Protracted respiratory failure in a case of global spinal syringomyelia and Chiari malformation following administration of diazepam: illustrative case.

Background: Syringomyelia is defined as dilation of the spinal cord's central canal and is often precipitated by skull base herniation disorders. Although respiratory failure (RF) can be associated with skull base abnormalities due to brainstem compression, most cases occur in pediatric patients and quickly resolve. The authors report the case of an adult patient with global spinal syringomyelia and Chiari malformation who developed refractory RF after routine administration of diazepam.

Peripheral Insertion of Pediatric Central Venous Catheters in Adults with Difficult I.V. Access.

Background: Difficult intravenous access is a frequent occurrence in critical care and emergency medicine. Prior intravenous access, chemotherapy use, and obesity are a few factors associated with difficult access. Alternatives to peripheral access are often contraindicated, not feasible, or not readily available.

Reports of Guillain-Barre Syndrome Following COVID-19 Vaccination in the USA: An Analysis of the VAERS Database.

Background And Purpose: An association between Guillain-Barre syndrome and its variants (GBS/V) and vaccines has led to hesitancy toward vaccination. COVID-19 vaccines could theoretically provoke GBS/V via immune activation. We analyzed reports of GBS/V after COVID-19 vaccination in the vaccine adverse event reporting system (VAERS).

Military Soft Skills Applicable to the ICU.

Unlabelled: To describe how soft skills acquired during military service can be applied to the practice of critical care medicine.

Data Sources: A systematic search was performed in PubMed.

Study Selection: We selected all studies that addressed soft skills in medicine.

Traumatic Optic Neuropathy: The Forgotten Concussion.

Cerebral concussions are a well-recognized issue in military and civilian practice. Although most physicians are well versed in recognizing concussion symptoms, many are not as adept at diagnosing and managing comorbid traumatic optic neuropathy (TON). Traumatic optic neuropathy typically follows cerebral concussions but is often not diagnosed as its symptoms are attributed to brain injury or the presence of altered consciousness impedes its recognition.

Use of Helicopter Medical Transportation to the Neuroscience Intensive Care Unit.

Background: Helicopter medical transportation (HMT) is a valuable resource that can expedite medical care by shortening transferring times. However, there is conflicting evidence regarding its cost and efficacy. No specific studies have addressed its use in patients transferred to the neuroscience intensive care unit (NSICU).

Perception of Provision of Futile Care Among Clinicians in the Neuroscience Intensive Care Unit.

Background: Futile care in the neuroscience intensive care unit (NSICU) can create moral distress for clinicians who may differ in their interpretation of the value of such care. We sought to compare the perception of provision of futile care in the NSICU among physicians, advanced practice providers, and intensive care unit registered nurses (ICURNs).

Methods: This is a cross-sectional study of 77 patients.

Critical Care Management of Anti-N-Methyl-D-Aspartate Receptor Encephalitis.

Objectives: Anti-N-methyl-D-aspartate receptor encephalitis is considered an immune-mediated form of encephalitis with paraneoplastic and nonparaneoplastic forms. Delay in recognition is common and patients typically present to the ICU without a diagnosis or with complications following a delayed diagnosis. The aim of this review is to provide a focused overview for the ICU clinician regarding presentation, diagnosis, and critical care management.

UVA-1 phototherapy for the management of atopic dermatitis: a large retrospective study conducted in a low-middle income country.

Background: Medium-dose ultraviolet light A - 1 (UVA-1) phototherapy, given in short courses, has shown efficacy in atopic dermatitis flares; little is known about its use, efficacy, and side effects in prolonged exposure used in the chronic disease despite its extensive use.

Methods: A descriptive retrospective study was conducted; convenience sampling of patients with atopic dermatitis treated with UVA-1 phototherapy was made; evaluation of clinical response by SCORAD, adverse effects, and protocols used in each patient were evaluated.

Results: Patients exposed to UVA-1 phototherapy showed a decrease in the SCORAD (30.

Tactical Neurocritical Care.

Neurocritical care is usually practiced in the comfort of an intensive care unit within a tertiary care medical center. Physicians deployed to the frontline with the US military or allied military are required to use their critical care skills and their neurocritical skills in austere environments with limited resources. Due to these factors, tactical critical care and tactical neurocritical care differ significantly from traditional critical care.

