There is no consensus on the terminology for rhythmic and periodic patterns (RPP) detected by continuous electroencephalography (cEEG) monitoring of unconscious patients in the neurological intensive care unit (NICU) (1). The growth in cEEG utilization has led to an increase in the recognition of these EEG patterns of uncertain diagnostic and prognostic information. Furthermore, there is controversy regarding which electrographic patterns are associated with neuronal injury, which require treatment, and how aggressively to treat these patterns (2,3).We aimed to examine the frequency of some electroencephalographic patterns including periodic discharges (PD), repetitive spike waves (RSW), rhythmic delta activities (RDA), nonconvulsive seizures (NCS), and nonconvulsive status epilepticus (NCSE) recorded by cEEG in critically ill patients with a change of consciousness. This study was also aimed to detect clinical and laboratory correlates of these patterns. METHODSWe retrospectively identified all critically ill patients over the age of 18 years with a change of consciousness (Glasgow Coma Score [GCS] ≤14) who underwent cEEG monitoring in the NICU during two years. Clinical information was gathered from a review of inpatient medical notes, neuroimaging studies and reports, and discharge summaries. Baseline demographic data (age, gender), past medical history, duration of hospitalization in the NICU, clinical seizures at admission, in the emergency department, or during hospitalization prior to cEEG; treatment with continuous IV or intermittent antiepileptic drugs (AED) and other treatments such as antibiotics, sedatives and anesthetics, all radiology and laboratory findings were investigated. Premonitoring and postmonitoring scores including GCS, modified Rankin Scale score of the patients, and also National Institutes of Health Stroke Scale score for those with acute ischemic stroke

Our findings suggest that SCC is highly compatible with clinical practice in the decision for treatment of patients with NCSE. The presence of "plus" modifiers in the EEG was found to be associated with mortality in these patients and was a significant marker for the high mortality rate.

ÖZETHastane dışı kardiyak arrest sonrası gelişen serebral hasar, morbidite ve mortalitenin önemli nedenidir. Hipotermi tedavisinin nörolojik prognoz üzerine olumlu etkisi gösterilmiş olmasına rağmen, ülkemizde rutin uygulamaya girmemiştir. Bu çalışmada kurumumuzda kardiyak arrest sonrası spontan dolaşım sağlanmasının ardından endovasküler soğutma ile tedavi edilen üç olgu bildirilecektir. Elli beş yaşında iki erkek ve 46 yaşında kadın üç olgunun ortalama hastaneye geliş süresi 15 dk., spontan dolaşım sağlanma (SDS) süresi 13,3 dk.'dır. Spontan dolaşım sağlandıktan sonra olguların GKS 3 idi ve beyin sapı refleksleri alınamıyordu. Femoral vene endovasküler soğutma kateteri (ALSIUS) yerleştirilerek hedef ısı 33°C olacak şekilde uygulama başlatıldı. Dolaşım kollapsından hipotermi başlangıcına kadar geçen ortalama süre 115 dk.'dır. Olgularımızda ortalama 285 dk.'da hedef ısıya ulaşıldı ve 18 saat bu ısıda izlendikten sonra yenidan ısıtma işlemine başlandı. Normotermi (36°C) 6 saat ortalama ile sağlandı ve komplikasyon gözlenmedi. Olgulara kranyal MR ve elektroensefalografi (EEG) incelemeleri yapıldı. İki olgunun 3. ve 6. ay Modifiye Rankin Skoru (mRS) 1, Glasgow-Pıttsburg Outcome Skoru (GPOS) 5 iken, dirençli myoklonik nöbetleri olan ve kranyal MR'da yaygın hipoksik hasarı tespit edilen üçüncü olgunun 3. ve 6 ay mRS 5, GPOS 2 olarak değerlendirildi. Kardiyak arrrest sonrası endovasküler terapötik hipotermi uygulanabilir ve güvenilir bir tedavi yöntemidir. Tedaviye erken başlanması ve hızlı bir şekilde hedef ısıya ulaşılması tedavinin etkinliği açısından önemlidir.Anahtar kelimeler: Kardiyak arrest, terapötik hipotermi, endovaskuler soğutma, eksternal soğutma, nörolojik prognoz SUMMARY Endovascular Therapeutic Hypothermia After Cardiac Arrrest due to Acute Myocardial InfarctionCerebral damage developing after out-of-hospital cardiac arrest, is a major cause of morbidity and mortality. Although hypothermic therapy demonstrated a positive effect on neurological outcomes, it is not yet in routine use in our country. In this study we reported three cases treated with endovascular cooling in our institution, following restoration of spontaneous circulation after out-of-hospital cardiac arrest. The mean return of spontaneous circulation (ROSC) time of 55-year-old two male, and a 46 year-old female patient were 15 and 13.3 minutes, respectively. Glascow coma score (GCS) was 3 points, and brain stem reflexes were absent in all cases. After placement of the cooling catheter (ALSIUS) into the femoral vein, the target temperature was set at 33°C. The average time between circulatory collapse and the start of hypothermic therapy was 115 minutes. The mean time to reach the target temperature was 285 minutes and rewarming was initiated after 18 hours. Normothermia (36°C) was achieved after an average of 6 hours and no complication was observed. Cranial MRI and electroencephalography (EEG) were performed. In two patients, 3 and 6 month-modified Rankin score (mRS) was 1, and Glasgow-Pittsburgh Outcome Score (GPOS) was 5. In the third...

Close hemodynamic monitoring is of paramount importance among critically ill patients to guide cardiovascular therapy for the optimal management and thus improved outcomes. 1-3 Although the pulmonary artery catheter has been the mainstay of hemodynamic monitoring for years, its use is decreasing given the inconclusive data on the outcome benefit in terms of improved morbidity and mortality among critically ill patients. 2-5 Another factor seems to be the introduction of less invasive hemodynamic monitoring methods such as transpulmonary thermodilution (TPTD) as validated in a variety of clinical settings. 2,3,6 Currently,

Aneurysmal subarachnoid hemorrhage is an important group of intracranial hemorrhage with a high risk of disability and mortality. The initial amount of bleeding, rebleeding, and delayed cerebral ischemia are considered as the most important factors in determining the prognosis of aneurysm-induced bleeding. In arteriovenous malformations, its location and deep venous drainage play a role in the prognosis. Cardiac complications, neurogenic pulmonary edema, hypertension, hyperglycemia, infections, and prolonged mechanical ventilation in aneurysmal subarachnoid hemorrhage lead to morbidity and mortality. Aneurysm bleeding control, appropriate fluid replacement to ensure euvolemia, when necessary external ventricular drainage and/or decompressive craniectomy, mannitol or hypertonic saline application, and infection control are the main principles of treatment.