Literature Watch

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, ...

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 ...

Lindner A, Rass V, Ianosi BA, et al. The Importance of PbtO2 Probe Location for Data Interpretation in Patients with Intracerebral Hemorrhage. Neurocritical Care . 2020 Sep 11:1-0.  Reviewed by Wazim Mohamed, MD Read the Article Background : Secondary brain injury after spontaneous intracerebral hemorrhage (ICH) continues to have a significant impact on long-term morbidity and mortality. Brain tissue oxygen tension monitoring (PbtO2) is an additional neuromonitoring modality that may provide insight into the extent of secondary brain injury ...

The Lancet Psychiatry (04/06/21) DOI: 10.1016/S2215-0366(21)00084-5 Taquet, Maxime; Geddes, John R.; Husain, Masud; et al. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00084-5/fulltext Approximately a third of people diagnosed with COVID-19 exhibited longer term neurological and psychiatric symptoms, a new study shows. For the retrospective cohort study, researchers from the University of Oxford examined the health records of 236,379 patients in the six months following their COVID-19 diagnosis and estimated the incidence ...

JAMA Neurology (03/01/21) DOI: 10.1001/jamaneurol.2021.0023 Wilcock, Andrew D.; Schwamm, Lee H.; Zubizarreta, Jose R.; et al. https://jamanetwork.com/journals/jamaneurology/article-abstract/2776793   Patients with ischemic stroke who received care at hospitals with telestroke services are more likely to receive reperfusion therapy, and their 30-day mortality rate is lower than that for patients treated at hospitals without telestroke capacity, according to a large study. The study, which include 153,272 patients treated for stroke, found that ...

JAMA Neurology (04/05/21) DOI: 10.1001/jamaneurol.2021.0520 Guterman, Elan L.; Betjemann, John P.; Aimetti, Alex; et al. https://jamanetwork.com/journals/jamaneurology/article-abstract/2777805 Highly refractory status epilepticus (SE) is associated with increased hospitalization costs and worse outcomes, according to new research. The cross-sectional study evaluated 43,988 hospitalizations related to SE from 2016 through 2018 in the United States. Patients were categorized by the administration of antiseizure drugs given while hospitalized: ...

Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional Neurology: Endorsed by the Neurocritical Care Society Stroke (03/11/21) ...

Circulation (03/08/21) DOI: 10.1161/CIR.0000000000000958 Dezfulian, Cameron; Orkin, Aaron M.; Maron, Bradley A.; et al. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000958 Opioid-associated out-of-hospital cardiac arrest (OA-OHCA) is clinically different from other types of cardiac arrest and more education is needed for people to recognize signs of an overdose, the American Heart Association (AHA) says in a new scientific statement. The "distinct features of OA-OHCA demand a critical appraisal of education and policy decisions to improve ...

The Lancet Neurology (02/01/21) Vol. 20, No. 2, P. 117 DOI: 10.1016/S1474-4422(20)30406-3 Badhiwala, Jetan H; Wilson, Jefferson R; Witiw, Christopher D; et al. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30406-3/fulltext Recovery of sensorimotor function was greater among patients who underwent surgical decompression within 24 hours of acute spinal cord injury (SCI), a new study shows. The pooled analysis used data from more than 1,000 patients between December 1991 and March 2017. At one year after spinal injury, the ...

JAMA Neurology (03/01/21) DOI: 10.1001/jamaneurol.2021.0084 Kowalski, Robert G.; Hammond, Flora M.; Weintraub, Alan H.; et al. https://jamanetwork.com/journals/jamaneurology/article-abstract/2776794 Most patients who became comatose after moderate or severe traumatic brain injury (TBI) recovered consciousness during rehabilitation — and nearly half regained functional independence, according to new research. The cohort study involved 17,470 patients with TBI who were enrolled in the Traumatic Brain Injury Model Systems National Database. The ...

Journal of the American Medical Association (01/19/21) 325(3): 244  DOI: 10.1001/jama.2020.23522 Suzuki, Kentaro; Matsumaru, Yuji; Takeuchi, Masataka; et al. https://jamanetwork.com/journals/jama/fullarticle/2775278 For patients with acute large vessel occlusion stroke, new research shows that mechanical thrombectomy alone did not demonstrate noninferiority regarding favorable functional outcome, compared with the combination of I.V. thrombolysis and mechanical thrombectomy. The randomized, open-label clinical trial involved 204 patients with ...

Journal of the American Medical Association (01/19/21) 325(3):234  DOI:10.1001/jama.2020.23523 Zi, Wenjie; Qiu, Zhongming; Li, Fengli; et al. https://jamanetwork.com/journals/jama/fullarticle/2775279 Research out of China investigated whether endovascular treatment by itself would be just as effective as endovascular treatment plus I.V. alteplase in achieving 90-day functional independence in certain stroke patients. The study enrolled 234 adults with acute ischemic stroke due to large vessel occlusion, all of whom qualified for I.V. thrombolysis. ...

Journal of the American Medical Association (01/19/21) 325(3):234  DOI:10.1001/jama.2020.23523 Zi, Wenjie; Qiu, Zhongming; Li, Fengli; et al. https://jamanetwork.com/journals/jama/fullarticle/2775279   Research out of China investigated whether endovascular treatment by itself would be just as effective as endovascular treatment plus I.V. alteplase in achieving 90-day functional independence in certain stroke patients. The study enrolled 234 adults with acute ischemic stroke due to large vessel occlusion, all of whom qualified for I.V. thrombolysis. ...