Neurocritical Care最新文献

{"title":"Utility and Value of Movement Recording with Combined EEG-EMG Monitoring in the Intensive Care Unit.","authors":"Julie Lévi-Strauss, Clémence Marois, Yulia Worbe, Laurine Bedoucha, Raouf Benchikh Lehocine, Benjamin Rohaut, Nicolas Weiss, Sophie Demeret, Emmanuelle Apartis, Virginie Lambrecq","doi":"10.1007/s12028-025-02230-3","DOIUrl":"10.1007/s12028-025-02230-3","url":null,"abstract":"<p><p>Continuous electroencephalographic (EEG) monitoring has become a standard of care in several contexts in the intensive care unit (ICU), especially for the management of refractory status epilepticus. ICU patients often present movement disorders that may be of epileptic or nonepileptic origin, and their correct identification is crucial for the diagnostic and therapeutic process. Video analysis is often insufficient to precisely detect or characterize movement disorders and the ICU environment is prone to many artifacts. Combined EEG electromyogram (EMG) monitoring can enhance the detection of epileptic seizures with subtle motor expression and help identify nonepileptic movement disorders, such as postanoxic myoclonus, dystonia, or tremor. We will review the various scenarios in which combined EEG-EMG monitoring is useful in routine ICU practice. We also provide a practical guide for easily placing surface EMG electrodes during continuous EEG recording, along with clinical examples to illustrate the significance of this combined approach.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542633","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 General Anesthesia at Terminal Extubation: \"Go Gentle into that Good Night\".","authors":"Christos Lazaridis","doi":"10.1007/s12028-025-02228-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02228-x","url":null,"abstract":"<p><p>Withdrawal of life-sustaining treatments in the intensive care unit most often culminates into the discontinuation of mechanical ventilation and removal of the endotracheal tube or \"terminal extubation.\" Standards of practice call for the appropriate use of analgesia and sedation before, during and after extubation with an explicit goal to relieve suffering but not to hasten death. Patients subjected to this procedure are exposed to variable pharmacologic agents, modes, and doses, without any knowledge or monitoring of what these patients are experiencing. This practice seems to rest on contestable assumptions regarding the reliability of bedside examination, the experiential states of unresponsive patients, and the scope of the doctrine of double effect; instead, I argue for palliative general anesthesia in order to safeguard against potential suffering at the end of life. I employ philosophical notions of harm to justify the normative status of palliative anesthesia, in conjunction with contemporary evidence as it relates to the phenomena of covert consciousness and cognitive-motor dissociation. If this analysis is correct, then it may serve as a valid challenge toward current practice without having engaged into controversial debates over the soundness of the doctrine of double effect, or euthanasia. Primun non nocere offers the strongest justification for general anesthesia when terminal extubation is planned.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542632","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":"Perihematomal Edema in Minimally Invasive Surgery for Spontaneous Cerebellar Hemorrhage: Prognostic Clue or Red Herring?","authors":"Anil Ramineni, Joseph D Burns","doi":"10.1007/s12028-025-02220-5","DOIUrl":"https://doi.org/10.1007/s12028-025-02220-5","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516251","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":"Prognostic Significance of Preoperative Perihematomal Edema in Spontaneous Cerebellar Hemorrhage After Minimally Invasive Surgery.","authors":"Haixiao Liu, Dongbo Li, Yaning Cai, Longlong Zheng, Zhijun Tan, Feng Liu, Fei Gao, Hui Zhang, Yong Du, Gaoyang Zhou, Feifei Sun, Ruixi Fan, Ping Wang, Lei Wang, Shunnan Ge, Tianzhi Zhao, Tao Zhang, Rongjun Zhang, Guoqiang Xie, Yan Qu, Wei Guo","doi":"10.1007/s12028-025-02221-4","DOIUrl":"https://doi.org/10.1007/s12028-025-02221-4","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery (MIS), including endoscopic evacuation and minimally invasive catheter (MIC) evacuation, has been widely used in patients with spontaneous cerebellar hemorrhage (SCH). However, the long-term prognosis varies widely. Herein, a case-control study nested within a multicenter cohort was conducted to explore the risk factors for unfavorable prognosis in patients with SCH after MIS.