Neurocritical Care最新文献

{"title":"Palliative Care in the Neurocritical Care Unit: Increasing Primary Palliative Care Skills.","authors":"Matthew N Jaffa, Claire J Creutzfeldt","doi":"10.1007/s12028-024-02091-2","DOIUrl":"10.1007/s12028-024-02091-2","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"382-384"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874214","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":"COVID-19 Infection and Associated Outcomes in Patients with Nontraumatic Intracerebral Hemorrhage: Analysis of National Inpatient Sample 2020-2022.","authors":"Andrea Loggini, Faddi G Saleh Velez, Jessie Henson, Jonatan Hornik, Amber Schwertman, Karam Dallow, Alejandro Hornik, Denise Battaglini","doi":"10.1007/s12028-025-02259-4","DOIUrl":"10.1007/s12028-025-02259-4","url":null,"abstract":"<p><strong>Background: </strong>Nontraumatic intracerebral hemorrhage (ICH) is a devastating form of stroke with high mortality and morbidity. The COVID-19 pandemic introduced additional complexities and challenges in managing ICH. This study evaluates the impact of concurrent COVID-19 infection on the demographics, outcomes, and resource use of patients with ICH. The primary outcome was in-hospital mortality, and secondary outcomes included neurological and systemic complications, length of stay, and cost of hospitalization.</p><p><strong>Methods: </strong>The National Inpatient Sample database was screened to identify patients with and without COVID-19 infection and ICH from 2020 to 2022. Sociodemographic characteristics, comorbidities, and clinical severity were compared between the two groups. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the preselected outcomes. A p value of < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 99,780 patients with ICH were included, of whom 4917 (4.9%) had concomitant COVID-19 infection. COVID-19-positive patients with ICH were younger (median 66 [interquartile range (IQR) 55-76] vs. 68 [IQR 57-78], years), more likely to identify as Black (25.6 vs. 23.5%) or Hispanic (17.1 vs. 10.9%), and more frequently in the lower quartile of median household income (31.4 vs. 29.2%) (p < 0.05 for all). Distinct multivariate regression models adjusted for demographics, baseline comorbidities, and ICH severity revealed that COVID-19 infection was independently associated with higher odds of in-hospital mortality (aOR 2.432; 95% confidence interval [CI] 2.273-2.602), systemic complications (aOR 1.527; 95% CI 1.432-1.628), longer hospital stay (aOR 2.115; 95% CI 1.957-2.286), and higher hospitalization costs (aOR 1.256; 95% CI 1.162-1.357). In contrast, COVID-19 infection was also associated with lower odds of neurological complications (aOR 0.811; 95% CI 0.76-0.865).</p><p><strong>Conclusions: </strong>COVID-19 exacerbated the existing disparities in ICH, disproportionately affecting younger, socioeconomically disadvantaged, and minority populations. Additionally, patients with ICH with concomitant COVID-19 infection experienced worse clinical outcomes and greater healthcare resource use. These findings highlight the impact that the pandemic had on patients with acute neurological conditions, particularly among more vulnerable populations.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"581-589"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025864","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":"Blood Pressure Variability After Acute Ischemic Stroke and Intracerebral Hemorrhage: Refining Its Definition, Intervention Opportunities, and Research Directions.","authors":"David Z Rose, Alejandro A Rabinstein, May Kim-Tenser, Sergio D Bergese, Gabriel V Fontaine, Charles Kircher, Adnan I Qureshi","doi":"10.1007/s12028-025-02263-8","DOIUrl":"10.1007/s12028-025-02263-8","url":null,"abstract":"<p><p>Increased blood pressure variability (BPV) in the acute phases of cerebrovascular emergencies, such as acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), has been shown to result in worsened outcomes. Although several studies have reported this association, no consensus exists for specific BPV targets or a consistent, unified definition of BPV in AIS or ICH. Therefore, we convened the Blood Pressure Variability in Cerebrovascular Emergencies Consortia, consisting of a multidisciplinary group of experts in stroke, neurocritical care, perioperative medicine, emergency medicine, and clinical pharmacy to assess the clinical impact of BPV and to develop a working consensus on defining BPV, identifying interventions to mitigate negative outcomes from increased BPV, and laying the groundwork for BPV research concepts in the future. First, the Consortia proposed bifurcating systolic BPV (SBPV) into two distinct periods-SBPV₁ and SBPV₂. SBPV₁ involves hyperacute management, when rapid and smooth blood pressure control is crucial. SBPV₂, the plateauing phase, consists of a more gradual, maintenance-therapy slope. For both periods, enabling a \"smooth\" (SBPV₁) and \"sustained\" (SBPV₂) trajectory is likely ideal, but more phase-specific research is required to validate this concept. Secondly, Consortia proposed to calculate BPV by subtracting maximum and minimum systolic blood pressure over subsequent measurements because it represents the most clinically feasible option among many proposed equations in the literature. Third, for ICH, the Consortia preferred intravenous antihypertensive medication to reach BPV goals as fast, safe, and efficiently as possible, consistent with American Heart Association/American Stroke Association guidelines recommending \"treatment regimens that limit BPV and achieve smooth, sustained blood pressure control.