المؤلفون: Ujjwal P. Dutta, Jugal Hiren Bhatt, Irfan Nagori, Nency Kagathara, Rushit Zalavadiya, Dilip Sapkota

المصدر: Clinical Case Reports, Vol 12, Iss 2, Pp n/a-n/a (2024)

مصطلحات موضوعية: hypoxic brain injury, myocardial infarction, stent thrombosis, ventricular tachycardia, Medicine, Medicine (General), R5-920

الوصف: Key Clinical Message The case highlights the imperative requirement for multidisciplinary action in handling a myocardial infarction case, complicated by rare and severe events like ventricular tachycardia, stent thrombosis, hypoxic brain injury, and multi‐organ failure. Abstract This article presents a case of a 53‐year‐old male, who presented with myocardial infarction that was managed by percutaneous coronary intervention and stent placement. However, it progressed to multiple complications in sequence (ventricular tachycardia, stent thrombosis, hypoxic brain injury, and multi‐organ failure). Hopefully, the condition of the patient improved after 2 months from GSC‐4 to GCS‐9 by a multidisciplinary approach and was discharged for home‐based treatment.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2050-0904Test

الوصول الحر: https://doaj.org/article/6ae00e38fab94d659f369845607d5060Test

المؤلفون: Anna V. Jones, Alana Shunnarah, Andrew Gwaltney, Marilyn Bulloch, Grier Stewart

المصدر: Intensive Care Research, Vol 3, Iss 3, Pp 237-244 (2023)

مصطلحات موضوعية: Hypoxic brain injury, Sedation, Methadone, Clonidine, Encephalopathy, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9, Medicine

الوصف: Abstract Background Achieving therapeutic doses of sedation and analgesia are necessary for the safety and comfort of mechanically ventilated patients. Patients with complicated psychiatric histories, are neurocritical, and have acute respiratory distress syndrome usually require maximum sedation, making sedation weaning an arduous task. Case Presentation A 42-year-old female presented with a chief complaint of headache, hypertensive crisis, confusion, and nausea. Her past medical history is notable for hypertension, attention deficit hyperactivity disorder, bipolar II disorder, manic depression, agoraphobia, anxiety, and prior suicide attempts. Noncompliance with anti-hypertensive and psychiatric medications and prior substance abuse history was reported. A head computerized tomography scan revealed multifocal intraparenchymal hemorrhages and multifocal subarachnoid hemorrhages throughout the cerebrum. Within two hours, the patient became obtunded and required intubation. The patient’s severe agitation, likely due to metabolic encephalopathy, was difficult to control. Despite being on maximum dexmedetomidine, fentanyl, and quetiapine doses, the patient’s agitation remained. Due to her substance abuse and psychiatric history, a methadone and clonidine taper was initiated to attempt sedation weaning. Conclusion Sedation and analgesia weaning protocols for patients with psychiatric or substance abuse histories may aid in decreasing time on mechanical ventilation and/or in the ICU. The successful clonidine and methadone taper utilized in this patient has potential to be utilized in patients with similar histories. Future trials and approved sedation and analgesia weaning protocols for patients with a profound psychiatric and substance abuse history are urgently needed.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2666-9862Test

الوصول الحر: https://doaj.org/article/017390a66c6b4c6c8d13212534c96246Test

المؤلفون: Tran, Kevin, Wu, Joseph

المصدر: Brain Injury. 33(10)

مصطلحات موضوعية: Biological Psychology, Biomedical and Clinical Sciences, Clinical Sciences, Psychology, Brain Disorders, Clinical Research, Neurosciences, Behavioral and Social Science, Attention Deficit Hyperactivity Disorder (ADHD), Mental Health, Pediatric, Biomedical Imaging, Aetiology, 2.1 Biological and endogenous factors, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, Mental health, Neurological, Anisotropy, Attention Deficit Disorder with Hyperactivity, Brain, Carotid Stenosis, Child, Diffusion Tensor Imaging, Humans, Hypoxia, Brain, Infant, Magnetic Resonance Imaging, Male, Neuroimaging, Positron-Emission Tomography, Psychiatric Status Rating Scales, Attention deficit hyperactivity disorder, diffusion tensor imaging, positron emission tomography, quantitative volumetrics, hypoxic brain injury, Medical and Health Sciences, Psychology and Cognitive Sciences, Rehabilitation, Clinical sciences, Allied health and rehabilitation science, Clinical and health psychology

