Neurocritical Care最新文献

{"title":"Impaired Cerebral Autoregulation in Pediatric Patients with ECMO: A Retrospective Analysis of ECMO Time Periods and Association with Neurologic Injury.","authors":"Ethan L Sanford, David R Busch, Neel Shah, Chasity Custer, Nicolas Joram, Michael Morris, Sumit Singh, Lakshmi Raman","doi":"10.1007/s12028-026-02531-1","DOIUrl":"10.1007/s12028-026-02531-1","url":null,"abstract":"<p><strong>Objective: </strong>Neurologic injury is common in pediatric patients with extracorporeal membrane oxygenation (ECMO). Impaired cerebral autoregulation (CAR) may increase the risk of neurologic injury. We aimed to measure CAR in different phases of ECMO and analyze for association with radiographic neurologic injury.</p><p><strong>Methods: </strong>We performed a retrospective, single-center, observational cohort study of pediatric (0-18 years) ECMO patients with no prior neurologic injury, cardiopulmonary bypass, ECMO, or congenital heart disease who underwent brain imaging. Correlation of time-matched cerebral oximetry and mean arterial blood pressure (MAP) data determined the cerebral oximetry index (COx) a noninvasive estimate of CAR. Impaired CAR was tested for association with neurologic injury score (NIS) as measured by blinded neuroradiologists. Secondarily, we calculated the area under the curve (AUC) of MAP above or below age-based 50th percentile MAP in temporal windows with impaired CAR. Univariate analysis and a multivariable linear regression model adjusting for type of ECMO, ECMO indication, and age determined the association between impaired CAR and the AUC metric with NIS.</p><p><strong>Results: </strong>Data from 72 children were analyzed. The median age was 11.7 months, 47 children (65.3%) received VA ECMO, and severe neurologic injury (SNI) occurred in 9 (12.5%). There was no association between percent time with impaired CAR and SNI (16.6% versus 12.2%, P = 0.38). Impaired CAR burden was significantly higher pre-ECMO as compared with peri-cannulation and intra-ECMO time periods (26.5% versus 14.8% and 16.6%, P < 0.01). The multivariable linear regression model discerned a significant association between pre-ECMO hypotension during impaired CAR and NIS (coefficient = -0.008; -0.015, -0.001; P = 0.026; R² = 0.19).</p><p><strong>Conclusions: </strong>Total time with impaired CAR measured by the cerebral oximetry index was not associated with neurologic injury in pediatric patients with ECMO. However, impaired CAR was more common pre-ECMO, and pre-ECMO AUC incorporating magnitude of blood pressure derangement was significantly associated with neurologic injury, implicating pre-ECMO clinical derangements as imparting risk.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"750-759"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147973924","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":"Prophylactic Antiepileptic Drugs in Nontraumatic Intracerebral Hemorrhage: A Network Meta-Analysis.","authors":"Natan Lucca Lima, Marcos Henrique da Silva Mezzari, Josete Mazon, Gustavo Rassier Isolan","doi":"10.1007/s12028-026-02514-2","DOIUrl":"10.1007/s12028-026-02514-2","url":null,"abstract":"<p><strong>Background: </strong>The utility of antiepileptic drugs (AEDs) for seizure prophylaxis following nontraumatic intracerebral hemorrhage (ICH) remains uncertain, with guidelines based on low-quality evidence that often pools heterogeneous medications. We conducted a network meta-analysis (NMA) to evaluate the utility of AEDs and to compare the efficacy and safety of individual agents in this setting.</p><p><strong>Methods: </strong>A comprehensive systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to 22 October 2025 was conducted. We included studies involving adults with nontraumatic ICH that compared individual prophylactic AEDs against each other or a control group. We employed a Bayesian random-effects NMA to synthesize the data. Primary outcomes were early seizure incidence and unfavorable functional outcome. Secondary outcomes included adverse events, serious adverse events, NIHSS score at last follow-up, and mortality. Risk of bias was assessed using Cochrane Risk of Bias 2 (RoB 2) and Risk Of Bias In Non-randomized Studies-of Interventions, Version 2 (ROBINS-I V2) tools, and the certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>Out of 2142 identified citations, 17 studies (4 RCTs, 13 observational; N = 6597 patients) met the inclusion criteria. No AED significantly reduced early seizures or improved functional outcomes compared with placebo. However, ranking probabilities (surface under the cumulative ranking curve, SUCRA) suggested valproate was most likely to prevent early seizures (SUCRA = 0.8330) and improve functional outcomes (SUCRA = 0.7938). Valproate also ranked highest for overall safety (SUCRA = 0.8085) and NIHSS improvement (SUCRA = 0.8187), while levetiracetam ranked best for serious adverse events (SUCRA = 0.7935). Eslicarbazepine was associated with increased mortality, whereas valproate showed the most favorable ranking for this outcome (SUCRA = 0.7705). The certainty of evidence across comparisons ranged from low to very low.