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Background: Brain protection and cosmetic aspects are the major indications of cranioplasty (CP) after decompressive craniectomy. CP can avoid the recurrence of brain damage, achieve the plastic effect, protect the patient from seizures, and relieve the syndrome of trephine. Materials and Methods: This was a prospective, observational study done over a period of 2 years from April 2017 to April 2019 in the Department of Neurosurgery at Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati. Patients of age group 20-60 years who underwent CP after decompressive craniectomy for traumatic brain injury or cerebrovascular accidents with refractory intracranial hypertension were included. The study population was divided into two groups: early and late CP groups. Neurocognitive assessment was done 72 h before and 3 months after CP by mini-mental state examination (MMSE), Glasgow outcome score (GOS), and PGI battery of brain dysfunction (PGIBBD) scores. Cerebral glucose metabolism was assessed by 18F-FDG PET scan. Results: In both early and late CP groups, there was a highly significant difference between the mean pre- and postoperative values of MMSE, GOS, and PGIBBD, suggesting significant improvement in neurocognitive parameters of patients postoperatively. There was no significant difference between early and late CP groups for mean standard uptake values (SUVs) on PET scan for both affected (P-value- 0.40) and nonaffected (P-value- 0.30) sides. Conclusion: CP improves the cerebral metabolism and neurocognitive outcome, weather it is done early or late. Keywords: Cognitive outcome, cranioplasty, decompressive craniectomy, PET scan, standard uptake values (SUVs), Author(s): Vivek Sharma [1]; Venkata Vemula Rameshchandra [2]; Bodapati Chandramouliswara Prasad [2]; Rinu Dwivedi (corresponding author) [3] Key Message: Cranioplasty after decompressive craniectomy does improve cerebral glucose metabolism however timing [...]

Over the past decades, electroencephalography (EEG) has become a widely applied and highly sophisticated brain monitoring tool in a variety of intensive care unit (ICU) settings. The most common indication for EEG monitoring currently is the management of refractory status epilepticus. In addition, a number of studies have associated frequent seizures, including nonconvulsive status epilepticus (NCSE), with worsening secondary brain injury and with worse outcomes. With the widespread utilization of EEG (spot and continuous EEG), rhythmic and periodic patterns that do not fulfill strict seizure criteria have been identified, epidemiologically quantified, and linked to pathophysiological events across a wide spectrum of critical and acute illnesses, including acute brain injury. Increasingly, EEG is not just qualitatively described, but also quantitatively analyzed together with other modalities to generate innovative measurements with possible clinical relevance. In this review, we discuss the current knowledge and emerging applications of EEG in the ICU, including seizure detection, ischemia monitoring, detection of cortical spreading depolarizations, assessment of consciousness and prognostication. We also review some technical aspects and challenges of using EEG in the ICU including the logistics of setting up ICU EEG monitoring in resource-limited settings., Author(s): Ayham Alkhachroum [sup.1] [sup.2], Brian Appavu [sup.3] [sup.4], Satoshi Egawa [sup.5], Brandon Foreman [sup.6], Nicolas Gaspard [sup.7], Emily J. Gilmore [sup.8] [sup.9], Lawrence J. Hirsch [sup.8], Pedro Kurtz [sup.10] [...]

Author(s): Claudio Sandroni [sup.1] [sup.2], Tobias Cronberg [sup.3], Jeannette Hofmeijer [sup.4] [sup.5] Author Affiliations: (1) grid.414603.4, Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, , [...]

Byline: Ibrahim. Acir, Haci. Erdogan, Mert. Göbel, Gülhan. Özdemir, Vildan. Yayla Sir, Decompressive surgery (DS) is applied to reduce the increased intracranial pressure.[1] It has been reported that increased CRP [...]

