Neurohospitalist最新文献_第10页

Superficial Cerebellar Siderosis and Spontaneous Intracranial Hypotension Secondary to Dural Tear. 硬脑膜撕裂继发的小脑浅侧积和自发性颅内低血压。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-28 DOI: 10.1177/19418744231179346

Priscilla Nethala, Sandhya Gh, Sumanth Shivaram

引用次数: 0

Bilateral and Symmetrical Basal Ganglia Calcifications May Aid in Mitochondrial Disease Diagnosis in Resource-Limited Settings. 在资源有限的情况下，双侧和对称基底神经节钙化可能有助于线粒体疾病的诊断。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-06-01 DOI: 10.1177/19418744231173831

Amado Jiménez-Ruiz, Victor Aguilar-Fuentes, Fátima Gabriela Macías-Ortíz, José Luis Ruiz-Sandoval

引用次数: 0

Multidisciplinary Approach to Sedation and Early Mobility of Intubated Critically Ill Neurologic Patients Improves Mobility at Discharge. 插管危重神经系统患者镇静和早期活动的多学科方法改善出院时的活动能力。

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-06-21 DOI: 10.1177/19418744231182897

Megan E Barra, Christine Iracheta, Joseph Tolland, Johnathan Jehle, Ljubica Minova, Karen Li, Mary Amatangelo, Patricia Krause, Ayush Batra, Henrikas Vaitkevicius

{"title":"Multidisciplinary Approach to Sedation and Early Mobility of Intubated Critically Ill Neurologic Patients Improves Mobility at Discharge.","authors":"Megan E Barra, Christine Iracheta, Joseph Tolland, Johnathan Jehle, Ljubica Minova, Karen Li, Mary Amatangelo, Patricia Krause, Ayush Batra, Henrikas Vaitkevicius","doi":"10.1177/19418744231182897","DOIUrl":"10.1177/19418744231182897","url":null,"abstract":"Background and purpose: Over-sedation may confound neurologic assessment in critically ill neurologic patients and prolong duration of mechanical ventilation (MV). Decreased sedative use may facilitate early functional independence when combined with early mobility. The objective of this study was to evaluate the impact of a stepwise, multidisciplinary analgesia-first sedation pathway and early mobility protocol on medication use and mobility in the neuroscience intensive care unit (ICU).Methods: We performed a single-center prospective cohort study with adult patients admitted to a neuroscience ICU between March and June 2016-2018 who required MV for greater than 48 hours. Patients were included from three separate phases of the study: Phase I - historical controls (2016); Phase II - analgesia-first pathway (2017); Phase III - early mobility protocol (2018). Primary outcomes included propofol requirements during MV, total rehabilitation therapy provided, and functional mobility during ICU admission.Results: 156 patients were included in the analysis. Decreasing propofol exposure was observed during Phase I, II, and III (median 2243.7 mg/day vs 2065.6 mg/day vs 1360.8 mg/day, respectively; P = .04 between Phase I and III). Early mobility was provided in 59.7%, 40%, and 81.6% of patients while admitted to the ICU in Phase I, II, and III, respectively (P < .01). An increased proportion of patients in Phase III were walking or ambulating at ICU discharge (26.7%; 8/30) compared to Phase I (7.9%, 3/38, P = .05).Conclusions: An interdisciplinary approach with an analgesia-first sedation pathway with early mobility protocol was associated with less sedative use, increased rehabilitation therapy, and improved functional mobility status at ICU discharge.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"351-360"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10232152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Continuous EEG Characteristics in Critically ill Patients Presenting With Seizures Prior to Death From Cardiac Arrest. 心脏骤停死亡前出现癫痫发作的危重病人的连续脑电图特征

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Neurohospitalist Pub Date : 2023-10-01 Epub Date: 2023-05-12 DOI: 10.1177/19418744231174950