</p><p><strong>Conclusions: </strong>This NMA found no robust evidence to support the routine prophylactic use of AEDs after nontraumatic ICH. Nonetheless, valproate consistently demonstrated the best efficacy and relative safety profiles. This finding warrants investigation in future RCTs, particularly in subgroups of patients at high risk for post-ICH seizures.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"687-702"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840816","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":"Pulsatility Index Measurement via the Submandibular Internal Carotid Artery: An Alternative to Transcranial Assessment.","authors":"Yoshihisa Fujimoto, Kenji Numata, Aya Sakuma, Tsukasa Yoshida, Koichi Hayashi, Shigeki Fujitani","doi":"10.1007/s12028-026-02505-3","DOIUrl":"10.1007/s12028-026-02505-3","url":null,"abstract":"<p><strong>Background/objective: </strong>Pulsatility index (PI) measurements using transcranial color flow imaging via the temporal bone are one of the clinical substitutes for invasive intracranial pressure (ICP) monitoring. Although the PI measurements obtained through this window are commonly used, they cannot be evaluated in up to 20% of the patients. Given that PI in the internal carotid artery (ICA) can be easily measured through the submandibular window in all cases, this study aimed to investigate whether PI measurements through the submandibular window could be used as a substitute for PI measurements in the middle cerebral artery (MCA).</p><p><strong>Methods: </strong>This single-center, retrospective, observational study included cases from our intensive care unit between May 2024 and September 2024, in which transcranial ultrasound was performed during treatment of neurological disorders. The PI measurements from the temporal (MCA-PI) and submandibular (ICA-PI) windows were obtained at the same situation; the correlation between ICA-PI and MCA-PI was evaluated across various brain injuries using Pearson's correlation coefficient.</p><p><strong>Results: </strong>Data from 46 patients, totaling 116 measurements, were analyzed. The patients included 57 (49.1%) male patients aged 67 (interquartile range [IQR], 49-74) years. The primary diagnoses were subarachnoid hemorrhage [n = 52 (44.8%)], intracerebral hemorrhage [n = 21 (18.1%)], cerebral infarction [n = 9 (7.8%)], and traumatic brain injury [n = 8 (6.9%)]. The median MCA-PI was 1.11 [IQR: 0.87-1.36] and the median ICA-PI was 1.09 [IQR: 0.86-1.37]. A significant correlation was observed between the ICA-PI and MCA-PI, with a correlation coefficient of 0.894 (MCA-PI = 0.946 × ICA-PI + 0.057).</p><p><strong>Conclusions: </strong>Despite the inclusion of various neurocritical disorders, the ICA-PI through the submandibular window was strongly correlated with the conventional PI (i.e., MCA-PI through the temporal window). In neurocritical care, the ICA-PI may be used in combination with other ICP surrogate markers for integrated assessment when the view through the temporal window is unavailable.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"602-611"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628131","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":"Combination of Albumin and Cilostazol Improves Outcomes in a Rodent Model of Aneurysmal Subarachnoid Hemorrhage.","authors":"A Karim Ahmed, James Feghali, Yu-Chien Shih, Jackson Miller, Eli Yazigi, Landon J Hansen, Jawad Khalifeh, Sai Chandan Reddy, Risheng Xu, Justin Caplan, L Fernando Gonzalez, Rafael J Tamargo, Judy Huang, Jose I Suarez, Christopher M Jackson","doi":"10.1007/s12028-026-02491-6","DOIUrl":"10.1007/s12028-026-02491-6","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients recovering from aneurysmal subarachnoid hemorrhage (aSAH) often suffer secondary neurologic injury owing to delayed cerebral ischemia (DCI)-a multifactorial phenomenon. Both albumin and cilostazol have shown efficacy for treating DCI in preclinical and early clinical studies. However, the utility of combining these treatments has not yet been rigorously tested.