Pub Date : 2022-04-30DOI: 10.32587/jnic.2021.00451
J. Han, Se-Hoon Kim, J. Choi, Sung-Kon Ha, Sang-Dae Kim, D. Lim, Bum-Joon Kim
Objective: Patients with spinal cord injury (SCI) are often unstable and require intensive care unit (ICU) treatment in the acute phase. This study assists in the prognosis and treatment direction of SCI patients by retrospectively examining and analyzing the clinical characteristics of SCI patients admitted to the ICU.Methods: In this study, a total of 102 SCI patients were admitted to the ICU of our hospital from February 2013 to March 2019. Based on the medical records, the patient's gender, age, mechanism of injuries, day of hospitalization, surgery timing, tracheostomy, ventilator use, steroid use, underlying disease, and hypotension were investigated. To assess the clinical outcome, the american spinal injury association (ASIA) impairment scale and limb motor grade three weeks and six months after injury was evaluated.Results: Of the 102 patients, 76 (74.51%) were male, and the average age was 57.57 years. Of these, 87 (85.29%) had spinal surgery, while 30 (34.48%) had surgery within 36 h after injury. High doses of steroids were administered in 15 patients (14.85%). As for the ASIA impairment scale, Grade A at the initial stage of injury reached 15% of all patients but decreased to 5.1% after three weeks and 1.9% after six months.Conclusion: Early surgery was advantageous in improving the lower extremity motor grade at three weeks of injury. Although steroid use has no significant effect compared to the risk of complications in several previous studies, in this study, it was observed that the ASIA scale improved six months after injury in patients receiving high-dose steroids.
{"title":"Clinical Analyses of Traumatic Cervical Spinal Cord Injury Patients Treated in the Intensive Care Unit","authors":"J. Han, Se-Hoon Kim, J. Choi, Sung-Kon Ha, Sang-Dae Kim, D. Lim, Bum-Joon Kim","doi":"10.32587/jnic.2021.00451","DOIUrl":"https://doi.org/10.32587/jnic.2021.00451","url":null,"abstract":"Objective: Patients with spinal cord injury (SCI) are often unstable and require intensive care unit (ICU) treatment in the acute phase. This study assists in the prognosis and treatment direction of SCI patients by retrospectively examining and analyzing the clinical characteristics of SCI patients admitted to the ICU.Methods: In this study, a total of 102 SCI patients were admitted to the ICU of our hospital from February 2013 to March 2019. Based on the medical records, the patient's gender, age, mechanism of injuries, day of hospitalization, surgery timing, tracheostomy, ventilator use, steroid use, underlying disease, and hypotension were investigated. To assess the clinical outcome, the american spinal injury association (ASIA) impairment scale and limb motor grade three weeks and six months after injury was evaluated.Results: Of the 102 patients, 76 (74.51%) were male, and the average age was 57.57 years. Of these, 87 (85.29%) had spinal surgery, while 30 (34.48%) had surgery within 36 h after injury. High doses of steroids were administered in 15 patients (14.85%). As for the ASIA impairment scale, Grade A at the initial stage of injury reached 15% of all patients but decreased to 5.1% after three weeks and 1.9% after six months.Conclusion: Early surgery was advantageous in improving the lower extremity motor grade at three weeks of injury. Although steroid use has no significant effect compared to the risk of complications in several previous studies, in this study, it was observed that the ASIA scale improved six months after injury in patients receiving high-dose steroids.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"101 10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125971500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.32587/jnic.2022.00479
K. Lee, Byung Jun Kim, D. H. Park
A 66-year-old patient with nasopharyngeal cancer who had received chemotherapy and radiation therapy visited our emergency center with severe epistaxis. The patient was followed up with internal carotid artery trapping after a pseudoaneurysm was revealed in computed tomography angiography. Cerebrospinal fluid leakage was noted during follow-up observation after the intervention. This case presents various neurosurgical complications that can occur in patients with nasopharyngeal cancer.
