Neurocritical care
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The frequency and associations of spontaneous hyperventilation in subarachnoid hemorrhage (SAH) are unknown. Because hyperventilation decreases cerebral blood flow, it may exacerbate delayed cerebral ischemia (DCI) and worsen neurological outcome. ⋯ Spontaneous hyperventilation is common in SAH and is associated with DCI and poor neurological outcome.
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Leukocytosis is a reaction that is usually, but not always, associated with an infectious process. There is very little data on the significance of admission leukocytosis (AL) in patients with intracerebral hemorrhage (ICH). The purpose of this study was to investigate the associated clinical and radiologic findings and prognostic significance of AL in patients with ICH. ⋯ AL in ICH patients is often non-infectious, strongly associated with the presence of IVH, but not specifically an ominous indicator for outcome. Leukocyte count has an inverse relationship with GCS0. Prospective studies are needed to confirm these findings.
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Traumatic Brain Injury (TBI) was chosen as an Emergency Neurological Life Support topic due to its frequency, the impact of early intervention on outcomes for patients with TBI, and the need for an organized approach to the care of such patients within the emergency setting. This protocol was designed to enumerate the practice steps that should be considered within the first critical hour of neurological injury.
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We previously reported the presence of a cranial "bruit" in patients with cerebral vasospasm by signal processing cranial accelerometry signals time locked to the cardiac cycle. This shift to higher frequencies is likely related to the turbulence of blood flow produced by vascular narrowing. We sought to build a more quantitative model to predict cerebral vasospasm then test the accuracy of this technique to detect cerebral vasospasm in a prospective blinded study. ⋯ Highly sensitive skull accelerometry can detect cerebral vasospasm with clinically meaningful accuracy. This tool holds promise in the ICU environment to detect as well as reject cerebral vasospasm as the cause of neurological deficits in subarachnoid hemorrhage.
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There are many causes of acute myelopathy including multiple sclerosis, systemic disease (SD), and acute spinal cord compression (SCC). SCC should be among the first potential causes considered given the significant permanent loss of neurologic function commonly associated with SCC. ⋯ Bowel and bladder dysfunction and neck or back pain may also be part of the clinical presentation, but are not uniformly present. Because interventions are critically time-sensitive, the recognition and treatment of SCC was chosen as an ENLS protocol.