Neurocritical Care最新文献

{"title":"Effects of 'Head Up' Prone Position on Transcranial Color Doppler-Based Estimators of Intracranial Pressure in Moderate to Severe Acute Respiratory Distress Syndrome Without Brain Injury: A Cross-Over, Longitudinal, Physiological Study.","authors":"Domenico Junior Brunetti, Francesca Leonardis, Francesca Frisardi, Mario Dauri, Cristian Deana, Raffaele Aspide, Gianmaria Cammarota, Luigi Pisani, Rossella Adorno, Roberto Polidoro, Marco Tiseo, Paola Giuseppina Sergi, Luigi Vetrugno, Luciana Mascia, Daniele Guerino Biasucci","doi":"10.1007/s12028-025-02240-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02240-1","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning is recommended in acute respiratory distress syndrome (ARDS) to ensure adequate gas exchange. However, it may lead to an increase in intracranial pressure (ICP), mostly due to a reduction of venous return from the brain. ICP can be noninvasively estimated with transcranial color-coded Doppler (TCCD) using methods based on the relationships between the pulsatility index (PI) and ICP or methods based on the estimate of cerebral perfusion pressure (eCPP) and estimate of ICP (eICP). This study was aimed at assessing the effects of a 30° reverse Trendelenburg ('head up') prone position on two noninvasive estimators of ICP (eICP and PI).</p><p><strong>Methods: </strong>This is a cross-over, longitudinal, physiological study conducted on a cohort of adult patients fulfilling Berlin definition criteria for moderate to severe ARDS without brain injury but with clinical indication to prone positioning. We registered TCCD parameters of cerebral hemodynamic and systemic hemodynamic parameters, blood gas exchange data, and respiratory mechanics parameters in a horizonal supine position, in a 30° semirecumbent supine position, in the standard prone position, and, finally, in the 30° 'head up' prone position, obtained by tilting the entire bed to a reverse Trendelenburg position. One-way repeated measures analysis of variance was used to analyze data.</p><p><strong>Results: </strong>In 20 patients included, switching from a supine position to the standard prone position resulted in a significant increase in mean ± SD PI (from 0.99 ± 0.22 to 1.29 ± 0.25, p < 0.01) and eICP (from 12.5 ± 3.8 to 17.5 ± 4.1, p < 0.01), whereas moving from this latter position to the 'head up' prone position resulted in a decrease in the mean ± SD PI (from 1.29 ± 0.25 to 1.0 ± 0.23, p < 0.01). Hemodynamic and respiratory mechanics parameters did not differ.</p><p><strong>Conclusions: </strong>The 30° 'head up' prone position may limit the increase in PI in moderate to severe ARDS without brain injury. As a noninvasive estimator of ICP, PI may allow detection of changes in ICP when moving from the 'head up' semirecumbent supine position to the standard prone position and from this latter position to the 'head up' prone position.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710779","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 Evolution of Neurocritical Care Pharmacy: Historical Perspectives and Future Horizons.","authors":"Denise H Rhoney, Aaron M Cook, Karen Berger, Sherif Hanafy Mahmoud, Gretchen M Brophy, Salia Farrokh, Theresa Human, John Lewin, Jeffrey J Mucksavage, Kiranpal S Sangha, Eljim P Tesoro","doi":"10.1007/s12028-025-02239-8","DOIUrl":"https://doi.org/10.1007/s12028-025-02239-8","url":null,"abstract":"<p><p>This article reviews the history and evolution of the neurocritical care (NCC) pharmacy, a subspecialty of critical care pharmacy that focuses on the care of patients with acute neurological disorders. The origins of NCC pharmacies in the 1960s and 1970s are described, when pharmacists began to participate in patient rounds, clinical pharmacokinetic consults, and translational research with neurosurgeons and neurologists. The article also discusses the current state of NCC pharmacy practice, research, and education, highlighting the role of pharmacists as essential members of the NCC team, the contributions of pharmacists to NCC research and guidelines, and the challenges and opportunities for education and training in this unique subspecialty. Finally, the article envisions the future of NCC pharmacy, emphasizing the need for high expectations, visionary leadership, innovative education models, a robust scientific foundation, and multidisciplinary collaboration to advance NCC pharmacy and improve patient outcomes.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710723","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":"Is a Second Transcranial Doppler Study Needed to Confirm Neurocirculatory Arrest?","authors":"Tiffany Eatz, Yosdely Cabrera, Frank Cabrera, Mohan Kottapally, Amedeo Merenda, Ayham Alkhachroum, Jose G Romano, Sebastian Koch","doi":"10.1007/s12028-025-02241-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02241-0","url":null,"abstract":"<p><strong>Background: </strong>In determining brain death, transcranial Doppler (TCD) is one of the recommended ancillary tests when clinical examinations and apnea tests are contraindicated. The American Academy of Neurology 2023 guideline updates and 2020 World Brain Death Project advise conducting two TCDs 30 min apart to diagnose neurocirculatory arrest. Our study aimed to evaluate whether a second TCD is necessary when the first TCD shows neurocirculatory arrest (no flow, oscillating flow, or systolic spikes).