Neurocritical care
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Early prediction of hematoma expansion (HE) following nontraumatic intracerebral hemorrhage (ICH) may inform preemptive therapeutic interventions. We sought to identify how accurately machine learning (ML) radiomics models predict HE compared with expert clinicians using head computed tomography (HCT). ⋯ We introduced supervised ML algorithms demonstrating that HE prediction may outperform practicing clinicians. Despite overall moderate AUCs, our results set a new relative benchmark for performance in these tasks that even expert clinicians find challenging. These results emphasize the need for continued improvements and further enhanced clinical decision support to optimally manage patients with ICH.
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From visual, ocular, and pupillomotor abnormalities to qualitative and more importantly rapid quantitative disturbances of consciousness, top of the basilar artery syndrome (TOBS) represents a diagnostic challenge in neurocritical care. In this monocentric retrospective cross-sectional study, we will describe this particular patient group in detail and highlight its variability and the associated implications. ⋯ A large proportion of patients presenting with TOBS were severely affected by a significant reduction in vigilance, a condition that persists in the absence of recanalization and is then associated with a relevant dependency.
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Neurologic complications contribute significantly to morbidity and mortality in acute liver failure (ALF). However, clinical assessment of neurologic function in this population is often challenging. Continuous electroencephalography (cEEG) is a low-risk, noninvasive diagnostic tool that can monitor real-time cerebral function. We aimed to investigate cEEG findings and prognostic significance of specific EEG features in a cohort of strictly defined patients with ALF. ⋯ Worsening cEEG background continuity or frequency is associated with poor outcome in adults with ALF. cEEG may contribute useful prognostic information in these patients, in conjunction with other laboratory and clinical markers of disease severity.
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This study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement. ⋯ The study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.
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Intracranial pressure (ICP) monitoring is a cornerstone of neurointensive care. However, some limitations of invasive techniques for ICP monitoring to acknowledge are the risk for complications and the lack of robust evidence supporting individualized ICP safety thresholds. Cerebrospinal compliance (CSC) may serve as a more reliable indicator of brain health than ICP alone. Previously, intracranial compliance (Ci), was described as a mathematical model from invasive ICP to assess CSC, using ICP waveform amplitudes and cerebral arterial blood volume (CaBV) waveform amplitudes via transcranial Doppler (TCD). This study aimed to compare Ci with a surrogate parameter based on CaBV waveform amplitudes and pulsatile micrometric skull waveforms (Skw) amplitudes. This noninvasive parameter was named Bcomp. ⋯ Using CaBV, which reflects changes in arterial blood volume during the cardiac cycle and Skw pulse amplitudes, Bcomp demonstrated high agreement and correlation with Ci, defined as the product of CaBV and ICP pulse amplitude. The observed shift in CaBV among patients with poor CSC suggests that this vascular marker is influenced by intracranial resistance. These findings are promising for the real-time, noninvasive assessment of CSC in clinical settings and warrant further research.