Neurocritical care
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Editorial Comment
The life-saving properties of blood: mitigating cerebral insult after traumatic brain injury.
Transfusion of packed red blood cells in critically injured patients has been a lifesaving (although not completely benign) intervention for decades. The traumatically injured brain has been thought to be particularly susceptible to injury from anemia, due to the well-documented association of worsening mortality and functional outcome in the presence of hypotension and hypoxia, as well as the known vulnerability of many neuronal populations to ischemia. ⋯ Although many practitioners have commonly utilized hemoglobin (Hgb) or hematocrit thresholds for transfusion in these patients, the rationale for this practice has largely been centered on older studies in general critical care populations and animal evidence. Furthermore, in addition to an ideal " target " Hgb, many other questions remain about this clinical practice, such as the optimal duration of maintaining a specific Hgb level, and the ultimate effects of transfusion on neurological and functional outcome.
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Case Reports
Posterior reversible encephalopathy syndrome caused by hypertensive encephalopathy and acute uremia.
The posterior reversible encephalopathy syndrome (PRES) is a recently proposed cliniconeuroradiological entity. The most common causes of PRES are hypertensive encephalopathy, eclampsia, cyclosporin A neurotoxicity, and the uremic encephalopathy. On magnetic resonance imaging (MRI) studies, edema has been reported in a relatively symmetrical pattern, typically in the subcortical white matter and occasionally in the cortex of the posterior circulation area of the cerebrum. ⋯ Particular attention needs to be given to PRES because initiation of appropriate intervention can reverse the encephalopathic condition in most cases. Cerebral lesions may be more prominent in the anterior circulation area in some patients.
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Case Reports
Anesthetic management of the pregnant patient for endovascular coiling of an unruptured intracranial aneurysm.
Diagnosis of an intracranial aneurysm during pregnancy is a rare event requiring multidisciplinary care for successful management. The knowledge base for the anesthesiologist involves principles of both obstetric and neuroanesthesia, as well as critical care. This article reports such a case and discusses the relevant pathophysiology, along with details of the perioperative management by the anesthesiology team.