Articles: neurocritical-care.
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Neurocritical care has two main objectives. Initially, the emphasis is on treatment of patients with acute damage to the central nervous system whether through infection, trauma, or hemorrhagic or ischemic stroke. Thereafter, attention shifts to the identification of secondary processes that may lead to further brain injury, including fever, seizures, and ischemia, among others. ⋯ The concepts and design of each monitor, in addition to the patient population that may most benefit from each modality, will be discussed, along with the various tools that can be used together to guide individualized patient treatment options. Major clinical trials, observational studies, and their effect on clinical outcomes will be reviewed. The future of multimodal monitoring in the field of bioinformatics, clinical research, and device development will conclude the chapter.
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Frontiers in neurology · Jan 2017
ReviewAspects on the Physiological and Biochemical Foundations of Neurocritical Care.
Neurocritical care (NCC) is a branch of intensive care medicine characterized by specific physiological and biochemical monitoring techniques necessary for identifying cerebral adverse events and for evaluating specific therapies. Information is primarily obtained from physiological variables related to intracranial pressure (ICP) and cerebral blood flow (CBF) and from physiological and biochemical variables related to cerebral energy metabolism. Non-surgical therapies developed for treating increased ICP are based on knowledge regarding transport of water across the intact and injured blood-brain barrier (BBB) and the regulation of CBF. ⋯ Attempts to evaluate global cerebral energy state from microdialysis of intraventricular fluid and from the LP ratio of the draining venous blood have recently been presented. To be of clinical relevance, the information from all monitoring techniques should be presented bedside online. Accordingly, in the future, the chemical variables obtained from microdialysis will probably be analyzed by biochemical sensors.
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Review Historical Article
Neurocritical Care in China: Past, Present, and Future.
Despite the lack of resources and materials, there has been an increasing demand for acute neurologic care owing to the heavy burden of neurocritical illness in most developing countries, including China, where the morbidity and mortality of severe neurologic and neurosurgical disorders remains high. Neurointensive care units did not start appearing in China until the late 1980s. Although great progress has been made over the past 2 decades in the establishment of equipped neurocritical care centers, advancements in medical infrastructure, streamlining of resident training programs, and implementation of multidisciplinary care teams, there remain areas that warrant improvement to care for our growing patient population. Here we review and discuss the history, present state, and future of neurocritical care in the People's Republic of China.
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Emerg. Med. Clin. North Am. · Nov 2016
ReviewDiagnosis and Management of Acute Intracerebral Hemorrhage.
Intracerebral hemorrhage (ICH) is the deadliest type of stroke and up to half of patients die in hospital. Blood pressure management, coagulopathy reversal, and intracranial pressure control are the mainstays of acute ICH treatment. Prevention of hematoma expansion and minimally invasive hematoma evacuation are promising therapeutic strategies under investigation. This article provides an updated review on ICH diagnosis and management in the emergency department.
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J Intensive Care Med · Oct 2016
Review Case ReportsSpinal Decerebrate-Like Posturing After Brain Death: A Case Report and Review of the Literature.
Criteria for establishing brain death (BD) require absence of all brainstem-mediated reflexes including motor (ie, decerebrate or decorticate) posturing. A number of spinal cord automatisms may emerge after BD, but occurrence of decerebrate-like spinal reflexes may be particularly problematic; confusion of such stereotypic extension-pronation movements with brain stem reflexes may confound or delay definitive diagnosis of BD. We present a case in which we verified the noncerebral (ie, likely spinal) origin of such decerebrate-like reflexes. ⋯ Extension-pronation movements that mimic decerebrate posturing may be seen in a delayed fashion after BD. Verification of lack of any brain activity (by both examination and multiple ancillary tests) in this case and others prompts us to attribute these movements as spinal cord reflexes and propose they be recognized within the rubric of accepted post-BD automatisms that should not delay diagnosis or necessitate confirmatory testing.