Brainstem Monitoring in the Neurocritical Care Unit: A Rationale for Real-Time, Automated Neurophysiological Monitoring

Stone, James L.; Bailes, Julian E.; Hassan, A.; Sindelar, Brian; Patel, Vimal; Fino, John J.

doi:10.1007/s12028-016-0298-y

Cited by 6 publications

(4 citation statements)

References 148 publications

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“…Cerebral hemorrhage is also a common cause of intracranial mass lesion. It has an acute onset and is accompanied by severe neurological impairment [11]. Physicians should not only focus on the common causes of intracranial mass lesion but should consider all factors that might contribute to the disease.…”

Section: Discussionmentioning

confidence: 99%

A Case of Craniocervical Junction Arteriovenous Fistulas with a Brainstem Mass Lesion on Imaging: Case Report and Literature Review

et al. 2023

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Intracranial mass lesions occur within the cranial cavity, and their etiology is diverse. Although tumors and hemorrhagic diseases are the common causes, some rarer etiologies, such as vascular malformations, might also present with intracranial mass lesion manifestations. Such lesions are easily misdiagnosed due to the lack of manifestations of the primary disease. The treatment involves a detailed examination and differential diagnosis of the etiology and clinical manifestations. On 26 October 2022, a patient with craniocervical junction arteriovenous fistulas (CCJAVFs) was admitted to Nanjing Drum Tower Hospital. Imaging examinations showed a brainstem mass lesion, and the patient was initially diagnosed with a brainstem tumor. After a thorough preoperative discussion and a digital subtraction angiography (DSA) examination, the patient was diagnosed with CCJAVF. The patient was cured using interventional treatment, and an invasive craniotomy was not required. During diagnosis and treatment, the cause of the disease might not be apparent. Thus, a comprehensive preoperative examination is very important, and physicians need to conduct the diagnosis and differential diagnosis of the etiology based on the examination to administer precise treatment and reduce unnecessary operations.

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Section: Discussionmentioning

confidence: 99%

A Case of Craniocervical Junction Arteriovenous Fistulas with a Brainstem Mass Lesion on Imaging: Case Report and Literature Review

et al. 2023

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“…[ 6 , 10 , 12 , 25 ] On imaging, the vermis covers the tentorial notch, clears the cisterns, showing compression and flattening of the quadrigeminal plate, and the posterior third ventricle; it can compress the aqueduct of Sylvius, resulting in hydrocephalus. [ 9 , 14 , 18 , 21 ] UTH has a poor outcome;[ 10 ] therefore, we must make a prompt clinical diagnosis in patients with acute neurological deterioration after an EVD.…”

Section: Discussionmentioning

confidence: 99%

Upward transtentorial herniation: A new role for endoscopic third ventriculostomy

Moscardini-Martelli

Ponce-Gómez

Alcocer-Barradas

et al. 2021

Surgical Neurology International

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Background: The placement of external ventricular drainage (EVD) to treat hydrocephalus secondary to a cerebellar stroke is controversial because it has been associated to upward transtentorial herniation (UTH). This case illustrates the effectiveness of endoscopic third ventriculostomy (ETV) after the ascending herniation has occurred. Case Description: A 50-year-old man had a cerebellar stroke with hemorrhagic transformation, tonsillar herniation, and non-communicating obstructive hydrocephalus. Considering that the patient was anticoagulated and thrombocytopenic, an EVD was placed initially, followed by clinical deterioration and UTH. We performed a suboccipital craniectomy immediately after clinical worsening, but the patient did not show clinical or radiological improvement. On the 5th day, we did an ETV, which reverses the upward herniation and hydrocephalus. The patient improved progressively with good neurological recovery. Conclusion: ETV is an effective and safe procedure for obstructive hydrocephalus. The successful resolution of the patient’s upward herniation after the ETV offers a potential option to treat UTH and advocates further research in this area.

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“…The option of sedation holidays may not be safe to pursue in patients with intracranial hypertension (ICHt) [24]. Of note, assessment of brainstem responses remains usually reliable in sedated patients [25,26].…”

Section: Serial Neurological Examinationmentioning

confidence: 99%

How to manage traumatic brain injury without invasive monitoring?

Godoy

Rabinstein

2022

Current Opinion in Critical Care

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Purpose of reviewSevere traumatic brain injury (TBI) is an extremely serious health problem, especially in low-middle income countries (LMICs). The prevalence of severe TBI continues to increase in LMICs. Major limitations in the chain of care for TBI patients are common in LMICs including suboptimal or nonexistent prehospital care, overburdened emergency services, lack of trained human resources and limited availability of ICUs. Basic neuromonitoring, such as intracranial pressure, are unavailable or underutilized and advanced techniques are not available. Recent findingsAttention to fundamental principles of TBI care in LMICs, including early categorization, prevention and treatment of secondary insults, use of low-cost technology for evaluation of intracranial bleeding and neuromonitoring, and emphasis on education of human resources and multidisciplinary work, are particularly important in LMICs. Institutional collaborations between high-income and LMICs have developed evidence focused on available resources. Accordingly, an expert group have proposed consensus recommendations for centers without availability of invasive brain monitoring. SummarySevere TBI is very prevalent in LMIC and neuromonitoring is often not available in these environments. When intracranial pressure monitors are not available, careful attention to changes on clinical examination, serial imaging and noninvasive monitoring techniques can help recognize intracranial hypertension and effectively guide treatment decisions.

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Brainstem Monitoring in the Neurocritical Care Unit: A Rationale for Real-Time, Automated Neurophysiological Monitoring

Cited by 6 publications

References 148 publications

A Case of Craniocervical Junction Arteriovenous Fistulas with a Brainstem Mass Lesion on Imaging: Case Report and Literature Review

A Case of Craniocervical Junction Arteriovenous Fistulas with a Brainstem Mass Lesion on Imaging: Case Report and Literature Review

Upward transtentorial herniation: A new role for endoscopic third ventriculostomy

How to manage traumatic brain injury without invasive monitoring?

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