Neurocritical care
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Case Reports
Intra-arterial air thrombogenesis after cerebral air embolism complicating lower extremity sclerotherapy.
Cerebral arterial gas embolism is a potentially life-threatening event. Intraarterial air can occlude blood flow directly or cause thrombosis. Sclerotherapy is an extremely rare cause of cerebral arterial gas embolism. ⋯ We provide radiological evidence of hyperbaric oxygen therapy resolving intraarterial air but also demonstrate the thrombogenic potential of this procedural complication.
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Plateau waves often develop in neurointensive care patients. They are sudden increases in intracranial pressure (ICP) that lead to dramatic decreases of cerebral perfusion pressure (CPP) and can therefore contribute to ischemic secondary brain insult. The aim of this study was to analyze the occurrence of plateau waves in head injured patients requiring neurocritical care, their relation with cerebral autoregulation and impact on outcome. ⋯ Plateau waves are frequent phenomenon. They are not associated with worse outcome unless they lead to sustained intracranial hypertension.
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Symptomatic cerebral vasospasm (SCV) is a morbid sequela of subarachnoid hemorrhage (SAH). Its etiology is multifactorial and predicting onset can be challenging. Diabetes mellitus (DM) is known to affect vasoactive properties of vessels, but it has not been definitively correlated with SCV. We report that pre-existing DM is independently and strongly correlated with SCV, despite intensive glycemic control. ⋯ In this group of patients with SAH, diabetes mellitus is identified as a risk factor for development of SCV. Blood glucose management during hospitalization was similar in diabetics and non-diabetics, suggesting that the longstanding effects of microvascular disease may be more relevant in the development of SCV then acute glycemic control in these patients.
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Predicting extubation failure (EF) is one of the most challenging aspects of critical care medicine. The literature on EF in neurocritical care patients is very scarce. We sought to determine the ability of traditional weaning parameters to predict EF in neurocritical patients. ⋯ In this sample of neurocritical care patients undergoing extubation trial, traditional weaning parameters do not predict extubation failure.
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While tight glucose control has been widely adopted in the critical care setting, the optimal target glucose level following acute traumatic brain injury (TBI) remains debatable. This observational study was conducted to delineate the relationship between glucose levels and clinical outcomes during acute phase (first 5 days) of TBI. ⋯ Findings from our study suggest a glucose level > or =160 mg/dl within the first 24 h of admission following TBI is associated with poor outcomes irrespective of severity of injury, and this presents a timeframe for which active therapeutic interventions may improve clinical outcomes. Prospective efficacy trials are needed to corroborate these findings.