Articles: subarachnoid-hemorrhage.
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Optimal pharmacologic thromboprophylaxis dosing is not well described in patients with subarachnoid hemorrhage (SAH) with an external ventricular drain (EVD). Our patients with SAH with an EVD who receive prophylactic enoxaparin are routinely monitored using timed anti-Xa levels. Our primary study goal was to determine the frequency of venous thromboembolism (VTE) and secondary intracranial hemorrhage (ICH) for this population of patients who received pharmacologic prophylaxis with enoxaparin or unfractionated heparin (UFH). ⋯ In this retrospective study of patients with nontraumatic SAH with an EVD who received enoxaparin or UFH VTE prophylaxis or no VTE prophylaxis, there was no statistically significant difference in the incidence of VTE or secondary ICH. For patients receiving prophylactic enoxaparin, achieving higher steady-state target anti-Xa levels may be associated with a lower incidence of VTE without increasing the risk of secondary ICH.
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Chronic posthemorrhagic hydrocephalus often arises following spontaneous subarachnoid hemorrhage (SAH). Timely identification of patients predisposed to develop chronic shunt-dependent hydrocephalus may significantly enhance clinical outcomes. ⋯ ML models, including logistic regression, demonstrate strong predictive capability for early chronic shunt-dependent hydrocephalus following spontaneous SAH, which may potentially contribute to more timely shunt placement interventions. This predictive capability is supported by our web interface, which simplifies the application of these models, aiding clinicians in efficiently determining the need for shunt placement.
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To observe the outcome of surgical clipping in anterior circulation aneurysm in a modestly resourced hospital. ⋯ Surgical clipping of anterior circulation aneurysms is a safe and effective treatment, yielding favorable angiographic outcomes. Despite occasional complications, most patients achieved satisfactory results, especially in a setting having limited endovascular facilities or when coiling is not feasible. Future comparative studies with endovascular methods will further refine patient selection and surgical techniques.
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Curr Pain Headache Rep · Dec 2024
ReviewHeadache Management in the Neuroscience Intensive Care Unit.
Headache is a common symptom in the Neuroscience Intensive Care Unit (NeuroICU). Our goal is to provide an overview of approaches to headache management for common neurocritical care conditions. ⋯ Headache disorders afflict nearly half of patients admitted to the NICU. Commonly encountered disorders featuring headache include cerebrovascular disease, trauma, and intracranial infection. Approaches to pain are highly variable, and multimodal pain regimens are commonly employed. The overall body of evidence supporting therapeutic strategies to manage headache in the critical care setting is slim, and pain control remains suboptimal in many cases with persistent reliance on opioids. Headache is a complex, frequently occurring phenomenon in the NeuroICU care setting. At present, literature on evidence-based practice for management of headache in the critical care setting remains scarce, and despite multimodal approaches, reliance on opioids is commonplace.