الوصف: A 2-year-old male pediatric patient experienced a partial occlusion of the internal carotid and subsequent asphyxiation resulting in hypoxic brain injury that was later misdiagnosed as primary attention deficient hyperactivity disorder (ADHD). Imaging analyses using diffusion tensor imaging (DTI), positron emission tomography (PET), and magnetic resonance imaging (MRI) quantitative volumetrics (QV) were used nine years following the incident to identify whether his development of ADHD is of a primary heritability or secondary hypoxic brain injury sequelae. The patient's DTI analysis generated decreases in fractional anisotropy (FA) values in the anterior corpus callosum, bilateral internal capsule, and hippocampus. Decreases in FA are seen in ADHD patients, but the degree of FA decrease in the patient under study is several orders of magnitude greater than in ADHD patients. Also, not normally observed in ADHD patients were decreases in the metabolism of the orbitofrontal cortex, anterior cingulate, left anterior insular cortex, and left striatum. Additionally, QV showed enlargements of various regions of the brain including the amygdala which is often cited in the literature to be reduced in ADHD patients. The diagnosis of this patient despite having non-characteristic neuroimaging data suggests a unique specificity of the hypoxic injury to the development of a secondary hypoxic brain injury caused ADHD.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/17z797b4Test

المؤلفون: Franz Haertel, Josephine Babst, Christiane Bruening, Jurgen Bogoviku, Sylvia Otto, Michael Fritzenwanger, Thomas Gecks, Henning Ebelt, Sven Moebius-Winkler, P. Christian Schulze, Ruediger Pfeifer

المصدر: Journal of Clinical Medicine; Volume 12; Issue 8; Pages: 3015

مصطلحات موضوعية: neuron specific enolase, hemolysis, hypoxic brain injury, ECMO, CPR, Cerebral Performance Category Scale, intensive care

الوصف: Background: Hemolysis, a common adverse event associated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), may affect neuron-specific enolase (NSE) levels and potentially confound its prognostic value in predicting neurological outcomes in resuscitated patients without return of spontaneous circulation (ROSC) that require extracorporeal cardiopulmonary resuscitation (eCPR). Therefore, a better understanding of the relationship between hemolysis and NSE levels could help to improve the accuracy of NSE as a prognostic marker in this patient population. Methods: We retrospectively analyzed the records of patients who received a VA-ECMO for eCPR between 2004 and 2021 and were treated in the medical intensive care unit (ICU) of the University Hospital Jena. The outcome was measured clinically by using the Cerebral Performance Category Scale (CPC) four weeks after eCPR. The serum concentration of NSE (baseline until 96 h) was analyzed by enzyme-linked immunosorbent assay (ELISA). To evaluate the ability of individual NSE measurements to discriminate, receiver operating characteristic (ROC) curves were calculated. Serum-free hemoglobin (fHb, baseline until 96 h) served as a marker for identifying a confounding effect of parallel hemolysis. Results: 190 patients were included in our study. A total of 86.8% died within 4 weeks after ICU admission or remained unconscious (CPC 3–5), and 13.2% survived with a residual mild to moderate neurological deficit (CPC 1–2). Starting 24h after CPR, NSE was significantly lower and continued to decrease in patients with CPC 1–2 compared to the group with an unfavorable outcome of CPC 3–5. In addition, when evaluating on the basis of receiver operating characteristic curves (ROC), relevant and stable area under the curve (AUC) values for NSE could be calculated (48 h: 0.85 // 72 h: 0.84 // 96 h: 0.80; p < 0.01), and on the basis of a binary logistic regression model, relevant odds ratios for the NSE values were found even after adjusting for fHb regarding the ...

