Blogs

The Lancet (11/14/20) Vol. 396, No. 10262, P. 1574  doi: 10.1016/S0140-6736(20)32163-2 Thomalla, Götz; Boutitie, Florent; Ma, Henry; et al. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32163-2/fulltext   Although stroke patients with unknown time of onset have previously been ruled out for thrombolysis, researchers questioned whether the strategy would work in cases where imaging biomarkers have identified salvageable tissue. To learn more, they conducted a systematic review and meta-analysis involving four randomized clinical trials that met inclusion criteria. Each of the studies—WAKE-UP, EXTEND, THAWS, and ECASS-4—compared I.V. ...
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Neurology (11/17/20) Vol. 95, No. 20  doi: 10.1212/WNL.0000000000010738 Reznik, Michael E.; Moody, Scott; Murray, Kayleigh; et al. https://n.neurology.org/content/95/20/e2727   Researchers report an association between delirium and withdrawal of life-sustaining treatment (WLST) after intracerebral hemorrhage (ICH). In a single-center cohort study of 311 patients with ICH, 50% had delirium and WLST occurred in 26%. The median time to WLST was 1 day. Patients who developed delirium were more likely to have WLST. Rates of WLST were high among both early and later delirium patients. With an area under the curve (AUC) of 0.902, an ICH score-based model was ...
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By Yama Akbari MD, PhD, and Michael L. James MD, FAHA Acknowledgement: ROSC Currents Taskforce (Shraddha Mainali, MD; Jennifer Kim, MD, PhD; Ruchi Jha, MD; Tom Lawson, CNP; Minjee Kim, MD; Cassia Righy, MD, PhD; Caitlin Brown, PharmD) Translational research “moves [work] in a bidirectional manner from one type of research to another – from basic research to patient-oriented research, to population-based research, and back – and involves collaboration among scientists from multiple disciplines.” 1 In neurocritical care, translational research is especially important because much of the care we provide as neurointensivists lacks Level I evidence; thus, ...
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By Stephen A. Trevick, MD, Northwest Neurology, IL  The emotional impact of the COVID-19 pandemic will be felt throughout society for months and years to come.  This impact will come in many guises and patterns throughout medicine and certainly in the acute care of neurocritical care patients.  Resources will continue to be limited and healthcare providers may be reassigned between specialties and units.  Our neurological patients will have concerns, often justifiably, that their care is suffering. Each human being has a hierarchy of needs.  It is difficult to worry about the future when today is in question, and it is hard to take a broad picture of the ...
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(Pictured L to R) By Aleksandra Yakhkind, MD, Neurocritical Care Fellow, University of Pennsylvania; Pouya Ameli, MD, MS, Assistant Professor of Neurology Neurosurgery, University of Florida College of Medicine; Naomi Niznick, MD, Chair, NCS Trainee Section, Neurology Resident, University of Ottawa, Chair-Elect, NCS Trainee Section NCS realizes that finding a first "real job" can be challenging, especially during a pandemic. To help applicants find the right job and help hiring parties fill needs, the Trainee Section and the Fellowship Direction Section are mobilizing resources to update the NCS Career Center website in the coming year. Our first virtual ...
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By Lucie Pelunkova, MSc, Critical Care Nursing, Nurse Educational Specialist, Neurologic Critical Care Unit, Cleveland Clinic Abu Dhabi; Nouran Salem, PharmD, BCCCP, MBA, Critical Care Pharmacotherapy Specialist, Cleveland Clinic Abu Dhabi; Seby John, MD, Consultant Neurologist, Vascular Neurology and Neurointerventional Surgery, Neurological Institute, Cleveland Clinic Abu Dhabi; Fadi Hamed, MD, Consultant Intensivist, Section Head, Medical and Surgical Critical Care Unit, Critical Care Institute, Cleveland Clinic Abu Dhabi; and Jamil R. Dibu, MD, Consultant Intensivist, Neurocritical Care, Section Head, Neurologic Critical Care Unit, Critical Care Institute, ...