Purpose To assess the ability of clinical examination, blood biomarkers, electrophysiology or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict good neurological outcome, defined as no, mild, or moderate disability (CPC 1-2 or mRS 0-3) at discharge from intensive care unit or later, in comatose adult survivors from cardiac arrest (CA). Methods PubMed, EMBASE, Web of Science and the Cochrane Database of Systematic Reviews were searched. Sensitivity and specificity for good outcome were calculated for each predictor. The risk of bias was assessed using the QUIPS tool. Results A total of 37 studies were included. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. A withdrawal or localisation motor response to pain immediately or at 72-96 h after ROSC, normal blood values of neuron-specific enolase (NSE) at 24 h-72 h after ROSC, a short-latency somatosensory evoked potentials (SSEPs) N20 wave amplitude > 4 [micro]V or a continuous background without discharges on electroencephalogram (EEG) within 72 h from ROSC, and absent diffusion restriction in the cortex or deep grey matter on MRI on days 2-7 after ROSC predicted good neurological outcome with more than 80% specificity and a sensitivity above 40% in most studies. Most studies had moderate or high risk of bias. Conclusions In comatose cardiac arrest survivors, clinical, biomarker, electrophysiology, and imaging studies identified patients destined to a good neurological outcome with high specificity within the first week after cardiac arrest (CA)., Author(s): Claudio Sandroni [sup.1] [sup.2], Sonia D'Arrigo [sup.1], Sofia Cacciola [sup.1], Cornelia W. E. Hoedemaekers [sup.3], Erik Westhall [sup.4], Marlijn J. A. Kamps [sup.5], Fabio S. Taccone [sup.6], Daniele Poole [...]

Post-cardiac arrest brain injury (PCABI) is caused by initial ischaemia and subsequent reperfusion of the brain following resuscitation. In those who are admitted to intensive care unit after cardiac arrest, PCABI manifests as coma, and is the main cause of mortality and long-term disability. This review describes the mechanisms of PCABI, its treatment options, its outcomes, and the suggested strategies for outcome prediction., Author(s): Claudio Sandroni [sup.1] [sup.2], Tobias Cronberg [sup.3], Mypinder Sekhon [sup.4] Author Affiliations: (1) grid.8142.f, 0000 0001 0941 3192, Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro [...]

Purpose The majority of unconscious patients after cardiac arrest (CA) do not fulfill guideline criteria for a likely poor outcome, their prognosis is considered 'indeterminate'. We compared brain injury markers in blood for prediction of good outcome and for identifying false positive predictions of poor outcome as recommended by guidelines. Methods Retrospective analysis of prospectively collected serum samples at 24, 48 and 72 h post arrest within the Target Temperature Management after out-of-hospital cardiac arrest (TTM)-trial. Clinically available markers neuron-specific enolase (NSE) and S100B, and novel markers neurofilament light chain (NFL), total tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) were analysed. Normal levels with a priori cutoffs specified by reference laboratories or defined from literature were used to predict good outcome (no to moderate disability, Cerebral Performance Category scale 1-2) at 6 months. Results Seven hundred and seventeen patients were included. Normal NFL, tau and GFAP had the highest sensitivities (97.2-98% of poor outcome patients had abnormal serum levels) and NPV (normal levels predicted good outcome in 87-95% of patients). Normal S100B and NSE predicted good outcome with NPV 76-82.2%. Normal NSE correctly identified 67/190 (35.3%) patients with good outcome among those classified as 'indeterminate outcome' by guidelines. Five patients with single pathological prognostic findings despite normal biomarkers had good outcome. Conclusion Low levels of brain injury markers in blood are associated with good neurological outcome after CA. Incorporating biomarkers into neuroprognostication may help prevent premature withdrawal of life-sustaining therapy., Author(s): Marion Moseby-Knappe [sup.1], Niklas Mattsson-Carlgren [sup.1] [sup.2] [sup.3], Pascal Stammet [sup.4], Sofia Backman [sup.5], Kaj Blennow [sup.6] [sup.7], Josef Dankiewicz [sup.8], Hans Friberg [sup.9], Christian Hassager [sup.10] [sup.11], Janneke [...]

Byline: Robin. Rishi, Kokkula. Praneeth, Sunil. Gupta, Parth. Jani, Ashish. Aggarwal, Manju. Mohanty, Sahil. Mehta Background: In spite of advancements in treatment options for MCA infarct, there is a definite [...]

