Neurocritical Care最新文献

{"title":"Response to Letter to the Editor on \"Effect of Ketamine Analgosedation on Neurological Outcome in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Pilot study\".","authors":"Sourav Burman, Charu Mahajan, Rajendra Singh Chouhan, Niraj Kumar","doi":"10.1007/s12028-025-02368-0","DOIUrl":"https://doi.org/10.1007/s12028-025-02368-0","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001029","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":"Neuropalliative Care in the Emergency Department: Three Roles, One Goal.","authors":"Kristopher A Hendershot, Kei Ouchi","doi":"10.1007/s12028-025-02361-7","DOIUrl":"10.1007/s12028-025-02361-7","url":null,"abstract":"<p><p>Over the last decade, there has been an increased focus on incorporating palliative care principles into the practice of neurocritical care and emergency medicine (EM). In this article, we describe three different roles that EM clinicians can fill as they initiate the provision of primary neuropalliative care to neurocritically ill patients: the stage setter, the spokesperson, and the screener. As the stage setter, EM clinicians start to build trust with the family by \"breaking bad news\"; encouraging them to consider the patient's values, preferences, functional baseline, and directives; and providing support to the family during this emotional time as they hand them over to the admitting team who will continue this conversation. As the spokesperson, EM clinicians are involved in early treatment decisions, including whether the patient is admitted to the acute care service or the intensive care unit or transferred to a tertiary care facility, with the goal of preventing both the overuse and underuse of life-sustaining treatment. Lastly, as the screener, EM clinicians have a role to ensure that patients with chronic neurological diseases and patients with a medical history that puts them at high-risk of developing a neurological emergency have goals-of-care conversations and have acceptable control of their daily symptom burden. Further investigation is needed before interventions targeting the practice of neuropalliative care in the emergency department can be developed.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001034","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":"Comment on \"KidsBrainIT: Visualization of the Impact of Cerebral Perfusion Pressure Insult Intensity and Duration on Childhood Brain Trauma Outcome\".","authors":"Muhammad Hasan, Muhammad Hammad Chola","doi":"10.1007/s12028-025-02343-9","DOIUrl":"https://doi.org/10.1007/s12028-025-02343-9","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992964","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":"Reply to Comments on \"KidsBrainIT: Visualization of the Impact of Cerebral Perfusion Pressure Insult Intensity and Duration on Childhood Brain Trauma Outcome\".","authors":"Bavo Kempen, Bart Depreitere, Ian Piper, Tsz-Yan Milly Lo","doi":"10.1007/s12028-025-02344-8","DOIUrl":"https://doi.org/10.1007/s12028-025-02344-8","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992916","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":"Neurocritical Care Society Abstracts from the 23rd Annual Meeting 2025.","authors":"","doi":"10.1007/s12028-025-02334-w","DOIUrl":"10.1007/s12028-025-02334-w","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"1-244"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030257","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":"SAHRANG: Subarachnoid Hemorrhage Recovery and Galantamine: A Pilot Multicenter Randomized Placebo-Controlled Trial.","authors":"Bosco Seong Kyu Yang, Jude P J Savarraj, Elena Moreno, Kevin E Immanuel, Georgene Hergenroeder, Glenda Torres, Jung Hwan Kim, Sophie Samuel, Claudia Pedroza, James C Grotta, Andrew Barreto, H Alex Choi","doi":"10.1007/s12028-025-02349-3","DOIUrl":"10.1007/s12028-025-02349-3","url":null,"abstract":"<p><strong>Background: </strong>Subarachnoid hemorrhage (SAH) causes life-long neurologic dysfunction. Peripheral inflammatory processes as a reaction to brain injury have been shown to worsen outcomes after SAH. Galantamine has been shown to reduce proinflammatory microglial activities and improve synaptic connections. We hypothesize that galantamine treatment after SAH mitigates inflammation-mediated neuronal injury and improve outcomes. We conducted a pilot clinical trial to examine the tolerability and safety of galantamine in patients with SAH.