M N Diringer

..It remains unclear whether this association can be modified with more aggressive use of red blood cell (RBC) transfusions. The degree to which restrictive thresholds have been adopted in neurocritical care patients remains unknown...

..Currently, the most promising are magnesium sulfate, 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors, nitric oxide donors and endothelin-1 antagonists. This paper reviews established and emerging therapies for vasospasm...

..The accurate prediction of functional outcome requires the development of multivariate models. To enhance their contribution to such models, the predictive power of each component must be optimized...

..Despite low incidences of such events in rFVIIa-treated hemophiliacs, the frequency in older patients with more atherosclerosis and immobility has yet to be defined...

..In the present study they sought to determine if hyperventilation lowers CBF below the ischemic threshold of 18 to 20 ml/100 g/ min in any brain region and if those reductions cause energy failure (defined as a fall in CMRO2)...

..29%) and poor outcome (modified Rankin Scale, mRS, 4-6, 53 vs. 69%). This analysis was performed to determine the impact of rFVIIa on health-related quality of life (HRQoL) in those patients...

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..Hyponatremia is a common fluid-electrolyte disturbance, particularly in patients with neurologic disorders, in part because of the major role the central nervous system (CNS) plays in the regulation of sodium and water homeostasis...

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..Strong consideration was given to providing guidance and recommendations for all issues faced in the daily management of SAH patients, even in the absence of high quality data...

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..The purpose of this study was to determine whether the presence of hydrocephalus after ICH would predict mortality and functional outcome...

..We sought to determine predictors of acute hospital costs in patients presenting with acute ischemic stroke to an academic center using a stroke management team to coordinate care...

..Use of recombinant activated factor VII (rFVIIa) could increase TEs in high-risk patients. Factor Seven for Acute Hemorrhagic Stroke (FAST) trial data were reviewed to define the frequency of and risk factors for TE with rFVIIa...

..The authors tested the hypothesis that moderate hyperventilation induced early after TBI would not produce a reduction in CBF severe enough to cause cerebral energy failure (CBF that is insufficient to meet metabolic needs)...

..Cardiopulmonary complications are common. The management of patients with SAH focuses on the anticipation, prevention, and management of these secondary complications...

..To determine whether mortality rate after intracerebral hemorrhage (ICH) is lower in patients admitted to a neurologic or neurosurgical (neuro) intensive care unit (ICU) compared to those admitted to general ICUs...

..Thus, the authors found no evidence for ischemia in the periclot zone of hypoperfusion in acute ICH patients studied 5 to 22 hours after hemorrhage onset...

..The authors undertook this study to provide further information on the changes in whole-brain and periclot regional CBF that occur with pharmacologic reductions in mean arterial pressure (MAP) in patients with acute ICH...

..No patient had rebleeding or any significant complication during the course of therapy. CONCLUSIONS: Based on this limited series of patients, we believe that it may be safe to use HA in patients treated with GDC for SAH...

..Our goal was to determine the time course and cause for progression of mass effect after ICH...

..1 +/- 2.8 mL (0.6%, p < 0.005). Brain in the noninfarcted hemisphere shrank more (0.8 +/- 0.4%) than in the infarcted hemisphere (0.0 +/- 0.5%, p < 0.05)...

..To study this possibility, we performed continuous TCD monitoring of the middle cerebral artery during the induction and withdrawal of induced hypertension in patients after subarachnoid hemorrhage...

..Identifying factors associated with anemia may facilitate targeted interventions, such as the use of erythropoiesis-stimulating agents, which could minimize the burden of anemia and reduce red blood cell (RBC) transfusion requirements...

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..CONCLUSIONS: Endovascular treatment produces measurable increases in intracranial venous diameters. However, these changes do not correlate with changes in ICP...

..The neurointensivist thus needs to approach these issues differently from the approach an internist or general intensivist would take...

..Some patients do not respond to sustained mannitol administration with the expected rise in serum osmolality, and this may correlate with lack of therapeutic efficacy...

..Care is less likely to be withdrawn from African-American patients or those who had surgery...

..CONCLUSIONS: In euvolemic patients with vasospasm, intravascular volume expansion with a normal saline bolus raised CBF in regions of the brain most vulnerable to ischemia...

..Patients with SAH and hyponatremia should not be fluid restricted because of the risk of exacerbating vasospasm but treated with large volumes of isotonic or mildly hypertonic saline...

