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  1. Article ; Online: Management of anticoagulant-related intracranial hemorrhage: an evidence-based review.

    Ray, Bappaditya / Keyrouz, Salah G

    Critical care (London, England)

    2014  Volume 18, Issue 3, Page(s) 223

    MeSH term(s) Anticoagulants/therapeutic use ; Disease Management ; Evidence-Based Medicine/methods ; Humans ; Intracranial Hemorrhages/diagnosis ; Intracranial Hemorrhages/drug therapy ; Intracranial Hemorrhages/epidemiology
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2014-05-23
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/cc13889
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Posterior Reversible Encephalopathy Syndrome as a Complication of Induced Hypertension in Subarachnoid Hemorrhage: A Case-Control Study.

    Allen, Michelle L / Kulik, Tobias / Keyrouz, Salah G / Dhar, Rajat

    Neurosurgery

    2018  Volume 85, Issue 2, Page(s) 223–230

    Abstract: Background: Induced hypertension (IH) remains the mainstay of medical management for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). However, raising blood pressure above normal levels may be associated with systemic and ... ...

    Abstract Background: Induced hypertension (IH) remains the mainstay of medical management for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). However, raising blood pressure above normal levels may be associated with systemic and neurological complications, of which posterior reversible encephalopathy syndrome (PRES) has been increasingly recognized.
    Objective: To ascertain the frequency and predisposing factors for PRES during IH therapy.
    Methods: We identified 68 patients treated with IH from 345 SAH patients over a 3-yr period. PRES was diagnosed based on clinical suspicion, confirmed by imaging. We extracted additional data on IH, including baseline and highest target mean arterial pressure (MAP), comparing PRES to IH-treated controls.
    Results: Five patients were diagnosed with PRES at median 6.6 d (range 1-8 d) from vasopressor initiation. All presented with lethargy, 3 had new focal deficits, and 1 had a seizure. Although baseline MAP (prior to DCI) did not differ between cases and controls, both MAP immediately prior to IH (112 vs 90) and highest MAP targeted were greater (140 vs 120 mm Hg, both P < .01). Magnitude of MAP elevation was greater (54 vs 34 above baseline, P = .004) while degree of IH was not (37 vs 38 above pre-IH MAP). All 4 surviving PRES patients had complete resolution with IH discontinuation.
    Conclusion: PRES was diagnosed in 7% of SAH patients undergoing IH therapy, most often when MAP was raised well above baseline to levels that exceed traditional autoregulatory thresholds. High suspicion for this reversible disorder appears warranted in the face of unexplained neurological deterioration during aggressive IH.
    MeSH term(s) Adult ; Brain Ischemia/drug therapy ; Brain Ischemia/etiology ; Case-Control Studies ; Female ; Humans ; Hypertension/chemically induced ; Male ; Middle Aged ; Posterior Leukoencephalopathy Syndrome/etiology ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/drug therapy ; Vasoconstrictor Agents/therapeutic use
    Chemical Substances Vasoconstrictor Agents
    Language English
    Publishing date 2018-06-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 135446-2
    ISSN 1524-4040 ; 0148-396X
    ISSN (online) 1524-4040
    ISSN 0148-396X
    DOI 10.1093/neuros/nyy240
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Diffuse leptomeningeal carcinomatosis mimicking brain death.

    Kung, Nathan H / Dhar, Rajat / Keyrouz, Salah G

    Journal of the neurological sciences

    2015  Volume 352, Issue 1-2, Page(s) 132–134

    MeSH term(s) Aged ; Brain Death/diagnosis ; Brain Death/pathology ; Brain Death/physiopathology ; Diagnosis, Differential ; Humans ; Male ; Meningeal Carcinomatosis/complications ; Meningeal Carcinomatosis/pathology ; Meningeal Carcinomatosis/physiopathology
    Language English
    Publishing date 2015-05-15
    Publishing country Netherlands
    Document type Case Reports ; Letter
    ZDB-ID 80160-4
    ISSN 1878-5883 ; 0022-510X ; 0374-8642
    ISSN (online) 1878-5883
    ISSN 0022-510X ; 0374-8642
    DOI 10.1016/j.jns.2015.03.045
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Year in review 2011: Critical Care--Neurocritical care.