Tian Wang, Venkatesh K Raman, Gholam K Motamedi

{"title":"Continuous EEG Characteristics in Critically ill Patients Presenting With Seizures Prior to Death From Cardiac Arrest.","authors":"Tian Wang, Venkatesh K Raman, Gholam K Motamedi","doi":"10.1177/19418744231174950","DOIUrl":"10.1177/19418744231174950","url":null,"abstract":"Background: There have been limited reports about brain activity during cardiac arrest. Here we report 4 patients presenting with seizure who had cardiac arrest leading to their deaths while being on continuous video-EEG (cVEEG) monitoring and one-lead cardiac telemetry. Purpose: We illustrate characteristic stepwise EEG and EKG changes in these critically ill patients prior to their death. Research Design/Study Sample: All patients showed progressive broad spectrum of cardiac arrhythmias at or before the beginning of EEG suppression while there were no such changes seen in a control group of 4 randomly selected patients without cardiac arrest who had seizure on presentation and underwent cVEEG monitoring. Data Collection and Results: There was a progressive decline in EEG potentials associated with decreasing heart rate starting from the posterior region, more pronounced on the left, progressing to complete unilateral deactivation of the left fronto-central head regions while the right-sided networks became hyperactive before bilateral deactivation by the time of asystole. Conclusions: This case series provides a rare opportunity to compare EEG and EKG changes in patients who died while being on continuous EEG and EKG monitoring from hours to minutes prior to cardiac arrest and death.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 4","pages":"371-375"},"PeriodicalIF":0.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10494811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Malpractice Lawsuits Relating to Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review. 与急性缺血性脑卒中机械取栓术有关的渎职诉讼：系统回顾。

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Neurohospitalist Pub Date : 2023-07-01 Epub Date: 2023-04-27 DOI: 10.1177/19418744231170961

Kasim Qureshi, Muhammad U Farooq, Philip B Gorelick

{"title":"Malpractice Lawsuits Relating to Mechanical Thrombectomy for Acute Ischemic Stroke: A Systematic Review.","authors":"Kasim Qureshi, Muhammad U Farooq, Philip B Gorelick","doi":"10.1177/19418744231170961","DOIUrl":"10.1177/19418744231170961","url":null,"abstract":"Background and purpose: Medical-legal claims for malpractice relating to the use of alteplase for acute ischemic stroke (AIS) are usually for failure to treat rather than for complications. The advent of mechanical thrombectomy (MT) as a standard of AIS treatment has added a new dimension to the medical-legal landscape as there is a need for the delivery of a higher level of care creating the potential for delays and errors associated with such treatment. Information on causes of malpractice related to mechanical thrombectomy (MT) is currently lacking.Methods: We conducted a systematic review of legal databases (Westlaw, LexisNexis, Google Scholar Case Law, and VerdictSearch) to identify medical malpractice cases with and without verdicts filed in the United States up to March 31, 2021 which pertained to performance or non-performance of MT for AIS. We collected various case characteristics, case outcomes, and root causes for malpractice claims.Results: We found 25 cases, 16 of which alleged failure to treat with MT, 8 for harm due to delay in treatment and 1 case that alleged complications. Root causes included delay in vascular imaging, communication breakdowns, and transportation delays. Eight cases had an outcome in favor of the defendant, 9 in favor of the plaintiff, and 8 remained to be determined.Conclusions: As with alteplase, malpractice allegations regarding MT for AIS are largely for failure to treat or delay in treatment as opposed to complications. Addressing root causes of diagnostic delay, communication breakdowns, and transportation delays may reduce subsequent malpractice risk.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 3","pages":"228-235"},"PeriodicalIF":0.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10300892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Chimeric Antigen Receptor-T Cell Mediated Bilateral Facial Nerve Palsy: A Case Report. 嵌合抗原受体- t细胞介导的双侧面神经麻痹1例报告。

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Neurohospitalist Pub Date : 2023-07-01 DOI: 10.1177/19418744231167290

