Neurocritical care
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Cardiac abnormalities seen in patients with subarachnoid hemorrhage (SAH) are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. In patients with SAH, myocardial injury evidenced by troponin elevation appears to predict short and long-term outcomes independently of other conventional risk. ⋯ The early resuscitation phase in SAH represents the greatest opportunity for impacting clinical outcome and is thus the most promising window of opportunity to demonstrate a benefit when investigating novel therapeutic strategies related to protection and modulation of cardiovascular function. Specific measures, such as the early use of beta-adrenergic antagonists, to prevent these cardiac abnormalities and ameliorate its impact on morbidity and mortality are yet to be established.
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Anticoagulation increases the risk of intracerebral hemorrhage (ICH), yet whether different underlying disease processes are equally affected is unknown. We tested the hypothesis that coagulopathy, measured by admission international normalized ratio (INR), disproportionately increases the risk for lobar hemorrhages. ⋯ Abnormal coagulation occurs disproportionally in lobar versus deep ICH, and is associated with larger ICH volumes and higher mortality. These findings suggest a unique risk interaction between coagulopathy and underlying brain pathology due to cerebral amyloid angiopathy.
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Comparative Study
Outcome of poor-grade subarachnoid hemorrhage as determined by biomarkers of glucose cerebral metabolism.
The aim of this study was to determine if the measurement of blood biomarkers of glucose cerebral metabolism, performed with retrograde jugular catheter, could predict the outcome of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients. ⋯ Our data provide additional support to the view that the MR is a reliable marker for predicting the outcome of poor-grade aSAH patients. Prospective studies are needed to confirm its value in multimodal monitoring.
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Comparative Study
Factors associated with favorable response to hyperbaric oxygen therapy among patients presenting with iatrogenic cerebral arterial gas embolism.
Iatrogenic cerebral arterial gas embolism (CAGE) is an uncommon but potentially a fatal condition. Hyperbaric oxygen (HBO2) therapy is the only definitive treatment for patients with CAGE presenting with acute neurologic deficits. ⋯ A high proportion of CAGE patients treated with HBO2 had favorable outcomes. Time-to-HBO2 ≤ 6 h increased the odds of favorable outcome, whereas the presence of infarct/edema on CT/MRI scan before HBO2 reduced the odds of a favorable outcome. Timely diagnosis and differentiation from thrombo-embolic ischemic events appears to be an important determinant of successful HBO2 treatment.
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The goal of this study is to determine the presence of platelet dysfunction in patients with traumatic brain injury (TBI). The mechanisms underlying the coagulopathy associated with TBI remain elusive. The question of platelet dysfunction in TBI is unclear. ⋯ These data indicate that early platelet dysfunction is prevalent after severe TBI, can be measured in a point-of-care setting using TEG/PM, and correlates with mortality. The mechanism responsible for this platelet dysfunction and associated implications for TBI management remains to be defined.