Neurocritical care
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Controlled Clinical Trial
Early derangements in oxygen and glucose metabolism following head injury: the ischemic penumbra and pathophysiological heterogeneity.
Conclusive evidence of cerebral ischemia following head injury has been elusive. We aimed to use (15)O and (18)Fluorodeoxyglucose positron emission tomography (PET) to investigate pathophysiological derangements following head injury. ⋯ The low CBF and maintained CMRO2 in the high OEF ROIs is consistent with classical cerebral ischemia and the presence of an 'ischemic penumbra' following early head injury, while the metabolic heterogeneity that we observed suggests significant pathophysiological complexity. Other mechanisms of energy failure are clearly important and further study is required to delineate the processes involved.
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Airembolism without obvious trauma or surgery is rare. ⋯ In the absence of trauma, sinus disease, recent surgery, or vascular procedures, the presence of air in the brain is unusual, and pulmonary sources of air embolism should be considered.
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Comparative Study
Refractory status epilepticus in suspect encephalitis.
The California Encephalitis Project (CEP) is a program designed to determine causes of encephalitis. We sought to determine whether there are any distinguishing characteristics of patients with encephalitis who develop refractory status epilepticus from those who do not. ⋯ Encephalitis and refractory status epilepticus occur most commonly in the pediatric age group, an infectious etiology is usually not established, and outcomes are generally poor.
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Comparative Study
A comparison of nicardipine and labetalol for acute hypertension management following stroke.
Evaluate the ease of use and tolerability of labetalol (L) and nicardipine (N) for hypertension management in patients with acute stroke. ⋯ Nicardipine offers an alternative to labetalol with similar tolerability and appears to provide a smoother blood pressure control compared to labetalol.
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Dexmedetomidine is a centrally acting alpha(2)-adrenergic agonist which is currently FDA-approved for the short-term (less than 24 h) sedation of adults during mechanical ventilation. ⋯ Subsequent to this, no further issues with hypertension were noted.