</p><p><strong>Methods: </strong>A total of 83 mice, male and female, were randomly divided into five groups as follows: sham; vehicle (0.9% saline); 25% human albumin; cilostazol; and combination 25% human albumin with cilostazol. A total of 11 animals in each group underwent endovascular perforation of the internal carotid artery (ICA) to induce subarachnoid hemorrhage. Daily neuroscores were assessed for each animal, and brain water content was quantified as a surrogate for edema 96 h posthemorrhage. An additional five animals in each group underwent 11.7 T magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) at 96 h to quantify vasospasm.</p><p><strong>Results: </strong>There was a significant difference in vessel diameter in the left subclavian artery (L SCA; p = 0.014), right subclavian artery (R SCA; p = 0.018), and right internal carotid artery (R ICA; p = 0.026) in the experimental groups with combined treatment outperforming vehicle or either cilostazol or albumin monotherapy. Compared with SAH with vehicle control, treatment with albumin and cilostazol resulted in significantly improved MCA territory pixel intensity (p = 0.017). The treatment groups all had lower brain water contents than the SAH group, most pronounced in the SAH + albumin with cilostazol group compared with the SAH group (p < 0.001). There was a significant overall difference in survival between the groups (p < 0.001), and median neuroscore at all time points in the SAH + combined treatment group, compared with SAH alone; at 24 h (p = 0.036), 48 h (p = 0.001), 72 h (p = 0.001), and 96 h (p = 0.001).</p><p><strong>Conclusions: </strong>Combination albumin and cilostazol resulted in superior outcomes, including brain water content (edema), large vessel vasospasm, behavioral scores, and survival across brain water content, MRA imaging, 28-point neuroscore, and Kaplan-Meier analysis. These preclinical data support the need for a clinical trial testing this combination therapy.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"571-580"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609497","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 Effects of Milrinone Systemic Administration on Cerebral Perfusion as Measured with Computed Tomography in Aneurysmal Subarachnoid Hemorrhage Patients.","authors":"Vivien Szabo, Nesrine Kabli, Laura Matesanz, Audrey Vilella, Marine Le Corre, Cyril Dargazanli, Chiara Martinez, Pierre-François Perrigault, Quentin Mesnildrey, Kévin Chalard","doi":"10.1007/s12028-026-02559-3","DOIUrl":"10.1007/s12028-026-02559-3","url":null,"abstract":"<p><strong>Background: </strong>Aneurysmal subarachnoid hemorrhage (SAH) prognosis is determined by the occurrence of delayed cerebral ischemia (DCI), which is associated with specific dynamics of perfusion computed tomography (CTP) parameters. Systemic administration of milrinone is proposed to reduce DCI, though underlying mechanisms remain putative.</p><p><strong>Objective: </strong>This study aimed to describe the effects of milrinone intravenous infusion on systemic and cerebral hemodynamics in patients with SAH.</p><p><strong>Methods: </strong>We conducted a retrospective observational study including patients diagnosed with aneurysmal SAH and monitored with PiCCO device and CTP. Relationships between milrinone dose, cardiac index (CI), and CTP parameters were assessed.</p><p><strong>Results: </strong>A total of 17 patients were included, 88% presented cerebral vasospasm, 29% evolved with DCI. CI increased with systemic milrinone dose in the entire population (p < 0.001). Contrarily, cerebral blood flow (CBF) decreased with milrinone in the non-DCI subpopulation (p = 0.002) and was not correlated to it in the DCI one. However, CBF increased with CI in this DCI subpopulation (p = 0.008). Spatial heterogeneity of perfusion, quantified by the global (CoV) and regional (rCoV) coefficients of variation of CBF, decreased with milrinone dose in the non-DCI subpopulation (p < 0.001). While no correlation at the global scale emerged in the DCI subpopulation, rCoV increased with milrinone in DCI regions (p < 0.01).</p><p><strong>Conclusions: </strong>Intravenous infusion of milrinone did not seem to improve cerebral perfusion through systemic effects. In non-DCI patients, milrinone seemed to homogenize CBF and prevent evolution towards DCI. We suggest that in patients with DCI, it failed to do so, such that CBF spatial heterogeneity pathologically increased until infarction. We propose that spatiotemporal evolution of CBF heterogeneity is both a biomarker and a pathophysiological feature of DCI that advocates for further theoretical and experimental exploration.