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Qureshi AI, Huang W, Lobanova I, et al. Outcomes of Intensive Systolic Blood Pressure Reduction in Patients With Intracerebral Hemorrhage and Excessively High Initial Systolic Blood Pressure: Post Hoc Analysis of a Randomized Clinical Trial [published online ahead of print, 2020 Sep 8].  JAMA Neurol . 2020;e203075. doi:10.1001/jamaneurol.2020.3075 Reviewed by Shannon Hextrum, MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.       Background The American Heart Association and American Stroke Association guidelines endorse the safety of lowering systolic ...
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Currents is seeking contributors to grow our neurocritical care content offerings and showcase new perspectives. If you’re interested in learning more about how you can share your clinical expertise through Currents , contact Associate Editor Michael Reznik, MD . #NCSRoundup
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Annals of Clinical and Translational Neurology (10/05/20) doi: 10.1002/acn3.51210 Liotta, Eric M.; Batra, Ayush; Clark, Jeffrey R.; et al. https://onlinelibrary.wiley.com/doi/full/10.1002/acn3.51210 Most hospitalized COVID-19 patients experienced neurologic symptoms at some point during the course of the disease, according to new research. The retrospective study—conducted within a hospital network in Chicago—identified neurologic manifestations at COVID-19 onset among 42.2% (215) of 509 patients, at hospitalization in 62.7% (319), and at any time during the disease in 82.3% (419). The most frequent neurologic symptoms were myalgias, headaches, encephalopathy, ...
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Stroke (09/20) Vol. 51, No. 9  doi: 10.1161/STROKEAHA.120.030173 Zhang, Xiaohao; Xie, Yi; Wang, Huaiming; et al. https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.030173 Researchers sought to create a risk model able to predict symptomatic intracranial hemorrhage (sICH) in Chinese ischemic stroke patients who were treated with endovascular thrombectomy (EVT). The team, noting the varying causes of artery occlusion among different ethnic groups, developed the Alberta Stroke Program Early CT Score, Baseline Glucose, Poor Collateral Circulation, Passes With Retriever, and Onset-to-Groin Puncture Time (ASIAN) score. The team’s research included a derivation ...
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By Yingying Su, MD, PhD The 11th National Conference of Neurocritical Care Committee of the Chinese Society of Neurology (NCC/CSN) was held on Aug. 23-29 2020. We would like to thank Prof. Jose, the director of Neurocritical Care, and Prof. Gene and Brophy, the former director of Neurocritical Care, for their emails and videos to wish the conference a success. May the COVID-19 epidemic end soon, and the neurointensivists of Neurocritical Care Society (NCS) around the world will meet again.  The whole conference was held online for the first time. In order to ensure academic exchange, we changed the previously held eight sections in 1.5 days of onsite conference ...
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By Hana Nobleza, MD; Deepa Maliayandi, MD; and Diana Greene-Chandos, MD, FNCS We have all seen our lives changed by the global COVID-19 pandemic since the first reported case of COVID-19 on Dec. 31, 2020. The mission of Women in Neurocritical Care (WINCC) continued to be strengthened during these times. In this pandemic, we saw the rise of neurocritical care not only directly tackling COVID-19 but also getting involved in social activism, continued friendship, international collaboration, and improving diversity, equity and inclusion. This article will serve to celebrate the recent accomplishments of WINCC, discuss our events at the recent virtual Annual Meeting ...
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Claiborne Johnston, Pierre Amarenco, et al. for the THALES investigators.Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA. N Engl J Med   2020;383:207-17.
DOI: 10.1056/NEJMoa1916870
 Reviewed by Sanjeev Sivakumar,MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Backgound/Methods Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel has been shown to prevent recurrent strokes. Clopidogrel requires hepatic conversion to its active form and may be ineffective in a substantial number of Caucasians and patients of Asian ...
