Targeted temperature management (TTM) as a neuroptotective strategy is applied in a number of scenarios; post-ROSC in cardiac arrest, neonatal asphyxia, traumatic brain injury, to name some. The Neurocritical Care Society have taken it upon themselves to formulate an evidence-based guideline to the implementation and practical management of TTM in a number of settings. Although… Continue reading TTM – New Guidelines from NCS
Okonkwo et al, ten ICUs in the United States. Read their article in Critical Care Medicine, November 2017-issue. They found that management of severe traumatic brain injury informed by multimodal intracranial pressure and brain tissue monitoring reduced brain tissue hypoxia, with a trend toward lower mortality and more favorable outcomes, compared with treatment guided by… Continue reading Brain Oxygen Optimization in Severe Traumatic Brain Injury Phase-II: A Phase II Randomized Trial
This is a subject that has been on our backburner for a while and it’s now due for a discussion on neuroscand.com. The use of beta-blockers in traumatic brain injury is nothing new. The indications have been largely centered on targeting and preventing paroxysmal sympathetic hyperactivity (PSH) and associated post-TBI autonomic phenomena. Please see our… Continue reading Beta-blockers and TBI
Subarachnoid haemorrhage and traumatic brain injury can cause Terson syndrome, a bleeding in corpus vitreum. Read the study by Narayanan et al: ““Visual Outcomes after Vitrectomy for Terson Syndrome Secondary to Traumatic Brain Injury”. Our neurosurgeons suggest ophthalmoscopy once a week. Look for loss of red reflex.
Here’s a few resources on anaesthesia for awake craniotomies that have recently come to our attention, thanks to some of our colleagues: The first, from UpToDate, was updated this year. The second is part of the British Journal of Anaesthesia’s Continuing Education in Anaesthesia Critical Care & Pain series. It dates back to 2013 but is still… Continue reading Awake Craniotomy: Useful Resources
The world of medical publishing is waking up from its summer slumber and a host of good neurology articles have been released lately. And here’s one on SAH from NEJM’s clinical practice series. A nice and easily read synopsis on the subject. Can be found here.
We have probably all struggled with these phenomena in our TBI patients in the neuro ICU: swinging blood pressures, episodic tachycardia and fever, occurring even several weeks after the initial traumatic event. In this article in the Lancet, Meyfroidt and colleagues offer us some insight into the clinical syndrome now known as paroxysmal sympathetic hyperreactivity.… Continue reading Lancet: Paroxysmal Sympathetic Hyperactivity after TBI – An Underrecognized Clinical Entity