Literature Watch

By Kyle Hobbs, MD and Sara Stern-Nezer, MD   Coma secondary to acute brain injury is extremely common in the neurocritical care unit, but prognosis after coma is challenging. Electroencephalography provides a window into the comatose brain, revealing brain activity even in the absence of clinical responses. The reviewed studies below investigate the role of EEG in comatose patients.   Electroencephalographic reactivity as predictor of neurologic outcome in postanoxic coma: A multicenter prospective cohort study.  Ann Neurol 2019; 86:17-27   ...

By   Ma, H., Campbell, B.C., Parsons, M.W., et al. New England Journal of Medicine ,  380 (19), pp.1795-1803. Summary Methods: The recently successful thrombectomy trials (DEFUSE 3 and DAWN) have set a paradigm of reperfusion based on tissue viability assessed by perfusion imaging rather than time from symptom onset. However, this has also caused a disparity between the accepted time frame for chemical thrombolysis (up to 4.5 hours) and mechanical thrombectomy (up to 24 hours). This international multicenter phase 3 randomized controlled trial ...

By Harahsheh, Y., Duff, O.C., Ho, K.M. “Thromboelastography predicts thromboembolism in critically ill coagulopathic patients.” CCM. 2019;47(6): 826-832. Summary : Thromboembolism is the main cause of preventable hospital-associated death. Coagulopathy is common in the ICU, often resulting in cessation of venous thromboembolism (VTE) prophylaxis, but some of these patients with abnormal coagulation may remain at high risk of VTE. This prospective cohort aimed to use thromboelastography (TEG) to risk-stratify risk of VTE in coagulopathic patients admitted ...

Authors: Roberts BW, Kilgannon JH, Hunter BR, et al. Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study. CCM. 2019 Jan;47(1):93-100. Reviewed by: Sara Stern-Nezer, MD, MPH; and Kyle Hobbs, MD  Read the article .*  *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.  Even in the era of TTM, a large number of post-cardiac arrest patients have poor outcomes, in part owing ...

Authors: Tsai MS, Chuang PY, et al. Postarrest steroid use may improve outcomes of cardiac arrest survivors. CCM. 2019 Feb;47(2):167-175. Reviewed by: Sara Stern-Nezer, MD, MPH; and Kyle Hobbs, MD  Read the article. * *You will need to log in to US National Library of Medicine National Institutes of Health to read this article.    Even in the era of TTM, a large number of post-cardiac arrest patients have poor outcomes, in part owing to the ongoing secondary brain injury that occurs after ROSC. In these reviews, we consider additional targets ...

Authors: Leslie-Mazwi TM, Hamilton S, et al. DEFUSE 3 Non-DAWN Patients: A Closer Look at Late Window Thrombectomy Selection. Stroke . 2019 Feb 6 :STROKEAHA-118 . 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 The 2018 American Heart Association guidelines for the management of acute ischemic stroke recommend ...

Authors: Galovic M, Stauber AJ, Leisi N, et al. Development and Validation of a Prognostic Model of Swallowing Recovery and Enteral Tube Feeding After Ischemic Stroke.  JAMA Neurol . Published online February 11, 2019. doi :10.1001/jamaneurol.2018.4858 Reviewed by: Lara L. 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. ...

By Shraddha Mainali, MD, and Paul M. Vespa, MD, FCCM, FAAN, FANA, FNCS Special thanks to Jose Javier Provencio MD, FCCM, FAAN, FNCS; Susanne Muehlschlegel MD, MPH, FNCS, FCCM; and Daiwai Olson, RN, PhD , CCRN, FNCS It is an exciting time to be in neurocritical care. There has been tremendous growth of this field with important progress in education, patient quality and advocacy, and training in the last decade. The progress in research has been remarkable, with the recent publication of important clinical trials and observational studies. However, ...

By Tamara T. Barghouthi, MD; Quang Vu, MD; Charles Tegeler, MD; Aarti Sarwal, MD Reversed Robin Hood Syndrome (RRHS) is a condition seen in acute stroke and TIA patients with large vessel occlusions in which there is a paradoxical decrease in flow velocity in the affected vessel, distal to occlusion of the vessel, which can occur spontaneously or in response to vasodilatory stimuli (such as breath holding) and result in worsening or recurrence of stroke symptoms. This cerebral steal phenomenon was first described by Alexandrov et al in 2007. It is ...

Authors: Rey A. Rossetti AO, et al. Late Awakening in Survivors of Postanoxic Coma: Early Neurophysiologic Predictors and Association With ICU and Long-Term Neurologic Recovery. Critical Care Medicine. 2019 Jan 1;47(1):85-92. Reviewed by: Wazim Mohamed, MD, Assistant Professor of Neurology, Division of Neurotrauma and Critical Care Neurology, Wayne State University Methods Over the last decade, survival from coma after cardiac arrest (CA) has approached 50% and up to 1/3 of survivors may experience late awakening, defined as time to awakening ...

Authors: Roberts BW, Kilgannon JH, Hunter BR, et al. Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study. Critical Care Medicine. 47(1):93–100. Reviewed by: Lara L. 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 ...

Authors: Oppong MD, Gembruch O, Pierscianek D, et al. Post-treatment antiplatelet therapy reduces risk for delayed cerebral ischemia due to aneurysmal subarachnoid hemorrhage. Neurosurgery 2018; 0: 1-7. Reviewed by: Kyle Hobbs, MD, Director, Neurocritical Care Fellowship, Assistant Professor of Neurology, 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. Methods Delayed cerebral ischemia (DCI) occurs in approximately 30 percent of ...

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 ...