Literature Watch

By Kyle Hobbs, MD, and Sara Stern-Nezer, MD Due to their efficacy and favorable rates of complications when compared to vitamin K antagonist therapy, direct or novel oral anticoagulant (NOAC/DOAC) use is now widespread, and reversal agents exist for many of these medications. The studies reviewed below analyzed how different disease outcomes (traumatic brain injury and subdural hematoma) were affected by the use of DOAC therapy. The novel oral anticoagulants have worse outcomes compared with warfarin in patients with intracranial hemorrhage after ...

Authors: Cooper DJ, Nichol AD, Bailey M, Bernard S, Cameron, PA, Fili-Floury S, Forbes A, Gantner D, Higgins AM, Huet O, Kasza J, Muray L, Newby L, Presneill JJ, Rashford S, Rosenfeld JV, Stephenson M, Vallance S, Varma D, Webb SAR, Trapani T, McArthur C. “Effect of early sustained prophylactic hypothermia on neurological outcomes among patients with severe traumatic brain injury: the POLAR randomized clinical trial.” JAMA 2018 Oct 24. doi: 10.1001/ jama.2018.17075 . Published online ahead of print. Reviewed by: Sara Stern-Nezer, MD, MPH, Assistant ...

Authors: Nasi D, Gladi M, Di Rienzo A, et al. Risk factors for post-traumatic hydrocephalus following decompressive craniectomy. Acta neurochirurgica . 2018 Sep 1;160(9):1691-8. Reviewed by: Wazim Mohamed, MD, Assistant Professor of Neurology, Division of Neurotrauma and Critical Care Neurology, Wayne State University Read the article .* * You will need to log in to US National Library of Medicine National Institutes of Health to read this article.  Methods Post-traumatic hydrocephalus (PTH) occurs in up to a third of patients with traumatic ...

Authors: Naidech AM, Beaumond J, Muldoon K, et al. Prophylactic seizure medications and health-related quality of life after intracerebral hemorrhage . Crit Care Med. 2018 Sep;46(9):1480-1485. Reviewed by: Lara Zimmermann, MD, Co-Director, Neurocritical Care Service, Assistant Professor of Neurological Surgery and Neurology, UC Davis School of Medicine Read the article .* * You will need to log in to US National Library of Medicine National Institutes of Health to read this article.    Summary Methods: Seizures are common after intracerebral ...

Authors: Armangue T, Spatola M, Vlagea A, et al. Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis. Lancet Neurol 2018; 17:760-72. Reviewed by: Kyle Hobbs, MD, Director, Neurocritical Care Fellowship, Assistant Professor of Neurology and Neurocritical Care, Wake Forest School of Medicine Read the article .* * You will need to log in to US National Library of Medicine National Institutes of Health to read this article.    ...

Authors: Husain, AM, Lee, JW, Kolls, BJ, et al. “Randomized trial of lacosamide versus fosphenytoin for nonconvulsive seizures.” Ann Neurol 2018; 83:1174-1185 Reviewed by: Sara Stern-Nezer, MD, MPH, Assistant Clinical Professor, University of California, Irvine Read the article .* * You will need to log in to US National Library of Medicine National Institutes of Health to read this article.    Methods The Treatment of Recurrent Electrographic Non-convulsive Seizures (TRENdS) study is a prospective, noninferiority multicenter randomized control ...

By Brian Gilbert, PharmD, BCPS, BCCCP According to the Centers for Disease Control, it is estimated that over 1.5 million people sustain a traumatic brain injury (TBI) in the United States each year. 1 Treatment modalities listed by the Brain Trauma Foundation Guidelines (BTFG) include: decompressive craniectomy, hyperosmolar therapy, cerebrospinal fluid drainage, ventilation techniques and anesthetics/analgesics/sedatives. 2 Mannitol and hypertonic saline (HTS) make up the majority of hyperosmolar therapies practiced for treatment of TBI today. ...

By Aimee Aysenne, MD (left), MPH, and Kyle Hobbs, MD (right) Kidney injury is common in the neurocritical care unit. It has a significant impact on ICU length of stay and ultimate recovery, and can be aggravated by interventions undertaken for neurologic disease. The reviewed studies below investigate the effect of aggressive blood pressure control in acute spontaneous intracerebral hemorrhage on renal function, as well kidney protection strategies in patients undergoing angiography. Aggressive BP lowering in intracerebral hemorrhage is associated ...