    Keyrouz, Salah G / Diringer, Michael N

    Critical care (London, England)

    2012  Volume 16, Issue 6, Page(s) 245

    Abstract: Contributions from the neurosciences to Critical Care in 2011 covered an array of topics. We learned about potential biomarkers for, and the effect of cerebral oxygen metabolism on, delirium, in addition to treatment of the latter. A group of ... ...

    Abstract Contributions from the neurosciences to Critical Care in 2011 covered an array of topics. We learned about potential biomarkers for, and the effect of cerebral oxygen metabolism on, delirium, in addition to treatment of the latter. A group of investigators studied surface cooling in healthy awake volunteers, and incidence of infection associated with therapeutic hypothermia. The effects of statin and erythropoietin on stroke were revisited, and the role of adhesion molecule in the inflammatory reaction accompanying intracerebral hemorrhage was scrutinized. Biomarkers in subarachnoid hemorrhage and their relationship to vasospasm and outcome, and effect of daylight on outcome in this patient population, as well as a new meta-analysis of statin therapy were among the research in subarachnoid hemorrhage. Moreover, 2011 witnessed the publication of a multidisciplinary consensus conference's recommendations on the critical care management of subarachnoid hemorrhage. Results of studies regarding the diagnosis and vascular complications of meningitis were reported. Traumatic brain injury received its share of articles addressing therapy with hypertonic saline and surgical decompression, the development of coagulopathy, and biomarkers to help with prognostication. Finally, research on the treatment of Guillain-Barre syndrome in children, prediction of long-term need of ventilatory support, and pathophysiology of critical illness polyneuropathy and myopathy were reported.
    MeSH term(s) Brain Injuries/therapy ; Critical Care/methods ; Critical Illness/therapy ; Delirium/therapy ; Humans ; Hypothermia, Induced ; Nervous System Diseases/therapy ; Peripheral Nervous System Diseases/therapy ; Stroke/therapy ; Subarachnoid Hemorrhage/therapy
    Language English
    Publishing date 2012-12-10
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/cc11825
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Trial of Early Minimally Invasive Removal of Intracerebral Hemorrhage.

    Pradilla, Gustavo / Ratcliff, Jonathan J / Hall, Alex J / Saville, Benjamin R / Allen, Jason W / Paulon, Giorgio / McGlothlin, Anna / Lewis, Roger J / Fitzgerald, Mark / Caveney, Angela F / Li, Xiao T / Bain, Mark / Gomes, Joao / Jankowitz, Brain / Zenonos, Georgios / Molyneaux, Bradley J / Davies, Jason / Siddiqui, Adnan / Chicoine, Michael R /
    Keyrouz, Salah G / Grossberg, Jonathan A / Shah, Mitesh V / Singh, Ranjeet / Bohnstedt, Bradley N / Frankel, Michael / Wright, David W / Barrow, Daniel L

    The New England journal of medicine

    2024  Volume 390, Issue 14, Page(s) 1277–1289

    Abstract: Background: Trials of surgical evacuation of supratentorial intracerebral hemorrhages have generally shown no functional benefit. Whether early minimally invasive surgical removal would result in better outcomes than medical management is not known.: ... ...

