Update on Neurocritical Care of Stroke

Siegel, Jason; Pizzi, Michael; Peel, Jeffrey B.; Alejos, David; Mbabuike, Nnenne; Brown, B. L.; Hodge, David O.; Freeman, W. David

doi:10.1007/s11886-017-0881-7

Cited by 9 publications

(8 citation statements)

References 88 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Brain ischemia is typically characterized as focal or global brain ischemia. The most common type of brain ischemia is stroke (focal ischemia), which to 85% is related to an occlusion of a cerebral artery or to less extent (15%) rupture of an cerebral artery and few treatment options is currently available and then related to clot removal or to resolve to clot in the immediate phase ( Siegel et al, 2017 ). In global ischemia, the entire brain is ischemic, where most common condition leading to global brain ischemia is cardiac arrest with successful resuscitation ( Joundi et al, 2016 ).…”

Section: Microglia–neuron Communication In Brain Ischemiamentioning

confidence: 99%

Bidirectional Microglia–Neuron Communication in Health and Disease

Szepesi

Manouchehrian²,

Bachiller³

et al. 2018

Front. Cell. Neurosci.

356

293

View full text Add to dashboard Cite

Microglia are ramified cells that exhibit highly motile processes, which continuously survey the brain parenchyma and react to any insult to the CNS homeostasis. Although microglia have long been recognized as a crucial player in generating and maintaining inflammatory responses in the CNS, now it has become clear, that their function are much more diverse, particularly in the healthy brain. The innate immune response and phagocytosis represent only a little segment of microglia functional repertoire that also includes maintenance of biochemical homeostasis, neuronal circuit maturation during development and experience-dependent remodeling of neuronal circuits in the adult brain. Being equipped by numerous receptors and cell surface molecules microglia can perform bidirectional interactions with other cell types in the CNS. There is accumulating evidence showing that neurons inform microglia about their status and thus are capable of controlling microglial activation and motility while microglia also modulate neuronal activities. This review addresses the topic: how microglia communicate with other cell types in the brain, including fractalkine signaling, secreted soluble factors and extracellular vesicles. We summarize the current state of knowledge of physiological role and function of microglia during brain development and in the mature brain and further highlight microglial contribution to brain pathologies such as Alzheimer’s and Parkinson’s disease, brain ischemia, traumatic brain injury, brain tumor as well as neuropsychiatric diseases (depression, bipolar disorder, and schizophrenia).

show abstract

Section: Microglia–neuron Communication In Brain Ischemiamentioning

confidence: 99%

Bidirectional Microglia–Neuron Communication in Health and Disease

Szepesi

Manouchehrian²,

Bachiller³

et al. 2018

Front. Cell. Neurosci.

356

293

View full text Add to dashboard Cite

show abstract

“…Due to central nervous system's sensitivity and the looming danger of disability influencing the patients in various degrees, providing timely care to patients with brain involvement is a vital issue in NCCU. Failing to take proper and timely therapeutic measures and hospitalizing such patients in ICU deteriorates their condition and secondary insults may occur (7,28). Long-term hospitalization of some patients in NCCU with inadequate equipment endangers their priorities.…”

Section: Discussionmentioning

confidence: 99%

“…Treating these diseases in neurocritical care unit (NCCU) reduces the mortality. Allocation of intensive care beds (also known as NCCU) to patients with neurological disorders result in greater reduction in the mortality compared with what is observed for general intensive care unit (ICU) (1)(2)(3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Neurocritical Care Unit Bed Allocation: Optimization Based on Prioritization Using Simulation

et al. 2018

View full text Add to dashboard Cite

Background: Neurological trauma and diseases are the second cause of mortality and the main reason of acquired disability. Neurocritical care plays a major role in treating such patients. A longer life expectancy, treatment of incurable diseases, and limited resources available to add to hospital beds necessitates engineering the knowledge of health systems to prioritize allocation of current resources and present a proper pattern.Objectives: The current study aimed at optimizing bed use and shortening the length of patients' hospitalization in neurocritical care unit (NCCU) of Loghman Hakim hospital affiliated to Shahid Beheshti University of Medical Sciences, Tehran, Iran, and completely stimulating the procedure of bed allocation and prioritization of patients.Methods: Data of 420 patients hospitalized in NCCU was gathered and the procedure of bed allocation simulation was performed considering the priorities defined based on the length of hospitalization and patients' chance of survival. The PROMETHEE (preference ranking organization method for enrichment evaluation) method was used to prioritize and allocate beds. To study the consequences of the suggested method, event discrete simulation tool was used to compare the current status and the results of the new method for 20 periods each including one month data. Results:The mean number of patients admitted to NCCU during one month without any prioritization was 76, while it increased to 86 based on prioritization. Conclusions:Patients' simulation and prioritization using the PROMETHEE method resulted in 13% rise in the number of patients admitted to NCCU and higher utilization of this ward.

show abstract

“…Brain cells die rapidly after stroke and any effective treatment must start as early as possible. In the clinical routine there is a “time-outcome” relationship, which continues to be the major limitation of therapeutic approaches [15,16]. The “time is brain” rational refers to the fact that brain cells die rapidly after the event of a stroke.…”

Section: Introductionmentioning

confidence: 99%

Point-of-Care-Testing in Acute Stroke Management: An Unmet Need Ripe for Technological Harvest

et al. 2017

View full text Add to dashboard Cite

Stroke, the second highest leading cause of death, is caused by an abrupt interruption of blood to the brain. Supply of blood needs to be promptly restored to salvage brain tissues from irreversible neuronal death. Existing assessment of stroke patients is based largely on detailed clinical evaluation that is complemented by neuroimaging methods. However, emerging data point to the potential use of blood-derived biomarkers in aiding clinical decision-making especially in the diagnosis of ischemic stroke, triaging patients for acute reperfusion therapies, and in informing stroke mechanisms and prognosis. The demand for newer techniques to deliver individualized information on-site for incorporation into a time-sensitive work-flow has become greater. In this review, we examine the roles of a portable and easy to use point-of-care-test (POCT) in shortening the time-to-treatment, classifying stroke subtypes and improving patient’s outcome. We first examine the conventional stroke management workflow, then highlight situations where a bedside biomarker assessment might aid clinical decision-making. A novel stroke POCT approach is presented, which combines the use of quantitative and multiplex POCT platforms for the detection of specific stroke biomarkers, as well as data-mining tools to drive analytical processes. Further work is needed in the development of POCTs to fulfill an unmet need in acute stroke management.

show abstract

Update on Neurocritical Care of Stroke

Cited by 9 publications

References 88 publications

Bidirectional Microglia–Neuron Communication in Health and Disease

Bidirectional Microglia–Neuron Communication in Health and Disease

Neurocritical Care Unit Bed Allocation: Optimization Based on Prioritization Using Simulation

Point-of-Care-Testing in Acute Stroke Management: An Unmet Need Ripe for Technological Harvest

Contact Info

Product

Resources

About