</p><p><strong>Methods: </strong>We conducted a single-center retrospective analysis of patients admitted to intensive care units from January 1, 2021, to February 1, 2025, at a community-based academic hospital. We included patients whose first study showed neurocirculatory arrest and who subsequently underwent a confirmatory TCD at least 30 min apart. A total of 48 patients were included in our final analysis. We compared the findings of the first TCD study with those of the second study and noted any differences.</p><p><strong>Results: </strong>In all 48 patients (100%), the second TCD confirmed the findings of the first TCD. Of these 48 patients, 44 patients (91.7%) had the same flow pattern on repeat TCD examination and 4 patients' (8.30%) TCDs showed different flow patterns, although still consistent with neurocirculatory arrest. Of the 44 patients with the same flow patterns found on first and repeat TCD examinations, 18 patients (40.9%) had both TCDs demonstrate brief systolic spikes; three patients (6.80%) had both TCDs demonstrate brief systolic spikes and oscillating flow; eight patients (18.2%) had both TCDs demonstrate no flow; seven patients (15.9%) had both TCDs demonstrate no flow and brief systolic spikes; one patient (2.30%) had both TCDs demonstrate no flow, brief systolic spikes, and oscillating flow; and, lastly, seven patients (15.9%) had both TCDs demonstrate oscillating flow.</p><p><strong>Conclusions: </strong>We found that requiring two sequential TCD examinations to confirm neurocirculatory arrest may be unnecessary when the first TCD shows neurocirculatory arrest. Further investigation and studies such as ours in larger populations are warranted.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710798","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 a Rescue Therapy in Prolonged Myasthenic Crisis in the Intensive Care Unit: A Case Series.","authors":"Hacer Durmus, Arman Çakar, Yesim Gülşen Parman","doi":"10.1007/s12028-025-02237-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02237-w","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670173","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":"https://doi.org/10.1007/s12028-025-02231-2","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-18","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":"Neurological Injury in Comatose Patients Following Substance-Use-Related Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study in a Safety Net Hospital.","authors":"Jonathan J Shih, Matheus Otero, Shital Gandhi, Jason Talbott, Bo Zhou, Jeffrey R Vitt, Neel S Singhal, Dominica Randazzo, Aaron Scheffler, J Claude Hemphill, Edilberto Amorim","doi":"10.1007/s12028-025-02229-w","DOIUrl":"https://doi.org/10.1007/s12028-025-02229-w","url":null,"abstract":"<p><strong>Background: </strong>Substance-use-related cardiac arrest (SURCA) is a public health crisis, contributing to high mortality and severe neurological disability, particularly affecting young adults. This study aims to characterize the demographic and multimodal neurological prognostication features of patients with SURCA.</p><p><strong>Methods: </strong>This retrospective study included patients with out-of-hospital cardiac arrest who presented to an urban academic safety net hospital between July 2016 and April 2022 and were comatose on admission. Patients with SURCA were identified through toxicology screening. Data on demographics, cardiac arrest characteristics, and multimodal neurological prognostication were collected. Poor neurological outcome was defined as a Cerebral Performance Category score of 3-5 at hospital discharge. Logistic regression was used to identify factors associated with poor neurological outcomes.</p><p><strong>Results: </strong>Among 253 patients, 99 (39%) were classified as having SURCA, with 67 testing positive for stimulants and 56 testing positive for opioids. Patients with SURCA were younger (49 vs. 66 years, p < 0.001), less likely to have a witnessed cardiac arrest (56% vs. 71%, p = 0.01), and more likely to present with nonshockable rhythms (88% vs. 73%, p < 0.001). Electroencephalogram (EEG) monitoring in the SURCA cohort revealed a higher incidence of generalized periodic discharges (54% vs. 35%, p = 0.02) and electrographic seizures (28% vs. 13%, p = 0.02). Outcomes were similar between SURCA and non-SURCA groups; 86% of patients with SURCA had poor neurological outcomes, with 67% not surviving to discharge, compared to 88% and 69% of patients with non-SURCA, respectively. Nonshockable rhythms and older age were associated with poor neurological outcomes, but SURCA was not.</p><p><strong>Conclusions: </strong>SURCA is common and is frequently associated with poor neurological outcomes despite affecting younger patients. A higher incidence of seizures and generalized periodic discharges on EEG was observed with SURCA; therefore, validation of this finding in larger multicenter cohorts is warranted. Public health interventions to improve bystander resuscitation education in populations at risk for SURCA may improve outcomes in this vulnerable population.