Neurocritical care
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This historical vignette revisits the main contributions by Nils Lundberg, a neurosurgeon, that were published in the late 1950s and early 1960s. The Lundberg studies also definitively established that symptoms of abnormal brainstem function resulted from abnormal intracranial pressure (ICP), and moreover, even variations in ICP could produce clinical symptoms. The most innovative result of continuous monitoring was the discovery of plateau-shaped waves that produced paradoxical symptoms previously designated as "decerebrate" and "tonic fits" or "acute coning."
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Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). ⋯ We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.
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Early hematoma expansion in intracerebral hemorrhage (ICH) patients is associated with poor outcome. We aimed to investigate whether the minimal computed tomography (CT) attenuation value predicted hematoma expansion and poor outcome. ⋯ The minimal CT attenuation value independently predicts early hematoma expansion and poor outcome in patients with ICH.