Neurocritical care
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The computed tomography (CT) appearance of subarachnoid hemorrhage (SAH) without subarachnoid blood has been labeled "pseudo-subarachnoid hemorrhage" (pseudo-SAH) and has been reported with several diffuse intracerebral insults including intrathecal contrast agents, meningitis, generalized cerebral edema, anoxic encephalopathy, and intracranial hypotension. ⋯ Our case suggests that PICA infarction can be associated with the CT finding of pseudo-SAH, thereby mimicking the clinical and radiographic presentation of SAH.
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The purpose of this study was to assess the agreement of Emergency Department (ED) attendings, ED residents, and neurology residents compared with stroke neurologists in the assessment of intravenous rt-PA eligibility. ⋯ This study suggests that the agreement between ED attendings and stroke neurologists for determination of rt-PA eligibility is good. There is room for improvement, however, in the determination of acute stroke therapy eligibility in the ED setting especially among trainees.
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Comparative Study
Therapeutic hypothermia after cardiac arrest: performance characteristics and safety of surface cooling with or without endovascular cooling.
Various methods are available to induce and maintain therapeutic hypothermia after cardiac arrest, but little data is available comparing device-mediated cooling to simple surface methods in this setting. ⋯ Use of an endovascular cooling catheter as part of a treatment protocol for hypothermia after cardiac arrest provides better control during maintenance of hypothermia, preventing temperature overshoot. Active cooling rates may be enhanced by the use of a larger cooling catheter.
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The crucial importance of monitoring both the infarcted and non-infarcted hemispheres in management of space occupying middle cerebral artery (MCA) infarction is increasingly recognized, but optimal technique is debated. We investigated the potential for bilateral Near Infrared Spectroscopy (NIRS) to non-invasively provide relevant information on intracranial oxygenation. ⋯ Bilateral NIRS may provide more useful information on cerebral oxygenation than unilateral measurements and its clinical validity to help predict worsening of brain swelling should be investigated further.
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Intracerebral hemorrhage (ICH) is a devastating form of stroke commonly resulting in severe morbidity and high mortality. Secondary brain injury often occurs in the days following the initial hemorrhage and is associated with significant neurological deterioration. The neurochemistry associated with secondary injury is poorly understood. The purpose of this study is to characterize the neurochemical changes in perihematomal tissue during frameless minimally invasive evacuation of spontaneous hematomas. ⋯ This study reports that elevated levels of glutamate are found in the perihematomal region after ICH and are decreased during hematoma drainage. Conversely, ischemic LPRs are not found in perihematomal regions and were unchanged during hematoma drainage. These data suggest that excitotoxicity related to glutamate may have an important impact on secondary injury. The data failed to support the role of ischemia in secondary perihematomal damage.