scholarly journals Critical care of subarachnoid haemorrhage

2017 ◽  
Vol 04 (04) ◽  
pp. S49-S55
Author(s):  
Michael Souter
Keyword(s):  
Critical Care ◽  
Subarachnoid Haemorrhage ◽  
Neurological Outcome ◽  
Neurocritical Care ◽  
Comprehensive Evaluation ◽  
Haemorrhagic Stroke ◽  
Care Team ◽  
Evidence Based ◽  
New Treatment ◽  
The Brain

AbstractSubarachnoid haemorrhage (SAH) is a consistent presentation of haemorrhagic stroke of significance to clinicians in neurocritical care, inducing consequent effects on non-neurological systems, while at the same time, rendering the brain vulnerable to secondary physiological insult modifying neurological outcome, despite control of the original point of haemorrhage. Coordinated treatment depends on comprehensive evaluation of both cerebral and systemic physiology, identifying and treating impaired function. The presence of a dedicated neurocritical care team can benefit outcome. Protocols of care have evolved to meet evidence-based challenges, discarding potentially deleterious components of hypervolaemia and haemodilution, while maintaining pressure-guided perfusion. Treatment targets have also evolved with a shift in focus away from SAH-associated vasospasm, towards actual ischaemic outcome – illustrated by lack of effectiveness of pharmaceutical treatments of vasospasm. Clinicians must consequently review pathophysiological mechanisms of injury and devise new treatment opportunities.

Neurocritical Care Pharmacotherapy

2018 ◽  
Author(s):  
Eelco F.M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Emergency Department ◽  
Critical Care ◽  
Critical Care Unit ◽  
Medication Reconciliation ◽  
Neurocritical Care ◽  
The Body ◽  
Drug Related Problems ◽  
The Brain

Drugs are used to treat, salvage, and protect the brain. This book provides information on how to prescribe and monitor the drugs most frequently used in the emergency department and the neurosciences critical care unit. Each drug is discussed in great detail to allow for its efficient use and to allow the recognition of drug-related problems. The book explains how these drugs work and what the body does with the drug in the acutely ill neurologic patient. It provides guidance on how these drugs are best administered and revisits how we can most effectively practice medication reconciliation. This manual has multiple useful concise tables and graphs summarizing over 150 drugs.

scholarly journals Acute Headache at Emergency Department: Reversible Cerebral Vasoconstriction Syndrome Complicated by Subarachnoid Haemorrhage and Cerebral Infarction

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
M. Yger ◽  
C. Zavanone ◽  
L. Abdennour ◽  
W. Koubaa ◽  
F. Clarençon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Subarachnoid Haemorrhage ◽  
Cerebral Arteries ◽  
Brain Mri ◽  
Occipital Lobe ◽  
Haemorrhagic Stroke ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Cerebral Vasoconstriction ◽  
The Right ◽  
The Brain

Introduction.Reversible cerebral vasoconstriction syndrome is becoming widely accepted as a rare cause of both ischemic and haemorrhagic stroke and should be evocated in case of thunderclap headaches associated with stroke. We present the case of a patient with ischemic stroke associated with cortical subarachnoid haemorrhage (cSAH) and reversible diffuse arteries narrowing, leading to the diagnosis of reversible vasoconstriction syndrome.Case Report.A 48-year-old woman came to the emergency department because of an unusual thunderclap headache. The computed tomography of the brain completed by CT-angiography was unremarkable. Eleven days later, she was readmitted because of a left hemianopsia. One day after her admission, she developed a sudden left hemiparesis. The brain MRI showed ischemic lesions in the right frontal and occipital lobe and diffuse cSAH. The angiography showed vasoconstriction of the right anterior cerebral artery and stenosis of both middle cerebral arteries. Nimodipine treatment was initiated and vasoconstriction completely regressed on day 16 after the first headache.Conclusion.Our case shows a severe reversible cerebral vasoconstriction syndrome where both haemorrhagic and ischemic complications were present at the same time. The history we reported shows that reversible cerebral vasoconstriction syndrome is still underrecognized, in particular in general emergency departments.

