Neurocritical care
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Case Reports
Lysergic acid amide-induced posterior reversible encephalopathy syndrome with status epilepticus.
Posterior reversible encephalopathy syndrome (PRES) is known to occur in association with several substances. However, lysergic acid amide (LSA) is not among the previously reported causes of PRES. ⋯ LSA, a hallucinogenic agent chiefly used for recreational purposes, should be added to the list of causes of PRES.
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Mechanical ventilation in neurologically injured patients presents a number of unique challenges. Patients who are intubated due to a primary neurologic injury often experience respiratory phenomena secondary to that injury, including elevation of intracranial pressure (ICP) in response to mechanical ventilation and variations in respiratory patterns. ⋯ Balancing the need to maintain brain oxygenation and control of ICP can be complicated by the effects of ventilator management on ICP. We will examine the consequences of ventilator management as they relate to parameters that affect ICP and brain oxygenation in patients who have neurologic injury.
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Stroke Units improve the outcome in patients with mild to moderate severity strokes. We sought to examine the role that a full-time neurointensivist (NI) might play on the outcomes of patients with more severe strokes admitted to a Neurosciences Intensive Care Unit (NICU). ⋯ The direct patient care offered and the organizational changes implemented by a NI shortened the NICU and hospital LOS and improved the disposition of patients with strokes admitted to a NICU.
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Battle's sign is a classical clinical sign that has long been held to be synonymous with fracture of the basal skull. As such the presence of Battle's sign is a strong indicator that a basal skull fracture could be present in the head injured patient, as exemplified by its inclusion as a major risk factor in scoring systems designed to assess the likelihood of basal skull fracture. ⋯ We present a case that describes the occurrence of this classic clinical sign in an unlikely setting and, for the first time since it was described more than 120 years ago, re-examine the pathologic basis for its appearance.
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The vast majority of patients with intracerebral hemorrhage (ICH) are admitted to an intensive care unit (ICU). Patients admitted to ICUs have a high risk of developing nosocomial infections, while complicating infection appears to be associated with a longer ICU stay. An increased length of ICU stay translates directly into increased costs. The aim of this study was to assess the impact of a complicating infection on the length of ICU stay in patients with ICH. ⋯ Complicating infection was an independent predictor of a prolonged ICU stay in patients with ICH.