{"title":"Neurosurgical Complications in Patients with Nasopharyngeal Cancer Accompanied by Skull Base Erosion: A case report","authors":"K. Lee, Byung Jun Kim, D. H. Park","doi":"10.32587/jnic.2022.00479","DOIUrl":"https://doi.org/10.32587/jnic.2022.00479","url":null,"abstract":"A 66-year-old patient with nasopharyngeal cancer who had received chemotherapy and radiation therapy visited our emergency center with severe epistaxis. The patient was followed up with internal carotid artery trapping after a pseudoaneurysm was revealed in computed tomography angiography. Cerebrospinal fluid leakage was noted during follow-up observation after the intervention. This case presents various neurosurgical complications that can occur in patients with nasopharyngeal cancer.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132205101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.32587/jnic.2021.00430
Tariq Janjua, A. Agrawal, Y. Picón-Jaimes, I. Lozada‐Martínez, Berhioska Valentina Perez-Velasquez, Alejandra Mendoza-Ortiz, L. Moscote-Salazar
ment decisions can be clouded with the clinician’s personal biases or unrecognized acumen judgment errors. This translates to therapeutic momentum (TM). Therapeutic momentum was a term proposed by Rodrigo et al in 2012, they describe as: In situations when doctors do not stop or because of personal clinical decisions they do not interrupt therapeutic strategies without any benefit and contrary to evidence that supports maintaining treatment. In addition to the definition, we propose 2 classes of Therapeutic momentum: When the doctor has the deleterious effects of maintaining a therapy, and when the physician is unaware of the deleterious effects of maintaining a therapy. The concept of TM is strongly presented in the realm of traumatic brain injury (TBI). The examples of therapeutic momentum in BTI may include but are not limited to: fluid therapy (Hypertonic-Mannitol) without evidence of increased intracranial pressure, anticonvulsants keeping post-trauma antiepileptics for more than 7 days, gastroprotection (maintaining proton inhibitors without evidence of digestive tract bleeding), neuroimaging (performing control neuroimaging in unstable patients with no obvious clinical indication), and invasive intracranial pressure monitoring (maintaining intracranial pressure monitor when intracranial hypertension has resolved) We propose an algorithm for TM in circumstances where we consider strategies that are not effective in patients with TBI (Fig. 1). Truly the progression of TBI through the stages of care can lead to TM moments and each step deviation can lead the patient to a path of declined status. The moment of initial management includes optimization of perfusion pressure, airway control, avoid hypotension1), hypercarbia, correction of coagulopathy, control of temperature, and decision to proceed to surgery. Decompression after 48 hours if intracranial pressure (ICP) and cerebral perfusion pressure (CPP) can be controlled is the preferred pathway. Early decompression might be required from epidural hemorrhage, marked ICP not controlled with medical management, or obstructive hydrocephalus. Without trying medical management and going right to surgery might lead to unnecessary systemic Received: November 25, 2021 Accepted: December 30, 2021
{"title":"Therapeutic Momentum: Scenarios in Patients with Neurotrauma","authors":"Tariq Janjua, A. Agrawal, Y. Picón-Jaimes, I. Lozada‐Martínez, Berhioska Valentina Perez-Velasquez, Alejandra Mendoza-Ortiz, L. Moscote-Salazar","doi":"10.32587/jnic.2021.00430","DOIUrl":"https://doi.org/10.32587/jnic.2021.00430","url":null,"abstract":"ment decisions can be clouded with the clinician’s personal biases or unrecognized acumen judgment errors. This translates to therapeutic momentum (TM). Therapeutic momentum was a term proposed by Rodrigo et al in 2012, they describe as: In situations when doctors do not stop or because of personal clinical decisions they do not interrupt therapeutic strategies without any benefit and contrary to evidence that supports maintaining treatment. In addition to the definition, we propose 2 classes of Therapeutic momentum: When the doctor has the deleterious effects of maintaining a therapy, and when the physician is unaware of the deleterious effects of maintaining a therapy. The concept of TM is strongly presented in the realm of traumatic brain injury (TBI). The examples of therapeutic momentum in BTI may include but are not limited to: fluid therapy (Hypertonic-Mannitol) without evidence of increased intracranial pressure, anticonvulsants keeping post-trauma antiepileptics for more than 7 days, gastroprotection (maintaining proton inhibitors without evidence of digestive tract bleeding), neuroimaging (performing control neuroimaging in unstable patients with no obvious clinical indication), and invasive intracranial pressure monitoring (maintaining intracranial pressure monitor when intracranial hypertension has resolved) We propose an algorithm for TM in circumstances where we consider strategies that are not effective in patients with TBI (Fig. 1). Truly the progression of TBI through the stages of care can lead to TM moments and each step deviation can lead the patient to a path of declined status. The moment of initial management includes optimization of perfusion pressure, airway control, avoid hypotension1), hypercarbia, correction of coagulopathy, control of temperature, and decision to proceed to surgery. Decompression after 48 hours if intracranial pressure (ICP) and cerebral perfusion pressure (CPP) can be controlled is the preferred pathway. Early decompression might be required from epidural hemorrhage, marked ICP not controlled with medical management, or obstructive hydrocephalus. Without trying medical management and going right to surgery might lead to unnecessary systemic Received: November 25, 2021 Accepted: December 30, 2021","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127368119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.32587/jnic.2021.00444
Tariq Janjua, Scott Myer, L. Moscote-Salazar
day, the MAP goal was relaxed and fluids were stopped. He was able to bear weight and take a few steps. The steroids were weaned off and Minocycline was restricted to a total of 7 days. He was discharged to the stroke unit followed by acute neurological rehabilitation. A for-mal and written informed consent was obtained from the patient for the publication of the case in-formation and images.