scholarly journals Spontaneous Subarachnoid Haemorrhage in a Case with Covid-19 Infection - Effect or Association? A Case Report

2021 ◽  
Vol 10 (41) ◽  
pp. 3607-3609
Author(s):  
Sourya Acharya ◽  
Samarth Shukla ◽  
Pankaj Banode ◽  
Shefali Sharma ◽  
Abhijeet Wadekar
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Severe Pneumonia ◽  
Haemorrhagic Stroke ◽  
Airway Disease ◽  
Acute Disseminated Encephalomyelitis ◽  
Neurological Complications ◽  
Multiple Organ ◽  
Chronic Obstructive ◽  
Acute Necrotizing Encephalopathy ◽  
The Brain

Covid-19 is a disease caused by the SARS-CoV-2 virus that usually causes mild flu-like illness in majority of the cases, but it can cause severe pneumonia and multiple organ dysfunction even death especially in elderly patients who also have comorbidities like hypertension, diabetes, chronic obstructive airway disease (COAD), asthma, and cardiac disease. The central and peripheral nervous systems are not spared, and neurological complications are frequently reported in severely ill patients who have comorbidities. The SARS-CoV-2 virus has the potential to invade the brain and it enters the brain via a haematogenous route or olfactory system through angiotensinconverting enzyme -2 receptors, present on endothelial cells of cerebral vessels. The most neurological manifestations, seen in Covid-19 infection are altered sensorium (agitation, delirium, and coma), ischemic or haemorrhagic stroke, acute disseminated encephalomyelitis or acute necrotizing encephalopathy, headaches, Guillain-Barré syndrome. Here is a case of a 70-year-old hypertensive female who presented to us with complaints of fever, headache and vomiting of 3 days duration and after investigations, a diagnosis of Covid -19 with hypertension and subarachnoid haemorrhage was made.

Subarachnoid haemorrhage

2019 ◽  
pp. 101-116
Author(s):  
Matthew A. Kirkman ◽  
Martin Smith
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Subarachnoid Haemorrhage ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Care Staff ◽  
Evidence Based ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study on subarachnoid haemorrhage. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

scholarly journals Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of spontaneous subarachnoid haemorrhage

2019 ◽  
Vol 4 (4) ◽  
pp. 176-181 ◽  
Author(s):  
Yi Dong ◽  
Zhen-Ni Guo ◽  
Qi Li ◽  
Wei Ni ◽  
Hongqiu Gu ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Clinical Management ◽  
Systems Of Care ◽  
Cerebrovascular Disorders ◽  
Haemorrhagic Stroke ◽  
Cerebrovascular Diseases ◽  
Evidence Based ◽  
Executive Summary ◽  
Writing Group ◽  
Aggressive Care

AimSpontaneous subarachnoid haemorrhage (SAH) caused by ruptured cerebral aneurysm is a severe subtype of haemorrhagic stroke. Although the incidence of SAH is relatively low among all cerebrovascular diseases, the mortality is the highest. The critical management of SAH is challenging. We provide this evidence-based guideline to present current and comprehensive recommendations for the diagnosis and treatment of non-trauma SAH.MethodsA formal literature search of MEDLINE (1 January 1990–30 June 2019) was performed. Data were synthesised with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The Chinese Stroke Association’s levels of evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by Chinese Stroke Association’s Stroke Fellow Committees. It is intended that this guideline be fully updated every 3 years.ResultsEvidence-based guidelines are presented for the care of patients presenting with non-trauma SAH. The focus of the guideline was subdivided into transfer and systems of care, diagnosis flowchart, aetiology and differentiation, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, management of vasospasm and delayed cerebral ischaemia, management of hydrocephalus, management of seizures and management of medical complications.ConclusionsThe guideline offers a framework for SAH management. Early professional and aggressive care of SAH might help dramatically.