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625467","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: Predisposing Factors of Progression from Refractory Status Epilepticus to Super-Refractory Status Epilepticus in ICU-Admitted Patients: Multicenter Retrospective Cohort Study in a Resource-Limited Setting.","authors":"Dannys Rivero Rodríguez, Telmo Fernandez, Daniela DiCapua Sacoto, Yanelis Pernas Sanchez, María Isabel Morales-Casado, Nelson Maldonado, Graham Pluck","doi":"10.1007/s12028-025-02232-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02232-1","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573427","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":"Inhibition of C3a/C3aR by SB290157 Attenuates Neuroinflammation via PKC/P38/NLRP3 Signaling Pathway After Intracerebral Hemorrhage.","authors":"Dongqing Qi, Pengju Wei, Yuhui Cui, Cameron Lenahan, Xiaogen Tao, Peng Jin","doi":"10.1007/s12028-025-02226-z","DOIUrl":"https://doi.org/10.1007/s12028-025-02226-z","url":null,"abstract":"<p><strong>Background: </strong>The C3a/C3aR axis has been shown to play an important role in a variety of neurological diseases. The aim of this study was to investigate the effects of the C3aR antagonist SB290157 on neuroinflammation in a mouse model of intracerebral hemorrhage (ICH) and the mechanism of the protein kinase C (PKC)/P38/NLRP3 signaling pathway in C3aR-mediated neuroinflammation.</p><p><strong>Methods: </strong>A total of 276 CD-1 mice were randomly assigned to different experimental groups. The ICH model was constructed by injecting autologous blood into the right basal ganglia, and SB290157 was administered intraperitoneally after 1 h. C3a (an endogenous ligand for C3aR), PMA (a specific PKC activator), and C3aR small interfering RNA (siRNA) were chosen to elucidate the underlying mechanisms. Western blots, immunofluorescence staining, Nissl staining, neurobehavioral tests, and brain water content tests were also performed.</p><p><strong>Results: </strong>C3aR was mainly expressed on microglia. The expression of C3a and C3aR was upregulated in the right hemisphere of the brain after ICH. Intraperitoneal injection of SB291057 improves short-term and long-term behavioral deficits, attenuates brain edema, and reduces the number of activated microglia and neutrophil infiltration after ICH and downregulates the expression of phosphorylated PKC, phosphorylated P38, and NLRP3, as well as tumor necrosis factor-α, interleukin-6 (IL-6), and IL-1β. Administration of C3aR siRNA and the C3aR endogenous agonist C3a reversed the protective effect of SB290157. In addition, selective activation of PKC/P38/NLRP3 signaling also attenuated the antiinflammatory effects of SB290157 after ICH.</p><p><strong>Conclusions: </strong>This study demonstrates that SB290157 inhibits neuroinflammation and improves short-term and long-term neurological function after ICH in mice, at least in part through regulation of the C3aR/PKC/P38/NLRP3 signaling pathway. Targeting C3aR to inhibit NLRP3-dependent neuroinflammation may provide a promising therapeutic approach for treating ICH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567323","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":"Evolution of EEG Findings in Patients with Acute Brain Injury.","authors":"Jackson A Narrett, MarieElena Byrnes, Emily J Gilmore, Lawrence J Hirsch, Vineet Punia, Adithya Sivaraju","doi":"10.1007/s12028-025-02227-y","DOIUrl":"10.1007/s12028-025-02227-y","url":null,"abstract":"<p><strong>Background: </strong>Increasing use of continuous electroencephalography (cEEG) provides the opportunity to observe temporal trends in EEG patterns during the acute phase of brain injury. These trends have not been extensively documented.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of patients undergoing cEEG between January 1st and June 30th, 2019, at two academic medical centers. Only patients with acute brain injury having electrographic or electroclinical seizures or epileptic EEG findings on day 1 of monitoring and ≥ 2 calendar days of cEEG were included. The temporal evolution of EEG patterns was depicted as a heatmap.</p><p><strong>Results: </strong>Of 1356 screened patients, 101 met the study criteria. Clinical acute symptomatic seizures occurred in 30 patients (29.7%) prior to EEG. The median number of days of cEEG was 4 (interquartile range 3-6 days). Among patients with electrographic seizures, status epilepticus, generalized periodic discharges, or sporadic epileptiform discharges, 24.6% had improvement and 54.1% had resolution of epileptic EEG findings by the final day of monitoring. In contrast, 65% of patients with lateralized periodic discharges or lateralized rhythmic delta activity persisted or worsened. Overall, 61.4% (62/101) of patients showed either improvement (19.8%) or resolution (41.6%) of their EEG findings prior to hospital discharge. Of the 36 patients with follow-up EEGs at a median of 4.5 (interquartile range 3-8) months after admission for acute brain injury, 83% (30/36) showed either improvement (1/36; 2.7%) or resolution (29/36; 80.6%).</p><p><strong>Conclusions: </strong>In patients with acute brain injury, we observed a trend over time toward the normalization of most epileptiform patterns, except for lateralized periodic discharges and lateralized rhythmic delta activity. The clinical significance of this trend as it relates to antiseizure medication treatment and neurologic outcomes warrants further investigation in an independent cohort.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557602","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":"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":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-04","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}