Neurocritical care
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Case Reports
Listeria monocytogenes meningitis associated with rhabdomyolysis and acute renal failure.
Numerous systemic infections are capable of inducing myositis and rhabdomyolysis. Clinical course of the disease is in the great majority of patients benign and without development of renal dysfunction. However, serious consequences are possible if acute renal failure (ARF) occurs, especially in critically ill patients. ⋯ We report a case of listerial meningitis complicated with non-oliguric ARF. Rhabdomyolysis should be considered in all patients with infection and increased CK, especially if consciousness is impaired is altered. Furthermore, despite the normal diuresis ARF could be present and result in adverse consequences. We infer that timely diagnosis and treatment should improve the outcome of infection-induced rhabdomyolysis and could prevent a proportion of associated ARF.
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We evaluated the effects of a change from routine surgical tracheostomy (ST), performed primarily by ENT surgeons, to bedside percutaneous tracheostomy (PT) performed by neurointensivists. ⋯ PT performed by neurointensivists was safe compared to ST. Timely PT by neurointensivists may offer significant advantages in terms of ventilator weaning, ICU LOS, and the cost of care.
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In order to identify whether low-dose (1 microg) tetracosactide (Synacthen) testing may be preferable to high-dose (250 microg) testing in the diagnosis of adrenal insufficiency in traumatic brain injury (TBI), as suggested by studies in other forms of critical illness. ⋯ In the low-dose tetracosactide test, it is sufficient to determine cortisol concentrations at baseline and at 30 min. Low-dose and high-dose tests give discordant results in a significant proportion of cases when using the same diagnostic threshold. Neither test can be used to guide the initiation of corticosteroid therapy in acute TBI.