Helmet-Induced Occipital Neuralgia in a Military Aviator.

Background: Headaches among military personnel are very common and headgear wear is a frequently identified culprit. Helmet wear may cause migrainous headaches, external compression headache, other primary cranial neuralgias, and occipital neuralgia. The clinical features and the response to treatment allow distinction between the different types of headaches.

New Onset Migraine Associated With a Civilian Burn Pit.

Background: Deployed service members exposed to burn pit smoke can experience a multitude of symptoms. Respiratory symptoms after burn pit smoke exposure are well recognized, but neurologic symptoms are less well recognized. There are reports of migraines triggered by odors but no specific reports of new onset migraines triggered by exposure to burn pit smoke.

The role of negative pressure wound therapy in the management of hidradenitis suppurativa: a case report and literature review.

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, recurrent inflammatory disease affecting skin that bears apocrine glands. It is characterised by the presence of tender subcutaneous nodules that may rupture, resulting in deep dermal abscesses, fibrosis with dermal contractures and induration of the skin. The management of HS is a challenge for physicians as the pathogenesis is not clearly defined and prevents the use and development of directed therapies.

Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting.

Background And Purpose: Patients with acute brain injuries require strict physiologic control to minimize morbidity and mortality. This study aimed to assess in-hospital compliance to strict physiologic parameters (BP, HR, ICP, SpO2) in these populations.

Methods: Patients with severe cerebrovascular events were admitted to the neurointensive care unit (NSICU) and were continuously monitored using the BedMasterEX (Excel Medical Electronics Inc, FL) system, which recorded hemodynamic data via an arterial catheter continuously in 5-s intervals.

Significance of Parenchymal Brain Damage in Patients with Critical Illness.

Background: To determine the prevalence, type, and significance of brain damage in critically ill patients with a primary non-neurological diagnosis developing acute brain dysfunction.

Methods: This retrospective cohort study was performed at the Johns Hopkins University School of Medicine, an academic tertiary care hospital. Medical records were reviewed of 479 consecutive ICU patients who underwent brain magnetic resonance imaging (MRI) over a 2-year period.

Comparison of endovascular treatment approaches for acute ischemic stroke: cost effectiveness, technical success, and clinical outcomes.

Introduction: The use of mechanical thrombectomy for the treatment of acute ischemic stroke has significantly advanced over the last 5 years. Few data are available comparing the cost and clinical and angiographic outcomes associated with available techniques. The aim of this study is to compare the cost and efficacy of current endovascular stroke therapies.

Guillain-Barre variant in the deployed setting.

Guillain-Barre syndrome (GBS) is a pleomorphic condition with multiple clinical presentations. Atypical presentations may elude diagnosis particularly in the deployed setting or austere environment where diagnostic resources are limited. I describe a soldier who developed an unusual GBS variant while deployed to Iraq.

Dabigatran-associated subdural hemorrhage: using thromboelastography (TEG(®)) to guide decision-making.

Novel oral anticoagulants present challenges and uncertainties in the management of hemorrhagic emergencies. An 84-year-old man taking dabigatran presented with a subdural hematoma requiring neurosurgical intervention. Routine coagulation assays were prolonged at admission and following administration of Factor VIII Inhibitor Bypassing Activity (FEIBA).

The white cerebellum sign: an under recognized sign of increased intracranial pressure.

Background: The "white cerebellum" sign is a rare imaging finding described mainly in children with hypoxic brain injury.

Materials And Methods: Single case report and review of the literature.

Findings: We describe a child with acute bacterial meningitis in whom plain CT and MRI showed the white cerebellum sign.

Perimesencephalic subarachnoid hemorrhage triggered by hypoxic training during swimming.

Introduction: Perimesencephalic subarachnoid hemorrhage is a rare neurologic condition of unclear etiology. Multiple mechanisms have been postulated as potential triggers, but none are universally accepted.

Methods: Single observational case report and review of the literature.

Headache and vasculitis.

Although headaches are common in the general population and have many causes, headaches secondary to inflammatory processes in the blood vessels in the Central Nervous System (CNS) are not so common. The most common types of vasculitis that are associated with headaches include primary CNS vasculitis, systemic necrotizing arteritis, granulomatous vasculitis, and systemic collagen diseases. It is important to differentiate between "true" vasculitides and a condition known and reversible cerebral vasoconstriction syndrome (RCVS).