وصف الملف: application/pdf

العلاقة: Intensive Care; https://dx.doi.org/10.3390/jcm12083015Test

الإتاحة: https://doi.org/10.3390/jcm12083015Test

المؤلفون: Haertel, Franz, Babst, Josephine, Bruening, Christiane, Bogoviku, Jurgen, Otto, Sylvia, Fritzenwanger, Michael, Gecks, Thomas, Ebelt, Henning, Moebius-Winkler, Sven, Schulze, P. Christian, Pfeifer, Ruediger

المساهمون: Tschernko, Edda

مصطلحات موضوعية: article, ScholarlyArticle, ddc:610, neuron specific enolase, hemolysis, hypoxic brain injury, ECMO, CPR, Cerebral Performance Category Scale, intensive care

الوصف: Background: Hemolysis, a common adverse event associated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), may affect neuron-specific enolase (NSE) levels and potentially confound its prognostic value in predicting neurological outcomes in resuscitated patients without return of spontaneous circulation (ROSC) that require extracorporeal cardiopulmonary resuscitation (eCPR). Therefore, a better understanding of the relationship between hemolysis and NSE levels could help to improve the accuracy of NSE as a prognostic marker in this patient population. Methods: We retrospectively analyzed the records of patients who received a VA-ECMO for eCPR between 2004 and 2021 and were treated in the medical intensive care unit (ICU) of the University Hospital Jena. The outcome was measured clinically by using the Cerebral Performance Category Scale (CPC) four weeks after eCPR. The serum concentration of NSE (baseline until 96 h) was analyzed by enzyme-linked immunosorbent assay (ELISA). To evaluate the ability of individual NSE measurements to discriminate, receiver operating characteristic (ROC) curves were calculated. Serum-free hemoglobin (fHb, baseline until 96 h) served as a marker for identifying a confounding effect of parallel hemolysis. Results: 190 patients were included in our study. A total of 86.8% died within 4 weeks after ICU admission or remained unconscious (CPC 3–5), and 13.2% survived with a residual mild to moderate neurological deficit (CPC 1–2). Starting 24h after CPR, NSE was significantly lower and continued to decrease in patients with CPC 1–2 compared to the group with an unfavorable outcome of CPC 3–5. In addition, when evaluating on the basis of receiver operating characteristic curves (ROC), relevant and stable area under the curve (AUC) values for NSE could be calculated (48 h: 0.85 // 72 h: 0.84 // 96 h: 0.80; p < 0.01), and on the basis of a binary logistic regression model, relevant odds ratios for the NSE values were found even after adjusting for fHb regarding the ...

وصف الملف: 11 Seiten

العلاقة: Journal of Clinical Medicine -- 2077-0383 -- http://uri.gbv.de/document/gvk:ppn:718632478Test -- 2662592-1 -- http://www.bibliothek.uni-regensburg.de/ezeit/?2662592Test -- http://www.mdpi.com/journal/jcmTest -- https://www.ncbi.nlm.nih.gov/pmc/journals/2745Test/; https://doi.org/10.3390/jcm12083015Test; https://nbn-resolving.org/urn:nbn:de:gbv:27-dbt-20230505-133550-007Test; https://www.db-thueringen.de/receive/dbt_mods_00057045Test; https://www.db-thueringen.de/servlets/MCRFileNodeServlet/dbt_derivate_00059993/jcm-12-03015.pdfTest

الإتاحة: https://doi.org/10.3390/jcm12083015Test
https://nbn-resolving.org/urn:nbn:de:gbv:27-dbt-20230505-133550-007Test
https://www.db-thueringen.de/receive/dbt_mods_00057045Test
https://www.db-thueringen.de/servlets/MCRFileNodeServlet/dbt_derivate_00059993/jcm-12-03015.pdfTest

