PubMed Health⌕ Search

Biomedical subjects

Eelco F M Wijdicks

Publications and source records attributed to Eelco F M Wijdicks.

At least 19 recordsLinked to original sources
PubMed2006

Determinants of outcome in anticoagulation-associated cerebral hematoma requiring emergency evacuation.

OBJECTIVE: To analyze the likelihood of recovery and prognostic factors in patients with massive anticoagulation-associated intracerebral hemorrhage treated with surgical evacuation after reversal of anticoagulation. DESIGN: Retrospective case series. SETTING: Neurological-Neurosurgical Intensive Care Unit at Mayo Clinic. Patients Seventeen consecutive patients with large anticoagulation-associated intracerebral hemorrhage. Intervention Surgical evacuation of intracerebral hemorrhage. Main Outcome Measure Functional outcome was assessed using the modified Rankin scale. RESULTS: Before surgery, all patients had pronounced (>1-cm) shift of the septum pellucidum and one third had clinical signs of uncal herniation. Still, favorable outcome (modified Rankin scale score < or =3) was achieved by 11 patients (65%). All patients with good recovery awoke within 36 hours of surgery. Older age (P = .05) and serious systemic complications after surgery (P<.01) were significantly associated with lack of neurological recovery and fatal outcome. CONCLUSIONS: Emergency surgery for select deteriorating patients with large anticoagulation-associated intracerebral hemorrhage is compatible with favorable outcome despite the presence of clinical and radiological signs of herniation before the evacuation.

Aged↗
PubMed2006

Progression of warfarin-associated intracerebral hemorrhage after INR normalization with FFP.

To identify hematoma progression in patients with warfarin-associated intracerebral hemorrhage (ICH) despite international normalized ratio (INR) normalization with fresh-frozen plasma (FFP), we reviewed 45 patients with warfarin-associated ICH given FFP. The median time for door to INR normalization was 30 hours (14 to 49.5), with 4 patients' hematomas enlarging after INR normalization. FFP is associated with substantial time delay to actual administration and pulmonary edema and may not prevent progression of ICH despite INR normalization.

Aged↗
PubMed2006

The portrayal of coma in contemporary motion pictures.

BACKGROUND: Coma has been a theme of screenplays in motion pictures, but there is no information about its accuracy. METHODS: The authors reviewed 30 movies from 1970 to 2004 with actors depicting prolonged coma. Accurate depiction of comatose patients was defined by appearance, the complexity of care, accurate cause of coma and probability of awakening, and appropriate compassionate discussion between the physician and family members. Twenty-two key scenes from 17 movies were rated for accuracy by a panel of neurointensivists and neuroscience nurses and then were shown to 72 nonmedical viewers. Accuracy of the scenes was assessed using a Likert Scale. RESULTS: Coma was most often caused by motor vehicle accidents or violence (63%). The time in a comatose state varied from days to 10 years. Awakening occurred in 18 of 30 motion pictures (60%). Awakening was sudden with cognition intact, even after prolonged time in a coma. Actors personified "Sleeping Beauty" (eyes closed, beautifully groomed). Physicians appeared as caricatures. Only two movies had a reasonable accurate representation (Dream Life of Angels and Reversal of Fortune). The majority of the surveyed viewers identified inaccuracy of representation of coma, awakenings, and conversations on the experience of being in a coma, except in 8 of the 22 scenes (36%). Twenty-eight of the 72 viewers (39%) could potentially allow these scenes to influence decisions in real life. CONCLUSIONS: Misrepresentation of coma and awakening was common in motion pictures and impacted on the public perception of coma. Neurologic advice regarding prolonged coma is needed.

Adolescent↗
PubMed2006

Cluster breathing associated with bihemispheric infarction and sparing of the brainstem.

OBJECTIVE: To report cluster breathing pattern associated with a nonbrainstem lesion. DESIGN: Case report. SETTING: Neurointensive care unit, St Mary's Hospital, Rochester, Minn. PATIENT: A patient with subarachnoid hemorrhage developed severe, diffuse, distal bilateral middle cerebral artery vasospasm with resultant cortical laminar necrosis and transient cluster breathing. Intervention Magnetic resonance imaging revealed bihemispheric lesions but no brainstem lesion. CONCLUSION: Cluster breathing may occur with nonbrainstem lesions.

Aged↗
PubMed2006

Arc de cercle and dysautonomia from anoxic injury.

