Practicality and cost-effectiveness of using MRI compatible EEG system in the critical care setting.

Background: Continuous video-EEG (cvEEG) monitoring is a vastly utilized tool for monitoring critically ill patients in the intensive care unit. Our study investigates the clinical utility and cost-effectiveness of using MRI Compatible EEG electrode system for patients being monitored in the intensive care unit.

Methods: This retrospective study included 14 critically ill patients who underwent cvEEG between March 2019 to March 2020.

COVID-19 Screening with Chest CT in Acute Stroke Imaging: A Clinical Decision Model.

Background And Purpose: Acute stroke patients may have undiagnosed coronavirus disease 2019 (COVID-19) infection, transmissible to medical professionals involved in their care. Our aim was to determine the value of incorporating a chest computed tomography (CT) scan during acute stroke imaging, and the factors that influence this decision.

Methods: We constructed a probabilistic decision tree of the value of acquiring a chest CT scan or not, expressed in quality-adjusted life months (QALM) of patients and medical professionals.

Intra-Arterial Dantrolene for Refractory Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage.

Background: Dantrolene has a safe side-effect profile and a mechanism of action that makes it attractive as an option for treatment of cerebral vasospasm. The authors report 2 cases of refractory cerebral vasospasm secondary to aneurysmal subarachnoid hemorrhage that were successfully treated with intra-arterial (IA) dantrolene.

Case Description: Two patients, a 63-year-old woman and 36-year-old woman, developed severe vasospasm refractory to IA vasodilators after rupture of anterior communicating artery aneurysms.

Primary Intraventricular Hemorrhage Isolated in Cerebral Aqueduct Secondary to Dural Arteriovenous Fistula.

Objective: We report a case of dural arteriovenous fistula (dAVF) presenting as isolated cerebral aqueduct hemorrhage.

Result: A 73-year-old man with a history of hypertension and chronic alcoholism presented with altered mental status and gait difficulties, bilateral fronto-occipital headaches, and intermittent dizziness. He had bilateral upward gaze restriction.

Dihydroergotamine Complicating Reversible Cerebral Vasoconstriction Syndrome in Status Migrainosus.

Reversible cerebral vasoconstriction syndrome (RCVS) is a clinicoradiological syndrome that occurs due to dysfunction of cerebrovascular autoregulation. It is characterized by recurrent thunderclap headache from cerebral vasoconstriction which can cause ischemic infarction, spontaneous intraparenchymal and subarachnoid hemorrhage. This syndrome can be triggered by a variety of etiologies including medications, infectious, and inflammatory conditions.

Spot Sign in Acute Intracerebral Hemorrhage in Magnetic Resonance Imaging: A Case Report and Review of the Literature.

Introduction: Intracranial hemorrhage (ICH) is associated with significant mortality and morbidity. Current treatment paradigms focus on correcting hypertension and coagulopathy to prevent hematoma expansion. Magnetic resonance imaging (MRI) is becoming more common in the hyperactive phase of ICH management.

Seizure prophylaxis in the neuroscience intensive care unit.

Background: Seizures are a considerable complication in critically ill patients. Their incidence is significantly high in neurosciences intensive care unit patients. Seizure prophylaxis with anti-epileptic drugs is a common practice in neurosciences intensive care unit.

White Matter Changes in Corpus Callosum in a Patient with Idiopathic Normal Pressure Hydrocephalus.

Idiopathic normal pressure hydrocephalus (INPH) is characterized by the clinical triad of gait and cognitive dysfunction and urinary incontinence. Ventriculoperitoneal (VP) shunting is often required for treatment. Review of literature shows few case reports discussing benign magnetic resonance imaging (MRI) T2 hyperintense changes in the corpus callosum of NPH patients after shunting due to mechanical compression of the middle and posterior regions of the body against falx cerebri leading to ischemic demyelination.

Improvement in Quality Metrics Outcomes and Patient and Family Satisfaction in a Neurosciences Intensive Care Unit after Creation of a Dedicated Neurocritical Care Team.

Introduction: Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU). Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU.

Extubating the Neurocritical Care Patient: A Spontaneous Breathing Trial Algorithmic Approach.

Background: Delaying extubation in neurologically impaired patients otherwise ready for extubation is a source for significant morbidity, mortality, and costs. There is no consensus to suggest one spontaneous breathing trial (SBT) over another in predicting extubation success. We studied an algorithm using zero pressure support and zero positive end-expiratory pressure (ZEEP) SBT followed by 5-cm HO pressure support and 5-cm HO positive end-expiratory pressure (i.

A new strategy in neurocritical care nurse continuing stroke education: A hybrid simulation pilot study.

Introduction: High-fidelity simulation is frequently utilized in medical education. Its use in the neurosciences is limited by the inherent limitations of the manikin to simulate neurological changes. We report here the use of a hybrid simulation - a combination of lecture and high-fidelity manikin - in the education of neurosciences nurses, involved in care of neurocritical care patients.

Prolonged duration of apnea test during brain death examination in a case of intraparenchymal hemorrhage.

Objective: Apnea test is required as part of the brain death examination. The duration of the apnea test is variable but typically requires 8-10 min. Prolonged apnea tests have been reported in the setting of hypothermia.

Successful Extubation Using Heliox BiPAP in Two Patients with Postextubation Stridor.

Postextubation stridor is associated with significant morbidity. It commonly results in extubation failure after established medical treatment fails, such as nebulized epinephrine and/or intravenous steroids. The role of heliox (i.

Variability in Diagnosing Brain Death at an Academic Medical Center.

. Research continues to highlight variability in hospital policy and documentation of brain death. The aim of our study was to characterize how strictly new guidelines of American Academy of Neurology (AAN) for death by neurological criteria were practiced in our hospital prior to appointment of neurointensivists.

Abnormal Breathing Patterns Predict Extubation Failure in Neurocritically Ill Patients.

In neurologically injured patients, predictors for extubation success are not well defined. Abnormal breathing patterns may result from the underlying neurological injury. We present three patients with abnormal breathing patterns highlighting failure of successful extubation as a result of these neurologically driven breathing patterns.

Evolution of Cerebral Atrophy in a Patient with Super Refractory Status Epilepticus Treated with Barbiturate Coma.

. Status epilepticus is associated with neuronal breakdown. Radiological sequelae of status epilepticus include diffusion weighted abnormalities and T2/FLAIR cortical hyperintensities corresponding to the epileptogenic cortex.

Vasopressin Bolus Protocol Compared to Desmopressin (DDAVP) for Managing Acute, Postoperative Central Diabetes Insipidus and Hypovolemic Shock.

. Management of postoperative central diabetes insipidus (DI) can be challenging from changes in volume status and serum sodium levels. We report a case successfully using a dilute vasopressin bolus protocol in managing hypovolemic shock in acute, postoperative, central DI.

Comparison of Two Surface Cooling Devices for Temperature Management in a Neurocritical Care Unit.

Fever increases mortality and morbidity and length of stay in neurocritically ill patients. Various methods are used in the neuroscience intensive care unit (NSICU) to control fever. Two such methods involve the Arctic Sun hydrogel wraps and the Gaymar cooling wraps.

Observed medical and surgical complications of prolonged barbiturate coma for refractory status epilepticus.

Background: Refractory status epilepticus is often treated with third-line therapy, such as pentobarbital coma. However, its use is limited by side effects. Recognizing and preventing major and minor adverse effects of prolonged pentobarbital coma may increase good outcomes.