</p><p><strong>Methods: </strong>The data on medical history, perioperative computed tomography scans, and 6-month prognosis of the observed patients were collected. A comparison of these variables between patients with favorable outcomes (modified Rankin Scale score ≤ 3) and those with unfavorable outcomes (modified Rankin Scale score ≥ 4) was conducted to investigate prognostic predictors.</p><p><strong>Results: </strong>Eighty patients from four clinical centers were enrolled in the present study. Four factors including advanced age, MIC evacuation, large postoperative perihematomal edema (PHE), and large preoperative PHE were identified as independent risk factors for 6 month unfavorable neurological outcome. Subsequent analysis demonstrated that preoperative PHE serves as a reliable predictor of unfavorable neurological outcome at 6 months (area under the curve = 0.849). Based on restricted cubic spline analysis, patients were subsequently stratified into a large preoperative PHE (≥ 10 ml) subgroup and a small preoperative PHE (< 10 ml) subgroup. The incidence of unfavorable outcomes in the large preoperative PHE subgroup (47.4%) was significantly higher than that in the small preoperative PHE subgroup (2.4%).</p><p><strong>Conclusions: </strong>Advanced age, MIC evacuation, large preoperative PHE, and postoperative PHE are independent factors associated with unfavorable outcome in patients with SCH who underwent MIS. Significantly, the large preoperative PHE is an independent predictor for unfavorable long-term neurological outcome, particularly when the preoperative PHE is ≥ 10 ml.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516253","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":"Machine Learning Approaches to Clinical Prognostication After Cardiac Arrest: Principles and Uncertainty.","authors":"Michael S Wolf, Mayur B Patel, E Wesley Ely","doi":"10.1007/s12028-025-02223-2","DOIUrl":"https://doi.org/10.1007/s12028-025-02223-2","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468649","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":"System for Predicting Neurological Outcomes Following Cardiac Arrest Based on Clinical Predictors Using a Machine Learning Method: The Neurological Outcomes After Cardiac Arrest Method.","authors":"Tae Jung Kim, Jungyo Suh, Soo-Hyun Park, Youngjoon Kim, Sang-Bae Ko","doi":"10.1007/s12028-025-02222-3","DOIUrl":"https://doi.org/10.1007/s12028-025-02222-3","url":null,"abstract":"<p><strong>Background: </strong>A multimodal approach may prove effective for predicting clinical outcomes following cardiac arrest (CA). We aimed to develop a practical predictive model that incorporates clinical factors related to CA and multiple prognostic tests using machine learning methods.</p><p><strong>Methods: </strong>The neurological outcomes after CA (NOCA) method for predicting poor outcomes were developed using data from 390 patients with CA between May 2018 and June 2023. The outcome was poor neurological outcome, defined as a Cerebral Performance Category score of 3-5 at discharge. We analyzed 31 variables describing the circumstances at CA, demographics, comorbidities, and prognostic studies. The prognostic method was developed based on an extreme gradient-boosting algorithm with threefold cross-validation and hyperparameter optimization. The performance of the predictive model was evaluated using the receiver operating characteristic curve analysis and calculating the area under the curve (AUC).</p><p><strong>Results: </strong>Of the 390 total patients (mean age 64.2 years; 71.3% male), 235 (60.3%) experienced poor outcomes at discharge. We selected variables to predict poor neurological outcomes using least absolute shrinkage and selection operator regression. The Glasgow Coma Scale-M (best motor response), electroencephalographic features, the neurological pupil index, time from CA to return of spontaneous circulation, and brain imaging were found to be important key parameters in the NOCA score. The AUC of the NOCA method was 0.965 (95% confidence interval 0.941-0.976).</p><p><strong>Conclusions: </strong>The NOCA score represents a simple method for predicting neurological outcomes, with good performance in patients with CA, using a machine learning analysis that incorporates widely available variables.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468580","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":"Continuous Electroencephalography in Acute Liver Failure: Findings and Prognostic Value.","authors":"Denise F Chen, Mirza Farrque, Ioannis Karakis, Navnika Gupta, Andres Rodriguez Ruiz, Prem Kandiah","doi":"10.1007/s12028-025-02216-1","DOIUrl":"https://doi.org/10.1007/s12028-025-02216-1","url":null,"abstract":"<p><strong>Background: </strong>Neurologic complications contribute significantly to morbidity and mortality in acute liver failure (ALF). However, clinical assessment of neurologic function in this population is often challenging. Continuous electroencephalography (cEEG) is a low-risk, noninvasive diagnostic tool that can monitor real-time cerebral function. We aimed to investigate cEEG findings and prognostic significance of specific EEG features in a cohort of strictly defined patients with ALF.