Neurocritical care
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Neuroendocrine changes have been reported after ischemic stroke, subarachnoid hemorrhage, and brain trauma. As there are no corresponding data in patients with intracerebral hemorrhage (ICH) we analyzed various neuroendocrine parameters to investigate possible alterations in hormone profiles of patients with ICH. ⋯ Overall, neuroendocrine changes in ICH patients are not as profound as reported for ischemic stroke or subarachnoid hemorrhage. The clinical significance of increased LH and FSH levels in small ICH is unclear, whereas elevation of prolactin in large ICH was anticipated. Future randomized controlled trials should also focus on neuroendocrine parameters to clarify the impact of possible hormonal alterations on functional outcome.
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Case Reports
Posterior reversible leukoencephalopathy syndrome presenting with global cerebral edema and herniation.
We report a case of global cerebral edema and herniation due to Posterior Reversible Leukoencephalopathy Syndrome (PRES). ⋯ Although PRES is typically considered to have a benign clinical course, clinician should be aware that severe cases can present with global cerebral edema and associated complications including intracranial hypertension and herniation.
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Case Reports
Anti-N-methyl-D-aspartate receptor encephalitis with favorable outcome despite prolonged status epilepticus.
To describe a case of auto-immune encephalitis in an adolescent with favorable outcome despite prolonged status epilepticus. ⋯ Auto-immune encephalitis is likely underdiagnosed in adolescents. In their most severe presentation, seizures may be resistant to a large number of anti-epileptic drugs, and the clinical improvement seems to be mainly because of the immunomodulatory therapy. Relapse is possible, as well as the delayed development of a teratoma or other tumor.
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Thiopental is a cornerstone in the treatment of refractory status epilepticus and intractable intracranial hypertension. In our center we observed that thiopental might cause falsely elevated serum sodium levels. ⋯ Thiopental treatment can result in falsely elevated serum sodium. This is a critical finding since high sodium levels preclude administrating mannitol or hypertonic saline for the treatment of elevated intracranial pressure. Moreover, a false high sodium level might lead to the inappropriate administration of hypotonic fluids potentially resulting in increased brain edema and even higher intracranial pressure. To our knowledge, this is the first paper describing this clinically relevant phenomenon.
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Physiotherapy plays an important role in the therapy of patients with acute cerebral diseases. Studies concerning the effects of physiotherapy on intracerebral pressure (ICP) and cerebral perfusion pressure (CPP) are, however, rare. ⋯ Physiotherapy with PROM can be used safely in patients with acute neurological diseases, even if ICP is elevated before therapy.