{"title":"Spinal Cord Reperfusion Injury after Decompression of Severe Cord Compression: Critical Care Management","authors":"Tariq Janjua, Scott Myer, L. Moscote-Salazar","doi":"10.32587/jnic.2021.00444","DOIUrl":"https://doi.org/10.32587/jnic.2021.00444","url":null,"abstract":"day, the MAP goal was relaxed and fluids were stopped. He was able to bear weight and take a few steps. The steroids were weaned off and Minocycline was restricted to a total of 7 days. He was discharged to the stroke unit followed by acute neurological rehabilitation. A for-mal and written informed consent was obtained from the patient for the publication of the case in-formation and images.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126823516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.32587/jnic.2021.00423
H. Choi, C. Yoon, J. Ryu
Background: To evaluate the acute kidney injury (AKI) predictors and their predictive performance during mannitol infusion, and the impact of AKI on in-hospital mortality of neurocritically ill patients.Methods: This was a retrospective, observational study of patients who were admitted at a tertiary university hospital, Seoul, Republic of Korea, neurosurgical intensive care unit (ICU) from January 2013 to December 2019. We included neurosurgical patients on mannitol infusion admitted in the ICU The primary endpoint was the occurrence of AKI.Results: A total of 3,964 patients were included in the final analysis. AKI was detected in 540 (13.6%) patients on mannitol infusion. Measured osmolality and osmolar gap were significantly higher in patients with AKI than those without (both p< 0.001). However, the predictive power of the two indicators was similar and were both weak predictors of AKI (both C-statistic <0.650). In the multivariable analysis, maximal measured osmolality, chronic kidney disease, Acute Physiology and Chronic Health Evaluation 2 score on ICU admission, use of vasopressor, use of glycerin, mechanical ventilation, and invasive ICP monitoring were significantly associated with AKI. In-hospital mortality was significantly higher in patients with AKI than those without (11.1% vs. 1.4%, p< 0.001).Conclusions: Based on our findings, kidney injury may be associated with poor clinical outcomes in neurosurgical and neurocritically ill patients, and monitoring serum osmolality and OG remains important in the prevention of kidney injury for patients on mannitol infusion. Moreover, clinical factors related to ICU management and pre-existing renal disease may aggravate AKI during mannitol infusion.
