Neurocritical care
-
Multicenter Study Observational Study
Toxic Metabolic Encephalopathy in Hospitalized Patients with COVID-19.
Toxic metabolic encephalopathy (TME) has been reported in 7-31% of hospitalized patients with coronavirus disease 2019 (COVID-19); however, some reports include sedation-related delirium and few data exist on the etiology of TME. We aimed to identify the prevalence, etiologies, and mortality rates associated with TME in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients. ⋯ TME occurred in one in eight hospitalized patients with COVID-19, was typically multifactorial, and was most often due to hypoxemia, sepsis, and uremia. After we adjustment for confounding factors, TME was associated with a 24% increased risk of in-hospital mortality.
-
Up to one fifth of patients with Guillain-Barré syndrome (GBS) require mechanical ventilation (MV). The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is a clinical predictive model developed in Europe to predict MV requirements among patients with GBS. However, there are significant differences between the Latin American and European population, especially in the distribution of GBS subtypes. Therefore, determining if the EGRIS is able to predict MV in a Latin American population is of clinical significance. ⋯ Although the EGRIS was higher in patients who required early MV than in those who did not, it only showed a moderate discrimination capacity (AUC = 0.63). Facial weakness, an item of the EGRIS, was not found to be a predictive factor in our population. We suggest assessing whether these findings are due to subtype predominance and whether a modified version of the EGRIS could improve performance.
-
Chronic subdural hematoma (cSDH) is a common neurosurgical condition responsible for excess morbidity, particularly in the geriatric population. Recovery after evacuation is complicated by fluctuating neurological deficits in a high proportion of patients. We previously demonstrated that spreading depolarizations (SDs) may be responsible for some of these events. In this study, we aim to determine candidate risk factors for probable SD and assess the influence of probable SD on outcome. ⋯ Unexplained neurological deficits after surgery for cSDH occur in nearly a quarter of patients and may be explained by SD. We identified several potential candidate risk factors. Patients with probable SD have worse outcomes, independent of other baseline risk factors. Further data with gold standard monitoring are needed to evaluate for possible predictors of SD to target therapies to a high-risk population.
-
Multicenter Study
Prognostic Value of Hemorrhagic Brainstem Injury on Early Computed Tomography: A TRACK-TBI Study.
Traumatic brainstem injury has yet to be incorporated into widely used imaging classification systems for traumatic brain injury (TBI), and questions remain regarding prognostic implications for this TBI subgroup. To address this, retrospective data on patients from the multicenter prospective Transforming Research and Clinical Knowledge in TBI study were studied. ⋯ These findings suggest two groups of patients with brainstem injuries may exist with divergent recovery potential after TBI. These data support the notion that newer CT imaging classification systems may augment traditional clinical measures, such as GCS in identifying those patients with TBI and brainstem injuries that stand a higher chance of favorable outcome.