The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation., Author(s): Jerry P. Nolan [sup.1] [sup.2], Claudio Sandroni [sup.3] [sup.4], Bernd W. Böttiger [sup.5], Alain Cariou [sup.6], Tobias Cronberg [sup.7], Hans Friberg [sup.8], Cornelia Genbrugge [sup.9] [sup.10], Kirstie Haywood [sup.11], [...]

Intracranial hypertension (IH) is a clinical condition commonly encountered in the intensive care unit, which requires immediate treatment. The maintenance of normal intracranial pressure (ICP) and cerebral perfusion pressure in order to prevent secondary brain injury (SBI) is the central focus of management. SBI can be detected through clinical examination and invasive and non-invasive ICP monitoring. Progress in monitoring and understanding the pathophysiological mechanisms of IH allows the implementation of targeted interventions in order to improve the outcome of these patients. Initially, general prophylactic measures such as patient's head elevation, fever control, adequate analgesia and sedation depth should be applied immediately to all patients with suspected IH. Based on specific indications and conditions, surgical resection of mass lesions and cerebrospinal fluid drainage should be considered as an initial treatment for lowering ICP. Hyperosmolar therapy (mannitol or hypertonic saline) represents the cornerstone of medical treatment of acute IH while hyperventilation should be limited to emergency management of life-threatening raised ICP. Therapeutic hypothermia could have a possible benefit on outcome. To control elevated ICP refractory to maximum standard medical and surgical treatment, at first, high-dose barbiturate administration and then decompressive craniectomy as a last step are recommended with unclear and probable benefit on outcomes, respectively. The therapeutic strategy should be based on a staircase approach and be individualized for each patient. Since most therapeutic interventions have an uncertain effect on neurological outcome and mortality, future research should focus on both studying the long-term benefits of current strategies and developing new ones., Author(s): Theodoros Schizodimos [sup.1], Vasiliki Soulountsi [sup.2], Christina Iasonidou [sup.1], Nikos Kapravelos [sup.1] Author Affiliations: (1) grid.415248.e, 0000 0004 0576 574X, 2nd Department of Intensive Care Medicine, George Papanikolaou General [...]

Author(s): M. Smith [sup.1] [sup.2], F. Servadei [sup.3], P. J. Hutchinson [sup.4] Author Affiliations: (1) grid.439749.4, 0000 0004 0612 2754, Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, [...]

La Despolarización Cortical Propagada o Fenómenos de Despolarización Cortical Propagada (DCP) es una onda de despolarización en las células neuronales y gliales que se propaga en la materia gris de la corteza cerebral descrita inicialmente por Leão en 1994. Ante la presencia de injuria cerebral, las bombas iónicas fallan y la corriente de eflujo se torna insuficiente produciendo despolarización sostenida, inactividad eléctrica, hiperosmolaridad citosólica acompañado de cambios dendríticos y edema citotóxico. La DCP se ha evidenciado mediante la adición de potasio, glutamato y acetilcolina o activación de los astrocitos, ademas, también se presenta en hipoxia, migraña, hipoglucemia, infarto, hemorragia subaracnoidea, estados convulsivos y trauma cerebral, lo que conlleva a una expansión del daño focal. El enfoque terapéutico aún no se encuentra totalmente establecido, sin embargo, se utilizan los inhibidores de los receptores de NMDA, ya que puede contrarrestar el comienzo y propagación de la DCP. Palabras clave: Despolarización cortical propagada, trauma craneoencefálico, trauma, lesión cerebral traumática. Abstract CSD is a wave of depolarization in neuronal and glial cells that propagates in the gray matter of the cerebral cortex initially described by Leão in 1994. In the presence of cerebral injury, ion pumps fail and the efflux current becomes insufficient producing sustained depolarization, electrical inactivity, cytosolic hyperosmolarity accompanied by dendritic changes and cytotoxic edema. CSD has been evidenced by the addition of potassium, glutamate and acetylcholine or activation of astrocytes, in addition, it also occurs in hypoxia, migraine, hypoglycaemia, infarction, subarachnoid hemorrhage, convulsive states and brain trauma, which leads to an expansion of the focal damage. The therapeutic approach is not yet fully established, however, inhibitors of NMDA receptors are used, since it can counteract the onset and spread of CSD. Key words: Cortical spreading depression, craniocerebral trauma, trauma, brain injuries, traumatic., Introducción Aristides Leáo, un fisiólogo brasileño, en 1994 obtuvo un hallazgo electrofisiológico de manera incidental mientras estudiaba la actividad de las convulsiones en la corteza cerebral de un conejo (1,2). [...]

