Definition พ.ญ.ส ธ ดา เย นจ นทร. Epidemiology. Definition 5/25/2016. Seizures after stroke Can we predict? Poststroke seizure
|
|
- Sydney Ramsey
- 5 years ago
- Views:
Transcription
1 Seizures after stroke Can we predict? พ.ญ.ส ธ ดา เย นจ นทร PMK Epilepsy Annual Meeting 2016 Definition Poststroke seizure : single or multiple convulsive episode(s) after stroke and thought to be related to reversible or irreversible cerebral damage due to stroke regardless of time of onset following the stroke Definition Poststroke epilepsy : recurrent seizures following stroke with confirmed diagnosis of epilepsy Epidemiology Stroke incidence increases with advancing age CVD is the number one cause of epilepsy in elderly Stroke registry data, 5%-20% will have poststroke seizure A small subset of this group develop epilepsy Arch Neurol.2002;59: Canada, Australia, Israel, Italy 1
2 Seizure occurred within 24 hours of stroke in 58% of children Youngest children (0-5 years) had early seizures > 6 years and older (p=0.28) No significance differences were found in the rate of seizure by stroke type The relative risk (95% CI) for seizure in the acute stroke setting in children vs. adults is 18 21% had seizure as initial sign of stroke, 10% had seizures during the acute hospitalization 17% had SE, did not vary in stroke subtypes but common in infants and patients with cortical strokes NCSE was captured only with patients with VEM, and always within 24 hours of monitoring Epub: Sep 10, % had epilepsy in next 6 months after stroke, all of whom experienced early-onset seizures Classification Early onset seizure : first 24 hours-2 weeks (1-4 weeks) : peak within 24 hours after stroke Late-onset seizure : after 2 weeks of stroke onset : peak within 6-12 months after stroke Postgrad Med J 2006;82: Acute ischemic stroke Early seizures ( 24 hrs- 4 wks) 1.8%- 15%, excitatory or inhibitory alterations in penumbral tissue Late seizures ( after 4 wks) 2.5%- 15%, gliosis and development of meningocerebral scar, 3 times higher risk for subsequent strokes Status epilepticus occurs 1/4-1/6 of poststroke seizures 2
3 2-3 times higher risk of seizures than ischemic stroke, esp. lobar or cortical hemorrhage Immediate seizures (with 24 hr) % Cumulative risk of seizure is higher within 5 days 28% of comatose or stupor pts in status epilepticus 31 Italian centers, 714 patients : 609 (85.3%) cerebral infarction, 32 with hemorrhagic change and 105 (14.7%) primary ICH Many strengths large sample size clear definition of time period for early seizure (first 7 days) excellent stroke classification by etiology, stroke subtype ( neuroimaging in all patients), stroke severity (NIH Stroke Scale and modified Rankin scale) complete F/U 6.3% (45/714 patients) had acute symptomatic seizures occurred within 1 week of stroke most early seizures (73%) occurred within 24 hours after stroke onset when acute physiologic derangements are most severe 68.1% were focal-onset seizure Early seizures 16.2% ICH 12.5% Cerebral infarction with hemorrhagic transformation 4.2% Cerebral infarction without hemorrhage Neurology, 2011;77: Neurology, 2011;77: In multivariate analysis : Independent predictors of early seizures were Stroke type ( ICH and hemorrhagic infarction) Cortical lesion Neurology, 2011;77:
4 522 patients ( age years, median age of 72 years) with spontaneous ICH and no history of previous seizure Many strengths large sample size clear definition of time period for early seizure (first 7 days) excellent assessment of risk factors nearly complete F/U at 6 months Neurology, 2011;77: The incidence of early seizures was 22% with lobar ICH (compared to 8% in deep ICH, 9% in posterior fossa ICH) 51% focal seizure, 43% generalized seizure and 4% CSE Higher incidence of early seizures : cortical involvement, more severe stroke, previous ICH, and younger age Early seizures were not independent predictors for mortality at 7 days and 6 months and did not influence functional outcome at 6 months Neurology, 2011;77: Aneurysmal SAH Incidence of seizures following Sx 10-25% High risk : Hunt & Hess grade 3-4, MCA aneurysm, rebleeding, large hematoma, vasospasm with cerebral infarction, shunt-dependent hydrocephalus, persistent neurological deficits 876 patients with SAH from saccular intracranial aneurysm ( sia SAH) and no history of previous epilepsy Cumulative incidence of epilepsy is 8% at 1 year and12% at 5 years Risk factors: ICH >15 cm 3, Hunt and Hess grade 3-4 and acute seizure Cerebral venous and sinus thrombosis Seizure are common, 29%-50% of patients Early seizures (within 2 wks), predicted by motor or sensory deficits, ICH, and cortical vein thrombosis Late seizures, may be common in patients with early seizures and ICH Neurology, 2015;84:
