Neurocritical care
-
Cerebral infarction is a common complication of aneurysmal subarachnoid hemorrhage (SAH), but usually occurs several days after onset as a complication of vasospasm or aneurysm repair. The frequency, causes, and clinical impact of acute infarction associated with the primary hemorrhage are poorly understood. ⋯ Early cerebral infarction on CT is a rare but devastating complication of acute SAH. The observed associations with coma, global cerebral edema, intraventricular hemorrhage, and loss of consciousness at onset suggest that intracranial circulatory arrest may play a role in the pathogenesis of this disorder.
-
Hyponatremia, defined as a serum sodium concentration ([Na+]) less than 135 mEq/L, is commonly caused by elevated levels of the hormone arginine vasopressin (AVP), which causes water retention. The principal organ affected by disease-related morbidity is the brain. The neurologic complications associated with hyponatremia are attributable to cerebral edema and increased intracranial pressure, caused by the osmotically driven movement of water from the extracellular compartment into brain cells. ⋯ Two other agents, tolvaptan and lixivaptan, are being evaluated in patients with euvolemic and hypervolemic hyponatremia. The AVP-receptor antagonists block the effects of elevated AVP and promote aquaresis, the electrolyte-sparing excretion of water, resulting in the correction of serum [Na+]. These agents may also have intrinsic neuroprotective effects.
-
Status epilepticus (SE) is a medical emergency requiring prompt treatment to try to limit mortality and improve outcome. So far, newer antiepileptic drugs (AED) have not assumed a noticeable role in the treatment of SE. This may be in part due to the lack of IV forms for the newer AEDs. The IV form of Levetiracetam (IV-LEV) has recently become available and has a potential role in the treatment of SE. ⋯ IV-LEV may have a potential role in the treatment of non-convulsive status epileptics.
-
Case Reports
Symptomatic cerebral air embolism during neuro-angiographic procedures: incidence and problem avoidance.
While clinically symptomatic cerebral air embolism secondary to neuro-angiographic procedures is rare, the incidence in a large series of procedures is unknown. Understanding this complication's frequency and etiology is critical if systems are to be instituted to reduce its incidence. ⋯ Symptomatic cerebral air embolism is a rare event during neuro-angiographic procedures. Analysis of the etiologies of this infrequent event may permit us to further reduce its incidence.
-
Case Reports
Successful intravenous thrombolysis in ischemic stroke caused by infective endocarditis.
Infective endocarditis can lead to serious neurological complications including ischemic stroke and intracranial hemorrhage. Treatment with intravenous thrombolysis within 3 h of symptom onset has become the standard of care in acute ischemic stroke, but the safety and efficacy of this intervention in patients with infective endocarditis is unknown. ⋯ Favorable response to thrombolysis may occur in patients with stroke due to infectious endocarditis. The safety of this therapy remains to be established.