Elevated cardiac troponin I (cTnI) values occur frequently in ICH and are independently associated with higher in-hospital mortality. Although cardiac causes of death were higher in those with elevated cTnI levels, due to its very low frequency (1.2%) this finding remains preliminary.

Manganese encephalopathy has protean clinical and imaging findings that can easily be overlooked.

Treatment of cerebral edema using osmotically active substances varies considerably between practitioners. This variation could hamper efforts to design and implement multicenter trials in neurocritical care.

Objective To identify the patients at greatest odds for SIRS and examine the association between Systemic Inflammatory Response Syndrome (SIRS) and outcomes in patients presenting with intracerebral hemorrhage (ICH). Methods We retrospectively reviewed consecutive patients presenting to a tertiary care center from 2008-2013 with ICH. SIRS was defined according to standard criteria as 2 or more of the following: (1) body temperature < 36°C or >38°C, (2) heart rate > 90 beats per minute, (3) respiratory rate > 20, or (4) white blood cell count < 4000/mm3 or > 12,000/mm3 or > 10% polymorphonuclear leukocytes for >24 hours in the absence of infection. The outcomes of interest, discharge modified-Rankin Scale (mRS 4-6), death, and poor discharge disposition (discharge anywhere but home or inpatient rehab), were assessed using logistic regression. Results A total of 249 ICH patients met inclusion criteria and 53 (21.3%) developed SIRS during their hospital stay. A score was developed (ranging from 0-3) to identify patients at greatest risk for developing SIRS. Adjusting for stroke severity, SIRS was associated with mRS 4-6 (OR 5.25, 95%CI 2.09-13.2) and poor discharge disposition (OR 3.74, 95%CI 1.58-4.83), but was not significantly associated with death (OR 1.75, 95%CI 0.58-5.32). We found that 33% of the effect of ICH score on poor functional outcome at discharge was explained by the development of SIRS in the hospital (Sobel 2.11, p=0.03). Conclusion We observed that approximately 20% of patients with ICH develop SIRS, and that patients with SIRS were at increased risk of having poor functional outcome at discharge.

Background Traditional treatment in acute ischemic stroke is based on time criteria when administering intravenous and intra-arterial therapies. However, recent evidence suggests that image-based criteria may be useful for selecting patients for intra-arterial interventions. The use of CT perfusion (CTP)-based criteria, regardless of time from symptom onset, in patient selection for intra-arterial treatment of ischemic stroke was assessed. Methods Patients with ischemic stroke who presented to the emergency department at the Medical University of South Carolina with a National Institute of Health Stroke Scale score of $ 8, regardless of time from symptom onset, were assessed retrospectively. CTP maps were qualitatively assessed for the presence of penumbra and infarction. Selected patients underwent mechanical aspiration of their occlusion using the Penumbra system. Functional outcome was then recorded using the modified Rankin scale (mRS) at 90 days or the closest follow-up to 90 days. Results 53 patients were included in the study. The median time from symptom onset to groin vascular access was 6.3 h. Eight patients (15%) had bleeding complications including subarachnoid hemorrhage, parenchymal hemorrhage and intraventricular hemorrhage. After CTP-based selection, the patients were divided into two groups for analysis: #6 h and >6 h from symptom onset to endovascular procedure. No difference was found in functional outcome between the two groups (38.5% and 40.7% achieved 90-day mRS #2, respectively (p¼1.0) and 57.7% and 51.9% achieved 90-day mRS #3, respectively (p¼0.785)). There was no difference in the rate of intracranial hemorrhage between the two groups (11.5 vs 18.5, p¼0.704). Conclusion This study demonstrated similar rates of good functional outcome and intracranial hemorrhage in patients with ischemic stroke when endovascular treatment was performed based on CTP selection rather than time-guided selection. These findings suggest that endovascular reperfusion in ischemic stroke may be effective and safe, and may allow patient selection not solely based on time from symptom onset. BACKGROUND