Neurocritical Care最新文献

{"title":"Anticoagulant Therapy for Cerebral Venous Sinus Thrombosis: A Propensity Score Matching Study and Inverse Probability Weighting.","authors":"Kai Liu, Mengmeng Zhang, Jiawei Zhao, Qinqin Dai, Yuan Gao, Shen Li, Lu Zhao, Yuming Xu, Bo Song","doi":"10.1007/s12028-025-02225-0","DOIUrl":"10.1007/s12028-025-02225-0","url":null,"abstract":"<p><strong>Background: </strong>New oral anticoagulants (NOACs) offer potential advantages for patients with cerebral venous sinus thrombosis (CVST). There is a lack of evidence to evaluate the efficacy and safety of NOACs in CVST. The purpose of this study was to compare the benefit and safety between NOACs and warfarin in patients with CVST.</p><p><strong>Methods: </strong>We performed a single-center prospective analysis including patients with CVST from the First Affiliated Hospital of Zhengzhou University between January 1, 2018, and December 31, 2021. The primary outcome was recurrent thrombotic events during the 6-month follow-up. Secondary outcomes included the modified Rankin scale (mRS) score, bleeding events, death, and cerebral venous recanalization during anticoagulant therapy. Propensity score matching (PSM) and inverse probability weighting (IPTW) were utilized to balance covariates between groups and mitigate selection bias in our study.</p><p><strong>Results: </strong>A total of 650 patients were identified. NOACs were used in 184 patients, and warfarin was used in 466 patients. Baseline characteristics were balanced between groups after IPTW or PSM. After 1:2 and 1:3 PSM, there were statistically significant differences between the two groups in death (2.2% vs. 8.0%, P = 0.014) and in mRS scores ≤ 2 (95. 1% vs. 88.7%, P = 0.020) in all patients. But there were no statistically significant differences between the two groups in recurrent CVST (odds ratio [OR] 0.543; 95% confidence interval [CI] 0.258-1.143; P = 0. 108), bleeding events (OR 0.823; 95% CI 0.074-9.143; P = 0.874), and partial/complete recanalization (OR 0.980; 95% CI 0.546-1.760; P = 0.946) in all patients. Similarly, there were no significant differences in patients who received anticoagulation therapy and in patients who received endovascular therapy plus anticoagulation therapy regarding any of the clinical outcomes. These results remained similar after IPTW analysis.</p><p><strong>Conclusions: </strong>Our study demonstrates that the use of NOACs in CVST has similar efficacy and safety compared to warfarin treatment. NOACs treatment may improve the clinical prognosis in patients with CVST.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"392-402"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557600","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":"Eighteen-Year Trends in Subarachnoid Hemorrhage Management and Outcomes: A Single-Center Experience.","authors":"Marie Renaudier, Vincent Degos, Gianluca Pisanu, Benjamin Granger, Lamine Abdennour, Caroline Tabillon, Dany Hijazi, Anne-Laure Boch, Bertrand Mathon, Frédéric Clarençon, Eimad Shotar, Louis Puybasset, Rémy Bernard, Alice Jacquens","doi":"10.1007/s12028-025-02268-3","DOIUrl":"10.1007/s12028-025-02268-3","url":null,"abstract":"<p><strong>Background: </strong>Although subarachnoid hemorrhage-related mortality has decreased in recent years due to improvements in treatment, data on the evolution of 1-year functional outcomes after subarachnoid hemorrhage are lacking. The objective of this study was to evaluate the evolution of patient management and their functional outcomes 1 year after subarachnoid hemorrhage over time in a single high-volume neurosurgical intensive care unit.</p><p><strong>Methods: </strong>In this observational retrospective study, all consecutive patients with aneurysmal subarachnoid hemorrhage admitted to our neurosurgical intensive care unit between 2002 and 2019 were included. A poor functional outcome was defined as a modified Rankin Scale score of 4-6. Linear regressions were performed, and relative risk reductions of a poor functional outcome were calculated.</p><p><strong>Results: </strong>Between 2002 and 2019, 1556 patients were included, of whom 329 (21%) had a poor functional outcome. Over time, the percentage of coiling procedures (p = 0.004) increased, and the percentage of delayed cerebral ischemia (p = 0.03) decreased. One-year mortality decreased over time (p < 0.001), whereas 1-year functional outcome improved (p = 0.002), with a relative risk reduction of poor functional outcomes of 38% (17-54%).</p><p><strong>Conclusions: </strong>The 1-year functional outcome of patients with subarachnoid hemorrhage improved between 2002 and 2019, and mortality decreased.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"598-606"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011395","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":"Advancing Understanding of Cerebrovascular Hemodynamic Perturbations in Pediatric Cerebral Malaria Using a Modified Critical Closing Pressure Evaluation- A Prospective, Observational Study.","authors":"Nicole F O'Brien, Madiha Q Raees, Hunter J Wynkoop, Mengxin Yu, Dylan Small, Karl B Seydel, Montfort Bernard Gushu, Tusekile Phiri, Sylvester June, Terrie E Taylor","doi":"10.1007/s12028-025-02245-w","DOIUrl":"10.1007/s12028-025-02245-w","url":null,"abstract":"<p><strong>Background: </strong>Cerebral malaria (CM) results in significant mortality globally. Abnormal cerebral blood flow (CBF) has been described in CM and may contribute to poor outcomes. Changes to vascular tone may be contributing to flow aberrations but measuring it in the clinical setting is difficult. Critical closing pressure (CrCP) is calculated as CrCP = intracranial pressure (ICP) + vascular tone + venous pressure. If CrCPs other components are determined, vascular tone can be inferred. CrCP can also be used to determine the diastolic closing margin (DCM = diastolic blood pressure (DBP)-CrCP) which represents the lower safety limit of cerebral perfusion pressure.