5 Acute ischemic stroke No prospective, randomized trials to examine the use of prophylactic AEDs to reduce seizure incidence Isolated early seizure does not require Rx or can be easily controlled Alcoholic patients with ICH ( 3 times higher risk for SE) should be treated with BDZ. If late seizures occur (2 weeks from onset), consider long-term AEDs * Some small clinical studies suggest that PHT, PB and BDZ should be avoided during the post-stroke : delay recovery * Cervoni L, et al. Neurosurg Rev 1994;17: Neurocrit Care,2007;7: EEG monitoring in unexplained change in mental status following ICH If EEG monitoring is unavailable, prophylactic treatment seems warranted 1, 2 American Heart Association guidelines suggest AEDs for 1 month in patients presented with seizures * Recommended prophylactics AEDs in selected cases : High risk : hemorrhage, large cortical involvement, acute confusional state, preexisting dementia 1. Berger AR, et al. Neurology 1988; 38 : Diringer MN. Crit Care Med 1993; 21: *Broderick JP, et al. Stroke 1999; 30: asah Highly significant reduction in seizures in endovascular coiling group compared to aneurysm clipping group 1 Meta-analysis of 4 prospective RCT ( n = 3,552) : old prophylactic AEDs ( PHT, PB, CBZ) revealed worse outcome at 3 months with AEDs use 2 1. ISAT collaborative group. Lancet 2005; 366 : Rosengart AJ, et al. Stroke 2004;35:250. asah half-life oral nimodipine with hepatic enzyme-inducing AEDs 1 May consider in periprocedurally patients ( the day before clipping and up to a week after surgery) 2 Three-day regimen of PHT prophylaxis is adequate to prevent seizures in asah 3 1. Tartara A, et al. Br J Clin Pharmacol1991;32: Baker CJ, et al. Neurosurg 1995;37: Chamnanvej S, et al. Neurosurgery 2007;60:
6 asah Early treatment with AEDs in asah patients with high risks of seizure -Hunt & Hess grade 3-4, MCA aneurysm, rebleeding, large hematoma, vasospasm with cerebral infarction, shunt-dependent hydrocephalus, persistent neurological deficits Long-term treatment with AEDs in asah patients remains controversial Cerebral venous and sinus thrombosis Absence data from randomized clinical trial May used prophylactic AEDs in this subset of patients with focal neurological deficits and focal abnormalities on CT/MRI Neurocrit Care,2007;7: Review randomised and qausi-randomised controlled trials in which participants were assigned to treatment or control group up to August 2013 Only one trial fulfilled the study criteria Cochrane Database Syst Rev;2014 Jan 24 A prospective randomised, double-blind, placebo-controlled trial comparing valproic acid with placebo for primary prevention of seizures in 72 adults (over 18 years of age) with spontaneous non-aneurysmal, non-traumatic ICH No statistically significant difference in outcome (seizure occurrence at one year) was demonstrated between groups. Currently, there is insufficient evidence to support the routine use of antiepileptic drugs for the primary or secondary prevention of seizures after stroke Further well-conducted research is needed for this important clinical problem 6
7 1,832 patients 3.4% poststroke early-onset seizures 5.0% poststroke epilepsy. Statin use was associated with a lower risk of poststroke early-onset seizures, mainly in patients who used a statin only in the acute phase No significant association between statin use and poststroke epilepsy In 63 patients with early-onset seizures, statin use was associated with reduced risk of poststroke epilepsy Neurology 2015;85: The effect of statins in reduction of poststroke early-onset seizures may be meidiated by Decrease in glutamateric synaptic transmission Thank you Reduction of infarction volume mediated by antiinflammatory and antioxidative effects, inhibition of apoptosis of neural cells Reduction of permeability of the BBB and brain inflammation 7
Neurosurgical decision making in structural lesions causing stroke. Dr Rakesh Ranjan MS, MCh, Dip NB (Neurosurgery)
Neurosurgical decision making in structural lesions causing stroke Dr Rakesh Ranjan MS, MCh, Dip NB (Neurosurgery) Subarachnoid Hemorrhage Every year, an estimated 30,000 people in the United States experience
More information(aneurysmal subarachnoid hemorrhage, 17%~60% :SAH. ,asah , 22%~49% : Willis. :1927 Moniz ;(3) 2. ischemic neurological deficit,dind) SAH) SAH ;(6)
,, 2. : ;,, :(1), (delayed ;(2) ischemic neurological deficit,dind) ;(3) 2. :SAH ;(4) 5-10 10 HT -1-1 ;(5), 10 SAH ;(6) - - 27%~50%, ( cerebral vasospasm ) Glasgow (Glasgow Coma Scale,GCS), [1],, (aneurysmal
More informationControversies in the Management of SAH
Controversies in the Management of SAH Disclosures: None Controversies Anti-fibrinolytics Anti-epileptic Drugs Goal Hemoglobin Hyponatremia Fever Anti-Fibrinolytics The risk of re-bleeding is highest in
More informationStarting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective
Starting or Resuming Anticoagulation or Antiplatelet Therapy after ICH: A Neurology Perspective Cathy Sila MD George M Humphrey II Professor and Vice Chair of Neurology Director, Comprehensive Stroke Center
More informationTHE EFFICACY AND SAFETY OF CILOSTAZOL IN SUBARACHNOID HEMORRHAGE. A META- ANALYSIS OF RANDOMIZED AND NON RANDOMIZED STUDIES DR. MUHAMMAD F.
