Neurocritical care
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Continuous electroencephalography (cEEG) monitoring is becoming increasingly used in neurologic and non-neurologic intensive care units (ICUs). Non-convulsive seizures (NCSz) and periodic discharges (PDs) are commonly seen in critically ill patients. ⋯ IIC patterns are associated with pathophysiologic changes that closely resemble those of seizures. Here we make the argument that, rather than feature description on EEG, associated changes in brain physiology should dictate management choices.
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The case of Jahi McMath has captured the attention of the public, healthcare professionals, and ethicists. Jahi was declared brain dead in late 2013, but her family transferred her to New Jersey to continue organ support. A lengthy legal battle has been ongoing since then. Jahi's family and two neurologists, Drs. Calixto Machado and Alan Shewmon, believe that she is not brain dead. Her family and Dr. Shewmon think that she is capable of following commands, thus making her minimally conscious. ⋯ Because brain death is an irreversible coma, one of three conclusions must be drawn: 1) Jahi was never dead; 2) Jahi met the criteria for brain death, but she isn't dead now; or 3) Jahi's movements are not purposeful responses, and she has been brain dead since 2013. The possibility that a person who was declared brain dead is now following commands threatens to erode the notion that brain death should be considered legal death. The discordant ideas that Jahi is brain dead and is following commands can only be reconciled if a formal evaluation for determination of death is repeated by reputable examiners.
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To determine the effectiveness of prolonged microcatheter-based local thrombolytic infusion in treatment of patients with cerebral venous thrombosis who achieved no or suboptimal recanalization with transvenous endovascular treatment. ⋯ Prolonged microcatheter-based local thrombolytic infusion appeared to be effective treatment in patients who have suboptimal response to acute transvenous endovascular treatment without any additional adverse events.
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Hypotension, hyperglycemia, dysoxia, and dyscarbia may contribute to reperfusion injury, and each is independently associated with poor outcome (PO) after cardiac arrest. We investigated whether the combined effects of these physiological derangements are associated with cardiac arrest outcomes. ⋯ Uncorrected physiological derangements in the first 24 h after cardiac arrest are independently associated with PO. Although causality cannot be established, these findings support preclinical models suggesting that aggressive normalization of physiology after resuscitation may be a reasonable strategy to decrease reperfusion injury.