Neurocritical care
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Case Reports
Apnea test for brain death determination in a patient on extracorporeal membrane oxygenation.
Apnea test is a key component to confirm brain death. For patients receiving extracorporeal membrane oxygenation (ECMO), apnea test remains challenging. Brain death (BD) diagnosis is often made without apnea test. ⋯ To assess brain death in patients on ECMO, apnea test can be performed without compromising oxygenation by decreasing (but not stopping) the sweep gas flow and increasing oxygen delivery through the membrane.
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Acute hemorrhagic leukoencephalopathy (AHLE) is a rare condition associated with H1N1. In this condition the infection triggers an autoimmune response which results in perivascular demyelination and hemorrhage in the brain parenchyma. ⋯ This case emphasizes the importance of awareness of this disease. The non-specific signs and symptoms, and the use of sedatives, make diagnosis challenging in the early stages of this disease. If suspected early, appropriate imaging can aid in the diagnosis. Treatment with immunosuppressive agents and plasmapheresis may prevent rapid progression and death. This is the first published case of AHLE in association with H1N1 that has been confirmed pathologically.
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Development of contrast-induced nephropathy in subarachnoid hemorrhage: a single center perspective.
The use of iodinated contrast-enhanced imaging studies is increasing in acute cerebrovascular diseases, especially in subarachnoid hemorrhage (SAH). In SAH, such studies are essential for both diagnosis and treatment of the cause and sequela of hemorrhage. These patients are often subjected to multiple contrast studies such as computed tomographic angiography, computed tomographic perfusion, and cerebral angiography. They are also predisposed to intravascular volume depletion as a part of the disease process from cerebral salt wasting (CSW) and as a result of multiple contrast exposure can develop contrast-induced nephropathy (CIN). Data regarding CIN in this population are scarce. We aimed to examine the incidence of CIN in SAH and identify potential associative risk factors. ⋯ The incidence of CIN in SAH patients is comparable to previously published reports on non-neurological cohorts. No definite association was noted with any predisposing factors postulated to be responsible for CIN, except for advanced age. Concurrent use of 3% HTS was not associated with CIN in this population.
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To evaluate the relationship between infarct location and QTc-prolongation in patients with posterior circulation strokes. ⋯ QTc-prolongation is common after posterior circulation stroke and associated with temporal lobe infarction. Prospective studies are needed to confirm these preliminary findings and to examine potential long-term consequences.
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To assess the safety and effectiveness of lumbar drains as adjuvant therapy in severe bacterial meningitis, and compare it to standard treatment. ⋯ In this study, the use of lumbar drainage in adult patients with severe bacterial meningitis was safe, and likely contributed to the low mortality and morbidity.