Autonomic dysregulation and catatonic posturing are well described following acute cerebral injury. Others have referred to this as diencephalic seizures, sympathetic storms, midbrain dysregulatory syndrome, and, most recently, paroxysmal autonomic instability with dystonia. Some of these syndromes can evolve into malignant catatonia requiring electroconvulsive therapy. Here we report a case of hanging associated anoxic brain injury resulting in severe dysautonomia and an extreme opisthotonus (arc de cercle).

Adolescent↗
PubMed2006

The declaration of death and the withdrawal of care in the neurologic patient.

Intensive care technologies have led to an increase in patients who are neurologically devastated and deceased. The practical, moral, and ethical situations encountered can be varied and challenging to manage. Decisions and discussions surrounding withdrawal of care, death by neurologic criteria, and organ donation require significant knowledge of the prognosis, ancillary testing, and definitions of these processes. Experience and skill are often required on the part of physicians and staff to guide families through these most difficult of circumstances.

Apnea↗
PubMed2006

Neuromuscular disorders in medical and surgical ICUs: case studies in critical care neurology.

The differential diagnosis of generalized weakness in ICU patients is quite broad. Although neuromuscular disorders are the most common causes of generalized weakness, a thorough evaluation is necessary to delineate the underlying cause of weakness. Biochemical studies, neuroimaging, and electrophysiologic studies help to delineate most of the common disorders associated with weakness. Prompt identification of a neurologic disorder and initiation of therapy speeds up recovery and reduces morbidity and mortality in these patients.

Biopsy↗
PubMed2006

BiPAP in early guillain-barré syndrome may fail.

BACKGROUND: Non-invasive mechanical ventilation (BiPAP) has been introduced for use in neuromuscular respiratory disease such as amyotrophic lateral sclerosis and myasthenia gravis. There is no experience in Guillain-Barré syndrome. METHODS: We describe for the first time the use of BiPAP to assist in the work of breathing in two consecutive patients with progressing Guillain-Barré syndrome (GBS) and marginal pulmonary function. RESULTS: Our initial attempts to use BiPAP in GBS and early neuromuscular respiratory failure were totally unsuccessful. There was marked initial improvement; however, emergency intubation was needed in both patients, one of which became acutely cyanotic. CONCLUSIONS: Until more experience is available, we strongly warn against using BiPAP in deteriorating patients with GBS.

Aged↗
PubMed2006

Drug Insight: adjunctive therapies in adults with bacterial meningitis.

Despite the availability of effective antibiotics, mortality and morbidity rates associated with bacterial meningitis are high. Studies in animals have shown that bacterial lysis, induced by treatment with antibiotics, leads to inflammation in the subarachnoid space, which might contribute to an unfavorable outcome. The management of adults with bacterial meningitis can be complex, and common complications include meningoencephalitis, systemic compromise, stroke and raised intracranial pressure. Various adjunctive therapies have been described to improve outcome in such patients, including anti-inflammatory agents, anticoagulant therapies, and strategies to reduce intracranial pressure. Although a recent randomized trial provided evidence in favor of dexamethasone treatment, few randomized clinical studies are available for other adjunctive therapies in adults with bacterial meningitis. This review briefly summarizes the pathogenesis and pathophysiology of bacterial meningitis, and focuses on the evidence for and against use of the available adjunctive therapies in clinical practice.

Adult↗
PubMed2006

Acute neuromuscular weakness in the intensive care unit.

INTRODUCTION: Patients in the intensive care unit develop generalized weakness due to a number of factors. Neuromuscular weakness is a common cause of failure to wean from the ventilator and decreased limb movements. A rational approach to evaluation of weakness will help to identify most of the common causes of neuromuscular weakness in the intensive care unit. AIMS: This review provides an analysis of neuromuscular weakness and a practical algorithm to assist in diagnostic evaluation. CONCLUSIONS: The most common acquired causes of weakness in the critically ill patient in the intensive care unit are critical illness polyneuropathy and critical illness myopathy. In the intensive care unit setting, electrophysiological studies, biopsies, and imaging studies are often necessary to complement the clinical impression.

Algorithms↗
PubMed2006

Gliomatosis cerebri angiographically mimicking central nervous system angiitis: case report.

OBJECTIVE: The diagnosis of isolated central nervous system angiitis often requires both cerebral angiography and biopsy for diagnosis. CLINICAL PRESENTATION: We present a case of gliomatosis cerebri with demonstrated angiographic changes suggestive of a central nervous system vasculitis. INTERVENTION: A 47-year-old woman presented with a 2-week history of worsening headache and progressive drowsiness. Magnetic resonance imaging scans revealed confluent nonenhancing T2-weighted hyperintensity involving the frontal white matter bilaterally, hypothalamus, and both thalami. A four-vessel angiogram revealed diffuse arterial beading with stenoses of a right frontal middle cerebral artery branch and the distal posterior cerebral artery and anterior cerebral artery branches, bilaterally. The biopsy revealed a Grade 2 fibrillary astrocytoma consistent with gliomatosis cerebri. CONCLUSION: Gliomatosis cerebri can mimic central nervous system vasculitis angiographically. Perivascular infiltration by tumor cells may be responsible for these changes.