Even though Decompressive Hemicraniectomy has been utilized already for a few decades, currently no consensus about its indications or the clinical conditions in which it should be done has been reached. An attempt has been made here to bring the knowledge on these issues up to date together with a description of its surgical technique. Keywords: Craniectomy, intracranial pressure, brain edema, outcome. Si bien es cierto que la hemicraniectomia descompresiva se ha venido utilizando ya por algunas décadas, en la actualidad aún no se ha llegado a un acuerdo sobre sus indicaciones ni en qué condiciones clínicas este procedimiento debiera llevarse a cabo. Aquí se ha intentado exponer el estado actual del conocimiento en ese ámbito y se ha descrito su técnica quirúrgica. Palabras clave: Craniectomia, presión intracraneana, edema cerebral, estado funcional., Introduction Different types of cerebral insults, be it traumatic, hemorrhagic or ischemic, may cause brain edema, which, depending on its intensity, can lead to an increase in intracranial pressure (ICP) [...]

Purpose To provide an update about the rapidly developing changes in the critical care management of acute ischaemic stroke patients. Methods A narrative review was conducted in five general areas of acute ischaemic stroke management: reperfusion strategies, anesthesia for endovascular thrombectomy, intensive care unit management, intracranial complications, and ethical considerations. Results The introduction of effective reperfusion strategies, including IV thrombolysis and endovascular thrombectomy, has revolutionized the management of acute ischaemic stroke and transformed outcomes for patients. Acute therapeutic efforts are targeted to restoring blood flow to the ischaemic penumbra before irreversible tissue injury has occurred. To optimize patient outcomes, secondary insults, such as hypotension, hyperthermia, or hyperglycaemia, that can extend the penumbral area must also be prevented or corrected. The ICU management of acute ischaemic stroke patients, therefore, focuses on the optimization of systemic physiological homeostasis, management of intracranial complications, and neurological and haemodynamic monitoring after reperfusion therapies. Meticulous blood pressure management is of central importance in improving outcomes, particularly in patients that have undergone reperfusion therapies. Conclusions While consensus guidelines are available to guide clinical decision making after acute ischaemic stroke, there is limited high-quality evidence for many of the recommended interventions. However, a bundle of medical, endovascular, and surgical strategies, when applied in a timely and consistent manner, can improve long-term stroke outcomes., Author(s): M. Smith [sup.1] [sup.2], U. Reddy [sup.1], C. Robba [sup.3], D. Sharma [sup.4], G. Citerio [sup.5] [sup.6] Author Affiliations: (1) 0000 0004 0612 2754, grid.439749.4, Neurocritical Care Unit, The [...]

Brain ultrasonography can be used to evaluate cerebral anatomy and pathology, as well as cerebral circulation through analysis of blood flow velocities. Transcranial colour-coded duplex sonography is a generally safe, repeatable, non-invasive, bedside technique that has a strong potential in neurocritical care patients in many clinical scenarios, including traumatic brain injury, aneurysmal subarachnoid haemorrhage, hydrocephalus, and the diagnosis of cerebral circulatory arrest. Furthermore, the clinical applications of this technique may extend to different settings, including the general intensive care unit and the emergency department. Its increasing use reflects a growing interest in non-invasive cerebral and systemic assessment. The aim of this manuscript is to provide an overview of the basic and advanced principles underlying brain ultrasonography, and to review the different techniques and different clinical applications of this approach in the monitoring and treatment of critically ill patients., Author(s): Chiara Robba [sup.1], Alberto Goffi [sup.2], Thomas Geeraerts [sup.3], Danilo Cardim [sup.4], Gabriele Via [sup.5], Marek Czosnyka [sup.6], Soojin Park [sup.7], Aarti Sarwal [sup.8], Llewellyn Padayachy [sup.9], Frank Rasulo [...]