\" For AIS, guidelines do not yet address BPV, but Consortia members proposed an algorithm with distinct SBPV goals based on time (as a function of stroke acuity), arterial subtype (large, medium, and small vessel), thrombolytic and/or thrombectomy status, and presenting SBP. As the understanding of BPV evolves, future research may build on and/or refine concepts proposed by this Consortia.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"368-377"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036628","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":"Intrathecal Dexamethasone as a FIRES Extinguisher: A 12-Patient Clinical Experience with Usage of Intrathecal Dexamethasone for Febrile Infection-Related Epilepsy Syndrome.","authors":"Raquel Farias-Moeller, Aurélie Hanin, Sadaf Ahsan, John Brooks, Scott D Caganap, Barry Czeisler, Emmanuel Cheuret, Brianna Cocuzzo, Cecil D Hahn, Henrik Kyureghyan, Marie-Odile Marcoux, Rana Mohamed, Carol Park, Michal Stern Zimmer, Vivek Barun, Yi Chen Lai, Lawrence J Hirsch","doi":"10.1007/s12028-025-02254-9","DOIUrl":"10.1007/s12028-025-02254-9","url":null,"abstract":"<p><strong>Background: </strong>New-onset refractory status epilepticus (NORSE) is a devastating condition with high mortality and poor long-term outcomes. Febrile infection-related epilepsy syndrome (FIRES) is a subset of NORSE, preceded by fever. Intrathecal dexamethasone (IT-DEX) has emerged as a potential treatment, but few cases have been reported. This study aims to describe the use of IT-DEX in NORSE/FIRES, focusing on treatment logistics, dosing strategies, and patient outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 12 patients (10 children and 2 adults) with NORSE (including FIRES) enrolled in an international multicenter clinical biorepository who received IT-DEX as part of their treatment. Demographic and clinical data were extracted. IT-DEX pharmacological details and administration logistics were collected by contacting the primary investigators. A descriptive analysis was performed to evaluate treatment timing, dosage, and concurrent management, as well as clinical outcomes and cytokine profiles.</p><p><strong>Results: </strong>All patients qualified as FIRES. Patients were treated with a median of five doses of IT-DEX, starting a median of 20 days after refractory status epilepticus onset, with a median dose per infusion of 5 mg (0.21 mg/kg/dose). Clinicians reported a perceived favorable effect on seizure control in 83% of cases, with a median delay of 5 days to wean off continuous infusions after the last IT-DEX administration. Cytokine analysis (based on data from four patients with serial cerebrospinal fluid measurements and two patients with serial blood measurements) revealed persistently elevated levels of proinflammatory markers in most patients, with no significant changes following IT-DEX administration. No adverse effects were reported.</p><p><strong>Conclusions: </strong>Most clinicians perceived a favorable effect of IT-DEX in refractory status epilepticus termination, and its use appears to be safe in patients with FIRES. This study provides a detailed description of administration logistics and dosing strategies from an international multicenter cohort. Additional studies are needed to confirm the safety and efficacy of IT-DEX and determine its impact on long-term outcomes including epilepsy prevention and functional recovery.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"563-571"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004151","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":"Neuroworsening in Traumatic Brain Injury: A Scoping Review of Definition, Prevalence, and Outcome.","authors":"Sebastián Vásquez-García, Karol Martínez-Palacios, Gregory W J Hawryluk, Alejandro Rabinstein, Daniel Agustín Godoy","doi":"10.1007/s12028-025-02234-z","DOIUrl":"10.1007/s12028-025-02234-z","url":null,"abstract":"<p><strong>Background: </strong>Neuroworsening (NW) refers to a state of deterioration of neurological status that occurs as a consequence of the progression of primary lesions or due to intracranial or systemic complications. NW has been associated with worse functional outcomes, and therefore its avoidance may improve prognosis. The objective of this scoping review was to analyze the definitions, prevalence, predisposing factors, and impact on the outcome of NW during all spectra of traumatic brain injury (TBI).</p><p><strong>Methods: </strong>We performed a scoping review following Joanna Briggs Institute guidelines.</p><p><strong>Results: </strong>A total of 92 studies were identified after the systematic review of the literature using four databases. After applying Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 19 studies were included in the final analysis. Criteria used to define NW were not specified in ten studies, two studies used clinical criteria, two used radiological criteria, and five used a combination of clinical and radiological criteria. The mean prevalence of NW of the total population was 17%; whereas the mean prevalence was 28.2% for severe TBI, 23.4% for moderate TBI, and 6.42% for mild TBI. The predictors of NW were multiple, with a predominance of neuroimaging findings.