</p><p><strong>Methods: </strong>This prospective, multicenter, double-masked, randomized, placebo-controlled study contiguously screened and enrolled adult patients presenting with aneurysmal SAH with a Fisher grade of 3 within 72 h of symptom onset. A total of 60 patients were enrolled with a 1:1 ratio to two treatment arms. The first 30 patients were randomly assigned to receive galantamine at 8 mg every 12 h or a placebo, and the other 30 patients to were randomly assigned to receive either galantamine at 12 mg every 12 h or a placebo. All medications were started within 36 h after securing the aneurysm and continued for 90 days. Primary outcomes-tolerability as assessed by the number of patients who stop study medication due to adverse events associated with the study drug and mortality due to the study drug-were assessed at 90 days.</p><p><strong>Results: </strong>There were no differences in tolerability and safety between the two groups. Bradycardia was the most common adverse event (37%), followed by clinical seizure (3%) and skin rash (3%). One study participant in the galantamine group discontinued medication due to a skin rash, and another study participant from the placebo group discontinued due to nausea (p = 0.92). Mortality did not differ between the two groups. At 90 days, one study participant from the galantamine group and four study participants from the placebo group died (p = 0.34).</p><p><strong>Conclusions: </strong>Galantamine was as tolerable and safe as a placebo based on discontinuation rates and mortality in patients with SAH when administered to patients with SAH during the early and subacute stages of the disease.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144961657","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 Etiology Analysis of Myasthenia Gravis with In-Hospital Mortality in the Neurocritical Care Unit.","authors":"Hongxi Chen, Yuan Wang, Nana Zhang, Jie Song, Xue Lin, Chong Yan, Xiao Huan, Ziyan Shi, Xiaofei Wang, Ying Zhang, Qin Du, Lingyao Kong, Dongren Sun, Rui Wang, Ziya Wang, Yangyang Zhang, Jianying Xi, Chongbo Zhao, Hongyu Zhou, Sushan Luo","doi":"10.1007/s12028-025-02352-8","DOIUrl":"https://doi.org/10.1007/s12028-025-02352-8","url":null,"abstract":"<p><strong>Background: </strong>Our objective was to investigate the characteristics and causes of death in deceased patients with myasthenia gravis (MG).</p><p><strong>Methods: </strong>This study conducted a retrospective analysis of data from patients with MG in the neurocritical unit at two large general hospitals in China spanning 10 years, from January 2014 to December 2023. Detailed demographic and clinical information were collected for deceased patients. Experienced physicians determined both the underlying and direct causes of death.</p><p><strong>Results: </strong>Among 3723 patients, the overall hospitalized mortality was 79 (2.12%). Thymoma was present in 52 (65.82%) of these patients. Compared with the nonthymomatous MG (NTMG) group (n = 27), patients with thymomatous MG (TMG) (n = 52) were significantly younger at death (53.71 ± 14.01 years vs. 65.37 ± 14.61 years, p = 0.001). Septic shock was the most common underlying cause of death, affecting 32 (40.51%) patients, followed by myasthenic crisis in 18 (22.78%) patients. This trend was observed in both the TMG and NTMG groups. In the TMG group, fulminant myocarditis was the third leading underlying cause of death in 9 (17.31%) patients, whereas no cases of fulminant myocarditis were reported in the NTMG group. Among all deceased patients (n = 79), pneumonia was the most common infection, affecting 55 (69.62%) patients, followed by urinary tract infections in 14 (17.72%) patients, bloodstream infections in 13 (16.46%) patients, and intracranial infections in 7 (8.86%) patients.</p><p><strong>Conclusions: </strong>The study suggests that thymoma may increase the risk of death, with septic shock and myasthenic crisis being the most frequent underlying causes in patients with MG.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962340","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 Applications of Point-of-Care and Diagnostic Transcranial Doppler in the Pediatric Acute Care Setting: A Scoping Review.","authors":"Virginie Plante, Nicole O'Brien, Simon MacDonald, Laurence Tabone, Camille Jutras, Eric Dornoff, Catherine Boulet, Kerri LaRovere","doi":"10.1007/s12028-025-02341-x","DOIUrl":"https://doi.org/10.1007/s12028-025-02341-x","url":null,"abstract":"<p><p>Transcranial Doppler (TCD) is increasingly used in pediatric acute care with emerging point-of-care ultrasound (POCUS) applications. However, no standardized definition distinguishes POCUS TCD from diagnostic/consultative TCD. This scoping review aims to (1) examine how the terminology \"POCUS TCD\" is used in pediatric literature, (2) describe physiologic indications driving TCD use in pediatric acute care settings, and (3) compare contexts of performance and operational characteristics across these indications. A comprehensive scoping review was conducted following published guidelines. Databases were searched from inception to June 2024 for studies addressing TCD use in children (≤ 18 years) in emergency departments, inpatient services, or intensive care units. Full-text eligibility