Literature Watch

Clinical Neurophysiology (05/06/22) DOI: 10.1016/j.clinph.2022.04.018 Amorim, Edilberto; Firme, Marcos S.; Zheng, Wei-Long; et al. https://www.sciencedirect.com/science/article/abs/pii/S1388245722002619 A recent study sought to estimate the prevalence of seizures and ictal-interictal continuum patterns in patients undergoing electroencephalography (EEG) during extracorporeal membrane oxygenation (ECMO). The retrospective review of a prospective ECMO registry from 2011-2018 included adult patients who had reduced level of consciousness and underwent ...

Arshdeep Kaur, MD PGY-3 resident in Neurology Wayne State University/Detroit Medical Center Wazim Mohamed, MD Associate Professor of Neurology and Neurosurgery Wayne State University Khan, Abid D., et al. "A multicenter validation of the Modified Brain Injury Guidelines (mBIG): are they safe and effective?." The Journal of Trauma and Acute Care Surgery (2022). Background/Methods: Traumatic brain injury accounts for a substantial number of ER visits and hospital admissions requiring extensive resource utilization. This patient ...

Journal of the American Medical Association (05/04/22) DOI: 10.1001/jama.2022.4798 Bösel, Julian; Niesen, Wolf-Dirk; Salih, Farid; et al. https://jamanetwork.com/journals/jama/fullarticle/2792016 Early tracheostomy does not significantly increase survival without severe disability at 6 months for patients with severe stroke receiving mechanical ventilation, researchers report. The SETPOINT2 study, which was conducted at U.S. and German neurocritical care units between 2015 and 2020, included 382 patients with severe acute ischemic or hemorrhagic ...

Intensive Care Medicine (06/01/22) DOI: 10.1007/s00134-022-06712-2 Lewis, Kimberley; Alshamsi, Fayez; Carayannopoulos, Kallirroi Laiya; et al. https://link.springer.com/article/10.1007/s00134-022-06712-2 A recent study highlights the benefits of dexmedetomidine for mechanically ventilated adults. According to the data, use of dexmedetomidine compared with other sedatives led to a lower risk of delirium and a modest reduction of mechanical ventilation and ICU stay, although the risk for bradycardia and hypotension increased. The systematic review ...

Matthew Bower, MD Neurology Resident (PGY-4), UC Irvine Incoming Neurocritical Care Fellow 2022 Johns Hopkins University Sara Stern-Nezer, MD, MPH Assistant Clinical Professor Departments of Neurology & Neurosurgery University of California, Irvine Ruijter B, Keijzer M, et al. Treating Rhythmic and Periodic EEG Patterns in Comatose Survivors of Cardiac Arrest. NEJM (2022). DOI: 10.1056/NEJMoa2115998 Background: Up to 10-35% of comatose post cardiac arrest patients have epileptiform activity such as periodic generalized discharges (GPDs) or ...

Gantner D, Wiegers E, Bragge P, Finfer S, Delaney A, van Essen T, Peul W, Maas AIR, Cooper DJ. Decompressive Craniectomy Practice following Traumatic Brain Injury in Comparison with Randomized Trials: Harmonized, Multi-Center Cohort Studies in Europe, the United Kingdom, and Australia. J Neurotrauma. 2022 Apr 6. doi: 10.1089/neu.2021.0312. Epub ahead of print. PMID: 35243877. Background : Severe traumatic brain injury (TBI) is highly disabling, with over 50% of patients facing mortality or long-term disability. Secondary decompressive craniectomy ...

Herniation World Federation of Neurosurgical Societies Scale Improves Prediction of Outcome in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage Stroke (03/22/22) DOI: 10.1161/STROKEAHA.121.036699 Raabe, Andreas; Beck, Jürgen; Goldberg, Johannes; et al. https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.036699 An international prospective multicenter study involving poor-grade aneurysmal subarachnoid hemorrhage patients compared the World Federation of Neurosurgical Societies (WFNS) classification with a modified version, the herniation ...

Effects of Clazosentan on Cerebral Vasospasm–Related Morbidity and All-Cause Mortality after Aneurysmal Subarachnoid Hemorrhage: Two Randomized Phase 3 Trials in Japanese Patients Journal of Neurosurgery (04/01/22) DOI: 10.3171/2022.2.JNS212914 Endo, Hidenori; Hagihara, Yasushi; Kimura, Naoto; et al. https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2022.2.JNS212914/article-10.3171-2022.2.JNS212914.xml New research out of Japan indicates that clazosentan led to significant reductions in the incidence of vasospasm-related morbidity ...

