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Neurology in Documentaries
Published in Eelco F. M. Wijdicks, Neurocinema—The Sequel, 2022
Two days before the accident, the documentary shows a night of drinking. Then we see the accident itself, when Kevin attempts a new “cab double cork,” which is a double backflip with a twist. Without bracing himself with his hands, he lands with his face flat on the icy wall. He immediately becomes comatose with a marked orbital hematoma. Witnesses later tell us that he had to be intubated and was “shaking.” Another bystander tells us that his left eye had a “blown pupil.” He is helicoptered out to the neurointensive care unit, where he stays for 26 days. Shown on film is the family receiving notification of the accident—accompanied by a request to grant permission for a ventriculostomy. We get a glimpse of Kevin’s MRI scan, which shows multiple, severe shearing lesions in the hippocampi and lesions peppered throughout the white matter. There is also an extensive intraventricular hemorrhage that likely prompted the ventriculostomy.
Nonconventional Clinical Applications of Otoacoustic Emissions: From Middle Ear Transfer to Cochlear Homeostasis to Access to Cerebrospinal Fluid Pressure
Published in Stavros Hatzopoulos, Andrea Ciorba, Mark Krumm, Advances in Audiology and Hearing Science, 2020
Blandine Lourenço, Fabrice Giraudet, Thierry Mom, Paul Avan
The physical view of OAEs, beyond their status of screening tools of hearing sensitivity that loses some interest after the neonatal stage, as highly sensitive probes of the environment and interfaces at the inner-ear boundary, leads to proposing novel diagnostic tools. Their validation in patients of neurosurgery and neurointensive care units took advantage of the direct ICP data available in these carefully monitored patients. Of course, they are not the target of future ICP measurements using OAEs. OAE-based monitoring of ICP should be proposed to subjects in whom invasive ICP measurements are potentially too risky to be considered in view of the expected benefit. In addition to already mentioned patients, those with chronic, shunted or not shunted hydrocephalus; patients with headache; patients with brain trauma far from well-equipped hospitals (victims of car or motorbike accidents, or of head trauma during a game); cases with idiopathic ICH; follow-up of malignant brain tumor (Fig. 8.9); patients with chronic open-angle glaucoma might benefit from combined ICP and intraocular monitoring, as it is thought that imbalance between the two pressures could be an important factor of appropriate treatment.
Neurosurgery: Supratentorial tumors
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Monica S. Tandon, Kashmiri Doley, Daljit Singh
Patients are usually transferred to the neurointensive care unit for postoperative observation, where they are closely monitored for adequacy of oxygenation and ventilation, hemodynamic stability, neurological recovery (especially level of consciousness, pupillary responses, motor examination, features of elevated ICP), pain control, fluid status, electrolytes (sodium, potassium), and glucose levels, and for occurrence of any postoperative complications. AEDs, corticosteroids, H2 blockers, osmotic diuretics, antibiotics, and thromboprophylaxis are continued in the immediate postoperative period, and gradually tapered off over the next few days. AED levels should be checked, as they are often in the subtherapeutic range because of the induced diuresis in the intraoperative period. Meticulous care is taken to provide relief of postcraniotomy pain, prophylaxis of postoperative nausea and vomiting (PONV), and VTE, and to maintain the fluid and electrolyte balance.
Cell therapies for acute and chronic traumatic brain injury
Published in Current Medical Research and Opinion, 2022
Masahito Kawabori, Dai Chida, Bijan Nejadnik, Anthony H. Stonehouse, David O. Okonkwo
In a follow-on retrospective cohort study, Liao et al. treated 10 pediatric patients with acute severe TBI with 6 × 106 cells/kg of autologous BMMNCs by IV infusion within 48 h of injury16. Cell-treated patients were compared to 19 age- and severity-matched control patients16. Compared with control patients, cell-treated patients required significantly lower treatment intensity for the management of intracranial pressure (Pediatric Intensity Level of Therapy scale, p < .05) and associated organ injury (Pediatric Logistic Organ Dysfunction score, p < .05) during the first week of treatment16. In addition, the mean duration of neurointensive care was significantly shorter in cell-treated compared to control patients (8.2 vs. 15.6 days, p < .05)16. Liao et al. reported that 1 patient in the cell-treated group developed hydrocephalus, which required multiple ventriculostomies and the establishment of a ventriculoperitoneal shunt, and 1 patient in the control group died16.
Microsurgical endoportal MRI/US-navigated approach for the resection of large intraventricular tumours: a 20-consecutive patients case series
Published in British Journal of Neurosurgery, 2021
Jody Filippo Capitanio, Carmine Antonio Donofrio, Pietro Panni, Lina Raffaella Barzaghi, Michele Bailo, Filippo Gagliardi, Pietro Mortini
Immediate postoperative CT-scan and 48-h MRI were provided in each case. After surgery, all patients were routinely transferred in the Neurointensive Care Unit. Preoperative administration of anti-epileptic drugs was performed only in patients who presented with seizures. Neurological outcomes were assessed at the time of last follow-up evaluating both neurological sequelae and the Functional Independence Measure (FIM) score, an 18-item score system based on physical, psychological and social function evaluation used to assess the patient’s level of disability. Each item is scored from 7 to 1, with 7 indicating complete independence and 1 total need of assistance, and the overall score runs from a minimum of 18 to a maximum of 126. Globally, the FIM score represents a useful indicator of the severity of patient disability, especially considering daily life activities.16,17
The prediction value of Glasgow coma scale-pupils score in neurocritical patients: a retrospective study
Published in Brain Injury, 2021
Yingxin Lin, Sheng Zhang, Weixing Zhang, Xinxin Wang, Lei Huang, Hua Luo
Neurocritical illnesses are resource-demanding and consuming diseases associated with unfavorable outcomes. Clinical judgments and decisions are made based on interpretation by observations and measurements of clinical conditions. Decisions such as whether to continue aggressive neurointensive care or long-term support address importance on prognosis for short-term mortality and prolonged disability. Nowadays many complex mathematic models by integrating information from vital signs, biomarkers, electrophysiology findings, neuroimaging techniques, and even genomics have been profoundly studied, however, most of these are not yet ready to be applied in clinical setting. Varieties between different neurological diseases and between available variables, scores, and scales make prognosis assessment in neurocritical care even more difficult. A prediction model, which is simple and universal but with sufficient statistical performance to guide decision making is needed.