Natalya Patrick, Nizar Bahlis, Steven Peters

{"title":"Chimeric Antigen Receptor-T Cell Mediated Bilateral Facial Nerve Palsy: A Case Report.","authors":"Natalya Patrick, Nizar Bahlis, Steven Peters","doi":"10.1177/19418744231167290","DOIUrl":"https://doi.org/10.1177/19418744231167290","url":null,"abstract":"Chimeric antigen receptor (CAR-T) cell therapy is highly effective against hematological cancers but is associated with immune mediated side effects, including neurotoxicity. The most commonly described presentations of immune cell mediated neurotoxicity syndrome (ICANS) include cortical symptoms and generally localize to the central nervous system. In this report, we present a patient with acute onset of bilateral facial nerve palsy following CAR-T cell therapy, followed by a complete clinical recovery. Aside from a temporary anisocoria, he had no other neurologic symptoms and no encephalopathy or seizures. MRI Brain was non-contributory and cerebrospinal fluid revealed a modest increase in lymphocytes without systemic leukocytosis and viral studies were all negative. He was diagnosed with bilateral facial nerve palsy secondary to CAR-T cell therapy and subsequently treated with a course of steroids. Several weeks after presentation he returned to his neurological baseline. The presentation of CAR-T cell mediated facial nerve palsy is both clinically and scientifically relevant for physicians, patients, and researchers.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 3","pages":"308-311"},"PeriodicalIF":1.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/1c/10.1177_19418744231167290.PMC10334052.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10304134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Concordance Between Active Partial Thromboplastin Time and Anti-Factor Xa Assays in Neurocritically Ill Patients Receiving Subcutaneous Heparin Prophylaxis. 接受皮下注射肝素预防治疗的神经重症患者的活性部分凝血活酶时间与抗因子 Xa 检测之间的一致性。

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Neurohospitalist Pub Date : 2023-07-01 Epub Date: 2023-04-23 DOI: 10.1177/19418744231159917

Grace Shinn, Karen Berger, David Roh, Kevin Doyle, Amelia K Boehme, Edward Sander Connolly, Soojin Park, Sachin Agarwal, Jan Claassen, Caroline Der-Nigoghossian

{"title":"Concordance Between Active Partial Thromboplastin Time and Anti-Factor Xa Assays in Neurocritically Ill Patients Receiving Subcutaneous Heparin Prophylaxis.","authors":"Grace Shinn, Karen Berger, David Roh, Kevin Doyle, Amelia K Boehme, Edward Sander Connolly, Soojin Park, Sachin Agarwal, Jan Claassen, Caroline Der-Nigoghossian","doi":"10.1177/19418744231159917","DOIUrl":"10.1177/19418744231159917","url":null,"abstract":"Background: Laboratory monitoring is not recommended when subcutaneous unfractionated heparin (SQ-UFH) is administered at prophylactic doses. However, aPTT prolongation and associated hemorrhage has been reported in the neurocritically ill. At our institution, Neuroscience Intensive Care Unit (Neuro-ICU) patients with prolonged aPTT are further evaluated with a follow up aPTT and anti-factor Xa.Purpose: The purpose of this study was to describe concordance between aPTT and anti-factor Xa in neurocritically ill patients receiving prophylactic SQ-UFH with evidence of aPTT prolongation.Methods: A retrospective chart review of adult patients admitted to the Neuro-ICU from June 2017 to June 2019 was performed. Patients were included if they received SQ-UFH with aPTT levels and at least one anti-factor Xa level drawn within one hour of each other. Concordance between paired aPTT and anti-factor Xa was evaluated using Cohen's weighted kappa.Results: Forty two patients with 56 paired aPTT and anti-factor Xa levels were included. The most prescribed SQ-UFH regimen was 5000 units every 8 hours (60.7%) and anti-factor Xa levels were drawn a median (IQR) of 5.7 (3.1-10.7) hours after the SQ-UFH dose. Only 16 (28.6%) pairs were in concordance. The analysis showed a weighted kappa of .09; 95% CI [-.05 to .22] indicating poor agreement.Conclusions: In neurocritically ill patients receiving prophylactic SQ-UFH with aPTT prolongation, there was poor concordance between aPTT and anti-factor Xa. This suggests that aPTT prolongation may not be solely driven by heparin activity and further evaluation of mechanistic drivers for coagulopathy in this population is necessary.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 3","pages":"221-227"},"PeriodicalIF":0.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10292741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Stroke and Disseminated Intravascular Coagulation in a Patient With Metastatic Prostate Cancer. 转移性前列腺癌患者的中风和弥散性血管内凝血。

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Neurohospitalist Pub Date : 2023-07-01 DOI: 10.1177/19418744231172622

Jonah P Zuflacht, Joshua M Levine

引用次数: 0

Bupropion-Induced Myoclonus: Case Report and Review of the Literature. 安非他酮诱发的肌阵挛：病例报告和文献综述。

