Neurocritical care
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Intracranial pressure (ICP) monitoring is currently an invasive procedure that requires access to the intracranial space through an opening in the skull. Noninvasive monitoring of ICP via the auditory system is theoretically possible because changes in ICP transfer to the inner ear through connections between the cerebral spinal fluid and the cochlear fluids. In particular, low-frequency distortion-product otoacoustic emissions (DPOAEs), measured noninvasively in the external ear canal, have magnitudes that depend on ICP. Postural changes in healthy humans cause systematic changes in ICP. Here, we quantify the effects of postural changes, and presumably ICP changes, on DPOAE magnitudes. ⋯ Changes in ICP can be detected using the auditory-based measurement of DPOAEs. In particular, changes are largest at low frequencies. Although this approach does not allow for absolute measurement of ICP, it appears that measurement of DPOAEs may be a useful means of noninvasively monitoring ICP.
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Cardiac dysfunction after aneurysmal subarachnoid hemorrhage (SAH) is often referred to as "neurogenic stunned myocardium," which does not accurately reflect the suspected pathophysiology. We propose an alternative terminology, "neurogenic stress cardiomyopathy," as a more appropriate label based on our review of the current literature. ⋯ Recognition of the unique features associated with SAH-induced cardiac complications allows optimal management of patients with SAH. We will also discuss the clinical and theoretical overlap of SAH-induced cardiac dysfunction with a syndrome known as tako-tsubo cardiomyopathy and explore therapeutic opportunities.
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Effective treatment for severe ischemic stroke continues to be largely an unmet medical need. Using a nonvascular (paravascular cerebrospinal fluid) pathway to provide oxygen and nutrients to ischemic tissues may be a means of treating this disease. The primary objective of this study was to evaluate the safety and technical feasibility of ventriculo-lumbar perfusion with the oxygenated fluorocarbon nutrient emulsion (OFNE) perfusion system in the treatment of patients with severe hemispheric cerebral ischemia. ⋯ It is technically feasible and safe to establish a ventriculo-lumbar perfusion pathway using a specially designed lumbar drainage catheter and to control intracranial pressure while perfusing large volumes of OFNE.
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Patients who present with only neurological symptoms and no pain challenge the recognition of acute aortic dissection. ⋯ Highly unusual presentations of aortic dissection with acute ischemic stroke exist. A wide mediastinum on plain chest X-ray was present in all cases.
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Our objective was to investigate the feasibility of lumbar drainage (LD) as a new therapeutic approach for the treatment of communicating hydrocephalus in patients with supratentorial intracerebral hemorrhage (ICH) and ventricular extension (IVH) who initially required an external ventricular drain (EVD). ⋯ Our preliminary data suggest that LD is a simple and reasonable alternative for treating communicating hydrocephalus after ICH and IVH. The combination of IVF to enhance clot resolution and to clear the third and fourth ventricle followed by LD may represent a new and promising approach in the therapy of hydrocephalus following severe ventricular hemorrhage.