</p><p><strong>Conclusions: </strong>NW is common after TBI, occurring in one in every five patients, and it is associated with high mortality and worse functional outcomes. The criteria to define NW has varied across studies; most used definitions based on clinical and neuroimaging criteria, but some included neuromonitoring parameters. Thus, lack of uniformity in the definition of NW remains a major limitation for the study of this major complication. A consensus to standardize the definition of NW and large-scale studies to determine its prevalence and risk factors are urgently needed.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"424-436"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982018","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 Reply: Comment on \"Real-Time Automated Measurements of Optic Nerve Sheath Diameter for Noninvasive Assessment of Intracranial Pressure in Aneurysmal Subarachnoid Hemorrhage\".","authors":"Dag Ferner Netteland, Mads Aarhus, Else Charlotte Sandset, Angelika Sorteberg, Llewellyn Padayachy, Eirik Helseth, Reidar Brekken","doi":"10.1007/s12028-025-02279-0","DOIUrl":"10.1007/s12028-025-02279-0","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"704-705"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111425","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":"Second Transcranial Doppler to Confirm Cerebral Circulatory Arrest.","authors":"Juan Antonio Llompart-Pou, Jon Pérez-Bárcena, Begoña Guardiola, Mariana Andrea Novo, Daniel Agustín Godoy","doi":"10.1007/s12028-025-02285-2","DOIUrl":"10.1007/s12028-025-02285-2","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"706-707"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111428","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":"Eculizumab as Treatment in Refractory Impeding and Myasthenic Crisis: A Case Series.","authors":"C Erra, D Ricciardi, C Vinciguerra, A Fasolino, V Andreone, F Habetswallner, F Tuccillo","doi":"10.1007/s12028-025-02272-7","DOIUrl":"10.1007/s12028-025-02272-7","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"685-690"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033803","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":"Comment on \"Real-Time Automated Measurements of Optic Nerve Sheath Diameter for Noninvasive Assessment of Intracranial Pressure in Aneurysmal Subarachnoid Hemorrhage\".","authors":"Umaya Memon","doi":"10.1007/s12028-025-02280-7","DOIUrl":"10.1007/s12028-025-02280-7","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"702-703"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111424","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":"Invasive and Noninvasive Intracranial Pressure Pulse Waveform in Neurocritical Care Patients with Different Cranium Integrity.","authors":"Magdalena Kasprowicz, Agnieszka Kazimierska, Marta Hendler, Danilo Cardim, Zofia Czosnyka, Marek Czosnyka, Wellingson Paiva, Sergio Brasil","doi":"10.1007/s12028-025-02382-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02382-2","url":null,"abstract":"<p><strong>Background: </strong>Pulse shape index (PSI) is a novel artificial intelligence-supported parameter that evaluates the pressure-volume compensatory reserve of the craniospinal system through intracranial pressure (ICP) pulse waveform classification. This study assessed the agreement between PSI derived from invasive ICP monitoring (PSI_ICP) and noninvasive brain4care (B4C) sensor signal (PSI_B4C) and investigated the influence of cranial integrity, age, and internal jugular vein (IJV) compression on PSI values.</p><p><strong>Methods: </strong>Simultaneous ICP and B4C monitoring was performed in 47 adult patients ( age: 43 (30) years) before and during IJV compression. Patients were grouped by cranial integrity: intact skull bone (n = 17), large skull fractures or craniotomies (n = 17), and craniectomies (n = 13). Pulse waveforms were automatically classified into four classes (from 1 = normal to 4 = pathological) by a neural network, and PSI was calculated as the weighted average of class numbers. Values are presented as median (interquartile range).</p><p><strong>Results: </strong>Bland-Altman analysis demonstrated good agreement between PSI_ICP and PSI_B4C, with approximately 6% outliers. PSI was significantly higher in patients who underwent craniectomy compared with those with intact skulls (PSI_ICP: 3.5 (0.8) vs. 2.0 (1.2) arbitrary units, p < 0.002; PSI_B4C: 3.0 (0.4) vs. 2.0 (0.6) arbitrary units, p < 0.005) or those with craniotomies or large fractures (PSI_ICP: 3.5 (0.8) vs. 2.0 (2.1) arbitrary units, p < 0.05; PSI_B4C: 3.0 (0.4) vs. 2.0 (2.2) arbitrary units, p < 0.05). IJV compression did not affect PSI. Both PSI_ICP (r_s = 0.35, p < 0.02) and PSI_B4C (r_s = 0.37, p = 0.01) correlated with age.</p><p><strong>Conclusions: </strong>This study supports the B4C signal's capability to noninvasively reflect ICP waveform morphology via PSI, offering a promising monitoring alternative. PSI appears to be influenced by age and craniectomy but not by a slight, sudden ICP change induced by IJV compression.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207106","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}