Purpose To determine the temporal evolution, clinical correlates, and prognostic significance of electroencephalographic (EEG) patterns in post-cardiac arrest comatose patients treated with hypothermia. Methods Prospective cohort study of consecutive post-anoxic patients receiving hypothermia and continuous EEG monitoring between May 2011 and June 2014 (n = 100). In addition to clinical variables, 5-min EEG clips at 6, 12, 24, 48, and 72 h after return of spontaneous circulation (ROSC) were reviewed. EEG background was classified according to the American Clinical Neurophysiological Society critical care EEG terminology. Clinical outcome at discharge was dichotomized as good [Glasgow outcome scale (GOS) 4-5, low to moderate disability] vs. poor (GOS 1-3, severe disability to death). Results Non-ventricular fibrillation/tachycardia arrest, longer time to ROSC, absence of brainstem reflexes, extensor or no motor response, lower pH, higher lactate, hypotension requiring >2 vasopressors, and absence of reactivity on EEG were all associated with poor outcome (all p values [less than or equal to]0.01). Suppression-burst at any time indicated a poor prognosis, with a 0 % false positive rate (FPR) [95 % confidence interval (CI) 0-10 %]. All patients (54/54) with suppression-burst or a low voltage (70 % for good outcome. Conclusions Suppression-burst or a low voltage at 24 h after ROSC was not compatible with good outcome in this series. Normal background voltage without epileptiform discharges predicted a good outcome., Author(s): Adithya Sivaraju [sup.1], Emily J. Gilmore [sup.2], Charles R. Wira [sup.3], Anna Stevens [sup.3], Nishi Rampal [sup.1], Jeremy J. Moeller [sup.1], David M. Greer [sup.2], Lawrence J. Hirsch [sup.1], [...]

