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The Monitoring of Brain Edema and Intracranial Hypertension
Mohammad I Hirzallah,H. Alex Choi 대한신경집중치료학회 2016 대한신경집중치료학회지 Vol.9 No.2
Preventing secondary brain injury after neurological insults is one of the primary goals of the neurocritical care unit. Our understanding of the roles of intracranial pressure (ICP) and cerebral edema in managing patients in the neurocritical care units is still evolving. Recent clinical trials examining the monitoring and treatment of elevated ICP have influenced the way we think about intracranial hypertension. Additionally, new methods of monitoring ICP, new physiologic surrogates derived from ICP measurements, and evolving technology to measure cerebral edema are currently being studied and tested for clinical efficacy. In this article, we will discuss both traditional and novel methods of monitoring ICP and cerebral edema.
뇌신경계 중환자실 전담 약사의 활동에 따른 약물 조정 효과 및 회피비용 분석
조의상,송영주,정영미,최경숙,이은숙,Eunkyung Euni Lee,한문구 대한신경집중치료학회 2018 대한신경집중치료학회지 Vol.11 No.2
Background: The role of clinical pharmacists in medication therapy to improve clinical and economic outcomes has been reported in the literature. This study was conducted to analyze the changes in details of medication interventions before and after the introduction of clinical pharmacists into the care of neurocritical care unit (NCU) patients, and to evaluate the economic effects of clinical pharmacists by calculating the avoidance cost. Methods: A retrospective study was conducted reviewing the electronic medical records from June 2013 to May 2014 (before), and from June 2016 to May 2017 (after). We calculated the number and rates of intervention, the acceptance rates of it, and also reviewed the list of interventions. We calculated avoidance cost if there was no intervention. Results: The monthly mean number of interventions increased from 8.0 (±5.7) to 31.7 (±12.8) (P <0.001) and the frequency of intervention also increased from 0.8% to 1.6% (P =0.003). The most frequently provided pharmacist intervention was nutritional support before introduction of clinical pharmacists and discussions on the medication plan after. The number of classified interventions was 14 before introduction of clinical pharmacist services and 33 after. The calculated cost avoidance associated with a clinical pharmacists’ integration was 77,990,615 won per year. Conclusions: Introduction of clinicals pharmacist into the NCU was associated with increased intervention rates and expanded types of clinical interventions. The cost avoidance achieved by the pharmacists’ interventions can be further explored to evaluate if similar expansions of pharmacists’ services achieve similar results in other settings.
심방세동을 가진 급성 허혈성 뇌졸중의 평균혈소판용적(mean platelet volume)의 상승
이진형,이지훈,유봉구 대한신경집중치료학회 2016 대한신경집중치료학회지 Vol.9 No.2
Background: Mean platelet volume (MPV) represents the platelet size, and is a surrogate marker of activated platelets. We investigated the relation between atrial fibrillation (AF) and MPV in patients with acute ischemic stroke. Methods: Total 357 consecutive patients (mean age, 65.8±13.0 years; 37.8% women) with acute ischemic stroke within 72 hours of onset, were retrospectively enrolled. Patients were divided into two groups: stroke with AF and stroke without AF. Various parameters were analyzed and compared between the two groups. Results: Sixty-three patients (17.65%) were enrolled in the stroke with AF group. The frequency of female gender, pre-existing coronary artery disease, heart failure and hyperlipidemia, age, and the NIHSS score at admission were all significantly higher in the stroke with AF group (P<0.05). The estimated glomerular filtration rate and triglyceride levels were significantly lower in the stroke with AF group (P<0.001 and P=0.001, respectively). MPV of stroke with AF group was significantly higher than that observed in stroke without AF group (8.4±1.0 and 8.0±0.9, respectively, P<0.01). The optimal cut-off value of MPV for distinguishing stroke with AF from stroke without AF was 7.95 (sensitivity 0.63, specificity 0.56, area under the curve 0.63). Multivariate logistic regression analysis demonstrated that MPV (odds ratio [OR], 1.52; P<0.05), previous anticoagulant medication (OR, 4.91; P<0.05), and NIHSS score on admission (OR, 1.14; P<0.001), were independently associated to stroke with AF group. Conclusions: MPV increases with AF in acute ischemic stroke.
