Current neurology and neuroscience reports
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Outcomes research is a new and developing field that attempts to better measure the results of medical care. Neurocritical care is a relatively new field of medicine focusing on the care of critically ill patients with primary or secondary neurologic problems. Much needs to be done to examine the outcomes of neurocritical care, and the following is a review of the pertinent concepts of both outcomes and neurocritical care research.
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Neglect, a failure to attend or act in one part of space, is a common disturbance following cerebral lesions. This article outlines the signs and symptoms of neglect. ⋯ Neglect in directions other than the horizontal is discussed, as are directional biases found in normal control subjects. The article also examines the anatomy of lesions causing neglect and theoretical models of the cerebral mechanisms underlying neglect.
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Curr Neurol Neurosci Rep · Nov 2001
ReviewCritical care of intracerebral and subarachnoid hemorrhage.
The acute management of primary intracerebral or aneurysmal subarachnoid hemorrhage requires a comprehensive approach involving stabilization of the patient, surgical intervention, and continued intensive care treatment of medical and neurologic complications. The are several causes of intracerebral hemorrhage (ICH), including hypertension, cerebral amyloid angiopathy, sympathomimetic drugs, and coagulopathies. More recently, use of thrombolytic agents in the treatment of acute ischemic stroke has increased the risk of ICH. ⋯ Patients with aneurysmal subarachnoid hemorrhage may experience rebleeding, symptomatic vasospasm, or hydrocephalus. Medical management in the intensive care unit with careful attention to fluid and electrolyte balance, nutrition, cardiopulmonary monitoring, and close observation for changes in the neurologic exam is vital. This review examines the diagnosis and intensive care management of patients with intracerebral or subarachnoid hemorrhage, and reviews some of the newer therapies for treatment of these disorders.
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Advances in neurologic therapeutics and intensive care medicine have expanded the arsenal of treatments available for the critical care of ischemic stroke. Several agents are available for acute reperfusion of the ischemic brain. These include intravenous recombinant tissue-plasminogen activator (rtPA), which is effective in a 3-hour time window, and intra-arterial thrombolytics, which may be effective within 6 hours. ⋯ Unfortunately, there is a critical lack of well-designed clinical studies to guide the clinician in the use of these interventions. In addition, there is concern that some of these interventions may preserve life at the cost of quality of life. This article reviews the evidence behind these approaches to the critical care of ischemic stroke.