THE EFFICACY AND SAFETY OF CILOSTAZOL IN SUBARACHNOID HEMORRHAGE. A META- ANALYSIS OF RANDOMIZED AND NON RANDOMIZED STUDIES DR. MUHAMMAD F. ISHFAQ ZEENAT QURESHI STROKE INSTITUTE AND UNIVERSITY OF TENNESSEE,
More informationThe Effect of Statin Therapy on Risk of Intracranial Hemorrhage
The Effect of Statin Therapy on Risk of Intracranial Hemorrhage JENNIFER HANIFY, PHARM.D. PGY2 CRITICAL CARE RESIDENT UF HEALTH JACKSONVILLE JANUARY 23 RD 2016 Objectives Review benefits of statin therapy
More informationNeurointensive Care of Aneurysmal Subarachnoid Hemorrhage. Alejandro A. Rabinstein Department of Neurology Mayo Clinic, Rochester, USA
Neurointensive Care of Aneurysmal Subarachnoid Hemorrhage Alejandro A. Rabinstein Department of Neurology Mayo Clinic, Rochester, USA The traditional view: asah is a bad disease Pre-hospital mortality
More informationSummary of some of the landmark articles:
Summary of some of the landmark articles: The significance of unruptured intracranial saccular aneurysms: Weibers et al Mayo clinic. 1987 1. 131 patients with 161 aneurysms were followed up at until death,
More informationModern Management of ICH
Modern Management of ICH Bradley A. Gross, MD Assistant Professor, Dept of Neurosurgery, University of Pittsburgh October 2018 ICH Background Assessment & Diagnosis Medical Management Surgical Management
More informationThe Worst Headache of My Life Hemorrhagic Stroke
The Worst Headache of My Life Hemorrhagic Stroke Lindsay Trantum ACNP-BC Neurocritical Care Nurse Practitioner Assistant in Anesthesiology, Division of Critical Care Objectives Identify the risk factors
More informationRecombinant Factor VIIa for Intracerebral Hemorrhage
Recombinant Factor VIIa for Intracerebral Hemorrhage January 24, 2006 Justin Lee Pharmacy Resident University Health Network Outline 1. Introduction to patient case 2. Overview of intracerebral hemorrhage
More informationIschemia cerebrale dopo emorragia subaracnoidea Vasospasmo e altri nemici
Ischemia cerebrale dopo emorragia subaracnoidea Vasospasmo e altri nemici Nino Stocchetti Milan University Neuroscience ICU Ospedale Policlinico IRCCS Milano stocchet@policlinico.mi.it Macdonald RL et
More information7/18/2018. Cerebral Vasospasm: Current and Emerging Therapies. Disclosures. Objectives
Cerebral : Current and Emerging Therapies Chad W. Washington MS, MD, MPHS Assistant Professor Department of Neurosurgery Disclosures None Objectives Brief Overview How we got here Review of Trials Meta-analysis
More informationGLYCEMIC CONTROL IN NEUROCRITICAL CARE PATIENTS
GLYCEMIC CONTROL IN NEUROCRITICAL CARE PATIENTS David Zygun MD MSc FRCPC Professor and Director Division of Critical Care Medicine University of Alberta Zone Clinical Department Head Critical Care Medicine,
More informationCerebrovascular Disorders. Blood, Brain, and Energy. Blood Supply to the Brain 2/14/11
Cerebrovascular Disorders Blood, Brain, and Energy 20% of body s oxygen usage No oxygen/glucose reserves Hypoxia - reduced oxygen Anoxia - Absence of oxygen supply Cell death can occur in as little as
More informationCommon EEG pattern in critical care
Common EEG pattern in critical care พ.ญ.ส ธ ดา เย นจ นทร Causes Direct neuronal injury Cerebral dysfunction : encephalopathy Psychic problems EEG in critical care 1 October 2009, Pramongkutklao Hospital
More informationOccurrence and Risk Factors for Post-traumatic Epilepsy in Civilian Poulations December 2, 2012
Occurrence and Risk Factors for Post-traumatic Epilepsy in Civilian Poulations December 2, 2012 Dale C Hesdorffer, PhD GH Sergievsky Center Columbia University American Epilepsy Society Annual Meeting
More informationDisclosures. Objectives. Critical Care Management of Subarachnoid Hemorrhage. Nothing to disclose
Critical Care Management of Subarachnoid Hemorrhage Nerissa U. Ko, MD, MAS UCSF Department of Neurology September 7, 2013 Nothing to disclose Disclosures Grant funding from American Heart Association,
More informationPhenytoin versus Levetiracetam for Prevention of Early Posttraumatic Seizures: A Prospective Comparative Study
136 Original Article Phenytoin versus Levetiracetam for Prevention of Early Posttraumatic Seizures: A Prospective Comparative Study Kairav S. Shah 1 Jayun Shah 1 Ponraj K. Sundaram 1 1 Department of Neurosurgery,
More informationEpidemiology And Treatment Of Cerebral Aneurysms At An Australian Tertiary Level Hospital
ISPUB.COM The Internet Journal of Neurosurgery Volume 9 Number 2 Epidemiology And Treatment Of Cerebral Aneurysms At An Australian Tertiary Level Hospital A Granger, R Laherty Citation A Granger, R Laherty.