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"823-832"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055980","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":"A Location-Specific Hyperdense Area Score Predicts Severe Mass Effect after Thrombectomy.","authors":"SiShan Wen, Hao Tang, JiaNan Li, QiJi Jin, Xi Shen, Lulu Xiao, AnYu Liao, WuSheng Zhu, ChangSheng Zhou, Liang Pan, Jie Chen, Wei Xing, Qian Chen, XinDao Yin, Duchang Zhai, JianRui Li, Wu Cai, XiaoQing Cheng","doi":"10.1007/s12028-026-02546-8","DOIUrl":"10.1007/s12028-026-02546-8","url":null,"abstract":"<p><strong>Background: </strong>In patients with anterior circulation large vessel occlusion stroke, hyperdense areas (HDAs) on post-thrombectomy computed tomography (CT) reflect blood-brain barrier injury and may herald malignant edema or hemorrhagic transformation. Both complications can progress to life-threatening mass effect, often necessitating surgical interventions such as decompressive craniectomy. We aimed to develop and validate a location-specific HDA score for predicting severe mass effect.</p><p><strong>Methods: </strong>This multicenter retrospective study analyzed 865 patients exhibiting HDAs on post-thrombectomy CT. The primary outcome was severe mass effect, defined as decompressive craniectomy or midline shift ≥ 5 mm on follow-up imaging. A location-specific HDA score was developed by expanding the ASPECTS template to include subarachnoid and ventricular compartments. Predictive models integrating imaging and clinical variables were constructed via LASSO regression and validated internally (bootstrapping) and externally.</p><p><strong>Results: </strong>Three HDA locations independently predicted the outcome: insula [adjusted odds ratio (aOR) = 2.02, 95% confidence interval (CI) 1.07-3.73, P = 0.030], subarachnoid space (aOR = 2.47, 95% CI 1.30-4.91, P = 0.005), and ventricles (aOR = 4.58, 95% CI 1.33-15.80, P = 0.016). The HDA score demonstrated a strong dose-response relationship with outcome risk, with scores ≤ 3 indicating low risk (< 10% probability) of severe mass effect and a high negative predictive value (88.8%). An integrated model (model 2) incorporating HDA features, admission blood glucose, National Institutes of Health Stroke Scale (NIHSS) and ASPECTS significantly outperformed a baseline clinical model (model 1) [area under the curve (AUC) 0.801 vs. 0.737, P < 0.001], showing high specificity (81.3%). Model performance was maintained in external validation (AUC 0.786) and in the contrast-staining subgroup (AUC 0.808).</p><p><strong>Conclusions: </strong>A simple, location-specific HDA score, especially when integrated into a clinical prediction model, effectively identifies patients at high risk for severe mass effect after thrombectomy. This tool enables early risk stratification and may guide timely intensive care management.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"760-770"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148006110","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":"Stereotactic Drainage Treatment is Associated with Improved Long-Term Neurological Recovery in Small-to-Moderate Volume Basal Ganglia Hemorrhages: A Systematic Review and Meta-Analysis.","authors":"Jiepu Wang, Xiongjie Fu, Zihao An, Gao Chen, Xiaobo Yu","doi":"10.1007/s12028-026-02527-x","DOIUrl":"10.1007/s12028-026-02527-x","url":null,"abstract":"<p><strong>Background: </strong>The optimal management of small-to-moderate volume (≤ 50 mL) basal ganglia spontaneous intracerebral hemorrhage (ICH) is controversial. This meta-analysis aimed to compare the efficacy and safety of stereotactic drainage treatment (SDT) with conservative medical treatment (CMT) in this patient population.</p><p><strong>Methods: </strong>We queried major databases up to October 2025 for studies comparing SDT versus CMT for basal ganglia ICH ≤ 50 mL. The primary endpoint was good functional recovery (modified Rankin Scale score 0-2). Subgroup analyses were performed on the basis of cohort-mean hematoma volume (< 25 mL vs. 25-50 mL) and follow-up duration.