</p><p><strong>Methods: </strong>Children 6 months-12 years with CM and age-matched healthy controls were enrolled. Using concurrent transcranial doppler ultrasound (TCD) CBF velocities and systemic blood pressure measurements, CrCP was determined, and DCM calculated. Non-invasive estimates of ICP were assessed and venous flow was measured. Vascular tone was deduced. Differences in CrCP between controls and CM patients were determined. DCM and its association with outcome was assessed.</p><p><strong>Results: </strong>We enrolled 220 children with CM and 400 controls. In CM patients, there were significantly more children with CrCP > 1SD below (n = 37, 17%) and > 1 SD above (n = 42, 19%) the mean normal value of the control group (n = 15, 5% > 1SD below and n = 20, 5% > 1 SD above, p < 0.001 for both). Opening pressure, an estimate of ICP, was not different between patients and controls. Venous flows were higher in children with CM than controls, but no difference was seen in CM patients with CrCP less than, within, or greater than 1SD from normal. A DCM < 20mmHg conferred a relative risk of poor outcome (RR 1.4, 95%CI 1.2-1.9, p = 0.008).</p><p><strong>Conclusions: </strong>CrCP was > 1SD lower or higher than the mean normal value in a significant number of children with CM. A low DCM is associated with a worse prognosis and may serve as a therapeutic target.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"493-503"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12436552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029600","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":"In Response to \"Second Transcranial Doppler to Confirm Cerebral Circulatory Arrest\".","authors":"Tiffany Eatz, Yosdely Cabrera, Frank Cabrera, Mohan Kottapally, Amedeo Merenda, Ayham Alkhachroum, Jose G Romano, Sebastian Koch","doi":"10.1007/s12028-025-02286-1","DOIUrl":"10.1007/s12028-025-02286-1","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"708-709"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111426","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":"Clinical Description and Acute Outcomes of Cryptogenic Encephalitis in the Intensive Care Unit.","authors":"Jackson A Roberts, Mohamed Ridha, Carla Y Kim, Yifei Sun, Elizabeth Carroll, Jan Claassen, Kiran T Thakur","doi":"10.1007/s12028-025-02287-0","DOIUrl":"10.1007/s12028-025-02287-0","url":null,"abstract":"<p><strong>Background: </strong>Prognosis of acute encephalitis is variable and dependent on the underlying etiology, early treatment, and clinical course. Despite extensive evaluation, a cause of acute encephalitis may not be discovered, presenting a challenge to clinicians when discussing prognosis with families. We sought to determine whether clinical and radiographic features may discriminate short-term outcomes in patients with severe cryptogenic encephalitis.</p><p><strong>Methods: </strong>We performed a single-center, retrospective study of patients admitted with cryptogenic encephalitis (i.e., unknown etiology at time of discharge) to the Columbia University Irving Medical Center neurologic intensive care unit (ICU) and the Morgan Stanley Children's Hospital ICU from 2010 to 2020. A favorable discharge outcome was defined as Glasgow Outcome Scale score greater than or equal to 4. Using multivariable logistic regression modeling, we analyzed clinical and radiographic variables associated with favorable short-term outcome.</p><p><strong>Results: </strong>Among 204 total patients with encephalitis admitted to the ICU, 51.0% were classified as cryptogenic. The median age was 49.9 (interquartile range 31-64) years, and the most common presenting symptoms were altered mental status (74.0%), fever (56.7%), and headache (46.2%). Favorable outcome occurred in 63.5% of cryptogenic cases. In the fully adjusted model, age above 50 years (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.11-0.81; p = 0.017), active malignancy (OR 0.07, 95% CI 0.01-0.63; p = 0.018), and intubation (OR 0.20, 95% CI 0.07-0.55, p = 0.002) were associated with reduced odds of favorable outcome. Older age, active malignancy, and intubation were identified as predictors of lower Glasgow Outcome Scale score using ordinal logistic regression.</p><p><strong>Conclusions: </strong>Clinical characteristics may aid early prognostication of cryptogenic encephalitis. Further mechanistic study of the association between active malignancy among patients with cryptogenic encephalitis is warranted.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"636-644"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181890","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":"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}