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MV in acute stroke is associated with high mortality. Mortality and outcome were similar for ISCH and HEM; however, the factors predictive of outcome may differ and influence decisions about the use of MV in such patients.

TOR may utilize visual systems to access an internal object representation. The parietal cortices and inferior frontal regions may be involved in a concomitant lexical strategy of naming the object being examined. Frontal polar activation likely serves a role in visuospatial working memory or in recognizing unusual representations of objects. Overall, these findings suggest that TOR could involve a network of cortical regions subserving somatosensory, motor, visual, and, at times, lexical processing. The primary finding suggests that in this normal study population, the visual cortices may be involved in the topographic spatial processing of TOR.

The authors conclude that early, brief, moderate hyperventilation does not impair global cerebral metabolism in patients with severe TBI and, thus, is unlikely to cause further neurological injury. Additional studies are needed to assess focal changes, the effects of more severe hyperventilation, and the effects of hyperventilation in the setting of increased ICP.

An elevated level of cTnI is a good indicator of left ventricular dysfunction in patients with SAH. In this study cardiac dysfunction was reversible and should not necessarily preclude these patients from undergoing operative interventions or becoming heart donors. Clinical management may require more aggressive hemodynamic monitoring until cardiac function returns to normal.

Transient abnormalities in ECGs, echocardiograms, and cardiac enzymes have been described in the acute setting of subarachnoid haemorrhage. In addition, left ventricular dysfunction has been reported at the time of brain death. A patient with an acute subarachnoid haemorrhage who presented with raised troponin I (TnI) concentrations and diVuse left ventricular dysfunction is described. After declaration of brain death 32 hours later, the heart was felt initially not suitable for transplantation. A normal cardiac catheterisation, however, lead to successful transplantation of the donor heart. Raised catecholamine concentrations and metabolic perturbations have been proposed as the mechanisms leading to the cardiac dysfunction seen with brain death. This may be a biphasic process, allowing time for myocardial recovery and reversal of the left ventricular dysfunction. Awareness of this phenomenon in the acutely ill neurologic population needs to be raised in order to prevent the unnecessary rejection of donor hearts. (Heart 2000;84:205-207) Keywords: heart transplantation; troponin I; left ventricular dysfunction Abnormal ECGs, cardiac arrhythmias, and raised cardiac enzymes are common in intracerebral haemorrhage, acute ischaemic stroke, subarachnoid haemorrhage, and severe head trauma. More recently, evidence of left ventricular dysfunction has been shown by echocardiography. An important and often unrecognised characteristic of these abnormalities is that they are reversible in the setting of subarachnoid haemorrhage.We report a case of a patient who suVered a subarachnoid haemorrhage and later progressed to brain death. Despite concerns over raised troponin I (TnI) concentrations and poor cardiac function before brain death, further cardiac evaluation found the heart to be functioning normally and suitable for transplant. Case reportA 51 year old African American female transiently lost consciousness and on arrival to the emergency department, complained of severe occipital headache with blurred vision. Her Glasgow coma scale was 14 and she had mild right sided facial weakness. Past medical history included tobacco use (half pack per day for 30 years). There was no prior history of diabetes, hypertension, coronary artery disease, cardiac arrhythmias, or chest pain. Computed tomography of the head revealed diVuse subarachnoid haemorrhage with intraventricular extension and mild hydrocephalus. A large right vertebral artery aneurysm was discovered on cerebral angiography.Moderate pulmonary oedema was present on chest radiogram and the ECG was abnormal, demonstrating sinus tachycardia (106 beat per minute), a PR interval of 152 ms, a QRS duration of 92 ms, a prolonged QTc interval of 489 ms, and a QRS axis of 67°. Flattened and inverted T waves were seen in leads I and AVL respectively. Total creatine kinase (CK), CK-MB fraction, and TnI values are presented in table 1. Echocardiogram on admission revealed global hypokinesis with an estimated left ventricular ejection fraction of 40%.Approximately 24 ho...

This study supports the need for a concussed athlete to have access to a provider trained in concussion management in a timely fashion in order to prevent delayed recovery and return to play.

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