Literature Watch

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 ...

This article is reproduced in part from a review published in the journal Cerebrovascular Diseases, with permission from S. Karger AG, Basel. (Venketasubramanian N, Anderson C, Ay H, Aybek S, Brinjikji W, de Freitas G, R, Del Brutto O, H, Fassbender K, Fujimura M, Goldstein L, B, Haberl R, L, Hankey G, J, Heiss W, -D, Lestro Henriques I, Kase C, S, Kim J, S, Koga M, Kokubo Y, Kuroda S, Lee K, Lee T, -H, Liebeskind D, S, Lip G, Y, H, Meairs S, Medvedev R, Mehndiratta M, M, Mohr J, P, Nagayama M, Pantoni L, Papanagiotou P, Parrilla G, Pastori D, Pendlebury ...

Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study JAMA Neurology (07/06/21) DOI: 10.1001/jamaneurol.2021.2043 McCrea, Michael A.; Giacino, Joseph T.; Barber, Jason; et al. https://jamanetwork.com/journals/jamaneurology/article-abstract/2781523   Patients with moderate to severe traumatic brain injury (msTBI) often made significant functional improvements between 2 weeks and 12 months after their injuries, according to new research. "Severe impairment in ...

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest New England Journal of Medicine (07/17/21) Vol. 384, No. 24, P. 2283, DOI: 10.1056/NEJMoa2100591 Dankiewicz, Josef; Cronberg, Tobias; Lilja, Gisela; et al.  For unconscious patients after out-of-hospital cardiac arrest, targeted hypothermia did not reduce mortality at 6 months compared with targeted normothermia, new research shows. The findings run counter to practice-changing trials published in 2002 that reported the benefits of hypothermia in this setting. In the new Targeted ...

Critical Care Medicine (07/02/21) DOI: 10.1097/CCM.0000000000005149 Gutierrez, Cristina; Brown, Anne Rain T.; May, Heather P.; et al. https://journals.lww.com/ccmjournal/Abstract/9000/Critically_Ill_Patients_Treated_for_Chimeric.95168.aspx   In a new study, U.S. researchers report a multicenter cohort of patients who required ICU admission due to cytokine release syndrome (CRS) or immune effector cell-associated neurotoxicity syndrome following chimeric antigen receptor (CAR) T-cell therapy. The retrospective cohort study included 105 adult patients ...

Journal of the American Medical Association (05/25/21)  DOI: 10.1001/jama.2021.5561 Roquilly, Antoine; Moyer, Jean Denis; Huet, Olivier; et al. https://jamanetwork.com/journals/jama/article-abstract/2780326   For the COBI clinical trial, researchers compared outcomes in adults with traumatic brain injury (TBI) after treatment with or without continuous infusion of hypertonic saline solution. Fluid therapy is critical for individuals sustaining this type of damage, but its effect on neurological recovery was unknown. To learn more, investigators ...

The Lancet Neurology (04/01/21)  DOI: 10.1016/S1474-4422(20)30494-4 Walgaard, Christa; Jacobs, Bart C; Lingsma, Hester F; et al. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30494-4/fulltext   New research finds no benefit but a risk of serious adverse events from a second intravenous immunoglobulin dose (SID) for patients with Guillain-Barré syndrome with a poor prognosis. Investigators had investigated the efficacy of a SID in this population, as treatment with one standard dose of I.V. immunoglobulin is not sufficient ...

JAMA Neurology (05/03/21) DOI: 10.1001/jamaneurol.2021.0925 Murthy, Santosh B.; Zhang, Cenai; Diaz, Ivan; et al. https://jamanetwork.com/journals/jamaneurology/article-abstract/2779594 Intracerebral hemorrhage correlated with a greater risk of ischemic stroke and myocardial infarction, according to data from four population-based cohort studies. "These findings suggest that intracerebral hemorrhage may be a novel risk marker for arterial ischemic events," the researchers wrote. For the study, the team analyzed pooled data from four population-based, ...

JAMA Network Open (05/11/21) DOI: 10.1001/jamanetworkopen.2021.12131 Chou, Sherry H.-Y.; Beghi, Ettore; Helbok, Raimund; et al. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779759 Neurological manifestations are common among patients hospitalized with COVID-19, according to new research, and are associated with an increased risk for in-hospital mortality. The cohort study — which involved 3,744 patients hospitalized with COVID-19 in 13 countries on four continents — sought to determine the neurological incidence of neurological ...

Reviewed by Sanjeev Sivakumar, MD Read the Article* *Article access requires subscription/login  Impact of Statins on Hematoma, Edema, Seizures, Vascular Events, and Functional Recovery After Intracerebral Hemorrhage. Maximilian I. Sprügel, Joji B. Kuramatsu et al. Stroke 2021 Mar;52(3):975-984. doi: 10.1161/STROKEAHA.120.029345  Background : Statins play an important role in the treatment and prevention of ischemic cerebrovascular and cardiovascular disease. The debate on statin therapy and ICH risk is one that is ongoing, ever since ...

Reviewed by Shannon Hextrum, MD Read the Article Ammar AA, Ammar MA, Owusu KA, et al. Andexanet Alfa Versus 4-Factor Prothrombin Complex Concentrate for Reversal of Factor Xa Inhibitors in Intracranial Hemorrhage [published online ahead of print, 2021 Jan 6].  Neurocrit Care . 2021;10.1007/s12028-020-01161-5. doi:10.1007/s12028-020-01161-5 Background: Andexanet alfa is FDA-approved for reversal of life-threatening bleeding related to oral factor Xa inhibitors (FXi). Trial data from ANNEXA-4 has shown that andexanet administration in life-threatening ...

Hernández-Durán S, Meinen L, Rohde V, von der Brelie C. Invasive Monitoring of Intracranial Pressure After Decompressive Craniectomy in Malignant Stroke. Stroke . 2021 Jan;52(2):707-711. doi: 10.1161/STROKEAHA.120.032390. Epub 2020 Dec 4. Reviewed by Shannon Hextrum, MD READ THE ARTICLE* *Article access requires subscription to PubMed Background: Decompressive hemicraniectomy (DC) improves mortality in malignant cerebral infarction (MCI). There is little evidence to guide the use of intracranial pressure (ICP) monitoring in the management ...