Swedish consensus reached on recording, interpretation and reporting of neonatal continuous simplified electroencephalography that is supported by amplitude-integrated trend analysis.

Continuous monitoring of electroencephalography (EEG), with a focus on amplitude-integrated EEG (aEEG), has been used in neonatal intensive care for decades. A number of systems have been suggested for describing and quantifying aEEG patterns. Extensive full-montage EEG monitoring is used in specialised intensive care units. The American Clinical Neurophysiology Society published recommendations for defining and reporting EEG findings in critically ill adults and infants. Swedish neonatologists and clinical neurophysiologists collaborated to optimise simplified neonatal continuous aEEG and EEG recordings based on these American documents. CONCLUSION: This paper describes the Swedish consensus document produced by those meetings.

[Assessment of neurologic prognosis after cardiac arrest. Updated recommendations from the Swedish CPR Council Expert Group]. / Bedömning av neuro­logisk prognos efter hjärtstopp - Uppdaterade rekommendationer från Svenska HLR-rådets expertgrupp.

Assessment of neurologic prognosis after cardiac arrest. Updated recommendations from the Swedish CPR Council Expert Group European Resuscitation Council (ERC) issued updated guidelines for postresuscitation care in 2015. This paper provides updated Swedish recommendations for neurological prognostication of patients remaining unconscious after cardiac arrest (CA). The prognostication should be based on independent methods; clinical and neurophysiological examinations, imaging and biomarkers. It should not be performed earlier than three days after CA and any influence from sedatives must be negligible. Bilateral absence of both corneal and pupillary reflexes and bilaterally absent Somatosensory Evoked N20 Potentials (SSEP) at 72 hours are reliable predictors of poor outcome but the ocular reflexes have limited sensitivity and SSEP has limited availability. Hence, further delay of at least 24 hours and combinations of findings from multiple methods are often needed for reliable prognostication.  If firm evidence of a poor prognosis is lacking four days after CA, further expectation with repeated examinations is recommended.

[Multifocal motor neuropathy--unusual cause of hypoglossal palsy]. / Multifokal motorisk neuropati--ovanlig orsak till tungpares.

Multifocal motor neuropathy with conduction block (MMN-CB) very rarely presents with cranial nerve symptoms. We describe a 72-year old man who was referred for a neurological evaluation because of a one-year long history of right-sided hypoglossal palsy with fasciculations. Since the examination also revealed slight atrophy in the hands, a motor neuron disease (MND) was suspected. The neurophysiological examination revealed bilateral ulnar conduction blocks indicative of MMN-CB. The patient was treated with lvlg and improved considerably. A short review of MMN-CB and of hypoglossal palsies is presented. This is, to the best of our knowledge, the first case described in which MMN-CB presents with hypoglossal palsy.

Neurological prognostication after cardiac arrest--recommendations from the Swedish Resuscitation Council.

Cardiopulmonary resuscitation is started in 5000 victims of out-of-hospital cardiac arrest in Sweden each year and the survival rate is approximately 10%. The subsequent development of a global ischaemic brain injury is the major determinant of the neurological prognosis for those patients who reach the hospital alive. Induced hypothermia is a recommended treatment after cardiac arrest and has been implemented in most Swedish hospitals. Recent studies indicate that induced hypothermia may affect neurological prognostication and previous international recommendations are therefore no longer valid when hypothermia is applied. An expert group from the Swedish Resuscitation Council has reviewed the literature and made recommendations taking into account the effects of induced hypothermia and concomitant sedation. A delayed neurological evaluation at 72 h after rewarming is recommended for hypothermia treated patients. This evaluation should be based on several independent methods and the possibility of lingering pharmacological effects should be considered.