Objective To estimate the proportion of participants in clinical trials who understand different components of informed consent. Methods Relevant studies were identified by a systematic review of PubMed, Scopus and Google Scholar and by manually reviewing reference lists for publications up to October 2013. A meta-analysis of study results was performed using a random-effects model to take account of heterogeneity. Findings The analysis included 103 studies evaluating 135 cohorts of participants. The pooled proportion of participants who understood components of informed consent was 75.8% for freedom to withdraw at any time, 74.7% for the nature of study, 74.7% for the voluntary nature of participation, 74.0% for potential benefits, 69.6% for the study's purpose, 67.0% for potential risks and side-effects, 66.2% for confidentiality, 64.1% for the availability of alternative treatment if withdrawn, 62.9% for knowing that treatments were being compared, 53.3% for placebo and 52.1% for randomization. Most participants, 62.4%, had no therapeutic misconceptions and 54.9% could name at least one risk. Subgroup and meta-regression analyses identified covariates, such as age, educational level, critical illness, the study phase and location, that significantly affected understanding and indicated that the proportion of participants who understood informed consent had not increased over 30 years. Conclusion The proportion of participants in clinical trials who understood different components of informed consent varied from 52.1% to 75.8%. Investigators could do more to help participants achieve a complete understanding. [TEXT NOT REPRODUCIBLE IN ASCII] [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Estimer la proportion des participants a des essais cliniques qui comprennent les differents composants du consentement edaire. Methodes Les etudes pertinentes ont ete identifiees par une revue systematique de PubMed, Scopus et Google Scholar et par l'examen manuel des listes des references des publications allant jusqu'a octobre 2013. Une meta-analyse des resultats de l'etude a ete realisee a l'aide du modele a effets aleatoires pourtenir compte de l'heterogeneite. Resultats L'analyse a inclus 103 etudes evaluant 135 cohortes de participants. La proportion regroupee des participants qui ont compris les composants du consentement edaire etait de 75,8% pour la liberte de se retirer a tout moment, de 74,7% pour la nature de l'etude, de 74,7% pour la nature volontaire de la participation, de 74,0% pour les benefices potentiels, de 69,6% pour l'objectif de l'etude, de 67,0% pour les risques et effets indesirables potentiels, de 66,2% pour la confidentiality de 64,1% pour la disponibilite d'un traitement alternatif en cas de retrait de l'etude, de 62,9% pour la connaissance des traitements evalues, de 53,3% pour le placebo et de 52,1% pour la randomisation. La plupart des participants (62,4%) n'avaient pas d'idees fausses sur le traitement, et 54,9% d'entre eux pouvaient citer au moins un risque. Les analyses de sous-groupe et de metaregression ont identifie des covariables, telles que l'age, le niveau d'education, la maladie grave, la phase et le site de l'etude, qui affectaient significativement la comprehension et indiquaient que la proportion des participants ayant compris le consentement edaire n'avait pas augmente sur une periode de 30 ans. Conclusion La proportion des participants a des essais cliniques, qui ont compris les differents composants du consentement edaire, variait de 52,1% a 75,8%. Les investigateos pourraient en faire davantage pour aider les participants a parvenir a la comprehension complete. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Estimar la proporcion de participantes de ensayos clinicos que comprende los distintos componentes del consentimiento informado. Metodos Se identificaron los estudios pertinentes mediante una revision sistematica de PubMed, Scopus y Google Scholar y el examen manual de listas de referencia a fin de hallar publicaciones anteriores a octubre de 2013. Se realizo un metanalisis de los resultados del estudio mediante un modelo de efectos aleatorios para tener en cuenta la heterogeneidad. Resultados El analisis incluyo 103 estudios que evaluaron 135 cohortes de participantes. La proporcion combinada de participantes que entendia los componentes del consentimiento informado fue del 75,8% para la libertad de retirarse en cualquier momento, 74,7% para la naturaleza del estudio, 74,7% para el caracter voluntario de la participacion, 74,0% para los beneficios potenciales, 69,6% para el proposito del estudio, 67,0% para los riesgos y efectos secundarios potenciales, 66,2% para la confidencialidad, 64,1% para la disponibilidad de tratamiento alternativo si el paciente se retira, 62,9% para saber que se comparaban tratamientos, 53,3% para el placebo y 52,1% para la aleatorizacion. La mayoria de los participantes, el 62,4%, no tenia una idea equivocada sobre la terapia y el 54,9% no fue capaz de nombrar al menos un riesgo. Los analisis de subgrupos y la metarregresion identificaron covariables, como edad, nivel educativo, enfermedad critica, fase de estudio y ubicacion, que influian considerablemente en la comprension y senalaron que la proporcion de participantes que entendia el consentimiento informado no habia aumentado en 30 anos. Conclusion La proporcion de participantes de ensayos clinicos que entendia los diferentes componentes del consentimiento informado vario del 52,1% al 75,8%. Los investigadores podrian realizar esfuerzos mayores para ayudar a los pacientes a lograr una comprension total., Introduction Informed consent has its roots in the 1947 Nuremberg Code and the 1964 Declaration of Helsinki and is now a guiding principle for conduct in medical research. (1,2) Within [...]

Purpose Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality worldwide. In part due to the availability of more aggressive treatments, increasing numbers of patients with AIS are being admitted to the intensive care unit (ICU). Despite the availability of consensus guidance for the general management of AIS, there is little evidence to support its ICU management. The purpose of this article is to provide a contemporary perspective, and our recommendations, on the ICU management of AIS. Methods We reviewed the current general AIS guidelines provided by the European Stroke Organisation, the American Stroke Association, and the UK National Institute for Health and Care Excellence, as well as the wider literature, for the data most relevant to the ICU management of AIS. Results There are four interventions in AIS supported by class I evidence: care on a stroke unit, intravenous tissue plasminogen activator within 4.5 h of stroke onset, aspirin within 48 h of stroke onset, and decompressive craniectomy for supratentorial malignant hemispheric cerebral infarction. However, robust evidence for specific AIS management principles in the ICU setting is weak. Management principles currently focus on airway and ventilation management, hemodynamic and fluid optimization, fever and glycemic control, management of anticoagulation, antiplatelet and thromboprophylaxis therapy, control of seizures and surgical interventions for malignant middle cerebral artery and cerebellar infarctions. Conclusions We have provided our recommendations for the principles of ICU management of AIS, based on the best available current evidence. Encouragement of large-scale recruitment of patients with AIS into clinical trials should aid the development of robust evidence for the benefit of different interventions in the ICU on outcome., Author(s): Matthew A. Kirkman [sup.1] [sup.2], Giuseppe Citerio [sup.3], Martin Smith [sup.1] [sup.4] Author Affiliations: (1) grid.439749.4, Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, University College London [...]