Recurrent aseptic meningitis as an initial clinical presentation of primary Sjögren’s syndrome
Dong-Hyun Lee,이세진 대한신경집중치료학회 2019 대한신경집중치료학회지 Vol.12 No.1
Background: The neurological manifestations of Sjögren’s syndrome (SjS) are nonspecific and may precede the onset of sicca symptoms. Hence, the diagnosis of SjS is often delayed. Recurrent aseptic meningitis is an uncommon neurological manifestation of primary SjS; only few cases have been reported in the medical literature. Case Report: A 54-year-old woman was admitted for recurrent aseptic meningitis. The patient had a history of two episodes of aseptic meningitis, which had occurred 12 and 7 years before this presentation. The patient had overt sicca symptoms for 5 years. SjS was diagnosed based on the results of serum autoantibody tests, Schirmer’s test, and salivary scintigraphy. We concluded that recurrent aseptic meningitis occurred as an initial presentation of primary SjS. Conclusion: This case suggest that SjS should be included in the differential diagnosis of recurrent aseptic meningitis.
자가면역성 갑상선 질환과 연관된 스테로이드 반응성 뇌병증을 가진 환자에서 가역적 뇌량팽대 병변과 동반된 뇌염 또는 뇌병증에 대한 증례
김갑수,김명진,신동진,박기형,박현미,이영배,성영희,양지원,신동훈 대한신경집중치료학회 2016 대한신경집중치료학회지 Vol.9 No.1
Background:Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinical-radiological entity, characterized by mild encephalitis or encephalopathy associated with a reversible lesion of the corpus callosum, which commonly involves the splenium. MERS with autoimmune thyroid disease has rarely been reported. Case Report:A 37-year-old man with Grave’s disease presented to our institution, with symptoms of confused mentality, visual hallucinations, headache, and fever. Because there was no other etiology for changed mentality, headache, and fever, except for elevated antithyroid antibodies (antimicrosomal antibodies, anti-thyroglobulin antibody, and thyrotropin binding inhibitor immunoglobulin) in the blood and mild pleocytosis in the CSF study, we diagnosed the case as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT). A hyperintense signal on T2-weighted images, a hypointense signal on T1-weighted images, and a non-enhancing lesion in the splenium of corpus callosum on initial magnetic resonance imaging (MRI) disappeared on follow-up MRI, which was compatible with the criteria of MERS. Conclusion:Although MRI images in autoimmune thyroid disease have usually been unremarkable, we report a case of MERS in SREAT.
Neurogenic Pulmonary Edema Following Acute Cerebral Infarction
박무석,김정민,윤영철,권오상,배재한 대한신경집중치료학회 2016 대한신경집중치료학회지 Vol.9 No.2
Background: Neurogenic pulmonary edema is non-cardiogenic pulmonary edema due to sudden excessive activation of sympathetic system after central nervous system injury. We report an acute cerebral infarction patient who developed neurogenic pulmonary edema requiring intubation and mechanical ventilation care. Case Report: A 77-year-old Korean woman visited emergency room complaining of sudden onset right side weakness which started one hour ago. She had a history of atrial fibrillation with normal ejection fraction. Neurological examination revealed motor aphasia and right side weakness. Brain computerized tomography angiography showed left middle cerebral artery occlusion without frank ischemic change. Intravenous thrombolytic therapy was considered, but suspended because she suddenly complained of respiration difficulty. Conclusions: This case suggests that large hemispheric infarction can result in acute onset pulmonary edema which is severe enough to require intubation and to delay thrombolytic treatment.
박인휘 대한신경집중치료학회 2017 대한신경집중치료학회지 Vol.10 No.1
Kidney impairment due to acute kidney injury or chronic kidney disease is a potent risk factor for stroke which is a leading cause of morbidity and mortality worldwide. Patients with kidney impairment have various neurologic complications, including uremic encephalopathy, polyneuropathy, and cognitive impairment as well as higher rates of ischemic and hemorrhagic stroke and frequent seizures. Due to hypertension, coagulopathy, platelet dysfunction, and vascular disease, patients with kidney impairment are at high risk for types of catastrophic intracranial hemorrhages and strokes that typically lead to intracranial hypertension and cerebral herniation syndrome. Kidney impairment can alter drug pharmacokinetics and pharmacodynamics, and consequently patients with kidney impairment are at risk of experiencing adverse effects. Several central nervous system imaging modalities are not recommended in patients with compromised kidney function. Therefore, management of acute neurological conditions requires special attention in patients with kidney impairment. Given these common acute neurological conditions, physicians who care for patients with kidney impairment must be aware of evaluation and treatment of neurological diseases to achieve positive neurological outcomes.