scholarly journals New migraine preventive options: an update with pathophysiological considerations

2002 ◽  
Vol 57 (6) ◽  
pp. 293-298 ◽  
Author(s):  
Marcelo E. Bigal ◽  
Alan M. Rapoport ◽  
Fred D. Sheftell ◽  
Stewart J. Tepper
Keyword(s):  
Botulinum Toxin A ◽  
Treatment Options ◽  
Public Health Problem ◽  
New Drugs ◽  
Evidence Based ◽  
Long Time ◽  
Multiple Threads ◽  
New Treatment ◽  
The Brain ◽  
Calcium Channelopathy

BACKGROUND: The pharmacological treatment of migraine may be acute or preventive. Frequent, severe and long-lasting migraine attacks require prophylaxis. Multiple threads of research over the last 15 years have led to the concept that migraine is generated from a hyperexcitable brain. A variety of causes for hyperexcitability of the brain in migraine have been suggested. These causes include low cerebral magnesium levels, mitochondrial abnormalities, dysfunctions related to increased nitric oxide or the existence of a P/Q type calcium channelopathy. The better knowledge about migraine pathophisiology led us to discuss new treatment options. OBJECTIVES: The aim of the present study is to present an evidence-based review of some new drugs or some agents that even though available for a long time, are not frequently used. METHODS/RESULTS: We present a review of anticonvulsants with various mechanisms of action such as lamotrigine, gabapentin, topiramate, tiagabine, levetiracetam and zonisamide. We also review natural products, like riboflavin and magnesium, botulinum toxin A, a specific CGRP antagonist and the anti-asthma medication montelukast, with pathophysiological discussion. CONCLUSIONS: We aimed to present an update of newer or less frequently used preventive migraine therapies, drugs that might reduce the burden and the costs of a disease that should be considered as a public health problem all around the world.

scholarly journals Lean into Clinical Pharmacy: An Experience in Implementing Key Performance Indicators and Gemba Walks into Clinical Pharmacy Services

2021 ◽  
Vol 12 (4) ◽  
pp. 15
Author(s):  
Jocelyn Owusu-Guha ◽  
Connie Yoon ◽  
Jordan DeWitt ◽  
Pamela L. Buschur ◽  
Jennifer Bauer ◽  
...  
Keyword(s):  
Critical Care ◽  
Process Improvement ◽  
Clinical Pharmacy ◽  
Performance Indicators ◽  
Lessons Learned ◽  
Care Team ◽  
Evidence Based ◽  
Pharmacy Services ◽  
Medication Utilization ◽  
Critical Care Team

Purpose: The Lean methodology was applied to clinical metrics by a critical care pharmacy team. The experiences associated with the development and implementation of clinical metrics and their impact on daily workflow are described. Summary: The Lean methodology has been introduced into the healthcare system as a means of process improvement, which can eliminate waste through appropriate medication utilization. At OhioHealth Riverside Methodist Hospital, the department of pharmacy was tasked with the development of clinical metrics after a health system wide Gemba walk was initiated. The pharmacy department's critical care team developed a strategy identifying and evaluating clinical metrics pertaining to their everyday workflow. Each clinical metric was evaluated in accordance with a pre-defined goal. Metrics requiring heavy documentation and those in which the pharmacist does not have autonomous authority to manage were often challenging to implement and were less successful. Throughout this process, the lessons learned focused on generating ideas that were easily documented, evidence-based, and department specific. The critical care team discovered that the outcome of the most successful metrics highlighted clinical pharmacist value and data generated could be used to support funding for additional resources. Conclusion: The critical care pharmacy team developed a streamlined process to implement clinical metrics as means of identifying areas for improvement using the Lean methodology. 

Sign in / Sign up

Export Citation Format

Share Document