</p><p><strong>Results: </strong>Eleven studies involving 1634 participants were analyzed. Compared with CMT, SDT was associated with a higher proportion of favorable functional outcome up to 12 months (P < 0.001). Subgroup analysis showed consistent functional benefits across both volume strata (< 25 mL and 25-50 mL), with significant superiority emerging from 3 months onwards (all P < 0.001). Mortality did not differ significantly between groups (P = 0.05). SDT also accelerated hematoma resolution and reduced hospital stay (all P < 0.05) without increasing infection (P = 0.17) or rebleeding risks (P = 0.19).</p><p><strong>Conclusions: </strong>SDT was associated with improved long-term functional recovery compared with CMT in cohorts with small-to-moderate basal ganglia ICH. Safety outcomes showed no statistically significant differences between groups. Large, multicenter randomized trials with standardized protocols are needed to confirm SDT's efficacy and safety and to refine patient selection.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"651-662"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729608","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":"Increased Antidepressant Use after Intensive Care for Aneurysmal Subarachnoid Haemorrhage: A Machine-Learning-Enhanced Propensity-Matched Nationwide Cohort Study.","authors":"Ryan Falck-Jones, Johan Olsson, Cecilia Åkerlund, Erik von Oelreich, Jesper Eriksson, Anders Oldner, Peter Alpkvist, Johan Lundberg, Mikael Svensson, Linn Hallqvist","doi":"10.1007/s12028-026-02517-z","DOIUrl":"10.1007/s12028-026-02517-z","url":null,"abstract":"<p><strong>Background: </strong>Mood disorders after aneurysmal subarachnoid haemorrhage (aSAH) are common. Meanwhile, mood disorders are also common after intensive care for any reason, and whether aSAH confers an excess risk remains unknown.</p><p><strong>Methods: </strong>In this retrospective study, patients with cases of aSAH admitted to intensive care in 2012-2023 were identified in nationwide registers and antidepressant (AD) prescriptions used as a proxy for mood disorders. The primary outcome was incidence of AD therapy in patients who were previously AD-naïve, along with attributable risk factors and impact on sick leave and disability pensions. To investigate the risk of AD treatment in aSAH exceeding what would be expected after intensive care, a control cohort of all patients in the intensive care unit (ICU) nationwide between 2012 and 2018 was identified. Using machine-learning-driven nearest-neighbour propensity score (PS) matching, the relative risk of AD treatment in ICU-treated aSAH cases vs. non-neurovascular ICU cases was calculated.</p><p><strong>Results: </strong>In all, 3149 patients with aSAH who were AD-naïve were identified, with a cumulative incidence of AD treatment within 1 year of 25.5% and markers of disease severity being the main risk factors for AD treatment. Patients with aSAH who were treated with ADs used significantly more sick leave and disability pensions than patients with aSAH who were not treated with ADs. After propensity score matching with a general ICU cohort, patients with aSAH still had a risk ratio (RR) of 1.333 [95% confidence interval (CI) 1.241-1.425] of AD treatment within 1 year, indicating an additional impact of aSAH on the development of mood disorders.</p><p><strong>Conclusions: </strong>Our results suggest patients with aSAH have a risk of mood disorders exceeding what would be expected after intensive care for non-neurovascular reasons.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"673-686"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840798","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":"Promoting Consciousness Recovery in Patients with Acquired Brain Injury Through Multimodal Sensory Stimulation: A Randomized Controlled Trial of Median Nerve and Auricular Stimulation.","authors":"Hai Li, Wei Song, Shuping Zeng, Ling Liu, Changyu Liu, Hanjing Lu","doi":"10.1007/s12028-026-02543-x","DOIUrl":"10.1007/s12028-026-02543-x","url":null,"abstract":"<p><strong>Background: </strong>Addressing disorders of consciousness (DOC) secondary to acquired brain injury (ABI) remains challenging in neurorehabilitation. Median nerve electrical stimulation (MNES) is a noninvasive therapeutic option, but its benefits as monotherapy are restricted. The auricular intradermal needle, a prolonged-stimulation traditional Chinese medicine technique, has not been assessed for consciousness restoration. This study examined the safety and effectiveness of combining MNES with auricular needling for patients with DOC post-ABI.