Neurocritical care
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Review Historical Article
The Origin of Intracranial Pressure Causing Brainstem Hemorrhages.
The origin of secondary brainstem hemorrhages following an acute expansive hemispheric lesion has been attributed to Henri Duret, who proposed that hemorrhaging was caused by a shock wave through the cerebral spinal fluid. However, other experiments have shown important findings correlating brainstem hemorrhages to arterial hemorrhages. Animal studies found that the rapidity of expansion of a lesion would be crucial in producing these lesions, but there was no consistent correlation with paratentorial grooving so commonly seen with increased intracranial pressure. This historical perspective studies the different experimentalists who paved the way for the discovery of these secondary brainstem hemorrhages-often named after Duret-and now known not to be invariably associated with poor outcome.
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The objective of this study was to examine whether heart rate variability (HRV) measures can be used to detect neurocardiogenic injury (NCI). ⋯ HRV measures are significantly associated with our label of NCI and a machine learning approach using features derived from HRV measures can classify SAH patients that develop NCI.
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For decades, half of the electrodes used in traditional electroencephalography (EEG) have been dedicated to midline and parasagittal coverage. Recently, newer EEG devices have used fewer electrodes without direct coverage over the midline or parasagittal regions. However, no systematic study to date has explored the prevalence of midline parasagittal seizures, and as such the risk of missing such seizures with only ten electrodes remains unknown. ⋯ Our study serves as the first to systematically explore the scope of EEG abnormalities captured exclusively by midline or parasagittal electrodes and document their very low prevalence.
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The absence of the pupillary light reflex (PLR) 3 days after cardiac arrest predicts poor outcome, but quantitative PLR assessment with pupillometry early after recovery of spontaneous circulation (ROSC) and throughout targeted temperature management (TTM) has rarely been evaluated. ⋯ Very early after resuscitation from cardiac arrest, abnormal Neurological Pupil index and pupillary light reflex measurements by pupillometer are predictive of poor outcome, and are not usually associated with dilated pupils.
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Guillain-Barré syndrome (GBS), when severe, involves the autonomic nervous system; our objective was to assess the spectrum and predictors of dysautonomia, and how it may impact functional outcomes. ⋯ Dysautonomia in GBS is a manifestation of more severe involvement of the peripheral nervous system. Accordingly, mortality and functional outcomes are worse. There is a need to investigate if more aggressive treatment is warranted in this category of GBS.