Neurocritical care
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Numerous scoring scales have been proposed and validated to evaluate coma for rapid pre-hospital assessment and triage, disease severity, and prognosis for morbidity and mortality. These scoring systems have been predicated on core features that serve as a basis for this review and include ease of use, inter-rater reliability, reproducibility, and predictive value. Here we review the benefits and limitations of the most popular coma scoring systems. ⋯ The best known and widely accepted scale is the Glasgow Coma Scale (GCS). The Reaction Level Scale (RLS85) has utility and proven benefit, but little acceptance outside of Scandinavia. The newer Full Outline of UnResponsiveness (FOUR) score provides an attractive replacement for all patients with fluctuating levels of consciousness and is gradually gaining wide acceptance.
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Clinical Trial
Continuous and intermittent CSF diversion after subarachnoid hemorrhage: a pilot study.
We examine two accepted methods of managing cerebrospinal fluid (CSF) drainage in patients following subarachnoid hemorrhage (SAH). The first is intermittent CSF drainage when intracranial pressure (ICP) reaches a pre-defined threshold (monitor-first) and the second is continuous CSF drainage (drain-first) at set pressure thresholds. This pilot study is designed to determine if there is a cause for a randomized study of comparing the two methods. ⋯ This pilot study was neither powered, nor expected to detect a difference between groups. The results of this study provide support for the design and conduct of a randomized study to assess the impact of two methods of CSF diversion for patients with SAH.
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Diffuse cerebral vasospasm after brain tumor resection is rare. This is the first report of diffuse cerebral vasospasm following resection of a posterior fossa ependymoma. Various etiologies as to the cause of vasospasm after brain tumor resection have been described. A review of the current literature and pathophysiology is discussed. ⋯ Neurologic deterioration in the post-operative period following tumor resection, unexplained by other causes, should raise the concern for possible cerebral vasospasm. Vasospasm in these cases can be diffuse. Early recognition and prompt treatment using both hemodynamic augmentation and endovascular techniques can significantly improve patient outcome.
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Comparative Study
Gender influences cerebral oxygenation after red blood cell transfusion in patients with severe traumatic brain injury.
Important differences with respect to gender exist in the prognosis and mortality of traumatic brain injury (TBI) patients. The objective of this study was to assess the role of gender as an independent factor in cerebral oxygenation variations following red blood cell transfusion (RBCT). ⋯ Our results suggest that the effect of RBCT on cerebral oxygenation, as measured by PbrO(2), is greater in women than in men.
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Clinical Trial
Lower head of the bed position does not change blood flow velocity in subarachnoid hemorrhage.
Transcranial Doppler (TCD) is commonly used to monitor for vasospasm in patients with aneurysmal subarachnoid hemorrhage (aSAH). Changes in head of the bed (HOB) positions alter blood flow velocities measured by TCD in patients with ischemic stroke. However, the effects of HOB position on the velocities of the cerebral blood flow have not been studied in aSAH patients. ⋯ HOB position did not significantly affect MFV in our patients with aSAH.