Neurological research
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Alteration of sensorium or an encephalopathy is a common diagnostic dilemma in critically ill patients and can be caused by a number of conditions. Sepsis associated encephalopathy (SAE) is now the most common encephalopathy encountered among intensive care unit (ICU) patients. ⋯ It is important to recognize SAE for its therapeutic and prognostic aspects. SAE worsens morbidity and mortality among ICU patients. Most therapeutic options center around aggressive treatment of the underlying infection.
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Neurological research · Oct 2007
Brain tissue oxygen tension in clinical brain death: a case series.
Brain death is a clinical diagnosis often confirmed with supplementary tests. In this study, we examined the relationship between brain death and the partial pressure of brain tissue oxygen (PbtO(2)). We hypothesized that a sustained PbtO(2) of 0 is associated with brain death. ⋯ A sustained (>30 minutes) brain PbtO(2) of 0 is consistent with brain death. We suggest that a sustained 'zero' PbtO(2) may be used to determine when a brain death examination is appropriate in the pharmacologically suppressed patient.
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Neurological research · Oct 2007
Impact of hyperglycemia on neurological deficits and extracellular glucose levels in aneurysmal subarachnoid hemorrhage patients.
Hyperglycemia after aneurysmal subarachnoid hemorrhage (SAH) is associated with serious complications. Blood glucose may indicate a target for therapy to prevent delayed ischemic neurological deficits (DIND) and improve outcome. The objective of this study was to investigate energy metabolism in the extracellular/cerebrospinal fluid and blood in relation to outcome. ⋯ This study confirms the relevance of hyperglycemia to neurological outcome in SAH patients. Cerebral glucose was significantly lower in AFND patients despite hyperglycemic blood levels. More detailed works are necessary to select risk patients for optimized targeted therapy to avoid insulin-induced cerebral metabolic crisis.
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Neurological research · Oct 2007
In-hospital delays to stroke thrombolysis: paradoxical effect of early arrival.
To determine the causes of in-hospital delays for thrombolysis. ⋯ An unexpected delay between order and actual initiation of i.v. tPA infusion resulted in almost one-third of patients receiving thrombolytics after 3 hours from symptom onset. The cause of this delay could not be discerned by this study. The paradoxical effect between early arrival to hospital and delayed treatment may be related to a sense of urgency in those arriving close to 3 hours after onset. Critical reviews such as this permit identification of hospital delays in stroke treatment, thus allowing institution of appropriate strategies to ensure prompt treatment.
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Neurological research · Oct 2007
Monitoring of cerebral metabolism: non-ischemic impairment of oxidative metabolism following severe traumatic brain injury.
To investigate and compare the respective dynamics of cerebral blood flow (CBF) and metabolism in response to changes in neurological condition and intracranial pressure (ICP) in severe traumatic brain injury (TBI). ⋯ This study shows that cerebral metabolic failure following TBI is a common finding that is not of ischemic origin in most instances. Unlike frequently assumed, cerebral metabolism is not constrained within the narrow range of a static depression sustained for weeks but rather subject to significant variations in response to changes in ICP or neurological condition.