</p><p><strong>Methods: </strong>This randomized controlled trial enrolled 116 patients with DOC (GCS 4-8), randomly assigned to a treatment group (n = 58, standard care + MNES + auricular intradermal needling) or a comparison group (n = 58, standard care + MNES). MNES was administered twice daily for 60 min per session; auricular needles were embedded for 3 days (three pressings/day), with the total protocol spanning 11 days. Primary outcome was Coma Recovery Scale-Revised (CRS-R) score, evaluated at 4 weeks postintervention and 3 months post-ABI. Secondary outcomes included GCS score, awakening rate, Glasgow Outcome Scale (GOS) score, and family satisfaction.</p><p><strong>Results: </strong>Intent-to-treat (ITT) analysis showed that the experimental group had a significantly greater CRS-R score increase than controls at 4 weeks (mean difference: 1.62, P = 0.022) and 3 months (mean difference: 2.05, P = 0.006). All secondary outcomes differed significantly: higher GCS scores, higher awakening rates (48.28% vs. 27.59% at 4 weeks; 62.07% vs. 41.38% at 3 months), more favorable GOS outcomes (4-5: 55.17% vs. 31.03%), and improved family satisfaction. No serious treatment-related adverse events occurred.</p><p><strong>Conclusions: </strong>Integrating MNES with auricular intradermal needle enhances therapeutic outcomes for DOC following ABI, proving more effective than MNES alone in promoting consciousness recovery and neurological improvement without compromising safety. This complementary method represents a viable and promising advancement in noninvasive DOC management. Trial registration ClinicalTrials.gov Identifier: NCT07273864.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"833-849"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055954","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":"Cerebral Vasospasm Detection and Delayed Cerebral Ischemia Prediction after Aneurysmal Subarachnoid Hemorrhage: A Scoping Review.","authors":"João Brainer Clares de Andrade, Nayara de Lima Froio, Paula Sanchez Nascimento, Sophia Oliveira Querobin, Nathalia Souza de Oliveira, Thiago S Carneiro","doi":"10.1007/s12028-026-02509-z","DOIUrl":"10.1007/s12028-026-02509-z","url":null,"abstract":"<p><strong>Background/objective: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) is complicated by angiographic cerebral vasospasm and delayed cerebral ischemia (DCI), distinct entities with different reference standards and surveillance targets. We mapped the evidence on (1) diagnostic accuracy of vasospasm monitoring tools using digital subtraction angiography (DSA) as the reference standard and (2) detection and prediction of DCI using the 2010 consensus definition.</p><p><strong>Methods: </strong>We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)-guided scoping review of PubMed/MEDLINE, Google Scholar, and PubMed Central (1 January 2005-31 January 2025). Vasospasm studies required DSA as comparator; DCI studies were categorized by outcome definition (2010 consensus vs. alternative definitions). Methodological quality was assessed with QUADAS-2 (diagnostic accuracy) and Prediction Model Risk of Bias Assessment Tool (PROBAST; prediction models).</p><p><strong>Results: </strong>From 762 records, 136 studies met inclusion criteria. For vasospasm detection (DSA reference), transcranial Doppler (18 studies; n = 3256) demonstrated sensitivity 66% (60-72) and specificity 97% (95-99), while computed tomography angiography (CTA) (15 studies; n = 2145) showed sensitivity 76% (72-80) and specificity 93% (91-95). For DCI detection (2010 consensus), CT perfusion (30 studies; n = 1786) yielded sensitivity 86% (78-86) and specificity 80% (75-85) with substantial protocol heterogeneity; continuous electroencephalography (cEEG) (8 studies; n = 523) achieved sensitivity 88% (80-94) and specificity 89% (83-93). Across 84 DCI predictor studies, machine-learning models (23 models) outperformed traditional risk factors (area under the curve [AUC] 0.68-0.88 vs. ~0.63), but only 44% underwent independent validation, and 67% were at high risk of bias.</p><p><strong>Conclusions: </strong>The evidence supports a two-track framework: DSA-referenced tools for vasospasm detection and consensus-defined markers for DCI detection/prediction. Multimodal strategies integrating physiologic and imaging data are most promising, whereas machine-learning approaches require prospective, externally validated evaluations before routine clinical deployment.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"853-863"},"PeriodicalIF":4.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729635","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}