背景:评价甘露醇输注过程中急性肾损伤(AKI)的预测指标及其预测效果，以及AKI对神经危重症患者住院死亡率的影响。方法:对2013年1月至2019年12月在韩国首尔某大学附属医院神经外科重症监护病房(ICU)住院的患者进行回顾性观察性研究。我们纳入了在ICU接受甘露醇输注的神经外科患者，主要终点是AKI的发生。结果:共3964例患者纳入最终分析。甘露醇输注540例(13.6%)患者检出AKI。AKI患者的渗透压和渗透压间隙明显高于无AKI患者(p< 0.001)。然而，这两个指标的预测能力相似，都是AKI的弱预测指标(c统计量均<0.650)。在多变量分析中，最大渗透压测量值、慢性肾脏疾病、ICU入院时的急性生理和慢性健康评估2评分、血管加压剂的使用、甘油的使用、机械通气和有创ICP监测与AKI显著相关。AKI患者的住院死亡率显著高于无AKI患者(11.1% vs. 1.4%， p< 0.001)。结论:根据我们的研究结果，神经外科和神经危重症患者的肾损伤可能与较差的临床预后有关，监测血清渗透压和OG对于预防甘露醇输注患者的肾损伤仍然很重要。此外，与ICU管理和既往肾脏疾病相关的临床因素可能加重甘露醇输注期间的AKI。
{"title":"Acute Kidney Injury Following Mannitol Infusion in Neurosurgical Patients","authors":"H. Choi, C. Yoon, J. Ryu","doi":"10.32587/jnic.2021.00423","DOIUrl":"https://doi.org/10.32587/jnic.2021.00423","url":null,"abstract":"Background: To evaluate the acute kidney injury (AKI) predictors and their predictive performance during mannitol infusion, and the impact of AKI on in-hospital mortality of neurocritically ill patients.Methods: This was a retrospective, observational study of patients who were admitted at a tertiary university hospital, Seoul, Republic of Korea, neurosurgical intensive care unit (ICU) from January 2013 to December 2019. We included neurosurgical patients on mannitol infusion admitted in the ICU The primary endpoint was the occurrence of AKI.Results: A total of 3,964 patients were included in the final analysis. AKI was detected in 540 (13.6%) patients on mannitol infusion. Measured osmolality and osmolar gap were significantly higher in patients with AKI than those without (both p< 0.001). However, the predictive power of the two indicators was similar and were both weak predictors of AKI (both C-statistic <0.650). In the multivariable analysis, maximal measured osmolality, chronic kidney disease, Acute Physiology and Chronic Health Evaluation 2 score on ICU admission, use of vasopressor, use of glycerin, mechanical ventilation, and invasive ICP monitoring were significantly associated with AKI. In-hospital mortality was significantly higher in patients with AKI than those without (11.1% vs. 1.4%, p< 0.001).Conclusions: Based on our findings, kidney injury may be associated with poor clinical outcomes in neurosurgical and neurocritically ill patients, and monitoring serum osmolality and OG remains important in the prevention of kidney injury for patients on mannitol infusion. Moreover, clinical factors related to ICU management and pre-existing renal disease may aggravate AKI during mannitol infusion.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116129016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-30DOI: 10.32587/jnic.2022.00486
Subhas K Konar, Indubala Maurya, D. Shukla, V. Maurya, Balachandar Deivasigamani, Priyadarshi Dikshit, Rakesh Mishra, A. Agrawal
Head injury or traumatic brain injury (TBI) is considered an instant epidemic in the developed world. Head injuries account for one quarter to a third of all trauma-related deaths. According to the Global Status Report on Road Safety 2018, more than 1.35 million people were killed in a single year. Out of these, 90% of the casualties occurred in developing countries, and India contributes about 11% of the total share. Until the last decade, cardiac disease, cancer, and road traffic accidents were considered the leading causes of death in our country. It is predicted that if the incidence of Road Traffic Accidents continues at the present rate, then by the end of 2025, the head injury will become the most common cause of death worldwide. The head injury patients pose a unique challenge to the treating physicians in the early period of hospitalization and the later duration of follow-up. The primary role of intensive care management is preventing and treating intracranial hypertension, which causes derangement in cerebral perfusion pressure (CPP), thereby preventing secondary brain injury. In the present review, we discuss the effective management of TBI in the critical care unit.