المؤلفون: R. Jayakrishnan, MD Radiodiagnosis, Nada Rashid, MD Radiodiagnosis, Rita Thomas Cheenath, MD Radiodiagnosis, Josey Verghese, DNB Radiodiagnosis

المصدر: Radiology Case Reports, Vol 16, Iss 11, Pp 3311-3314 (2021)

مصطلحات موضوعية: Hypoxic brain injury, posthypoxic leukoencephalopathy, anoxic leukoencephalopathy, Grinker's myelinopathy, Medical physics. Medical radiology. Nuclear medicine, R895-920

الوصف: A 68-year-old woman presented with chest pain and loss of consciousness following an anterior wall myocardial infarction. Magnetic resonance imaging of brain showed features of hypoxic brain injury. She subsequently developed memory deficits, drowsiness and behavioral changes. Magnetic resonance imaging of brain done 4 months after ischemic insult showed evidence of delayed posthypoxic leukoencephalopathy also known as Grinker's myelinopathy.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S1930043321005550Test; https://doaj.org/toc/1930-0433Test

الوصول الحر: https://doaj.org/article/38ad8dd6147a4d9e8a4b1626ec634951Test

المؤلفون: I. Tahir, MBBCh, BAO, M.U. Islam, M.D.

المصدر: Radiology Case Reports, Vol 16, Iss 10, Pp 3039-3043 (2021)

مصطلحات موضوعية: Delayed post hypoxic leucoencephalopathy, Neuroradiology, Hypoxic brain injury, Medical physics. Medical radiology. Nuclear medicine, R895-920

الوصف: Delayed post hypoxic leukoencephalopathy (DPHL) is a rare consequence of hypoxic brain injury that occurs several days to weeks following an initial hypoxic insult. Most of the previously published cases occur in the setting of drug overdoses or carbon monoxide poisoning, where the incidence of DPHL is as high as 3%. Our case depicts a patient with delayed hypoxic brain injury following cardiac arrest with cardiopulmonary resuscitation. Initial neuroimaging was normal, and a repeat MRI scan six days later revealed DWI changes consistent with DPHL. Our patient remained comatose throughout his clinical course until his eventual death nine days after the initial incident. The autopsy confirmed hypoxic-ischemic brain injury with co-existent Wernicke's encephalopathy, a known consequence of alcohol use disorder. This case outlines the clinical course of DPHL accompanied by the unique neuroimaging features that distinguish it from conventional hypoxic-ischemic brain injury.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S1930043321005033Test; https://doaj.org/toc/1930-0433Test

الوصول الحر: https://doaj.org/article/79990cc6dc0a4c71b151dded1bbfc969Test

المؤلفون: Guri Hagberg, Håkon Ihle-Hansen, Else Charlotte Sandset, Dag Jacobsen, Henning Wimmer, Hege Ihle-Hansen

المصدر: Frontiers in Aging Neuroscience, Vol 14 (2022)

مصطلحات موضوعية: cardiac arrest, cognition, dementia, hypoxic brain injury, cognitive impaiment, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571

الوصف: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide. With better pre- and inhospital treatment, including cardiopulmonary resuscitation (CPR) as an integrated part of public education and more public-access defibrillators available, OHCA survival has increased over the last decade. There are concerns, after successful resuscitation, of cerebral hypoxia and degrees of potential acquired brain injury with resulting poor cognitive functioning. Cognitive function is not routinely assessed in OHCA survivors, and there is a lack of consensus on screening methods for cognitive changes. This narrative mini-review, explores available evidence on hypoxic brain injury and long-term cognitive function in cardiac arrest survivors and highlights remaining knowledge deficits.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fnagi.2022.885226/fullTest; https://doaj.org/toc/1663-4365Test

الوصول الحر: https://doaj.org/article/3a59b417547748f29cd9a386c209b2a0Test

المؤلفون: Xiaohui Chen, Dongtai Chen, Pinzhong Chen, Andi Chen, Jianhui Deng, Jianjie Wei, Weian Zeng, Xiaochun Zheng

