Category: Neurocritical Care

ICP/CPP management · Neurocritical Care · Neurotrauma · Osmotherapy · Traumatic Brain Injury

Mannitol vs. Hypertonic Saline in TBI – A Retrospective Study

andersfeylingLeave a comment

The optimal hyperosmotic agent for treatment of intracranial hypertension following TBI has been an inexhaustible subject of debate. Scant evidence underlies these discussions despite widespread and long-standing use of both agents. In this article Anstey et al. retrospectively analysed data from 14 different centres to compare outcomes in mannitol-only and hypertonic saline-only cohorts. They excluded… Continue reading Mannitol vs. Hypertonic Saline in TBI – A Retrospective Study

Basic Sciences & Physiology · Cardiovascular Conditions · General Topics · Haemodynamics · Neuroanaesthesia · Pharmacology · Traumatic Brain Injury

SNACC.org – Article of the Month: Effects of Vasopressors on Cerebral Circulation and Oxygenation

andersfeylingLeave a comment

SNACC’s article of the month for July is an excellent narrative review on the pharmacodynamics of vasopressors in health and in the setting of brain injury. The review is preceded by an introductory commentary by neuroscand.com contributor Dr. Riikka Takala.

Acute Cerebrovascular Conditions · Intracerebral Haemorrhage · Neurocritical Care · Neurovascular Surgery

ATACH II Follow-up Subgroup Analysis: Intensive BP Reduction Reduces Expansion of Deep ICH, But No Difference in Functional Outcome

andersfeylingLeave a comment

The landmark 2016 ATACH II trial compared aggressive blood pressure lowering (110-139 mmHg) with standard BP-targets (140-180) in patients with spontaneous ICH, and found no difference between the groups. The main endpoints were mortality and functional neurological outcome (modified Rankin scale). The only discernible difference was a tendency towards less haematoma expansion in the intervention… Continue reading ATACH II Follow-up Subgroup Analysis: Intensive BP Reduction Reduces Expansion of Deep ICH, But No Difference in Functional Outcome

Acute Cerebrovascular Conditions · Cardiovascular Conditions · Haemodynamics · Intracerebral Haemorrhage · Neurocritical Care · Systemic Effects of CNS Pathology

Cardiovascular Abnormalities in ICH – a Narrative Review

andersfeylingLeave a comment

Intracerebral haemorrhage is associated with a number of haemodynamic consequences. These are not just limited to arrhythmias. Lele and colleagues have summarised the most common and important ones in this review in the Journal of Neurosurgical Anesthesiology.

Neurocritical Care · Paediatrics · Pharmacology · Seizure Control

ConSEPT and EcLiPSE Trials: Levetiracetam Equal to Phenytoin in Efficacy for Convulsive Status Epilepticus in Children

andersfeylingLeave a comment

Just a quick update on two recent trials on pharmacological treatment for status epileptics in children: Both articles were published in the Lancet this spring. ConSEPT and EcLiPSE, both high-quality trials, found levetiracetam and phenytoin to be equally effective in seizure control and similar in safety profile. The findings were be remarkably consistent across the… Continue reading ConSEPT and EcLiPSE Trials: Levetiracetam Equal to Phenytoin in Efficacy for Convulsive Status Epilepticus in Children

Coagulopathy and Bleeding · Neurocritical Care · Neurotrauma · Pharmacology · TBI General · Traumatic Brain Injury

Impact of DOACs in TBI in the over 60s

andersfeylingLeave a comment

The ever-increasing use of direct (or novel) oral anticoagulants (DOACs) has had a profound effect on primary and secondary prevention of thromboembolic events, especially in the elderly. Whilst many patients benefit from switching over to these newer drugs from older anticoagulants like warfarin, thus foregoing such nuisances as INR-guided dosing, they have also inevitably led… Continue reading Impact of DOACs in TBI in the over 60s

Acute Cerebrovascular Conditions · Air Embolism · Aneurysm Surgery · Cervical Spine Surgery · General Topics · Haemodynamics · ICP/CPP management · Intracranial Surgery General · Ischaemic Stroke · Neuroanaesthesia · Neuromonitoring · Neurovascular Surgery · Perioperative Management · Sedation · Seizure Control · Subarachnoid Haemorrhage · Thoracolumbar Spine Surgery · US Guidelines · Ventilation and Oxygenation

SNACC – How to Handle Neuroanaesthetic Emergencies

andersfeylingLeave a comment

From our quality-focused colleagues at the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) comes this set of guidelines for management of the most common emergencies encountered in neuroanaesthetic practice. Conceived with the purpose of addressing complex emergent issues in a concise, goal-directed and simplified manner, these cognitive aids are clear-cut and based on… Continue reading SNACC – How to Handle Neuroanaesthetic Emergencies

Acute Cerebrovascular Conditions · Ischaemic Stroke · Neurovascular Surgery

Recent study in JACC – Procedure Time in Stroke Thrombectomies Has Impact on Outcomes

andersfeylingLeave a comment

Endovascular thrombectomy is a cornerstone of ischaemic stroke managament. Time from stroke to intervention has been clearly linked to functional outcome (1) and is a key metric to which much attention is devoted. But what about the duration of the procedure itself? Earlier data has suggested that length of procedure may affect functional outcomes after… Continue reading Recent study in JACC – Procedure Time in Stroke Thrombectomies Has Impact on Outcomes

Neurocritical Care · Neurotrauma · Paediatrics · Traumatic Brain Injury · US Guidelines

BTF Guidelines for Paediatric TBI 2019 – Finally Updated

andersfeylingLeave a comment

In a long overdue update, the Brain Trauma Foundation have issued their recently revised guidelines for management of paediatric severe traumatic brain injury. We at neuroscand.com have yet to assess all of the recommendations yet, so expect more as we get through the whole document. At first glance, though, there seems to be little substantial… Continue reading BTF Guidelines for Paediatric TBI 2019 – Finally Updated

Acute Cerebrovascular Conditions · Ischaemic Stroke · Neuroprotection · Thermoregulation

Addition of hypothermia to decompressive hemicraniectomy is not useful in MCA stroke – JAMA

riikkatakalaLeave a comment

This study, recently published in JAMA, revealed no beneficial effect from hypothermia as an adjunct to decompressive hemicraniectomy in the setting of middle cerebral artery stroke. In fact, the authors’ findings even suggest harm. Find the article here.