Perera KS, et al. Young ESUS Investigators. Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source: The Young ESUS Longitudinal Cohort Study. JAMA Neurol. 2022 Mar 14. PMID: 35285869 Background: Embolic stroke of undetermined source (ESUS) is defined as ischemic stroke(s) that is non-lacunar in nature and without any identified major cardioembolic etiology. In younger adults (<50 years of age), ESUS can comprise up to 40 percent of ischemic stroke cases. Silent atrial fibrillation (AF) has been ...

Endovascular Therapy for Acute Stroke with a Large Ischemic Region New England Journal of Medicine (04/07/22) DOI: 10.1056/NEJMoa2118191 Yoshimura, Shinichi; Sakai, Nobuyuki; Hiroshi Yamagami; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2118191 Researchers conducted a randomized clinical trial in Japan involving patients with occlusion of large cerebral vessels and sizable strokes on imaging, as indicated by an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) value of 3 to 5. The multicenter, open-label study randomized ...

New England Journal of Medicine (02/24/22); 386(8):724-734. DOI: 10.1056/NEJMoa2115998 Ruijter, Barry J.; Keijzer, Hanneke M.; Tjepkema-Cloostermans, Marleen C.; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2115998 The Treatment of Electroencephalographic Status Epilepticus after Cardiopulmonary Resuscitation (TELSTAR) trial sought to determine whether the use of intensive, stepwise antiseizure and sedative therapy to suppress rhythmic and periodic EEG patterns detected in continuous EEG monitoring would affect the outcomes for comatose ...

Background: Non-traumatic subarachnoid hemorrhage (SAH) is a devastating disease that accounts for less than 10% of all strokes but is one of the most common cause of stroke-related deaths. However, for a small subset of these patients, specifically those in which a bleed source cannot be identified (angiogram-negative), outcomes tend to be more favorable. This group can be further subdivided into patients with a perimesencephalic bleed (PMH) and non-perimesencephalic (nPMH) bleeding patterns, with some studies suggesting differences in outcomes between ...

Journal of the American Medical Association (02/22/22); 327(8):737-747. DOI: 10.1001/jama.2022.1025 Belohlavek, Jan; Smalcova, Jana; Rob, Daniel; et al. https://jamanetwork.com/journals/jama/fullarticle/2789313 The combination of early intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and invasive assessment and treatment did not significantly increase survival with neurologically favorable outcome at 180 days for patients with refractory out-of-hospital cardiac arrest (OHCA), compared with standard resuscitation, according ...

Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT): A Multicenter International Study Stroke (02/10/22) DOI: 10.1161/STROKEAHA.121.037541 Yaghi, Shadi; Shu, Liqi; Bakradze, Ekaterina; et al. https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.037541 An international retrospective study compared direct oral anticoagulants (DOACs) with warfarin in a real-world cerebral venous thrombosis (CVT) cohort. The study included 845 patients with CVT who received oral anticoagulants from January 2015 ...

Statins and the risk of Intracranial hemorrhage. Is there a link? Amarenco P, et al; Treat Stroke to Target Investigators. Intracranial Hemorrhage in the TST Trial. Stroke. 2022 Feb;53(2):457-462. DOI: 10.1161/STROKEAHA.121.035846 Background/Methods Statins are recommended after a transient ischemic attack (TIA) or an ischemic stroke of atherosclerotic origin according to the AHA/ASA guidelines. The SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Level) found patients with an ischemic event on statins had lower risk of ...

Endovascular Therapy for Acute Stroke with a Large Ischemic Region New England Journal of Medicine (02/09/22) DOI: 10.1056/NEJMoa2118191 Yoshimura, Shinichi; Sakai, Nobuyuki; Yamagami, Hiroshi; et.al. https://www.nejm.org/doi/full/10.1056/NEJMoa2118191 Researchers in Japan explored the effect of endovascular therapy for acute ischemic stroke with large infarctions. In a sample population of 203 participants, they randomized one-half to receive usual medical care only and the other one-half to receive usual medical care plus endovascular therapy. ...