..Awareness of this phenomenon in the acutely ill neurologic population needs to be raised in order to prevent the unnecessary rejection of donor hearts...

..Brain death was more common in African Americans, whereas life-sustaining interventions were withdrawn or limited early more often in whites...

..In conclusion, hypernatremia is common in the NNICU, more so in patients treated with mannitol. In this population, severe (but not mild or moderate) hypernatremia is independently associated with increased mortality...

..They point to a new direction for investigation and development of therapeutic interventions for ICH patients...

..The purpose of the present study is to investigate possible risk factors for thromboembolic events and to determine their frequency and time course...

..However, the cerebral response to transfusion remains uncertain, because higher hemoglobin may increase viscosity and further impair cerebral blood flow (CBF) in the setting of vasospasm...

..We ascertained the frequency and predictors of SIRS after spontaneous SAH, and determined whether degree of early systemic inflammation predicted the occurrence of vasospasm and clinical outcome...

..This case report is only the second to provide compelling evidence that hypertension can lead to direct dilation of vasospastic arteries, thereby providing valuable insight into its potential mechanism...

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..Activated recombinant factor VII (rFVIIa) promotes hemostasis at sites of vascular injury and may minimize hematoma growth after ICH...

..We postulated that patients whose BP is not initially elevated are unlikely to have elevated BP later and, therefore, may not need prolonged BP monitoring...

..Though ADL scales may take longer to administer, their increased sensitivity may make them more useful in treatment trials by allowing fewer subjects to be enrolled...

..We performed this phase 3 trial to confirm a previous study in which recombinant activated factor VII (rFVIIa) reduced growth of the hematoma and improved survival and functional outcomes...

..On multivariate analysis, older age independently predicted poor recovery (odds ratio 2.9 per 10-year increase in age)...

..We report an exploratory analysis from a randomized study of recombinant activated factor VII (rFVIIa) in patients with intracerebral hemorrhage (ICH) examining potential factors associated with hemorrhage growth...

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..This article presents a detailed analysis of trials of induced hypothermia in patients with acute neurologic insults and describes methods of fever control...

..CONCLUSIONS: Use of osmolality to limit mannitol use and thus prevent MI-ARI may be unwarranted. Prospective studies are needed...

..We sought to determine whether recombinant activated factor VII (rFVIIa) can reduce hematoma growth after intracerebral hemorrhage...

..Further improvements in balloon design, such as smaller inflated diameters and better tracking, are necessary. Finally, thromboembolic complications remain an important concern, and severe vasospasm may recur after balloon angioplasty...

..Although cardiac causes of death were higher in those with elevated cTnI levels, due to its very low frequency (1.2%) this finding remains preliminary...

..We conducted this trial to evaluate the safety of activated recombinant factor VII (rFVIIa; NovoSeven) for preventing early hematoma growth in acute ICH...

..This article presents a detailed analysis of trails of induced hypothermia in patients with acute neurologic insults and describes methods of fever control...

..In this report, the authors present a case of aneurysmal subarachnoid hemorrhage and active bacteremia in which intravenous antibiotics and early endovascular therapy were successfully used. A review of the literature is also provided...

..Hypothermia has been shown to suppress epileptiform activity experimentally, but has not previously been used as a primary modality to control SE in humans...

..Data from human participants have failed to resolve the question whether cerebral blood flow (CBF) in the peri-infarct region will decrease due to impaired autoregulation when systemic mean arterial pressure (MAP) is rapidly reduced...

..Nevertheless, some patients with SAH do not receive such therapy. The objective of this study was to characterize the patients who do not receive treatment...

..CONCLUSIONS: The addition of this catheter-based cooling system to conventional management significantly improves fever reduction in neurologic intensive care unit patients...

..A prospective, randomized trial is needed to confirm these preliminary findings and to determine whether there is a clinical benefit...

..To evaluate predictors of intraventricular hemorrhage (IVH) and IVH growth, impact of IVH growth on outcome, and impact of recombinant activated factor VII (rFVIIa) in patients with intracerebral hemorrhage (ICH)...

..These devices appear to be more effective than conventional means and might allow us to design studies that definitively answer the question: "Does controlling fever improve outcome?"..

..In this report, we describe 3 such patients who were treated with activated factor VII (FVIIa) to stop ongoing hemorrhage that was refractory to conventional treatment...