Author(s): Claudio Sandroni [sup.1], Jasmeet Soar [sup.2], Hans Friberg [sup.3] Author Affiliations: (1) grid.8142.f, 0000000109413192, Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, , Largo Gemelli, 8, [...]

Author(s): Andrea O. Rossetti [sup.1] Author Affiliations: (1) grid.9851.5, 0000000121654204, Service de Neurologie, BH07, Department of Clinical Neuroscience, University Hospital (CHUV) and Faculty of Biology and Medicine, , 1011, Lausanne, [...]

Author(s): Geert Meyfroidt [sup.1], Pierre-Edouard Bollaert [sup.2], Paul E. Marik [sup.3] Author Affiliations: (1) grid.5596.f, 0000000106687884, Intensive Care Medicine, KU Leuven, , Line 1: UZ Leuven, 3000, Louvain, Belgium (2) [...]

Byline: Pornpatr. Dharmasaroja, Sombat. Muengtaweepongsa, Junya. Pattaraarchachai Background: Recanalization therapies have been increasingly applied in clinical practice, which might change the outcomes of patients with large middle cerebral artery (MCA) [...]

Byline: Chetan. Shirodkar, S. Rao, Dnyaneshwar. Mutkule, Yogesh. Harde, Pradeep. Venkategowda, M. Mahesh Background and Aims: The aim was to evaluate efficacy of optic nerve sheath diameter (ONSD) by ultrasound [...]

Byline: Vinod. Rai, Rohit. Bhatia, Kameshwar. Prasad, M. Padma Srivastava, Shaily. Singh, Neha. Rai, Ashish. Suri Background: Malignant middle cerebral artery (MCA) infarction is associated with high mortality and morbidity. [...]

Byline: Amandeep. Kumar, Manish. Sharma, Bhawani. Sharma, Rohit. Bhatia, Manmohan. Singh, Ajay. Garg, Rajinder. Kumar, Ashish. Suri, Poodipedi. Chandra, Shashank. Kale, Ashok. Mahapatra Introduction: Life-threatening, space occupying, infarction develops in [...]

Byline: Chia-Lin. Tsai, Hsin. Chu, Giia-Sheun. Peng, Hsin-I. Ma, Chun-An. Cheng, Dueng-Yuan. Hueng Objective: Decompressive hemicraniectomy is accepted as the most effective life-saving treatment for malignant middle cerebral artery (MCA) [...]

Byline: J. M. K. Murthy Space occupying, malignant middle cerebral artery infarct (mMCAI) accounts for 1% and 10% of all supratentorial ischemic strokes [sup][1],[2],[3] and is associated with about 80% [...]

Byline: Kameshwar. Prasad, Subhash. Kaul, M. Padma, S. Gorthi, Dheeraj. Khurana, Asha. Bakshi Introduction Scope of the guidelines These National Clinical Guidelines for stroke cover the management of patients with [...]

Byline: Rahul. Lath, Sudhir. Kumar, Rajesh. Reddy, Gnana. Boola, Amitava. Ray, Subhashini. Prabhakar, Alok. Ranjan Background : Cerebral venous sinus thrombosis (CVST) is one of the common causes of stroke [...]

The Extent of the Problem Stroke, about 80% of which is ischaemic caused by occlusion of an intracerebral artery and 20% caused by intracerebral bleeding, is the second most common [...]

ABSTRACT Cerebrovascular disease is the second most common cause of death and leading cause of acquired disability. The approach to management has in general been nihilistic. Most patients are offered [...]

Byline: Rajinder. Dhamija, Geoffrey. Donnan Background: There is a need for early recognition, diagnosis, and therapy in patients with acute stroke. The most important therapies are thrombolysis or aspirin in [...]

Author(s): Fernando Godinho Zampieri [sup.1] [sup.2], César Biselli Ferreira [sup.1], Cláudia Gennari Lacerda Jorge [sup.1], Marcelo Park [sup.1] Author Affiliations: (1) grid.11899.38, 0000000419370722, Medical Intensive Care Unit, Disciplina de Emergências [...]