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Kwak HS, Park JS. Mechanical Thrombectomy in Basilar Artery Occlusion: Clinical Outcomes Related to Posterior Circulation Collateral Score.  Stroke . 2020;51(7):2045-2050. doi:10.1161/STROKEAHA.120.029861 Reviewed by Shannon Hextrum, MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Background/Methods Ischemic strokes due to basilar artery occlusion (BAO) are associated with high morbidity and mortality. The American Heart Association/American Stroke Association report uncertain benefit of mechanical thrombectomy in BAO given lack of trial data, though ...
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By Michelle Schober, MD James Baldwin said, “Not everything that is faced can be changed, but nothing can change until it is faced.” Many who previously doubted the existence of racial inequity in our society now finally accept it as a grave problem. Sadly, many of the newly convinced fail to internalize the realization, thus perpetuating racial inequity by inaction.   Individual inaction often stems from the unconscious separation many create between “society” and our day-to-day lives. Compartmentalization of the racial inequity “out there” separate from our professional and personal lives perpetuates racial inequity.  If we truly want change, each one ...
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Circulation (08/26/20) doi: 10.1161/CIR.0000000000000885 Gaudino, Mario; Benesch, Curtis; Bakaeen, Faisal; et al. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000885    A scientific statement from the American Heart Association (AHA) recommends specific preoperative, intraoperative, and postoperative steps to reduce the risk of perioperative stroke in adult patients undergoing cardiac and proximal thoracic aortic operations and improve the outcomes of patients who experience a perioperative stroke. The statement notes that perioperative stroke is associated with 5- to 10-fold higher risk of in-hospital mortality, increased cost, longer hospital ...
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JAMA Neurology (09/08/20) doi: 10.1001/jamaneurol.2020.3263 Sheth, Kevin N.; Mazurek, Mercy H.; Yuen, Matthew M.; et al. https://jamanetwork.com/journals/jamaneurology/fullarticle/2769858   A recent study demonstrates the successful use of low-field, portable magnetic resonance imaging (MRI) for bedside neuroimaging in an intensive care setting. The cohort study involved a series of 50 patients imaged with the portable device, including individuals with ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, traumatic brain injury, brain tumor, and COVID-19 and altered mental status. The patients were admitted to the neuroscience or COVID-19 intensive ...
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Yang P, Zhang Y, Zhang L, et al. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. N Engl J Med . 2020 May 21;382(21):1981-93. Reviewed by Wazim Mohamed, MD Read the article .*   *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.     Background/Methods As thrombectomy has become the mainstay of treatment for large vessel occlusion strokes, the additional benefit offered by thrombolytics has come into question. Thrombolysis with alteplase may aid in early reperfusion prior to thrombectomy and may have a role in dissolving distal thrombi post-thrombectomy ...
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By Thomas D. Bernier, PharmD; and Michael Schontz, PharmD, BCPS, BCCCP Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of all strokes, and due to a multitude of complications, patients are at exceptional risk of mortality and morbidity. 1 The incidence of aSAH is geographically diverse varying between 2 and 16.5 per 100,000 hospitalized adults globally. 2 Patients are at risk of multifactorial mortality and morbidity in aSAH, as patients can experience rebleeding, hydrocephalus, seizures, infections and notably delayed cerebral ischemia (DCI). 3 DCI occurs in approximately one-third of patients following aneurysmal rupture, typically presenting ...
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The Neurocritical Care Society (NCS) is proud to launch the September 2020 issue of Currents , featuring a compilation of content published on Currents throughout this extraordinary year.  This special annual issue reflects on how neurocritical care professionals have addressed COVID-19, while sharing how our Society and the field will embrace the future. This content provides a mere snapshot of the work our community has done during the pandemic, and we are immensely proud to showcase it in this issue.  Currents highlights innovative ideas and perspectives from multidisciplinary neurocritical care clinicians, and we welcome you to share your insight ...
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