Neurocritical care
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Transcranial Dopplers (TCDs) have been used to monitor cerebral blood flow velocities in subarachnoid hemorrhage (SAH).The purpose of our two-part study was to compare the reliability of relative increases in flow velocities with conventionally used absolute flow velocity indices and to correct for hyperemia-induced flow velocity change. ⋯ Relative changes in flow velocities in patients with aneurysmal SAH correlated better with clinically significant vasospasm than absolute flow velocity indices. Correction for hyperemia improved predictive value of TCD in vasospasm.
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It is unclear whether patients or subpopulations of patients might benefit from EEG monitoring. ⋯ Our study suggests that CEEG monitoring may be more valuable for detection of seizures in patients with ASBLs than in patients with metabolic encephalopathies.
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Paroxysmal sympathetic storm (PSS) is a rare syndrome characterized by episodic hypertension, hyperhydrosis, hyperthermia, tachycardia, tachypnea, and extensor posturing. ⋯ These observations underscore the importance of central opioid receptors and nonselective beta-adrenergic antagonists in modulating catecholamine pathways.
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Current applications of lytic therapy for intraventricular hemorrhage (IVH) rely on exclusion of vascular abnormalities as etiology. Its use in patients with recently coiled aneurysms remains far from considered safe. We report a patient with subarachnoid hemorrhage (SAH) and massive IVH from aneurysmal rupture, which was safely treated with intraventricular recombinant tissue plasminogen activator (rt-PA) after endovascular coiling. We also review two other similar cases reported in the literature. ⋯ We report the safe administration of intraventricular rt-PA after endovascular coiling of a ruptured cerebral aneurysm. Two other similar cases were found in the literature and are reviewed. Hindrance of aneurysmal cavity thrombosis by early administration of rt-PA (increasing the risk of rerupture) remains a widespread concern. The lack of such instances should therefore be acknowledged. We propose that inclusion of such patients in trials assessing safety/efficacy of thrombolytic therapy in the treatment of patients with intracranial hemorrhage should be carefully considered.