inform goals of care (GoC) decisions and research participation among health care professionals and surrogates of behaviorally unresponsive patients.</p><p><strong>Methods: </strong>This was a two-center study of surrogates of and health care professionals caring for unconscious patients with severe neurological injury who were enrolled in two prospective US-based studies. Participants completed a 13-item survey to assess demographics, religiosity, minimal acceptable level of recovery, enthusiasm for research participation, and receptiveness for CMD to support GoC decisions.</p><p><strong>Results: </strong>Completed surveys were obtained from 196 participants (133 health care professionals and 63 surrogates). Across all respondents, 93% indicated that they would want their loved one or the patient they cared for to participate in a research study that supports recovery of consciousness if CMD were detected, compared to 58% if CMD were not detected. Health care professionals were more likely than surrogates to change GoC with a positive (78% vs. 59%, p = 0.005) or negative (83% vs. 59%, p = 0.0002) CMD result. Participants who reported religion was the most important part of their life were least likely to change GoC with or without CMD. Participants who identified as Black (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.04-0.36) or Hispanic/Latino (OR 0.39, 95% CI 0.2-0.75) and those for whom religion was the most important part of their life (OR 0.18, 95% CI 0.05-0.64) were more likely to accept a lower minimum level of recovery.</p><p><strong>Conclusions: </strong>Technology-supported prognostication and enthusiasm for clinical trial participation was supported across a diverse spectrum of health care professionals and surrogate decision-makers. Education for surrogates and health care professionals should accompany integration of technology-supported prognostication.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"786-793"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504781","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":"Outcomes of Spinal Cord Infarction with Thrombolysis: A Nationwide Analysis.","authors":"Ali Al-Salahat, Danielle B Dilsaver, Ali Bin Abdul Jabbar, Saif Bawaneh, Abhishek Singh, Evanthia Bernitsas","doi":"10.1007/s12028-025-02251-y","DOIUrl":"10.1007/s12028-025-02251-y","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"1102-1106"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780639","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":"Response to Comment on \"Symptoms, Imaging Features, Treatment Decisions, and Outcomes of Patients with Top of the Basilar Artery Syndrome: Experiences from a Comprehensive Stroke Center\".","authors":"Franziska Lieschke","doi":"10.1007/s12028-025-02265-6","DOIUrl":"10.1007/s12028-025-02265-6","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"1128-1129"},"PeriodicalIF":3.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045288","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}