المصدر: Antioxidants, Vol 11, Iss 11, p 2199 (2022)

مصطلحات موضوعية: dexmedetomidine, NADPH oxidase 2, oxidative stress, neuronal apoptosis, neurological deficits, hypoxic brain injury, Therapeutics. Pharmacology, RM1-950

الوصف: Hypoxic–ischemic brain injury is an important cause of neonatal neurological deficits. Our previous study demonstrated that dexmedetomidine (Dex) provided neuroprotection against neonatal hypoxic brain injury; however, the underlying mechanisms remain incompletely elucidated. Overactivation of NADPH oxidase 2 (NOX2) can cause neuronal apoptosis and neurological deficits. Hence, we aimed to investigate the role of neuronal NOX2 in Dex-mediated neuroprotection and to explore its potential mechanisms. Hypoxic injury was modeled in neonatal rodents in vivo and in cultured hippocampal neurons in vitro. Our results showed that pre- or post-treatment with Dex improved the neurological deficits and alleviated the hippocampal neuronal damage and apoptosis caused by neonatal hypoxia. In addition, Dex treatment significantly suppressed hypoxia-induced neuronal NOX2 activation; it also reduced oxidative stress, as evidenced by decreases in intracellular reactive oxygen species (ROS) production, malondialdehyde, and 8-hydroxy-2-deoxyguanosine, as well as increases in the antioxidant enzymatic activity of superoxide dismutase and glutathione peroxidase in neonatal rat hippocampi and in hippocampal neurons. Lastly, the posthypoxicneuroprotective action of Dex was almost completely abolished in NOX2-deficient neonatal mice and NOX2-knockdown neurons. In conclusion, our data demonstrated that neuronal NOX2-mediated oxidative stress is involved in the neuroprotection that Dex provides against apoptosis and neurological deficits in neonates following hypoxia.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2076-3921/11/11/2199Test; https://doaj.org/toc/2076-3921Test

الوصول الحر: https://doaj.org/article/360d323d228943c889b1e4c1bed8418fTest

المؤلفون: Ryo Yamamoto, Jo Yoshizawa

المصدر: Journal of Intensive Care, Vol 8, Iss 1, Pp 1-8 (2020)

مصطلحات موضوعية: Cardiac arrest, Post cardia arrest syndrome, Oxygen, Hyperoxia, Hypoxic brain injury, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9

الوصف: Abstract High oxygen tension in blood and/or tissue affects clinical outcomes in several diseases. Thus, the optimal target PaO2 for patients recovering from cardiac arrest (CA) has been extensively examined. Many patients develop hypoxic brain injury after the return of spontaneous circulation (ROSC); this supports the need for oxygen administration in patients after CA. Insufficient oxygen delivery due to decreased blood flow to cerebral tissue during CA results in hypoxic brain injury. By contrast, hyperoxia may increase dissolved oxygen in the blood and, subsequently, generate reactive oxygen species that are harmful to neuronal cells. This secondary brain injury is particularly concerning. Although several clinical studies demonstrated that hyperoxia during post-CA care was associated with poor neurological outcomes, considerable debate is ongoing because of inconsistent results. Potential reasons for the conflicting results include differences in the definition of hyperoxia, the timing of exposure to hyperoxia, and PaO2 values used in analyses. Despite the conflicts, exposure to PaO2 > 300 mmHg through administration of unnecessary oxygen should be avoided because no obvious benefit has been demonstrated. The feasibility of titrating oxygen administration by targeting SpO2 at approximately 94% in patients recovering from CA has been demonstrated in pilot randomized controlled trials (RCTs). Such protocols should be further examined.

وصف الملف: electronic resource

العلاقة: http://link.springer.com/article/10.1186/s40560-020-00477-wTest; https://doaj.org/toc/2052-0492Test

الوصول الحر: https://doaj.org/article/22f33d661f0343af8b48e492a5a025e8Test