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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Neurocritical illness heavily burdens the developing world. In spite of a lack of resources for population-based health in most developing countries, there is an increasing demand for resource-intense strategies for acute neurological care. ⋯ Possible steps to improve the global practice of neurocritical care include: (1) emphasis on prevention of neurocritical illness through traffic safety and adequate outpatient treatment; (2) standardization of training requirements and skill sets; (3) guidelines on cost-effective measures including medications, equipment, and devices; (4) strengthening of surveillance systems and registries for both noncommunicable and communicable neurological diseases; (5) expanded use of teleneurology; (6) educational exchanges of neurointensive health care workers; and (7) monitoring of neurological intensive care unit death rates due to nosocomial infections, neurological disease, and other causes. A summary of reported mortality rates among neurocritically ill patients in African countries in recent years is provided as an illustrative example.
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Review Comparative Study
High-frequency oscillation as a rescue strategy for brain-injured adult patients with acute lung injury and acute respiratory distress syndrome.
Acute lung injury and acute respiratory distress syndrome (ARDS) occur frequently in brain-injured patients. Single organ dysfunction ventilator strategies result in a conflict between lung protective ventilation and the prevention of secondary neurological insult(s). The objectives of this study were to determine if clinical and physiological benefits of high-frequency oscillatory ventilation (HFOV) exist compared to conventional ventilation and to determine what data there are on the effects of HFOV on cerebral perfusion pressure and intracranial pressure. ⋯ In the small, low quality, studies that have been reported there have not been uncontrollable changes in intracranial pressure. HFOV has not been shown to have any mortality benefit in adults with ARDS. There are insufficient data to clarify the role, or safety, of HFOV in adults with TBI and concurrent ARDS.
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Terson's syndrome is intraocular hemorrhage (IOH) subsequent to subarachnoid hemorrhage (SAH). Its presence is associated with higher mortality in SAH. We report a case of Terson's syndrome and review the literature. ⋯ Terson's syndrome occurs frequently following SAH, although it is under-reported. Suspected visual loss following SAH should prompt a search for Terson's syndrome by funduscopy, as its presence is an adverse prognostic factor.