scholarly journals Effects of Appointing a Full-Time Neurointensivist to Run a Closed-Type Neurological Intensive Care Unit

2019 ◽  
Vol 15 (3) ◽  
pp. 360
Author(s):  
Myung-Ah Ko ◽  
Jung Hwa Lee ◽  
Joong-Goo Kim ◽  
Suyeon Jeong ◽  
Dong-Wha Kang ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Full Time ◽  
Neurological Intensive Care Unit ◽  
Neurological Intensive Care ◽  
Closed Type

Time to Detection of the First Seizure in Patients With Nonconvulsive Status Epilepticus in the Neurological Intensive Care Unit

2019 ◽  
Vol 51 (1) ◽  
pp. 70-73
Author(s):  
Nese Dericioglu ◽  
Ethem Murat Arsava ◽  
Mehmet Akif Topcuoglu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Eeg Monitoring ◽  
Neurological Intensive Care Unit ◽  
Neurological Intensive Care ◽  
Eeg Recordings ◽  
Gcs Score ◽  
Early Seizure ◽  
Video Eeg

Video-EEG monitoring is often used to detect nonconvulsive status epilepticus (NCSE) in critical care patients. Short recording durations may fail to detect seizures. In this study, we investigated the time required to record the first ictal event, and whether it could be correlated with some clinical or EEG parameters. Video-EEG recordings of patients who were followed up in our neurological intensive care unit were evaluated retrospectively. The EEG recordings of patients with NCSE were reviewed to determine the timing of the first seizure occurrence. Demographic data and EEG findings were obtained from patient charts and EEG reports. Possible correlations between the presence of periodic discharges (PD), Glasgow Coma Scale (GCS) score and early seizure detection (defined as a seizure within the first hour of recording) were explored statistically. Out of 200 patients who underwent video-EEG monitoring, we identified 30 cases (15%; 18 male, 12 female; age 24-86 years; mean recording duration 99 hours) with NCSE. The first seizure was recorded within 0 to 1 hour in 22 patients (73%) and within 1 to 12 hours in 6 patients (22%). Interictal PDs were identified in 19 patients (63%). GCS score was ≤8 in 16 patients (53%). There was no correlation between early seizure detection and PDs (p=1.0) or GCS score ( P = .22). In our study, >90% of the seizures were captured within 12 hours. This finding suggests that most of the NCSE cases can be identified even in centers with limited resources. The presence or absence of PDs or GCS score does not predict the timing of the first seizure.

scholarly journals Quantitative Pupillometry in the Intensive Care Unit

2019 ◽  
pp. 088506661988112
Author(s):  
Matthew M. Bower ◽  
Alexander J. Sweidan ◽  
Jordan C. Xu ◽  
Sara Stern-Nezer ◽  
Wengui Yu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Objective Assessment ◽  
Light Response ◽  
Pressure Monitoring ◽  
Neurological Intensive Care Unit ◽  
Neurological Intensive Care ◽  
Pupillary Light ◽  
Pupillary Reactivity ◽  
Neurological Pupil Index

Quantitative pupillometry provides a noninvasive and objective assessment within the neurological examination. This review details the physiology of the pupillary light response, the clinical significance of changes in pupillary reactivity, and the variables that compose the Neurological Pupil index or NPi are discussed. This article reviews the most recent applications and advances in quantitative pupillometry for noninvasive intracranial pressure monitoring, postcardiac arrest prognostication, and subarachnoid hemorrhage. Also discussed are the limitations and confounders of quantitative pupillometry in the modern neurological intensive care unit.

scholarly journals Refractory Status Epilepticus: Experience in a Neurological Intensive Care Unit

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
O. H. Hernandez ◽  
J. F. Zapata ◽  
M. Jimenez ◽  
M. Massaro ◽  
A. Guerra ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Short Term ◽  
Neurological Intensive Care Unit ◽  
Term Outcome ◽  
Neurological Intensive Care ◽  
Refractory Status ◽  
Short Term Outcome

Introduction. Refractory status epilepticus (RSE) has significant morbidity and mortality, and its management requires an accurate diagnosis and aggressive treatment. Objectives. To describe the experience of management of RSE in a neurological intensive care unit (NeuroICU) and determine predictors of short-term clinical outcome. Methods. We reviewed cases of RSE from September 2007 to December 2008. Management was titrated to findings on continuous video EEG (cVEEG). We collected patients’ demographics, RSE etiology, characteristics of seizures, cVEEG findings, treatments, and short-term outcome. Control of RSE was to achieve burst suppression pattern or electrographic cessation of ictal activity. Results. We included 80 patients; 63.8% were in coma, 25% had subclinical seizures, and 11.3% had focal activity. 51.3% were male and mean age was 45 years. Etiology was neurological lesion in 75.1%, uncontrolled epilepsy in 20%, and systemic derangements in 4.9%. 78.8% were treated with general anesthesia and concomitant anticonvulsant drugs. The control of RSE was 87.5% of patients. In-hospital mortality was 22.5%. The factors associated with unfavorable short-term outcome were coma and age over 60 years. Conclusions. RSE management guided by cVEEG is associated with a good seizure control. A multidisciplinary approach can help achieve a better short-term functional outcome in noncomatose patients.

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