Neurocritical care
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Socioeconomic status affects outcomes in cerebrovascular disease, although its role in the withdrawal of life-sustaining treatments (WLST) remains uncertain. We aim to examine the impact of socioeconomic factors on outcomes including WLST in aneurysmal subarachnoid hemorrhage (aSAH). ⋯ Higher EIS and residing in areas with higher neighborhood incomes were associated with higher odds of WLST in aSAH. Further multicenter studies are needed to investigate the underlying mechanisms that contribute to these associations.
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Neurovascular coupling (NVC) refers to the process of aligning cerebral blood flow with neuronal metabolic demand. This study explores the potential of contralateral NVC-linking neural electrical activity on the stroke side with cerebral blood flow velocity (CBFV) on the contralesional side-as a marker of physiological function of the brain. Our aim was to examine the association between contralateral NVC and neurological outcomes in patients with ischemic stroke following endovascular thrombectomy. ⋯ A better contralateral coupling between stroke-side EEG and contralesional CBFV is associated with favorable neurological outcomes, suggesting that contralateral NVC analysis may aid in assessing brain function after recanalization. Replication with a deeper understanding of the mechanisms is needed before clinical translation.
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Neuroleptic malignant syndrome (NMS) is a psychiatric-neurologic emergency that may require intensive care management. There is a paucity of information about NMS as a critical illness. We reviewed the Mayo Clinic experience. ⋯ Neuroleptic malignant syndrome can become a critical illness, but there is often rapid recovery. Mortality proximate to NMS was uncommon, but late mortality remained substantial. The overwhelming majority of cases coded as NMS did not meet DSM-5 diagnostic criteria. Stricter criteria should be applied when diagnosing NMS in critical care and emergency medicine settings.
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Invasive mechanical ventilation can present complex challenges for patients with acute brain injury (ABI) in middle-income countries (MICs). We characterized the impact of country income level on weaning strategies and outcomes in patients with ABI. ⋯ In an international registry of patients with ABI requiring invasive mechanical ventilation, MICs had higher odds of ICU mortality, tracheostomy placement, and hospital mortality compared with HICs, which may be due to difference in neurocritical care resources and management.
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Paroxysmal sympathetic hyperactivity (PSH) occurs with high prevalence among critically ill patients with traumatic brain injury (TBI) and is associated with worse outcomes. The PSH-Assessment Measure (PSH-AM) consists of a Clinical Features Scale and a diagnosis likelihood tool (DLT) intended to quantify the severity of sympathetically mediated symptoms and the likelihood that they are due to PSH, respectively, on a daily basis. Here, we aim to identify and explore the value of dynamic trends in the evolution of sympathetic hyperactivity following acute TBI using elements of the PSH-AM. ⋯ This study adds to the sparse research characterizing the heterogeneous temporal trends of sympathetic nervous system activation during the acute phase following TBI. This may open avenues for early identification of at-risk patients to receive tailored interventions to limit secondary brain injury associated with autonomic dysfunction and thereby improve outcomes in patients with TBI.