Leading Insights

There was a trail of blood around the house that led to the basement. He recalls pacing back and forth, trying to take care of a wound. He had blacked out at some point, but he remembers his dog vigorously licking him to get up and answer the door.   Christopher’s memory and speech still aren’t what they used to be, but they’ve been steadily getting better. He turned 21 years old in 2019, and the year has been one of recovery and rebirth. He continues to make constant progress, and he hopes that someday soon he may yet return to his electrician’s apprenticeship ...

The Currents Editorial Board is seeking Stories of Hope submissions for 2020. Stories of Hope tells the stories of patients who have fought their way to recovery and the experiences of their family and/or medical providers. By sharing these stories, we remind each other of what we are all working for and reinforce each other’s resilience and hope. Do you have a story to share? Email your idea as a brief paragraph to krehan@neurocriticalcare.org  with the subject line “Stories of Hope.” #LeadingInsights ​

Emily Grodinsky, MD (left), Edith Graham, MD Neurology Residents (center), David Walker, MD (center), Lauren Koffman, DO, MS Assistant Professor of Neurological Sciences (right) Aaron Smith is the kind of guy you want to be around. He is 20 years old, with maturity and wisdom beyond his years — forged from having lost his mother at a young age. As a result of his loss, he has grown closer to his father and other relatives, and has developed into someone who is “gentle, reserved, hardworking, loving, and hilarious” according to his niece, Tyler.  ...

By Jody Manners Dr. Cherylee Chang was born on Kauai, Hawaii and raised in Los Angeles from an early age. She graduated from Stanford University and completed medical school and her internship year at the University of California at San Diego. She returned to Stanford for her neurology residency. She returned to UCSD to complete an internal medicine residency before traveling to Charlottesville where she completed fellowships in internal medicine critical care and neurological critical care at the University of Virginia. She now serves as the Medical ...

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. ...