Leading Insights

By Amr A. Akl, BMSc, Medical Student, Kuwait University (left); Brouj Miskin, BMSc, Medical Student and Biomedical Sciences MSc Student, Kuwait University (center); Azzah A. Alrashidi, BMSc, Medical Student, Kuwait University (center); Hamad J. AlKhader, BMSc, Medical Student, Kuwait University (right) Stroke is one of the most common healthcare-related diseases in modern day medicine. It is ranked as the second most common cause of death and third cause of disability worldwide. Temporal changes in stroke incidence were reported over the previous ...

By P.J. Papadakos, MD, FCCM, FAARC, Director Critical Care Medicine University of Rochester and police surgeon for the New York State Police  It should be the goal of every neurocritical care unit to provide community health education in conditions such as stroke and traumatic brain injury. One of the most successful ways to reach this goal is to partner and work closely with first responders in your city or town. First responders have a long history of being at the forefront of community education at schools, religious centers, community centers, ...

By Megan E. Barra, PharmD, BCPS, BCCCP, Brian L. Edlow, MD   The efficacy of pharmacologic stimulant therapy in patients with severe traumatic brain injury (TBI) was demonstrated in a 2012 randomized controlled trial that provided Level I evidence for using amantadine to accelerate subacute recovery. 1 Amantadine therapy is now recommended for patients with post-traumatic disorders of consciousness in the 2018 Disorders of Consciousness management guideline. 2  Although prescribing trends in stimulant use after the 2012 amantadine trial have yet ...

By: (from left to right) Sydney Moseley, MD, Hussein Alshammari, MD, Scott Woolf, DO, Fawaz Al-Mufti, MD 1 1 Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College The authors have no actual or potential conflict of interest in relation to the topics discussed in this column. This article may discuss non-FDA approved devices and “off-label” uses. The NCS and Currents do not endorse any particular device. Many neurological insults require close monitoring of intracranial pressure (ICP) and simultaneous ...

By:  Danielle Marut, PharmD (left), Jessica Traeger, PharmD, BCCCP (right) The use of oral factor Xa inhibitors, including rivaroxaban and apixaban, has increased over the last several years. Historically, strategies for the treatment of bleeding patients taking these agents included supportive care (due to the drugs’ short half-lives) or prothrombin complex concentrates (PCC), which are not FDA-approved for the reversal of factor Xa inhibitors. Drug-specific anti-Xa levels for rivaroxaban and apixaban are not FDA-approved or widely available, leading ...

By Bnar Shawki, MD, MBChB, F.I.C.M.S, FIPP, Head of Anesthesia Department in RozhHalat Emergency Hospital, Erbil, Iraq (left); Firas Abdulmajeed, MBChB, Assistant Professor of Critical Care Medicine and Neurology, University of Pittsburgh, USA (right) The population of Iraq is 37,203,000, according to WHO data from 2016. Life expectancy at birth in that year was 68/72 (male/female). The probability of dying between 15 and 60 years of age per 1,000 people in 2016 was 213/133 (male/female). Although we were not able to observe up-to-date accurate published ...

By Ariana Barkley, MD (left); Jonathan Medina-Beckwith DNP, ARNP, NP-C (center); Abhijit Lele, MBBS, MD, MS, FNCS (right)   Neurocritical care educational initiatives for staff at two hospitals in Phnom Penh, Cambodia emerged as a capacity development initiative that native healthcare providers enthusiastically voiced when a survey was conducted in October 2018. The Emergency Neurological Life Support Course (ENLS) serves as a paradigm of organized neurocritical care education and exists on a platform that allows dissemination of educational resources ...

By: Daniel B. Rubin, MD, PhD (left); Henrikas Vaitkevicius, MD (right)   As the field of neurocritical care becomes increasingly recognized as essential to the care of patients with serious neurologic injury, we are necessarily encountering a more complex and diverse patient population. As a consequence, neurointensivists must learn how to use new treatment modalities and understand the risks associated with them. Effective collaboration with other specialists has become increasingly necessary to provide comprehensive and effective care, to keep up ...

By Jonathan Gomez (left), Aarti Sarwal (left), John Bennett (center), Chandrika Garner (center), Adrian Lata (right), Charles Tegeler IV (right) Neurological complications in the perioperative period of cardiothoracic (CT) interventions occur in about 50-60 percent of patients. These complications may range from focal neurological deficits to confusion and memory deficits, with stroke rate approaching 2-8 percent.[1]  Patients who experience operative complications exhibit an increased mortality rate of 10-21 percent. Neurointensivists may be called ...

By Jeb Rodgers, MD, Resident Physician, University of Missouri Department of Emergency Medicine (left);  Niraj Arora, MD, Assistant Professor of Clinical Neurology, University of Missouri Department of Neurology (center); and Section Editor Michael Reznik, MD, Assistant Professor of Neurology & Neurosurgery, Brown University, Alpert Medical School/Rhode Island Hospital (right). Steve Maddox is a man with many titles—devoted father, loving husband, dedicated driveway basketball player, motorcycle-rider, lover of jokes and wisecracks, shop foreman at ...