{"title":"Intensive Care Unit Management of Traumatic Brain Injury Patients","authors":"Subhas K Konar, Indubala Maurya, D. Shukla, V. Maurya, Balachandar Deivasigamani, Priyadarshi Dikshit, Rakesh Mishra, A. Agrawal","doi":"10.32587/jnic.2022.00486","DOIUrl":"https://doi.org/10.32587/jnic.2022.00486","url":null,"abstract":"Head injury or traumatic brain injury (TBI) is considered an instant epidemic in the developed world. Head injuries account for one quarter to a third of all trauma-related deaths. According to the Global Status Report on Road Safety 2018, more than 1.35 million people were killed in a single year. Out of these, 90% of the casualties occurred in developing countries, and India contributes about 11% of the total share. Until the last decade, cardiac disease, cancer, and road traffic accidents were considered the leading causes of death in our country. It is predicted that if the incidence of Road Traffic Accidents continues at the present rate, then by the end of 2025, the head injury will become the most common cause of death worldwide. The head injury patients pose a unique challenge to the treating physicians in the early period of hospitalization and the later duration of follow-up. The primary role of intensive care management is preventing and treating intracranial hypertension, which causes derangement in cerebral perfusion pressure (CPP), thereby preventing secondary brain injury. In the present review, we discuss the effective management of TBI in the critical care unit.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121753865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-28DOI: 10.32587/jnic.2022.00458
Tariq Janjua, L. Moscote-Salazar
can be a help. A lower dose of anticoagulation infusion can be used to avoid any further hemorrhage in an active condition of intracranial hemorrhage 11) . Hemolung ® uses room airflow to remove CO 2 without a need for a high flow oxygen supply. This device will be useful in conditions as men-tioned with acute brain injury. In conclusion, we suggest that Hemolung ® device should be present in high capacity neurocritical care unit. Neurointensivist training and competency need to be maintained. Early inclusion of this de-Utility
{"title":"Utility of Hemolung® in Acute Neurological Crisis with Ventilatory Failure","authors":"Tariq Janjua, L. Moscote-Salazar","doi":"10.32587/jnic.2022.00458","DOIUrl":"https://doi.org/10.32587/jnic.2022.00458","url":null,"abstract":"can be a help. A lower dose of anticoagulation infusion can be used to avoid any further hemorrhage in an active condition of intracranial hemorrhage 11) . Hemolung ® uses room airflow to remove CO 2 without a need for a high flow oxygen supply. This device will be useful in conditions as men-tioned with acute brain injury. In conclusion, we suggest that Hemolung ® device should be present in high capacity neurocritical care unit. Neurointensivist training and competency need to be maintained. Early inclusion of this de-Utility","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128055824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-28DOI: 10.32587/jnic.2022.00472
L. Moscote-Salazar, Tariq Janjua, A. Pacheco-Hernandez
{"title":"Neurotrauma Code: Proposal for the Implementation of Strategies in Areas of Difficult Care for a Time-dependent Condition.","authors":"L. Moscote-Salazar, Tariq Janjua, A. Pacheco-Hernandez","doi":"10.32587/jnic.2022.00472","DOIUrl":"https://doi.org/10.32587/jnic.2022.00472","url":null,"abstract":"","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"193 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121198650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-30DOI: 10.32587/jnic.2021.00402
S. Rho, Hyo Joon Kim, Min Park
Initially described in 1921, Creutzfeldt-Jakob disease (CJD) is a rare, transmissible prion disease. There are four types of CJD known. Sporadic, familial, iatrogenic and variant, of which sporadic Creutzfeldt-Jakob disease (sCJD) is the most common, and sCJD has characteristic clinical and diagnostic features. It is a rapidly progressive, deadly infectious disease that usually results in death within a year of onset. The disease is thought to be caused by an abnormal isoform of a cellular glycoprotein known as prion protein, and is found in about 1 in 1 million people. Sporadic Creutzfeldt-Jakob disease, like other prion diseases, is classified as a transmissible spongiform encephalopathy and occurs as a sporadic disease without a recognizable transmission pattern in approximately 85% of patients. Current criteria for diagnosis include a distinct phenotype, periodic sharp and slow-wave complexes at electroencephalography (EEG), Clinical features seen in patients with sporadic Creutzfeldt-Jakob disease (sCJD) may be diverse symptoms. Due to diverse clinical features, it may be necessary to differentiate from cerebrovascular disease or psychotic symptoms during initial evaluation. In this case, we discuss the clinical case of a 57-year-old female patient with multiple neurological symptoms. The patient showed clinical features of alice in Wonderland syndrome during evaluation and conservative care, and was diagnosed with sCJD. In this regard, it is considered that evaluation and management are required along with recognition of the possibility of non-specific neurological symptoms such as AIWS in sCJD patients in the future.