</p><p><strong>Methods: </strong>This was a retrospective, single-center study of adult patients with ALF who underwent cEEG monitoring for at least 6 h between 2013 and 2022. Clinical, laboratory, imaging, and treatment characteristics were evaluated. cEEG variables included background continuity, background frequency, the presence of sporadic epileptiform discharges, rhythmic or periodic patterns, and electrographic or electroclinical seizures. The primary outcome was mortality or transition to end-of-life care during the index admission.</p><p><strong>Results: </strong>A total of 32 patients with ALF were included. 56.3% of patients had rhythmic or periodic patterns, of which the majority were generalized periodic discharges (37.5%). 12.5% of patients had sporadic epileptiform discharges, and 6.3% of patients demonstrated electrographic or clinical seizures. Eighteen (56.3%) patients died or were transitioned to end-of-life care during the index admission. Worsening background continuity or frequency over the course of the cEEG recording was significantly associated with poor outcome (p = 0.001, p = 0.007, respectively), with a 100% mortality rate in patients demonstrating these EEG trends. A worst recorded continuity of suppression, attenuation, and burst-suppression was also associated with poor outcome (p = 0.012). The presence of rhythmic or periodic patterns, sporadic epileptiform discharges, or seizures was not predictive of outcome.</p><p><strong>Conclusions: </strong>Worsening cEEG background continuity or frequency is associated with poor outcome in adults with ALF. cEEG may contribute useful prognostic information in these patients, in conjunction with other laboratory and clinical markers of disease severity.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370794","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":"Validation of a Noninvasive Approach for Cerebrospinal Compliance Monitoring.","authors":"Sérgio Brasil, Igor Ben-Hur, Danilo Cardim, Marek Czosnyka, Wellingson S Paiva, Gustavo Frigieri","doi":"10.1007/s12028-024-02205-w","DOIUrl":"https://doi.org/10.1007/s12028-024-02205-w","url":null,"abstract":"<p><strong>Background: </strong>Intracranial pressure (ICP) monitoring is a cornerstone of neurointensive care. However, some limitations of invasive techniques for ICP monitoring to acknowledge are the risk for complications and the lack of robust evidence supporting individualized ICP safety thresholds. Cerebrospinal compliance (CSC) may serve as a more reliable indicator of brain health than ICP alone. Previously, intracranial compliance (Ci), was described as a mathematical model from invasive ICP to assess CSC, using ICP waveform amplitudes and cerebral arterial blood volume (CaBV) waveform amplitudes via transcranial Doppler (TCD). This study aimed to compare Ci with a surrogate parameter based on CaBV waveform amplitudes and pulsatile micrometric skull waveforms (Skw) amplitudes. This noninvasive parameter was named Bcomp.</p><p><strong>Methods: </strong>Neurocritical patients undergoing ICP monitoring were evaluated using TCD and the skull micrometric deformation sensor (B4C). ICP waveform (from invasive ICP probes) and Skw (from noninvasive B4C) were analyzed to extract pulse amplitudes, whereas TCD provided cerebral blood velocities from the middle cerebral arteries for CaBV calculation. CSC was measured using the volume/pressure relationship, with CaBV amplitude serving as the volume surrogate, and ICP and B4C pulse amplitudes as surrogates for ICP values. Agreement and correlation analysis was calculated between Ci and Bcomp.</p><p><strong>Results: </strong>Data from 71 patients were analyzed, with 68% of the sample having suffered traumatic brain injury. Maximum CaBV was significantly delayed in patients with poor CSC (p < 0.001). Ci and Bcomp showed strong agreement and linear correlation (mean difference of - 0.28 and Spearman correlation of 0.88, p < 0.001).</p><p><strong>Conclusions: </strong>Using CaBV, which reflects changes in arterial blood volume during the cardiac cycle and Skw pulse amplitudes, Bcomp demonstrated high agreement and correlation with Ci, defined as the product of CaBV and ICP pulse amplitude. The observed shift in CaBV among patients with poor CSC suggests that this vascular marker is influenced by intracranial resistance. These findings are promising for the real-time, noninvasive assessment of CSC in clinical settings and warrant further research.