More informationSmall UIAs, <7 mm in diameter, uncommonly cause aneurysmal symptoms and are the most frequently detected incidentally.
Research grant from Stryker Neurovascular Research grant from Covidien/ Medtronic Consultant and proctor for Stryker Neurovascular Consultant and proctor for Covidien/ Medtronic Consultant for Codman Neurovascular
More informationTCD AND VASOSPASM SAH
CURRENT TREATMENT FOR CEREBRAL ANEURYSMS TCD AND VASOSPASM SAH Michigan Sonographers Society 2 Nd Annual Fall Vascular Conference Larry N. Raber RVT-RDMS Clinical Manager General Ultrasound-Neurovascular
More informationWhen to start, which drugs and when to stop
When to start, which drugs and when to stop Dr. Suthida Yenjun, MD. PMK Epilepsy Annual Meeting 2016 The main factors to consider in making the decision The risk for recurrent seizures, which varies based
More informationDecompressive Hemicraniectomy in Acute Neurological Diseases
Decompressive Hemicraniectomy in Acute Neurological Diseases Angela Crudele, MD 1 ; Syed Omar Shah, MD 1 ; Barak Bar, MD 1,2 Department of Neurology, Thomas Jefferson University, Philadelphia, PA, Department
More informationEmergency Department Management of Acute Ischemic Stroke
Emergency Department Management of Acute Ischemic Stroke R. Jason Thurman, MD Associate Professor of Emergency Medicine and Neurosurgery Associate Director, Vanderbilt Stroke Center Vanderbilt University,
More informationMulti-modality management of intracranial aneurysms
Multi-modality management of intracranial aneurysms Christopher Koebbe, Maj, USAF, MC Staff Neurosurgeon San Antonio Military Medical Consortium Clinical Assistant Professor Department of Neurological
More informationAneurysmal subarachnoid hemorrhage in the elderly:
Aneurysmal subarachnoid hemorrhage in the elderly: Helsinki experience 1980-2008 Eljas Supponen, BM Student number: 013302559 Helsinki 04.05.2012 Thesis eljas.supponen@helsinki.fi Supervisors: Martin Lehecka,
More informationLothian Audit of the Treatment of Cerebral Haemorrhage (LATCH)
1. INTRODUCTION Stroke physicians, emergency department doctors, and neurologists are often unsure about which patients they should refer for neurosurgical intervention. Early neurosurgical evacuation
More informationSubarachnoid Hemorrhage (SAH) Disclosures/Relationships. Click to edit Master title style. Click to edit Master title style.
Subarachnoid Hemorrhage (SAH) William J. Jones, M.D. Assistant Professor of Neurology Co-Director, UCH Stroke Program Click to edit Master title style Disclosures/Relationships No conflicts of interest
More informationSub-arachnoid haemorrhage
Sub-arachnoid haemorrhage Dr Mary Newton Consultant Anaesthetist The National Hospital for Neurology and Neurosurgery UCL Hospitals NHS Trust mary.newton@uclh.nhs.uk Kiev, Ukraine September 17 th 2009
More informationClinical trial registration no.: NCT (clinicaltrials.gov) https://thejns.org/doi/abs/ / jns161301
CLINICAL ARTICLE J Neurosurg 128:120 125, 2018 Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial Robert F. Spetzler, MD, 1 Joseph M. Zabramski, MD, 1 Cameron G. McDougall, MD, 1 Felipe
More informationCurrent status of temperature management in the neuro-icu
Current status of temperature management in the neuro-icu Gregor Brössner, MD Neurologic Intensiv Care Unit Innsbruck, Austria Disclosures: Gregor Brössner has recieved an unrestricted Grant by Alsius
More informationCOMPREHENSIVE SUMMARY OF INSTOR REPORTS
COMPREHENSIVE SUMMARY OF INSTOR REPORTS Please note that the following chart provides a sampling of INSTOR reports to differentiate this registry s capabilities as a process improvement system. This list
More informationNeurosurgical Management of Stroke
Overview Hemorrhagic Stroke Ischemic Stroke Aneurysmal Subarachnoid hemorrhage Neurosurgical Management of Stroke Jesse Liu, MD Instructor, Neurological Surgery Initial management In hospital management
More informationIDENTIFYING TARGET POPULATIONS & DESIGNING CLINICAL TRIALS FOR ANTIEPILEPTOGENESIS. Ettore Beghi Istituto Mario Negri, Milano ITALY
IDENTIFYING TARGET POPULATIONS & DESIGNING CLINICAL TRIALS FOR ANTIEPILEPTOGENESIS Ettore Beghi Istituto Mario Negri, Milano ITALY OUTLINE Definitions & background risks in epilepsy End-points Target populations
More informationSinus Venous Thrombosis
Sinus Venous Thrombosis Joseph J Gemmete, MD FACR, FSIR, FAHA Professor Departments of Radiology and Neurosurgery University of Michigan Hospitals Ann Arbor, MI Outline Introduction Medical Treatment Options
More informationRaw and Quantitative EEG for Identification of Ischemia
Raw and Quantitative EEG for Identification of Ischemia Susan T. Herman, MD Assistant Professor of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA Disclosures None relevant
More information7 TI - Epidemiology of intracerebral hemorrhage.