Cereda CW, Bianco G et al. Perfusion Imaging Predicts Favorable Outcomes after Basilar Artery Thrombectomy. ANN NEUROL 2022;91:23–32 Summary Background/Methods Randomized trials support the use of perfusion imaging to identify patients with anterior circulation large vessel occlusive disease that are likely to benefit from thrombectomy. There is paucity of data on the use of perfusion imaging as well as demonstrating a benefit of thrombectomy in basilar artery occlusion (BAO). The authors of the current study sought to investigate the utility ...

van Veen E, van der Jagt M, Citerio G, et al. Occurrence and timing of withdrawal of life-sustining measures in traumatic brain injury patients: a CENTER-TBI study. Intensive Care Med . 2021;47(10):1115-1129. doi:10.1007/s00134-021-06484-1 Read the Full Article Background: In patients with devastating brain injury, the Neurocritical Care Society recommends 72 hours of observation prior to formal decisions on the withdrawal of life sustaining measures (WSLM). Prognostication in patients with severe traumatic brain injury is challenging, and ...

Monitoring Spinal Cord Tissue Oxygen in Patients With Acute, Severe Traumatic Spinal Cord Injuries Critical Care Medicine (01/06/22) DOI: 10.1097/CCM.0000000000005433 Visagan, Ravindran; Hogg, Florence R.A.; Gallagher, Mathew J.; et al. https://journals.lww.com/ccmjournal/Abstract/9000/Monitoring_Spinal_Cord_Tissue_Oxygen_in_Patients.95024.aspx A recent study investigated whether monitoring tissue oxygen tension from the injury site (p sct O 2 ) in patients with acute, severe traumatic spinal cord injuries is feasible. The study involved 26 ...

Regional Distribution of Brain Injury After Cardiac Arrest: Clinical and Electrographic Correlates Neurology (01/11/22) DOI: 10.1212/WNL.0000000000013301 Snider, Samuel B.; Fischer, David; McKeown, Morgan E; et al. https://n.neurology.org/content/early/2022/01/11/WNL.0000000000013301   Disorders of consciousness after cardiac arrest are linked with widely lower apparent diffusion coefficient (ADC) values on diffusion MRI, according to new research. The study, which provides Class IV evidence to that effect, also concluded the strongest associations ...

Disorders of Consciousness Associated With COVID-19: A Prospective, Multimodal Study of Recovery and Brain Connectivity Neurology (12/03/21) DOI: 10.1212/WNL.0000000000013067 Fischer, David; Snider, Samuel B.; Barra, Megan E.; et al. https://n.neurology.org/content/early/2021/12/02/WNL.0000000000013067   A prospective, longitudinal study aimed to describe the natural history of COVID-19 disorders of consciousness (COVID-DoC). The condition, for which the prognosis and pathophysiology are still unclear, can affect decisions regarding life-sustaining ...

van Veen E, van der Jagt M, Citerio G, et al. Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients: a CENTER-TBI study. Intensive Care Med . 2021;47(10):1115-1129. doi:10.1007/s00134-021-06484-1  Read the Full Article. Background: In patients with devastating brain injury, the Neurocritical Care Society recommends 72 hours of observation prior to formal decisions on the withdrawal of life sustaining measures (WSLM). Prognostication in patients with severe traumatic brain injury is challenging, and ...

Super-Refractory Status Epilepticus in Children: A Retrospective Cohort Study Pediatric Critical Care Medicine (12/21) Vol. 22, No. 12, p. e613 DOI: 10.1097/PCC.0000000000002786 Vasquez, Alejandra; Farias-Moeller, Raquel; Sánchez-Fernández, Iván; et al. https://journals.lww.com/pccmjournal/Abstract/2021/12000/Super_Refractory_Status_Epilepticus_in_Children__A.18.aspx   Patients with super-refractory status epilepticus experienced delayed initiation of nonbenzodiazepine antiseizure medication, increased medical complications and mortality, ...

Zampieri FG, Machado FR, et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA. 2021 Aug 10. doi: 10.1001/jama.2021.11684  Read the Full Article Background : Intravenous fluids are a mainstay of therapy for critically ill patients and much debate has existed over the optimum fluid. 0.9% NaCl was identified by a Dutch chemist in the 1890s who found that it did not cause red cell lysis in vitro and had the same freezing ...

Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion JAMA Neurology (11/08/21) DOI: 10.1001/jamaneurol.2021.4082 Nguyen, Thanh N.; Abdalkader, Mohamad; Nagel, Simon; et al. https://jamanetwork.com/journals/jamaneurology/fullarticle/2785854   The results of a new study show no significant differences in the clinical outcomes for patients undergoing proximal anterior circulation mechanical thrombectomy in the extended time window ...