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370890","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":"Development and External Validation of a Prediction Model for Early Postoperative Cerebral Infarction on Computed Tomography in Spontaneous Intracerebral Hemorrhage.","authors":"Kun Lin, Zhi-Yun Zhan, Yong-Xiu Tong, Zhi-Cheng Lin, Yin-Hai Tang, Yuan-Xiang Lin","doi":"10.1007/s12028-024-02193-x","DOIUrl":"https://doi.org/10.1007/s12028-024-02193-x","url":null,"abstract":"<p><strong>Background: </strong>Early postoperative cerebral infarction (ePCI) significantly worsens outcomes in patients with spontaneous intracerebral hemorrhage (ICH) undergoing surgery. This study aimed to develop and externally validate a nomogram to assess ePCI risk.</p><p><strong>Methods: </strong>Adult patients with spontaneous supratentorial ICH who underwent surgery between May 2015 and September 2022 at a large tertiary referral center (development cohort) and another tertiary referral center (external validation cohort) were retrospectively included. ePCI was defined as a newly identified permanent low-density lesion observed within 72 h of surgery on computed tomography. We developed a nomogram using predictors identified through least absolute shrinkage and selection operator analysis. The model's discrimination, calibration, and clinical utility were evaluated.</p><p><strong>Results: </strong>The development cohort (n = 453) had 51 ePCI cases, and the external validation cohort (n = 184) had 20. The model incorporated the Glasgow Coma Scale (GCS), the Original Intracerebral Hemorrhage Scale (oICH), uncal herniation stage, and hematoma volume, demonstrating strong discrimination with an area under the receiver operating characteristic curve (AUC) of 0.915 (95% confidence interval [CI] 0.882-0.948) in the development cohort and an AUC of 0.942 (95% CI 0.897-0.988) in the external independent cohort. The model also showed excellent calibration and clinical applicability.</p><p><strong>Conclusions: </strong>This nomogram, including the GCS, the oICH, uncal herniation stage, and hematoma volume, effectively predicts ePCI risk in patients with spontaneous supratentorial ICH.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370798","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":"Symptoms, Imaging Features, Treatment Decisions, and Outcomes of Patients with Top of the Basilar Artery Syndrome: Experiences from a Comprehensive Stroke Center.","authors":"Franziska Lieschke, Maximilian Rauch, Bastian Roller, Jan Hendrik Schaefer, Martin A Schaller-Paule","doi":"10.1007/s12028-025-02219-y","DOIUrl":"https://doi.org/10.1007/s12028-025-02219-y","url":null,"abstract":"<p><strong>Background: </strong>From visual, ocular, and pupillomotor abnormalities to qualitative and more importantly rapid quantitative disturbances of consciousness, top of the basilar artery syndrome (TOBS) represents a diagnostic challenge in neurocritical care. In this monocentric retrospective cross-sectional study, we will describe this particular patient group in detail and highlight its variability and the associated implications.</p><p><strong>Methods: </strong>Consecutive patients with radiologically confirmed TOBS presenting to our comprehensive stroke center were analyzed from 2010 to 2022. Baseline parameters at admission, including clinical symptoms, National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, and imaging parameters (mode and success of recanalization measured by the Thrombolysis in Cerebral Infarction [TICI] score, extent of infarct, and infarct localization), were assessed. Functional dependence at discharge was analyzed with the modified Rankin scale (mRS) and Barthel Index.</p><p><strong>Results: </strong>We assessed 96 eligible patients with a mean age of 70 (SD ± 14) years, 41.67% of whom were female. The median NIHSS score at admission was 19 (interquartile range [IQR] 8-35), and the median GCS score was 7 (IQR 3-15). Dysphagia was identified in 51.72% of patients, with a significant number discharged with nasogastric tubes. Most patients received both intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) (47%), whereas 32% received MT only, and 10% received no acute recanalizing therapy. Patients receiving both IVT and MT had higher frequencies of successful vessel revascularization (higher TICI scores) and better clinical outcomes compared to those receiving only MT (median mRS score 4 [IQR 2-5] vs. 5 [IQR 2-6], p = 0.046). Multivariable regression analysis confirmed that successful recanalization (TICI) and GCS score at admission were key predictors of functional outcomes.</p><p><strong>Conclusions: </strong>A large proportion of patients presenting with TOBS were severely affected by a significant reduction in vigilance, a condition that persists in the absence of recanalization and is then associated with a relevant dependency.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370799","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}