Neurocritical care
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To determine the impact of physiologic doses of hydrocortisone on neurologic outcome after traumatic brain injury (TBI). ⋯ Adrenal insufficiency is frequent after TBI, and hydrocortisone replacement therapy seems to be associated with a favorable neurologic outcome.
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The characteristics of patients with anticoagulant-associated intracerebral hemorrhage (AAICH) have not been well characterized in a population-based setting. ⋯ AAICH preferentially affects the cerebellum. Despite its association with amyloid angiopathy, lobar ICH was no more likely to be anticoagulant-associated than deep cerebral ICH. The excess mortality among AAICH patients accrues within one day of hemorrhage. Patients with AAICH have a high burden of vascular risk factors. New treatments for AAICH with prothrombotic potential should be evaluated in randomized controlled trials before routine use.
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Little information is available on the efficacy of aggressive treatment such as surgery in improving the outcome of severely affected patients after supratentorial intracerebral hemorrhage (ICH). Our objective was to assess the effect of hematoma removal and ventricular drainage on the mortality of patients with severe primary supratentorial ICH. ⋯ Hematoma removal may reduce the mortality rate of patients with severe supratentorial ICH.
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To evaluate the impact of specialized neurocritical care on the population admitted to a neurovascular center and on the outcome of patients with severe aneurysmal subarachnoid hemorrhage (aSAH). ⋯ The availability of extended specialized neurocritical care seems to induce a change within the patient population towards a higher severity grade. Patients with highgrade aSAH might benefit most from highly specialized neurocritical care treatment.
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Effective treatment for severe ischemic stroke continues to be largely an unmet medical need. Using a nonvascular (paravascular cerebrospinal fluid) pathway to provide oxygen and nutrients to ischemic tissues may be a means of treating this disease. The primary objective of this study was to evaluate the safety and technical feasibility of ventriculo-lumbar perfusion with the oxygenated fluorocarbon nutrient emulsion (OFNE) perfusion system in the treatment of patients with severe hemispheric cerebral ischemia. ⋯ It is technically feasible and safe to establish a ventriculo-lumbar perfusion pathway using a specially designed lumbar drainage catheter and to control intracranial pressure while perfusing large volumes of OFNE.