ASEA UNINET Teaching Course on Neurocritical Care Medicine at the University of Karachi, Pakistan Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences (ICCBS), University of Karachi, Pakistan; March 7-8, 2019 In continuance to the neurocritical care teaching courses held in Kuala Lumpur in December 2015, August 2016 and March 2018, the organizing bodies — namely ASEA UNINET, Medical University Austria and the International Center for Chemical and Biological Sciences, University of ...

By Hannah Breit, MD, Neurology Resident, Rush University Medical Center, and Lauren Koffman, DO, MS, Assistant Professor of Neurological Sciences, Rush University Medical Center; Section Editor: Michael Reznik, MD, Assistant Professor of Neurology & Neurosurgery, Brown University, Alpert Medical School/Rhode Island Hospital April 20, 2018: It was a brisk and sunny day in Chicago. Danny and his wife Lexie woke up to the sounds of their three rambunctious children — a 7-year-old, a 2-year-old and an 8-month-old — and a house full of laughter and love. ...

By Sachin Agarwal, MD, MPH 1 (pictured); Alex Presciutti, MA 1 ; Deepti Anbarasan, MD 2 ; Linda S. Golding, MA BCC 3 ; and Marykay Pavol PhD 4 1 Division of Neurocritical Care, Department of Neurology 2 Division of Epilepsy, Department of Neurology 3 Pastoral Services, New York Presbyterian Hospital 4 Division of Neuropsychology, Department of Neurology Columbia University College of Physicians & Surgeons, New York Presbyterian Hospital Goals and Vision of the Program Life after cardiac arrest is like “walking around without a net.” 1 ...

By Andrew M. Naidech, MD, MSPH Randomized clinical trials (RCTs) are a keystone of modern medicine and considered the gold standard for determining if an intervention produces better patient outcomes in a variety of critical care and acute care settings. While observational data (e.g., registries, cohorts, databases) are valuable and advance knowledge, there are often measured and unmeasured confounders between the intervention and the patient outcome, such as uncontrolled factors that affect both the cause and apparent effect of an intervention. RCTs, ...

By Audrey Paulson, DNP Electroencephalograms (EEGs) are usually placed on the patient by the EEG tech, and the process takes at least 30 minutes. It is then read by the neurologist, occasionally in real time but often after the fact. This results in the diagnosis of a seizure long after the seizure is over. Nursing typically does not play a huge role in this process except to alert the physician if they see any type of seizure activity. One FDA-approved product available on the market is Ceribell™. It is a device that can change how nursing functions ...

By Chandrika R Garner, MD, FASE 1 (not pictured); Rohesh J Fernando, MD 1 (left); Aarti Sarwal, MD, FNCS, FAAN 2 (center); and Jose L. Diaz-Gomez, MD, FCCM, FASE 3 (right) Wake Forest School of Medicine, Department of Anesthesiology, Section on Cardiac Anesthesiology Wake Forest School of Medicine, Department of Neurology, Section on Neurocritical Care Mayo Clinic, Jacksonville, Fla., Departments of Critical Care Medicine, Anesthesiology & Perioperative Medicine, and Neurologic Surgery The use of point of care ultrasound (POCUS) or focused ...

By Katherine Salisbury (left) and Aarti Sarwal, MD (right) Traumatic brain injuries (TBI) are a major cause of hospitalization and death in the United States, with an estimated 1.7 million people sustaining TBIs annually and 52,000 of those dying from TBI-related factors 1 . While the hemodynamic and neurological responses depend upon severity, patient risk for significant injury does not conclude after primary impact. Modern TBI management centers around the need to reduce risk associated with secondary brain injuries resulting from a variety of ...

By Fawaz Al-Mufti, MD 1 ; Francisco Gomez, MD 2 ; Corey Scurlock, MD, MBA 1 ; and Chad Cole, MD, MSc 1 Westchester Medical Center at New York Medical College University of Pennsylvania Editor’s Note : The authors have no actual or potential conflict of interest in relation to the topics discussed in this column. This article may discuss non-FDA approved devices and “off-label” uses. NCS and Currents do not endorse any particular device.  As the population ages, critical care needs will increase proportionally and health systems will need ...

By (from left to right) Simona Ferioli, MD; Brandon Foreman, MD; and Kelly Rath, ACNP, University of Cincinnati, Department of Neurocritical Care Section Editor : Michael Reznik, MD, Brown University, Alpert Medical School, Rhode Island Hospital It was the Christmas season, which for Mary and Mark meant a time for reflection and making plans. Mark would retire, they agreed, while Mary would continue working her job as an operations specialist at Delta. They would continue to travel and enjoy living the American dream. And why not? Mary had just ...