Neurocritical care
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Low pressure hydrocephalus (LPH) is an uncommon entity. Recognition of this treatable condition is important when clinicians are faced with the paradox of symptomatic hydrocephalus despite low intracranial pressures (ICP). Its etiology remains enigmatic. ⋯ Low pressure hydrocephalus is a challenging diagnosis. The genesis of LPH was associated with a drop in EVD output, symptomatic ventriculomegaly, and a remarkable absence of intracranial hypertension. When LPH was treated with the sub-zero method, a 'diuresis' of CSF ensued. These observations support a Darcy's flux of brain interstitial fluid due to altered brain poroelastance; in simpler terms, a boggy brain state.
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Randomized Controlled Trial Comparative Study
A prospective randomized study to evaluate the antipyretic effect of the combination of acetaminophen and ibuprofen in neurological ICU patients.
To compare the antipyretic effect of simultaneously administered acetaminophen (APAP) plus ibuprofen (IBU) to either APAP or IBU alone in critically ill febrile neurological and neurosurgical patients. ⋯ The combination of IBU and APAP produces significantly greater fever control than APAP alone, with trends favoring the combination over IBU alone and IBU over APAP alone.
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Craniotomy is potentially life-saving in selected patients with intracerebral hemorrhage (ICH). Aside from specific scenarios (cerebellar hemorrhage with hydrocephalus, midline shift from an accessible lesion, etc.) the indications for surgical decompression are controversial. Based on the earlier work that aspirin and reduced platelet activity are associated with larger hemorrhage size and hemorrhage growth, we tested the hypothesis that aspirin or reduced platelet activity would be associated with increased odds of craniotomy, likely through hemorrhage growth. ⋯ After correction for ICH volume and location, aspirin use or reduced platelet activity was associated with similar increased odds for craniotomy.
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The influence of tracheostomy timing on outcome after severe head injury remains controversial. ⋯ These results indicate a complex relationship between tracheostomy timing and outcome, but suggest that a strategy of early tracheostomy, particularly when performed on patients with a reasonable chance of survival, results in a better overall clinical outcome than when the tracheostomy is performed in a delayed manner.
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Extubation failure in the neurocritical care unit (NCCU) is difficult to predict, and is an important source of prolonged intensive care, exposure to morbidity, and increased cost. ⋯ The ability to follow four commands and other examination criteria were strongly associated with extubation success in this observational study. Modeling suggests that specific neurologic examination parameters provide additional predictive information over GCS alone. A prospective, protocol-driven trial is needed to test and expand these findings.