1 TI - Multiple postoperative intracerebral haematomas remote from the site of craniotomy. AU - Rapana A, et al. SO - Br J Neurosurg. 1998 Aug;1():-8. Review. IDS - PMID: 1000 UI: 991958 TI - Cerebral
More informationCanadian Best Practice Recommendations for Stroke Care 3.6 Acute Subarachnoid Hemorrhage
Last Updated: May 21, 2013 Canadian Best Practice Recommendations for Stroke Care Canadian Best Practice Recommendations for Stroke Care 2011-2013 Update Contents Search Strategy... 2 CSN Current Recommendations...Error!
More informationClinical Analysis of Risk Factors Affecting Rebleeding in Patients with an Aneurysm. Gab Teug Kim, M.D.
/ 119 = Abstract = Clinical Analysis of Risk Factors Affecting Rebleeding in Patients with an Aneurysm Gab Teug Kim, M.D. Department of Emergency Medicine, College of Medicine, Dankook University, Choenan,
More informationAntithrombotic therapy in patients with transient ischemic attack / stroke (acute phase <48h)
Antithrombotic therapy in patients with transient ischemic attack / stroke (acute phase
More informationManagement of Cerebral Aneurysms in Polycystic Kidney Disease. Dr H Stockley Consultant Neuroradiologist Greater Manchester Neuroscience Centre
Management of Cerebral Aneurysms in Polycystic Kidney Disease Dr H Stockley Consultant Neuroradiologist Greater Manchester Neuroscience Centre What is a cerebral aneurysm? Developmental degenerative arterial
More informationAge-Associated Vasospasm in Aneurysmal Subarachnoid Hemorrhage
Age-Associated Vasospasm in Aneurysmal Subarachnoid Hemorrhage Sushant P. Kale, MD, MPH,* Randall C. Edgell, MD,* Amer Alshekhlee, MD,* Afshin Borhani Haghighi, MD,* Justin Sweeny, MD, Jason Felton, MD,
More informationLate Onset Shake-Etiology At Stake - A Prospective Study
Original Article Late Onset Shake-Etiology At Stake - A Prospective Study G Sendil 1, Arun N Kumar 1, Mohan V Kumar 2 1 Senior Resident, ESIC PGIMSR & MH, Bangalore, 2 Consultant Physician Columbia Asia
More informationControversies in Hemorrhagic Stroke Management. Sarah L. Livesay, DNP, RN, ACNP-BC, ACNS-BC Associate Professor Rush University
Controversies in Hemorrhagic Stroke Management Sarah L. Livesay, DNP, RN, ACNP-BC, ACNS-BC Associate Professor Rush University Disclosures AHA/ASA Outline Blood pressure VTE Coagulopathy Early mobilization
More informationDoes AED Prophylaxis Work in Posttraumatic Epilepsy December 2, 2012
Does AED Prophylaxis Work in Posttraumatic Epilepsy December 2, 2012 Marc A. Dichter, MD, PhD University of Pennsylvania American Epilepsy Society Annual Meeting Disclosure Name of Commercial Interest
More informationEndovascular Treatment of Cerebral Arteriovenous Malformations. Bs. Nguyễn Ngọc Pi Doanh- Bs Đặng Ngọc Dũng Khoa Ngoại Thần Kinh
Endovascular Treatment of Cerebral Arteriovenous Malformations Bs. Nguyễn Ngọc Pi Doanh- Bs Đặng Ngọc Dũng Khoa Ngoại Thần Kinh Stroke Vascular Malformations of the Brain Epidemiology: - Incidence: 0.1%,
More informationGuidelines and Beyond: Traumatic Brain Injury
Guidelines and Beyond: Traumatic Brain Injury Aimee Gowler, PharmD, BCCCP, BCPS Neuromedicine Critical Care Clinical Pharmacy Specialist UF Health Shands Disclosures I have no financial interests to disclose.
More informationSupplementary appendix
Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Pujar SS, Martinos MM, Cortina-Borja M, et
More informationIntracerebral Hemorrhage
Review of Primary Intracerebral Hemorrhage Réza Behrouz, DO Assistant Professor of Neurology University of South Florida College of Medicine STROKE 85% ISCHEMIC 15% HEMORRHAGIC HEMORRHAGIC STROKE 1/3 Subarachnoid
More informationAlbumin In SubArachnoid Hemorrhage: The ALISAH Study
Albumin In SubArachnoid Hemorrhage: The ALISAH Study Jose I Suarez, M.D. Professor of Neurology Neurointensivist and Vascular Neurologist Head Section of Neurocritical Care and Vascular Neurology Department
More informationAdvances in the treatment of posterior cerebral circulation symptomatic disease
Advances in the treatment of posterior cerebral circulation symptomatic disease Athanasios D. Giannoukas MD, MSc(Lond.), PhD(Lond.), FEBVS Professor of Vascular Surgery Faculty of Medicine, School of Health
More informationSV2A Ligands: New Antiepileptic Drug for Modern Neurosurgical Consideration!
SV2A Ligands: New Antiepileptic Drug for Modern Neurosurgical Consideration Sorayouth Chumnanvej,M.D. Neurosurgeon Ramathibodi Hospital, Mahidol University Professor Carole Longson, Director of the Health
More informationStroke: What did we learn in the last year?
