[Key problems of nutritional support in patients with ischemic stroke and nontraumatic intracranial hemorrhage].

The presented systematic literature review is focused on the main problems of nutritional support as a complex treatment of patients with ischemic stroke and non-traumatic intracranial hemorrhage. Nutritional support is one of the main points of intensive care in patients with stroke with a neurological deficit. Conducting rational nutritional therapy in this category of patients requires taking into account the characteristics of both the main and concomitant pathologies, in particular diabetes mellitus, cardiovascular pathology. Deep analysis of recent data shows that a number of questions for assessing the severity of hypermetabolic syndrome and differentiated correction of protein and energy metabolic disorders in various clinical forms (ischemic, hemorrhagic) of cerebral stroke with or without comorbid pathology has not been studied enough and are waiting to be resolved. The search continues for new techniques and optimal algorithms for nutritional support with the subsequent development of appropriate clinical recommendations for use in this category of patients. Controversial issues remain regarding the timing of the start of nutritional support, protein and energy requirements, ways to control the adequacy and effectiveness of clinical nutrition.

Association between enteral nutrition support and neurological outcome in patients with acute intracranial haemorrhage: A retrospective cohort study.

Association between the amount of enteral nutrition (EN) caloric intake and Glasgow coma scale scores at discharge (GCSdis) in intracranial haemorrhage (ICH) was retrospectively investigated in 230 patients in a single center from 2015 and 2017. GCSdis was used as a dichotomous outcome (≤8 or >8: 56/230 vs. 174/230) and its association with the amount of EN caloric intake within 48 hours was analysed in four logistic models. Model 1 used EN as a continuous variable and showed association with favourable GCSdis (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.08). Models 2 and 3 categorized EN into two (≤25 and >25 kcal/kg/48 hrs) and three caloric intake levels (≤10, 10~25, and >25 kcal/kg/48 hrs) respectively, and compared them with the lowest level; highest EN level associated with favourable GCSdis in both model 2 (OR, 2.77; 95%CI, 1.25-6.13) and 3 (OR, 4.68; 95%CI, 1.61-13.61). Model 4 transformed EN into four quartiles (Q1-Q4). Compared to Q1, OR increased stepwise from Q2 (OR 1.80, 95%CI 0.59-5.44) to Q4 (OR 4.71, 95%CI 1.49-14.80). Propensity score matching analysis of 69 matched pairs demonstrated consistent findings. In the early stage of ICH, increased EN was associated with favourable GCSdis.

Findings and differential diagnosis of fetal intracranial haemorrhage and fetal ischaemic brain injury: what is the role of fetal MRI?

Ventriculomegaly (VM) is a non-specific finding on fetal imaging. Identification of the specific aetiology is important, as it affects prognosis and may even change the course of current or future pregnancies. In this review, we will focus on the application of fetal MRI to demonstrate intracranial haemorrhage and ischaemic brain injury as opposed to other causes of VM. MRI is able to identify the specific aetiology of VM with much more sensitivity and specificity than ultrasound and should be considered whenever VM is identified on obstetric ultrasound. Advances in both fetal and neonatal MRI have the potential to shed further light on mechanisms of brain injury and the impact of chronic hypoxia; such information may guide future interventions.

[Infection Control Effect of Dietary Fluid with Whey Peptide in the Management of Patients with Severe Intracranial Hemorrhage During the Acute Stage].

UNLABELLED: Abstract BACKGROUND AND PURPOSE: Patients with severe intracranial hemorrhage (ICH) often develop infectious complications during the acute stage. Animal experiments have demonstrated that enteral immunonutrition with a dietary fluid containing whey peptide (WP) enhances immunoactivity and prevents infection. The aim of the current study was to investigate the infection control effect of WP in the clinical management of patients with severe ICH. METHODS: Fourteen patients with ICH were given enteral nutrition from January 2012 to December 2012. Nine patients were given WP (WP group) and the other five were given control dietary fluid (Non-WP group) for two weeks. We retrospectively analyzed the incidence of infectious complications and chronological changes in white blood cell (WBC) count, C-reactive protein (CRP), and total lymphocyte count. RESULTS: All patients in the Non-WP Group experienced infectious complications, whereas 5 out of 9 patients in the WP Group did not experience them. There was a tendency for a decrease in WBC count and CRP value in the WP group. In contrast, WBC and CRP increased in 3 patients in the Non-WP Group. Total lymphocyte count tended to increase earlier in the WP Group; however this tendency was not noted in the Non-WP Group. CONCLUSION: Although the number of cases was small, our study suggests that WP might have an infection control effect, capable of preventing infectious complications associated with severe ICH in the acute stage.