Functional MRI for Acute Covert Consciousness: Emerging Data and Implementation Case Series.

Although research studies have begun to demonstrate relationships between disorders of consciousness and brain network biomarkers, there are limited data on the practical aspects of obtaining such network biomarkers to potentially guide care. As the state of knowledge continues to evolve, guidelines from professional societies such as the American and European Academies of Neurology and many experts have advocated that the risk-benefit ratio for the assessment of network biomarkers has begun to favor their application toward potentially detecting covert consciousness. Given the lack of detailed operationalization guidance and the context of the ethical implications, herein we offer a roadmap based on local institutional experience with the implementation of functional MRI in the neonatal, pediatric, and adult intensive care units of our local government-supported health system. We provide a case-based demonstrative approach intended to review the current literature and to assist with the initiation of such services at other facilities.

Medical management of cerebral edema in large hemispheric infarcts.

Acute ischemic stroke confers a high burden of morbidity and mortality globally. Occlusion of large vessels of the anterior circulation, namely the intracranial carotid artery and middle cerebral artery, can result in large hemispheric stroke in ~8% of these patients. Edema from stroke can result in a cascade effect leading to local compression of capillary perfusion, increased stroke burden, elevated intracranial pressure, herniation and death. Mortality from large hemispheric stroke is generally high and surgical intervention may reduce mortality and improve good outcomes in select patients. For those patients who are not eligible candidates for surgical decompression either due timing, medical co-morbidities, or patient and family preferences, the mainstay of medical management for cerebral edema is hyperosmolar therapy. Other neuroprotectants for cerebral edema such as glibenclamide are under investigation. This review will discuss current guidelines and evidence for medical management of cerebral edema in large hemispheric stroke as well as discuss important neuromonitoring and critical care management targeted at reducing morbidity and mortality for these patients.

Endoscopic cystoventriculostomy of an arachnoid cyst using a neuroendovascular stent to maintain patency.

INTRODUCTION: Cystoventriculostomy is a surgical treatment for arachnoid cysts. We present a case using a neuroendovascular stent to maintain ostomy patency. CASE REPORT: A 6½-year-old male with symptomatic arachnoid cyst underwent endoscopic fenestration and Wingspan stent insertion. CONCLUSION: Neuroendovascular stent placement may be an adjunct to maintain patency in cystoventriculostomy.

Dural arteriovenous fistulas as a relative contraindication for lumbar puncture: brief report and literature review.

We report three patients who deteriorated after lumbar puncture (LP). Two patients were later found to have type іі (a + b) dural arteriovenous fistulas (DAVF) with high flow retrograde venous drainage on cerebral angiography. The third had a type II (a) DAVF. All patients recovered at least partially after DAVF treatment. In patients with signs and symptoms of increased intracranial pressure (ICP) but no evidence of focal mass lesion on cranial imaging, we suggest an evaluation for a DAVF before performing an LP.