Stroke: What did we learn in the last year? J. Claude Hemphill III, MD, MAS Associate Professor of Clinical Neurology and Neurological Surgery University of California, San Francisco Director, Neurocritical
More informationShould infants with perinatal thrombosis be screened for thrombophilia and treated by anticoagulants?
Should infants with perinatal thrombosis be screened for thrombophilia and treated by anticoagulants? Shoshana Revel-Vilk, MD MSc Pediatric Hematology Center, Pediatric Hematology/Oncology Department,
More informationProgress Review. Mervyn D.I. Vergouwen, MD, PhD; Rob J. de Haan, PhD; Marinus Vermeulen, MD, PhD; Yvo B.W.E.M. Roos, MD, PhD
Progress Review Effect of Statin Treatment on Vasospasm, Delayed Cerebral Ischemia, and Functional Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage A Systematic Review and Meta-Analysis Update
More informationInterventions in the Management of Acute Stroke. Dr Md Shafiqul Islam Associate Professor Neurosurgery Dhaka Medical College Hospital
Interventions in the Management of Acute Stroke Dr Md Shafiqul Islam Associate Professor Neurosurgery Dhaka Medical College Hospital Acute stroke intervention Number of stroke patients increasing day by
More informationEndovascular Treatment for Acute Ischemic Stroke
ular Treatment for Acute Ischemic Stroke Vishal B. Jani MD Assistant Professor Interventional Neurology, Division of Department of Neurology. Creighton University/ CHI health Omaha NE Disclosure None 1
More informationDavid Dredge, MD MGH Child Neurology CME Course September 9, 2017
David Dredge, MD MGH Child Neurology CME Course September 9, 2017 } 25-40,000 children experience their first nonfebrile seizure each year } AAN/CNS guidelines developed in early 2000s and subsequently
More informationAcute stroke update 2016 innovations in managing ischemic and hemorrhagic disease
Acute stroke update 2016 innovations in managing ischemic and hemorrhagic disease Christopher Koebbe, MD Endovascular Neurosurgeon Florida Spine Institute Director of Neurosciences Northside Hospital Overview
More informationPrimary Versus Comprehensive: What is the Difference?
Primary Versus Comprehensive: What is the Difference? April 26, 2018 Bethann Mercanti, PA-C Director of Clinical Practice Stroke Program Coordinator Cooper Neurological Institute Cooper Bon & Joint Institute
More informationLong-Term Excess Mortality After Aneurysmal Subarachnoid Hemorrhage Patients With Multiple Aneurysms at Risk
Long-Term Excess Mortality After Aneurysmal Subarachnoid Hemorrhage Patients With Multiple Aneurysms at Risk Justiina Huhtakangas, MD; Hanna Lehto, MD; Karri Seppä, MSc, PhD; Riku Kivisaari, MD, PhD; Mika
More informationAEROMEDICAL DECISION MAKING IN CEREBRAL ANEURYSMS. Pooshan Navāthé Michael Drane Peter Clem David Fitzgerald
AEROMEDICAL DECISION MAKING IN CEREBRAL ANEURYSMS Pooshan Navāthé Michael Drane Peter Clem David Fitzgerald Disclaimer I receive a salary from the Commonwealth of Australia. I have no financial relationships
More informationOrganic Mental Disorders. Organic Mental Disorders. Axes. Damrongsak Bulyalert Department of Internal Medicine
Organic Mental Disorders Damrongsak Bulyalert Department of Internal Medicine www.metadon.net 1 Organic Mental Disorders In DSM (Diagnostic and Statistical Manual of Mental Disorders), OMD includes Delirium,
More informationLife after ARUBA: Management of Unruptured Brain Arteriovenous Malformations (AVMs)
Life after ARUBA: Management of Unruptured Brain Arteriovenous Malformations (AVMs) Eric L. Zager, MD University of Pennsylvania Department of Neurosurgery No Disclosures Brain AVMs Incidence ~1 in 100,000
More informationDVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE)
DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE) Introduction VTE (DVT/PE) is an important complication in hospitalized patients Hospitalization for acute medical illness
More informationCurrent State of the Art
SAH Current State of the Art Thomas C. Steineke, M.D., Ph.D. Director of Neurovascular Surgery NJ Neuroscience Institute JFK Medical Center Introduction Signs and symptoms of a problem What are aneurysms
More informationContinuous EEG Monitoring in Spontaneous Intracerebral Hemorrhage
Continuous EEG Monitoring in Spontaneous Intracerebral Hemorrhage Ayman M Selim 1, Ghada R Mousa 1, Eman Awad 2, Wael Reda 3, Sherif Abdelfattah 4 Departments of Neurology, Zagazig University 1 ; Neurology,
More informationM. Edip Gurol, MD, MSc Stroke Service/Neurology, Massachusetts General Hospital, Harvard Medical School