{"title":"Creutzfeldt–Jakob Disease with Unusual Visual Hallucination : A Case Report","authors":"S. Rho, Hyo Joon Kim, Min Park","doi":"10.32587/jnic.2021.00402","DOIUrl":"https://doi.org/10.32587/jnic.2021.00402","url":null,"abstract":"Initially described in 1921, Creutzfeldt-Jakob disease (CJD) is a rare, transmissible prion disease. There are four types of CJD known. Sporadic, familial, iatrogenic and variant, of which sporadic Creutzfeldt-Jakob disease (sCJD) is the most common, and sCJD has characteristic clinical and diagnostic features. It is a rapidly progressive, deadly infectious disease that usually results in death within a year of onset. The disease is thought to be caused by an abnormal isoform of a cellular glycoprotein known as prion protein, and is found in about 1 in 1 million people. Sporadic Creutzfeldt-Jakob disease, like other prion diseases, is classified as a transmissible spongiform encephalopathy and occurs as a sporadic disease without a recognizable transmission pattern in approximately 85% of patients. Current criteria for diagnosis include a distinct phenotype, periodic sharp and slow-wave complexes at electroencephalography (EEG), Clinical features seen in patients with sporadic Creutzfeldt-Jakob disease (sCJD) may be diverse symptoms. Due to diverse clinical features, it may be necessary to differentiate from cerebrovascular disease or psychotic symptoms during initial evaluation. In this case, we discuss the clinical case of a 57-year-old female patient with multiple neurological symptoms. The patient showed clinical features of alice in Wonderland syndrome during evaluation and conservative care, and was diagnosed with sCJD. In this regard, it is considered that evaluation and management are required along with recognition of the possibility of non-specific neurological symptoms such as AIWS in sCJD patients in the future.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132298997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-30DOI: 10.32587/jnic.2021.00374
H. Park, Sung Ho Lee, Chul-Kee Park, E. Ha
A negative-pressure hydrocephalus (NePH) is a rare type of hydrocephalus characterized by the presence of negative intracranial pressure (ICP) and ventriculomegaly. Despite the low or negative ICP, patients with NePH often develop symptoms consistent with high ICP, and they frequently deteriorate. Several hypotheses have been proposed to demonstrate the underlying pathophysiology in NePH, but the exact mechanism still remains unclear. Multiple treatment options have been suggested, including the identification and repair of cerebrospinal fluid (CSF) leak, subatmospheric external ventricular drains (EVD), neck wrapping, or placement of CSF shunts. In this study, we present a case of a NePH patient refractory to the standard CSF shunt procedure and successfully treated with a modified ventriculoperitoneal shunt system. A negative-pressure hydrocephalus (NePH) is a rare type of hydrocephalus that is symptomatic despite the negative intracranial pressure (ICP). Because of the shortcomings of the existing shunt system that could not produce the necessary gradient for an effective cerebrospinal fluid (CSF) drainage in NePH patients, a refined method for CSF drainage is needed. We combined the traditional low-pressure valve with a distal catheter, which has no end hole and only has side slits, to prevent the CSF backflow and facilitate the siphon effect. Simultaneously, the active pumping of the shunt reservoir was also conducted to remove the excess CSF from the ventricular system. The treatment of NePH requires an appropriate reduction of excessive CSF until the CSF dynamics and brain compliance are restored. We suggest the use of this modified shunt system for NePH treatment, as it is easily modifiable and has sufficient effects.
{"title":"Negative-Pressure Hydrocephalus Treated with a Modified Shunt System: A Case Report","authors":"H. Park, Sung Ho Lee, Chul-Kee Park, E. Ha","doi":"10.32587/jnic.2021.00374","DOIUrl":"https://doi.org/10.32587/jnic.2021.00374","url":null,"abstract":"A negative-pressure hydrocephalus (NePH) is a rare type of hydrocephalus characterized by the presence of negative intracranial pressure (ICP) and ventriculomegaly. Despite the low or negative ICP, patients with NePH often develop symptoms consistent with high ICP, and they frequently deteriorate. Several hypotheses have been proposed to demonstrate the underlying pathophysiology in NePH, but the exact mechanism still remains unclear. Multiple treatment options have been suggested, including the identification and repair of cerebrospinal fluid (CSF) leak, subatmospheric external ventricular drains (EVD), neck wrapping, or placement of CSF shunts. In this study, we present a case of a NePH patient refractory to the standard CSF shunt procedure and successfully treated with a modified ventriculoperitoneal shunt system. A negative-pressure hydrocephalus (NePH) is a rare type of hydrocephalus that is symptomatic despite the negative intracranial pressure (ICP). Because of the shortcomings of the existing shunt system that could not produce the necessary gradient for an effective cerebrospinal fluid (CSF) drainage in NePH patients, a refined method for CSF drainage is needed. We combined the traditional low-pressure valve with a distal catheter, which has no end hole and only has side slits, to prevent the CSF backflow and facilitate the siphon effect. Simultaneously, the active pumping of the shunt reservoir was also conducted to remove the excess CSF from the ventricular system. The treatment of NePH requires an appropriate reduction of excessive CSF until the CSF dynamics and brain compliance are restored. We suggest the use of this modified shunt system for NePH treatment, as it is easily modifiable and has sufficient effects.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117062703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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