A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke New England Journal of Medicine (11/11/21) DOI: 10.1056/NEJMoa2107727 LeCouffe, Natalie E.; Kappelhof, Manon; Treurniet, Kilian M.; et al. https://www.nejm.org/doi/full/10.1056/NEJMoa2107727   The MR CLEAN-NO IV randomized study, conducted in Europe, evaluated the benefit of administering I.V. alteplase ahead of endovascular treatment (EVT) for acute ischemic stroke. The final analysis involved 539 patients, with half receiving usual care (EVT after I.V. ...

Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest Journal of the American Medical Association (09/29/21) DOI: 10.1001/jama.2021.16628 Andersen, Lars W.; Isbye, Dan; Kjærgaard, Jesper; et al. https://jamanetwork.com/journals/jama/article-abstract/2784625   A recent study questioned whether the combination of vasopressin and methylprednisolone can improve the return of spontaneous circulation for patients with in-hospital cardiac arrest. The Vasopressin ...

Verticalization for Refractory Intracranial Hypertension: A Case Series Neurocritical Care (08/17/21) DOI: 10.1007/s12028-021-01323-z Lachance, Brittany Bolduc; Chang, WanTsu; Motta, Melissa; et al. https://link.springer.com/article/10.1007%2Fs12028-021-01323-z   Researchers present a retrospective review of six cases of refractory intracranial hypertension in a tertiary care center. The authors also report a novel intervention of verticalization for treating intracranial hypertension refractory to aggressive medical treatment. The patients ...

Management of Arterial Partial Pressure of Carbon Dioxide in the First Week after Traumatic Brain Injury: Results from the CENTER-TBI Study Intensive Care Medicine (07/24/21) DOI: 10.1007/s00134-021-06470-7 Citerio, Giuseppe; Robba, Chiara; Rebora, Paola; et al. https://link.springer.com/article/10.1007%2Fs00134-021-06470-7   A secondary analysis of data from the CENTER-TBI study found substantial practice variation among countries and centers in terms of arterial partial pressure of carbon dioxide (PaCO 2 ) levels for patients in the first ...

Prevalence, Characteristics, and Outcomes of Undetermined Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis Stroke (08/04/21) DOI: 10.1161/STROKEAHA.120.031471 Malhotra, Konark; Zompola, Christina; Theodorou, Aikaterini; et al. https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.031471   Researchers evaluated the prevalence, radiological characteristics, and clinical outcomes of intracerebral hemorrhage (ICH) of undetermined etiology. The study involved a systematic review and meta-analysis of studies involving patients with ...

Risk of Acute Myocardial Infarction and Ischaemic Stroke Following COVID-19 in Sweden: A Self-Controlled Case Series and Matched Cohort Study The Lancet (08/14/21) Vol. 398, No. 10300, P. 599 DOI: 10.1016/S0140-6736(21)00896-5 Katsoularis, Ioannis; Fonseca-Rodríguez, Osvaldo; Farrington, Paddy; et al. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00896-5/fulltext   COVID-19 is an independent risk factor for acute myocardial infarction (MI) and ischemic stroke, according to new research out of Sweden. The study is believed ...

Reviewed by Shannon Hextrum, MD Early coma induction for status epilepticus after benzodiazepine therapy shortens duration of status and ICU length of stay.  De Stefano P, Baumann SM, Semmlack S, et al. Safety and Efficacy of Coma Induction Following First-Line Treatment in Status Epilepticus: A Two-Center Study [published online ahead of print, 2021 May 27].  Neurology . 2021;10.1212/WNL.0000000000012292. doi:10.1212/WNL.00000000000122   Read the full article. Background: The treatment approach for status epilepticus (SE) endorsed by international ...

Reviewed by Sanjeev Sivakumar MD Robba C, Graziano F, Rebora P et al. SYNAPSE-ICU Investigators. Intracranial pressure monitoring in patients with acute brain injury in the intensive care unit (SYNAPSE-ICU): an international, prospective observational cohort study. Lancet Neurol. 2021 Jul;20(7):548-558. doi: 10.1016/S1474-4422(21)00138-1. PMID: 34146513. Read the Article Background : In its latest iteration, the Brain Trauma Foundation downgraded the strength of recommendation for ICP monitoring in TBI. Consensus regarding specific thresholds ...