High Risk of Thromboembolism and ICH: Problems with Medical Management M. Edip Gurol, MD, MSc Stroke Service/Neurology, Massachusetts General Hospital, Harvard Medical School Disclosures Funding from NIH
More informationBlood Pressure Management in Acute Ischemic Stroke
Blood Pressure Management in Acute Ischemic Stroke Kimberly Clark, PharmD, BCCCP Clinical Pharmacy Specialist Critical Care, Greenville Health System Adjunct Assistant Professor, South Carolina College
More informationCode Stroke Intervention: Endovascular therapy for asah and management J. DIEGO LOZANO MD INTERVENTIONAL NEURORADIOLOGY
Code Stroke Intervention: Endovascular therapy for asah and management J. DIEGO LOZANO MD INTERVENTIONAL NEURORADIOLOGY Disclosures None Part B. Objectives Epidemiology of asah Concept: What is a brain
More informationPROPHYLACTIC ANTICONVULSANT THERAPY
PROPHYLACTIC ANTICONVULSANT THERAPY Dr. Khalid Siddiqui FRCSC, ABNS, FAANS Consultant Neurosurgery Assistant Medical Director Dr Sulaiman Alhabib Medical Group, Al-Rayan PAPNS 2015 11/24/2015 1 Introduction
More informationICU EEG MONITORING: WHY, WHEN AND FOR WHOM
ICU EEG MONITORING: WHY, WHEN AND FOR WHOM Aatif M. Husain, MD Duke University Veterans Affairs Medical Center Durham, NC In the last two decades much has been learned about the frequency with which seizures
More information9/16/2018. Recognizing & Managing Seizures in Pediatric TBI. Objectives. Definitions and Epidemiology
Recognizing & Managing Seizures in Pediatric TBI UW Medicine EMS & Trauma 2018 Conference September 17 and 18, 2018 Mark Wainwright MD PhD Herman and Faye Sarkowsky Professor of Neurology Division Head,
More informationKristin s Head Trauma Board Questions 11/07/14
Kristin s Head Trauma Board Questions { 11/07/14 A healthy 15 y/o boy was playing football at a park near his home with a group of friends when he tripped over a friend s leg while trying to catch a pass.
More informationClinical and radiological profile of post-stroke seizures
Original Research Article Sumit Kamble 1,*, Trilochan Srivastava 2, Vijay Sardana 3, Dilip Maheshwari 4, Bharat Bhushan 5, Piyush Ojha 6 1,6 Senior Resident, 2 Professor, 3 Senior Professor & Head, 4,5
More informationStudying Aneurysm Devices in the Intracranial Neurovasculature
Studying Aneurysm Devices in the Intracranial Neurovasculature The benefits and risks of treating unruptured aneurysms depend on the anatomical location. One approach to studying devices to treat unruptured
More information4/10/2018. The Surgical Treatment of Cerebral Aneurysms. Aneurysm Locations. Aneurysmal Subarachnoid Hemorrhage. Jerone Kennedy, M.D.
The Surgical Treatment of Cerebral Aneurysms Aneurysmal Subarachnoid Hemorrhage Jerone Kennedy, M.D. Medical Director, Vascular Neurosurgery CentraCare Health-Neurosciences St. Cloud Hospital Aneurysm
More informationReceived: 15 September 2014 /Accepted: 20 November 2014 /Published online: 6 December 2014 # Springer-Verlag Berlin Heidelberg 2014
Neuroradiology (2015) 57:269 274 DOI 10.1007/s00234-014-1472-6 DIAGNOSTIC NEURORADIOLOGY Quantification of structural cerebral abnormalities on MRI 18 months after aneurysmal subarachnoid hemorrhage in
More informationGLIOMA - VENOUS THROMBOEMBOLISM. Miguel Navarro. Hospital Universitario de Salamanca-IBSAL
GLIOMA - VENOUS THROMBOEMBOLISM Miguel Navarro. Hospital Universitario de Salamanca-IBSAL GLIOMA - VTE GLIOMA - VTE The two string problem Substantial risk for developing VTE Concern antithrombotic agents
More informationCarotid Artery Stenosis
Evidence-Based Approach to Carotid Artery Stenosis Seong-Wook Park, MD Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea Carotid Artery Stenosis Carotid
More informationEpilepsy in dementia. Case 1. Dr. Yotin Chinvarun M..D. Ph.D. 5/25/16. CEP, PMK hospital
Epilepsy in dementia Dr. Yotin Chinvarun M..D. Ph.D. CEP, PMK hospital Case 1 M 90 years old Had a history of tonic of both limbs (Lt > Rt) at the age of 88 years old, eye rolled up, no grunting, lasting
More informationGiuseppe Micieli Dipartimento di Neurologia d Urgenza IRCCS Fondazione Istituto Neurologico Nazionale C Mondino, Pavia
Giuseppe Micieli Dipartimento di Neurologia d Urgenza IRCCS Fondazione Istituto Neurologico Nazionale C Mondino, Pavia Charidimou et al, 2012 Pathogenesis of spontaneous and anticoagulationassociated
More informationISCHEMIC STROKE IMAGING
ISCHEMIC STROKE IMAGING ผศ.พญ พญ.จ ร ร ตน ธรรมโรจน ภาคว ชาร งส ว ทยา คณะแพทยศาสตร มหาว ทยาล ยขอนแก น A case of acute hemiplegia Which side is the abnormality, right or left? Early Right MCA infarction
More informationStroke in the ED. Dr. William Whiteley. Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian
Stroke in the ED Dr. William Whiteley Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian 2016 RCP Guideline for Stroke RCP guidelines for acute ischaemic stroke
More informationMethod Hannah Shotton
#asah Method Hannah Shotton 2 Introduction SAH Rupturing aneurysm Poor outlook Intervention Secure the aneurysm: clipping or coiling Recommended 48 hours Regional Specialist NSC Conservative management
More informationENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist
ENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist Pharmacy Grand Rounds 26 July 2016 2015 MFMER slide-1 Learning
More information[(PHY-3a) Initials of MD reviewing films] [(PHY-3b) Initials of 2 nd opinion MD]
2015 PHYSICIAN SIGN-OFF (1) STUDY NO (PHY-1) CASE, PER PHYSICIAN REVIEW 1=yes 2=no [strictly meets case definition] (PHY-1a) CASE, IN PHYSICIAN S OPINION 1=yes 2=no (PHY-2) (PHY-3) [based on all available
More informationOverview of Stroke: Etiologies, Demographics, Syndromes, and Outcomes. Alex Abou-Chebl, MD, FSVIN Medical Director, Stroke Baptist Health Louisville
Overview of Stroke: Etiologies, Demographics, Syndromes, and Outcomes Alex Abou-Chebl, MD, FSVIN Medical Director, Stroke Baptist Health Louisville Disclosure Statement of Financial Interest Within the
More informationOutline. What is a seizure? What is epilepsy? Updates in Seizure Management Terminology, Triage & Treatment
Outline Updates in Seizure Management Terminology, Triage & Treatment Joseph Sullivan, MD! Terminology! Videos of different types of seizures! Diagnostic evaluation! Treatment options! Acute! Maintenance
More information11/27/2017. Stroke Management in the Neurocritical Care Unit. Conflict of interest. Karel Fuentes MD Medical Director of Neurocritical Care
Stroke Management in the Neurocritical Care Unit Karel Fuentes MD Medical Director of Neurocritical Care Conflict of interest None Introduction Reperfusion therapy remains the mainstay in the treatment
More informationSAH READMISSIONS TO NCCU
SAH READMISSIONS TO NCCU Are they preventable? João Amaral Rebecca Gorf Critical Care Outreach Team - NHNN 2015 Total admissions to NCCU =862 Total SAH admitted to NCCU= 104 (93e) (12.0%) Total SAH readmissions=
More informationImpact of a Protocol for Acute Antifibrinolytic Therapy on Aneurysm Rebleeding After Subarachnoid Hemorrhage
Impact of a Protocol for Acute Antifibrinolytic Therapy on Aneurysm Rebleeding After Subarachnoid Hemorrhage Robert M. Starke, BA; Grace H. Kim, MD; Andres Fernandez, MD; Ricardo J. Komotar, MD; Zachary
More informationEvidence-based Diagnosis: A Workshop on Evaluating and Using Medical Tests Small Group 3: Friday, June 10, 11:00 12:30. Problems Without Answers
Evidence-based Diagnosis: A Workshop on Evaluating and Using Medical Tests Small Group 3: Friday, June 10, 11:00 12:30 A B C D E Objectives: RCT Checklist RRR vs. ARR NNT = 1/ARR NNH = 1/ARI NNT Treatment
More informationORIGINAL CONTRIBUTION. Frequency and Predictors of Nonconvulsive Seizures. continuous electroencephalographic
ORIGINAL CONTRIBUTION Frequency and Predictors of Nonconvulsive Seizures During Continuous Electroencephalographic Monitoring in Critically Ill Children Nathalie Jette, MD, MSc; Jan Claassen, MD; Ronald
More informationSubarachnoid Hemorrhage and Brain Aneurysm
Subarachnoid Hemorrhage and Brain Aneurysm DIN Department of Interventional Neurology What is SAH? Subarachnoid Haemorrhage is the sudden leaking (haemorrhage) of blood from the blood vessels of brain.
More informationINTRACEREBRAL HAEMORRHAGE:
INTRACEREBRAL HAEMORRHAGE: WHAT IS THE CAUSE? Prof. Charlotte Cordonnier Head, Department of neurology & stroke centre Director, Lille haemorrhagic stroke research program Lille University Hospital France
More informationWhat do we know about prognosis and natural course of epilepsies?
What do we know about prognosis and natural course of epilepsies? Dr. Chusak Limotai, MD., M.Sc., CSCN (C) Chulalongkorn Comprehensive Epilepsy Center of Excellence (CCEC) The Thai Red Cross Society First
More informationDiagnosis and Management of AVM in the Pregnant Patient
Diagnosis and Management of AVM in the Pregnant Patient Wade Cooper, D.O. University of Michigan Assistant Professor Departments of Neurology & Anesthesiology Disclosures Wade Cooper - None Developmental
More informationはじめに 対象と方法 39: , 2017 SAH 183 WFNS
39:107 原 著 39: 107 112, 2017 1 2 1 1 1 1 要旨 SAH 2010 1 2013 12 SAH 253 183 64 70 WFNS I III 72.7 Fisher CT 3 86.3 19.9 16.6 GR MD 73.2 73.1 80 WFNS Key words: subarachnoid hemorrhage, prognosis, rate of
More information