Authors: Guan, J., Karsy, M., Brock, A. et al. “Vitamin D status and 3-month Glasgow Outcome Scale scores in patients in neurocritical care: prospective analysis of 497 patients.” J Neurosurg 128: 1635-1641 Reviewed by: Sara Stern-Nezer, MD, MPH, Assistant Clinical Professor, University of California, Irvine Read the article .*  * You will need to log in to US National Library of Medicine National Institutes of Health to read this article.  Background/Study Design Prior studies have shown that vitamin D deficiency is associated with worse ...

Authors:  Kamarainen O, Huttunen J, Lindgren A, et al. Identification of potential organ donors after aneurysmal subarachnoid hemorrhage in a population-based neurointensive care in Eastern Finland. Acta Neurochirurgica 2018; 160:1507-1514. Reviewed by: Kyle Hobbs, MD, Assistant Professor of Neurology and Neurocritical Care, Wake Forest University School of Medicine Read the article * *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.  Summary Aneurysmal SAH is a leading cause of ...

Author: Simonsen CZ, Yoo AJ, Sorenson LH, et al. Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke: a randomized clinical trial. JAMA Neurol 2018; 75(4): 470-477 Reviewed by:  Kyle Hobbs, MD, Assistant Professor, Wake Forest School of Medicine Read the article * *You will need to log in or register for JAMA Neurology in order to read this article.  Summary The General or Local Anesthesia in Intra Arterial Therapy (GOLIATH) trial is a single-center, ...

Authors: Hart RG, Sharma M, Mundl et al. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med 2018; 378:2191-201. Reviewed by:  Kyle Hobbs, MD, Assistant Professor, Wake Forest School of Medicine Read the article * *You will need to log in or register for the  The New England Journal of Medicine  in order to read this article.  Summary Embolic stroke of undetermined source (ESUS) is a group of cryptogenic ischemic strokes not associated with proximal arterial stenosis or a cardioembolic source, and that ...

Authors: Curley, W.H., Forgacs, P.B., Voss, H.U., at al. Characterization of EEG signals revealing covert cognition in the injured brain. Brain. 141: 1404-1421, 2018. Reviewed by: Aimee Aysenne MD, MPH, Assistant Professor, Clinical Neurosciences, Tulane University, School of Medicine Read the article .* *You will need to log in or register for the  Brain  journal of neurology  in order to read this article.  Summary Cognitive motor dissociation (CMD) is defined as a state in which cognition can be detected via imaging including functional MRI, ...

By Aimee Aysenne, MD, MPH, (left) and Kyle Hobbs, MD (right) Antihypertensive medications are ubiquitous in ICUs. Still, complete understanding of the effect on the brain in neurologically patients is not well understood. In these reviews, we examine the cerebrovascular consequence of antihypertensives, namely the mortality benefit for patients who received beta blockers after TBI and the effect of nicardipine on transcranial Doppler in aneurysmal subarachnoid hemorrhage. Beta blockers associated with improved survival after acute traumatic brain ...

Authors: Lahiri, S., Nezhad, M., Schlick, K.H., et al. Paradoxical cerebrovascular hemodynamic changes with nicardipine. J Neurosurg 128: 1015-1019, 2018. Reviewed by: Aimee Aysenne MD, MPH, Assistant Professor, Clinical Neurosciences, Tulane University, School of Medicine Read the article * *You will need to log in or register for the Journal of Neurosurgery in order to read this article.  Summary Nicardipine is a commonly used intravenous dihydropyridine calcium channel blocker, which acts via smooth muscle relaxation, primarily of the systemic ...

Authors: Sauvigny T, Göttsche J, Czorligh P, Vettorazzi E, Westphal M, and Regelsberger J.  Intracranial pressure (ICP) in patients undergoing decompressive craniectomy: new perspective on thresholds. J Neurosurgery . March 2018; 128(3): 819-827 Reviewed by: Sara Stern-Nezer, MD, MPH, Assistant Clinical Professor, University of California, Irvine Read the article * *You will need to log in or register for the  Journal of Neurosurgery  in order to read this article.  Methods This study investigated the association between ICP and outcome ...