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Neurohospitalist Pub Date : 2023-07-01 Epub Date: 2023-04-25 DOI: 10.1177/19418744231173283

Asad Riaz, Hossam Tharwat Ali, Abdulrahman Allahham, Ana Leticia Fornari Caprara, Jamir Pitton Rissardo

{"title":"Bupropion-Induced Myoclonus: Case Report and Review of the Literature.","authors":"Asad Riaz, Hossam Tharwat Ali, Abdulrahman Allahham, Ana Leticia Fornari Caprara, Jamir Pitton Rissardo","doi":"10.1177/19418744231173283","DOIUrl":"10.1177/19418744231173283","url":null,"abstract":"Bupropion is an atypical antidepressant agent approved for treating major depressive disorders and prescribed for smoking cessation, attention deficit hyperactive disorder (ADHD), and sexual dysfunction. In a few cases, bupropion was associated with myoclonus. We present a case of a 58-year-old male, a heavy smoker seeking smoking cessation, was prescribed bupropion 150 mg twice daily. The subject doubled the dosage without medical advice. After 3 days of the increased dosage, he started to experience abnormal movements in his upper limbs associated with diffuse facial twitching. Neuroimaging, electrodiagnostic studies, and laboratory exams were unremarkable. Bupropion was discontinued, and clonazepam was initiated. The subject fully recovered within 24 hours. To the authors' knowledge, only 8 cases of bupropion-induced myoclonus were reported in the literature. Bupropion discontinuation was the most common management. All individuals except 2 cases fully recovered after bupropion withdrawal. The mechanism of bupropion is probably associated with the serotoninergic pathway.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 3","pages":"297-302"},"PeriodicalIF":0.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10302228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thrombectomy for Anterior Circulation Stroke in a Witnessed Late Time Window Versus Early Time Window. 见证晚期时间窗与早期时间窗的前循环卒中血栓切除术

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Neurohospitalist Pub Date : 2023-07-01 Epub Date: 2023-05-15 DOI: 10.1177/19418744231159457

Luís H de Castro-Afonso, Vitor R Fornazari, João P Machado, Guilherme S Nakiri, Thiago G Abud, Lucas M Monsignore, Octávio M Pontes-Neto, Daniel G Abud

{"title":"Thrombectomy for Anterior Circulation Stroke in a Witnessed Late Time Window Versus Early Time Window.","authors":"Luís H de Castro-Afonso, Vitor R Fornazari, João P Machado, Guilherme S Nakiri, Thiago G Abud, Lucas M Monsignore, Octávio M Pontes-Neto, Daniel G Abud","doi":"10.1177/19418744231159457","DOIUrl":"10.1177/19418744231159457","url":null,"abstract":"Introduction: Thrombectomy is the standard treatment for anterior circulation stroke due to large vessel occlusions in a late time window (6 to 24 hours) for patients selected based on perfusion imaging. Most patients treated in late time window studies presented as unwitnessed or wake-up strokes. Whether patients presenting with unwitnessed stroke have an actual time window greater than 6 hours is unclear. The aim of this study was to assess the outcomes of thrombectomy in the treatment of patients presenting with anterior circulation large vessel stroke in an actual late time window of more than 6 hours.Methods: This single-center registry of thrombectomy in the treatment of stroke caused by anterior circulation large vessel occlusions (LVOs) included 430 patients treated between 2011 and 2019. Patients were divided into 2 groups: an early time window (≤ 6 hours) group and a late time window group (> 6 hours).Results: Outcomes of the early and the late time window groups, respectively, were recanalization of 86.8% vs 82.7% (P = .29), symptomatic intracranial hemorrhage of 8.2% vs 5.7% (P = .40), good clinical outcome of 45.4% vs 41.3% (P = .46), and mortality of 20.2% vs 25% (P = .30) at 3 months.Conclusions: Thrombectomy for anterior circulation large vessel occlusions after 6 hours of symptoms onset seems to be as safe and effective as the standard thrombectomy within 6 hours from symptoms onset, even without perfusion analysis. Randomized trials are needed to confirm these findings.","PeriodicalId":46355,"journal":{"name":"Neurohospitalist","volume":"13 3","pages":"243-249"},"PeriodicalIF":0.9,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10334053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10292738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0