Neurocritical Care最新文献

Background: Cerebral ischemia is frequently detected after intracerebral hemorrhage (ICH) on diffusion-weighted imaging (DWI) and is associated with worse outcomes. Although the mechanism is uncertain, cerebral autoregulation impairment due to severe hypertension has been suggested from prior studies. We tested the hypothesis that more severe left ventricular hypertrophy (LVH), a marker of chronic hypertension-mediated organ damage, is associated with DWI lesions after ICH.

Methods: Using a single-center observational cohort study, we included all patients with spontaneous ICH between 2009 and 2019 with available magnetic resonance imaging (MRI) who underwent transthoracic echocardiography (TTE) during the index hospitalization. LVH was primarily categorized as none/mild or moderate/severe based on the TTE report and was secondarily defined using calculated left ventricular mass index (LVMI) measurement. The primary outcome measure was acute DWI lesion presence on brain MRI. The number of DWI lesions was assessed as a secondary outcome.

Results: A total of 187 patients (mean [SD] age 66.4 [14.5] years, 50.8% female) with a median baseline ICH volume of 12.6 (interquartile range 4.0-32.0) mL had TTE and DWI performed. Moderate/severe LVH was present in 23.5% of patients, and DWI lesions were detected in 30.5% of the cohort. Using multivariable logistic regression, the primary analysis found that moderate/severe LVH was associated with DWI lesion presence with adjustment for ICH severity (adjusted odds ratio [aOR] 2.74, confidence interval [CI] 1.32-5.71; p = 0.01). A similar association was demonstrated between the highest LVMI quartile and DWI lesion presence (aOR 3.60, CI 1.48-8.77; p = 0.01). Linear regression models found moderate/severe LVH was associated with greater DWI lesion count (adjusted B 1.32, CI 0.89-1.76; p < 0.01).

Conclusions: Greater LVH severity was associated with the presence and burden of DWI lesions after acute ICH. Echocardiography may be a tool to inform secondary ischemia risk stratification and prevention strategies.

Background: Anti-N-methyl D-aspartate-receptor encephalitis (anti-NMDARe) is a severe disease with a favorable outcome when immunomodulatory management is started rapidly. The main objective of this study is to compare the early efficacy of the two most frequently used therapeutics, i.e., intravenous immunoglobulin (IVIG) and therapeutic plasma exchange (TPE), in intensive care patients admitted for anti-NMDARe.

Methods: This is an observational retrospective study of patients hospitalized in a tertiary medical neurointensive care unit for severe anti-NMDARe. Patients were categorized according to the modality of first-line immunomodulatory therapies associated with corticosteroids: TPE, IVIG, or IVIG followed by TPE. The primary end point was the effectiveness of the first-line immunomodulatory treatment. Treatment was considered effective when no other immunomodulatory therapy was introduced and the patient met the following three conditions: response to simple commands, absence of epileptic seizures, and absence of abnormal movements.

Results: Thirty-seven patients were included in the study from January 2007 to December 2022: 8 were treated with TPE alone, 13 were treated with IVIG alone, and 16 were treated with IVIG followed by TPE. Of the 29 patients treated with IVIG, 13 showed improvement, with a median latency to treatment response of 36 days, whereas 16 were switched to TPE, with a median latency to treatment response of 30 days due to a lack of improvement. All eight patients treated with TPE improved, with a latency to treatment response of 31 days. TPE was significantly more effective than IVIG.

Conclusions: This study raises the hypothesis that immunotherapies may have differential response rates among patients with NMDARe. Although the retrospective nature of the analysis may be subject to bias and confounding, the potential for therapeutic impact deserves prospective evaluation.