By Aimee Aysenne, MD, MPH, and Kyle Hobbs, MD Recently, two landmark studies supporting an extended time window for the treatment of large vessel occlusion (LVO) have been published. DAWN, published in November, investigated thrombectomy between six and 24 hours from last known well time (LKW) and used clinical severity to imaging mismatch for the selection of patients. In January, DEFUSE3 was published and found benefit of thrombectomy for patients in the six to 16 hour window using infarcted core to ischemic penumbra mismatch on imaging alone. Both ...

Author: Konczalla J, Seifert V, Beck J, et al. Outcome after Hunt and Hess grade V subarachnoid hemorrhage: a comparison of pre-coiling era versus post-ISAT era (2005-2014). J Neurosurg 2018; 128:100-110. Reviewed by: Kyle Hobbs, MD, Assistant Professor, Wake Forest School of Medicine Treatment of poor grade subarachnoid hemorrhage (SAH) is controversial, both in terms of aggressiveness of care as well as modality of treatment (coiling vs clipping). This retrospective outcome analysis compared patients from two time periods admitted to Goethe-University ...

Author: Albers, G. W., Marks, M.P., Kemp, S., et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. NEJM Jan 2018. Reviewed by: Aimee Aysenne MD, MPH, Assistant Professor, Clinical Neurosciences, Tulane University, School of Medicine Summary DEFUSE3 is a multicenter, randomized, open-label trial for the use of mechanical thrombectomy in ischemic stroke patients with large vessel occlusion between 6 and 16 hours from last known well time and with known salvageable tissue on imaging using volumetric software. The trial ...

Read the article . Listen to the podcast . Author: Weisbord, SD, Gallagher M, Jneid H, et al. “Outcomes after angiography with sodium bicarbonate and acetylcysteine.” NEJM 2018; 378(7): 603-614 Reviewed by: Sara Stern-Nezer, MD, MPH, Assistant Clinical Professor, University of California, Irvine Methods This study was a multi-site, international double-blind, placebo and drug-controlled RCT done between 2013 and 2017.  Patients with decreased GFR (15-44.9 for all patients and 45-59.9 among those with DM) were enrolled and randomized in a 2x2 factorial ...

Read the article . Author: Al-Mufti F, Merkler AE, Boehme AK, et al.  Functional outcomes and delayed cerebral ischemia following nonperimesencephalic angiogram-negative subarachnoid hemorrhage similar to aneurysmal subarachnoid hemorrhage.  Neurosurg 2018; 82(3):359-364. Reviewed by: Kyle Hobbs, MD, Assistant Professor of Neurocritical Care, Wake Forest School of Medicine Summary Nonperimesencephalic angiogram-negative SAH (NPAN-SAH) encompasses ~5% of patients presenting with SAH.  This prospective observational cohort study evaluated 90-day ...

Read the article . Listen to the podcast .  Author: Garrett, M.P., Williamson, R.W., Bohl, M.A., et al. Computer tomography angiography as a confirmatory test for the diagnosis of brain death. J Neurosurg 128: 639-644, 2018. Reviewed by: Aimee Aysenne MD, MPH, Assistant Professor, Clinical Neurosciences, Tulane University, School of Medicine Summary Brain death standards have been published as an American Academy of Neurology (AAN) Practice Perimeter established in 1995, and reevaluated in 2010. In addition to the clinical exam, tests to confirm ...

Read the article .  Author: Ley EJ, Leonard SD, Barmparas G, et al. Beta blockers in critically ill patients with traumatic brain injury: Results from a multicenter, prospective, observational American Association for the Surgery of Trauma study . J Trauma Acute Care Surg 84(2):234-244, 2018. Reviewed by: Lara L. Zimmermann, MD, Assistant Professor, Neurosurgery and Neurocritical Care, UC Davis Health Summary The Fourth Edition of the Guidelines for the Management of Severe Traumatic Brain Injury (TBI) were published by the Brain Trauma Foundation ...

By Kelsey M. Woods, PharmD, and Katleen Wyatt Chester, PharmD, BCGP, BCCCP Approved in 1996, alteplase has long been the standard of care for acute ischemic stroke (AIS) patients presenting within the window for treatment. Alteplase is also utilized for pulmonary embolism (PE), myocardial infarction (MI), and cardiac arrest secondary to presumed PE or MI. While alteplase made a name for itself in the brain and heart, tenecteplase comes to us with a proven indication in MI, looking to expand its utilization to ischemic stroke. Tenecteplase varies ...