Angiography, Digital Subtraction↗
PubMed2006

Pulmonary complications after intracerebral hemorrhage.

OBJECTIVE: There are no data on pulmonary complications in an selected population of patients with intracerebral hemorrhages (ICH). At present, most data is extrapolated from series of patients with stroke that combine patients with both ischemic and hemorrhagic strokes. The purpose of this study was to determine the frequency, types of pulmonary complications in patients with ICH, their association with clinical variables, and contribution to hospital stay. MATERIALS AND METHODS: A total of 144 consecutive patients with ICH between January 1999 and October 2003 were analyzed for pulmonary complications such as pneumonia, pulmonary edema, pulmonary embolism, or miscellaneous complications. RESULTS: Overall, 41 patients (28%, 95% confidence interval, 22-36%) developed pulmonary complications. The most common events were pneumonia (19%) and pulmonary edema (8%). Complications were most often encountered immediately after the onset of ICH (63% detected on the day of admission). Pulmonary complications lengthened the duration of hospital stay among survivors. CONCLUSIONS: Our study provides data on pulmonary complications after acute ICH. Almost one-third of patients with ICH develop pulmonary complications. Pulmonary complications increased morbidity, mortality, and duration of hospital stay. Aggressive management of these complications can potentially reduce the morbidity, mortality, duration of hospital stay, and financial expenditure incurred in this group of patients.

Aged↗
PubMed2006

Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction.

OBJECT: Neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage (SAH) is associated with a wide spectrum of reversible left ventricular wall motion abnormalities and includes a subset of patients with a pattern of apical akinesia and concomitant sparing of basal segments called "tako-tsubo cardiomyopathy". METHODS: After obtaining institutional review board approval, the authors retrospectively identified among all patients admitted to the Mayo Clinic's Neurological Intensive Care Unit between January 1990 and January 2005 those with aneurysmal SAH who had met the echocardiographic criteria for tako-tsubo cardiomyopathy. Among 24 patients with SAH-induced reversible cardiac dysfunction, the authors identified eight with SAH-induced tako-tsubo cardiomyopathy. All eight patients were women with a mean age of 55.5 years (range 38.6-71.1). Seven patients presented with a poor-grade SAH, reflected by a Hunt and Hess grade of III or IV. Four patients underwent aneurysm clip application, and four underwent endovascular coil occlusion. The initial mean ejection fraction (EF) was 38% (range 25-55%), and the mean EF at recovery was 55% (range 40-68%). Cerebral vasospasm developed in six patients, but cerebral infarction developed in only three patients. CONCLUSIONS: The authors describe the largest cohort with aneurysmal SAH-induced tako-tsubo cardiomyopathy. In the SAH population, tako-tsubo cardiomyopathy predominates in postmenopausal women and is often associated with pulmonary edema, prolonged intubation, and cerebral vasospasm. Additional studies are warranted to understand the complex mechanism involved in tako-tsubo cardiomyopathy and its intriguing relationship to neurogenic stunned myocardium.

Adult↗
PubMed2006

Coverage of coma in headlines of US newspapers from 2001 through 2005.

OBJECTIVE: To review journalists' preferences and accuracy in reporting comatose states. METHODS: Using the Lexis-Nexis database, we selected newspaper headlines from January 1, 2001, through December 31, 2005, that included the words coma, comatose, unconsciousness, vegetative state, awakening, and brain dead. RESULTS: We identified 340 stories by headlines. The median age of persons in coma was 26 years. Coma cases in men were twice as common as those in women. In 71% of coma cases, the cause of coma was associated with motor vehicle crashes or violence. Persistent vegetative state was reported in 25 articles (7%), frequently when a family or physician conflict emerged. In 33 stories (10%), coma was medically induced but not mentioned in the headline. Three "miracle" recoveries involved resumption of speech in patients in a minimally conscious state. CONCLUSION: Few news reports had gross inaccuracies or misrepresentations; however, definitional difficulties of unconscious states with the reporters remain. The reporting of coma may be biased toward violence and trauma. Medically induced coma was present in 1 of 10 reports but rarely mentioned in the headline.

Coma↗