and data extraction were performed in duplicate by independent reviewers. Of 4,066 screened studies, 660 full texts were assessed, and 307 studies met eligibility criteria (258 original studies and 49 reviews, guidelines, or surveys). The term \"POCUS TCD\" was mentioned in only 3% of original studies and 26% of included reviews and guidelines, which were mostly published after 2018. Eleven physiologic indications for TCD use were identified, and specific subtypes of context of use emerged. TCD operational characteristics varied widely and were often incompletely reported. However, notable differences were observed across physiologic indications, particularly in TCD extent, operator type, and use of point-of-care machines. The terminology \"POCUS TCD\" is infrequently used in current pediatric research, and most studies do not specify the type of TCD performed or intended. Significant differences in the context of performance and operational characteristics across physiologic indications suggest the coexistence of distinct forms of TCD in current clinical practice despite the lack of explicit distinction between POCUS and diagnostic/consultative TCD. Standardizing terminology and improving reporting of operational contexts in future research will be essential to support safe and effective clinical integration of TCD in pediatric critical care.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962532","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":"Transfusion in Surgical SAH: Between Guidelines, New Evidence, and Physiology.","authors":"Cyril Pernod, Hilaire de Malleray, Philippe Goutorbe","doi":"10.1007/s12028-025-02346-6","DOIUrl":"https://doi.org/10.1007/s12028-025-02346-6","url":null,"abstract":"","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962322","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":"Impact of Nimodipine-Induced Blood Pressure Reductions on Cerebral Autoregulation and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage.","authors":"Kaitlyn A Stoehr, David Bartolome, Sithmi Jayasundara, Pwint Thinzar, David Vargas, Jennifer Kim, Jessica Magid-Bernstein, Lena M O'Keefe, Adam de Havenon, Ryan Hebert, Charles Matouk, Kevin N Sheth, Emily J Gilmore, Santiago Ortega-Gutierrez, Nils H Petersen","doi":"10.1007/s12028-025-02338-6","DOIUrl":"https://doi.org/10.1007/s12028-025-02338-6","url":null,"abstract":"<p><strong>Background: </strong>Impairment of cerebral autoregulation following aneurysmal subarachnoid hemorrhage (aSAH) increases susceptibility to secondary injury from blood pressure (BP) fluctuations. Although nimodipine is recommended to improve neurological outcomes, it is frequently associated with BP reduction. In this observational cohort study, we examined the effect of nimodipine-induced BP reductions that exceed autoregulatory capacity on functional outcome following aSAH.</p><p><strong>Methods: </strong>Autoregulatory function was measured continuously following aneurysm securement by correlating near-infrared spectroscopy-derived regional oxygen saturation with mean arterial pressure (MAP). The resulting autoregulatory index was used to derive the lower and upper limits of autoregulation (LLA and ULA). Physiologic parameters were compared between the hour before and the hour after nimodipine administration using linear mixed-effects models. Ordinal regression was used to assess the relationship between time with MAP below the LLA and functional outcome, as measured by the modified Rankin scale at 90 days post discharge.</p><p><strong>Results: </strong>Analysis included 682 nimodipine administrations among 31 patients with moderate to severe aSAH (mean age 57 ± 14 years, 71% female, median Hunt & Hess score 4 [interquartile range (IQR) 2-4], modified Fisher grade 4 [IQR 3-4], monitoring time 5.5 ± 4.7 days). Following nimodipine, MAP decreased from a mean ± SEM of 105.9 ± 0.7 to 100.1 ± 0.7 mm Hg (p < 0.001), resulting in increased time below the LLA from a mean ± SEM of 5.3 ± 0.5 to 13.9 ± 0.7 min (p < 0.001). Mean time below the LLA was significantly associated with worse functional outcome at 90 days (odds ratio for 10-min increase 3.6, 95% confidence interval 1.6-8.0, p = 0.0015). This association remained significant after adjusting separately for age, Hunt & Hess score, modified Fisher grade, delayed cerebral ischemia, and the magnitude of BP response to nimodipine.</p><p><strong>Conclusions: </strong>Nimodipine-induced BP reductions below personalized limits of autoregulation may be associated with worse functional outcome after aSAH. Further prospective studies are warranted to explore how autoregulatory sensitivity to nimodipine can be used to identify vulnerable patients and maximize benefits from current clinical interventions.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962564","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}