    Abstract Background: Trials of surgical evacuation of supratentorial intracerebral hemorrhages have generally shown no functional benefit. Whether early minimally invasive surgical removal would result in better outcomes than medical management is not known.
    Methods: In this multicenter, randomized trial involving patients with an acute intracerebral hemorrhage, we assessed surgical removal of the hematoma as compared with medical management. Patients who had a lobar or anterior basal ganglia hemorrhage with a hematoma volume of 30 to 80 ml were assigned, in a 1:1 ratio, within 24 hours after the time that they were last known to be well, to minimally invasive surgical removal of the hematoma plus guideline-based medical management (surgery group) or to guideline-based medical management alone (control group). The primary efficacy end point was the mean score on the utility-weighted modified Rankin scale (range, 0 to 1, with higher scores indicating better outcomes, according to patients' assessment) at 180 days, with a prespecified threshold for posterior probability of superiority of 0.975 or higher. The trial included rules for adaptation of enrollment criteria on the basis of hemorrhage location. A primary safety end point was death within 30 days after enrollment.
    Results: A total of 300 patients were enrolled, of whom 30.7% had anterior basal ganglia hemorrhages and 69.3% had lobar hemorrhages. After 175 patients had been enrolled, an adaptation rule was triggered, and only persons with lobar hemorrhages were enrolled. The mean score on the utility-weighted modified Rankin scale at 180 days was 0.458 in the surgery group and 0.374 in the control group (difference, 0.084; 95% Bayesian credible interval, 0.005 to 0.163; posterior probability of superiority of surgery, 0.981). The mean between-group difference was 0.127 (95% Bayesian credible interval, 0.035 to 0.219) among patients with lobar hemorrhages and -0.013 (95% Bayesian credible interval, -0.147 to 0.116) among those with anterior basal ganglia hemorrhages. The percentage of patients who had died by 30 days was 9.3% in the surgery group and 18.0% in the control group. Five patients (3.3%) in the surgery group had postoperative rebleeding and neurologic deterioration.
    Conclusions: Among patients in whom surgery could be performed within 24 hours after an acute intracerebral hemorrhage, minimally invasive hematoma evacuation resulted in better functional outcomes at 180 days than those with guideline-based medical management. The effect of surgery appeared to be attributable to intervention for lobar hemorrhages. (Funded by Nico; ENRICH ClinicalTrials.gov number, NCT02880878.).
    MeSH term(s) Humans ; Basal Ganglia Hemorrhage/mortality ; Basal Ganglia Hemorrhage/surgery ; Basal Ganglia Hemorrhage/therapy ; Bayes Theorem ; Cerebral Hemorrhage/mortality ; Cerebral Hemorrhage/surgery ; Cerebral Hemorrhage/therapy ; Minimally Invasive Surgical Procedures/methods ; Treatment Outcome ; Neuroendoscopy
    Language English
    Publishing date 2024-04-05
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMoa2308440
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Stroke prevention and treatment.

    Marsh, James D / Keyrouz, Salah G

    Journal of the American College of Cardiology

    2010  Volume 56, Issue 9, Page(s) 683–691

    Abstract: The decline in stroke incidence and mortality in the U.S. over the past 20 years is reaching a plateau, and the number of strokes may actually start to increase as the population ages. However, recent clinical trials have demonstrated that there are ... ...

    Abstract The decline in stroke incidence and mortality in the U.S. over the past 20 years is reaching a plateau, and the number of strokes may actually start to increase as the population ages. However, recent clinical trials have demonstrated that there are numerous opportunities to improve stroke prevention strategies and also opportunities to effectively intervene in and treat acute strokes. For patients with diabetes and for those with prior strokes or transient ischemic attacks, it has become evident that aggressive low-density lipoprotein lowering with statin medications will decrease the risk for total and fatal strokes. Optimal anticoagulation and antiplatelet therapy for primary and secondary stroke prevention in atrial fibrillation is being carefully defined. With numerous novel factor Xa and direct thrombin inhibitor drugs completing phase III clinical trials, it is likely that additional oral anticoagulant drugs will be clinically available for stroke prevention soon. Additionally, a major clinical trial is nearing completion that may resolve the role of carotid stenting and carotid endarterectomy in primary and secondary stroke prevention. There are recent notable advances in the acute treatment of stroke. It is likely that the time window for thrombolysis for appropriate patients with strokes will be increased from 3 to 4.5 h, permitting the inclusion of more patients in this treatment approach. There is ongoing investigation of intra-arterial thrombolysis and of acute intra-arterial thrombus extraction for treatment of selected patients with strokes. Unlike the progress in treatment of ischemic strokes, treatment of hemorrhagic stroke is progressing more slowly.
    MeSH term(s) Anticoagulants/administration & dosage ; Atrial Fibrillation/complications ; Brain Ischemia/therapy ; Cholesterol, LDL/drug effects ; Diabetic Angiopathies/prevention & control ; Endarterectomy, Carotid ; Foramen Ovale, Patent/complications ; Heart Diseases/complications ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Hypertension/complications ; International Normalized Ratio ; Intracranial Hemorrhages/therapy ; Stents ; Stroke/epidemiology ; Stroke/prevention & control ; Stroke/therapy ; Thrombectomy ; Thrombolytic Therapy ; Thrombosis/complications ; United States/epidemiology ; Warfarin/administration & dosage
    Chemical Substances Anticoagulants ; Cholesterol, LDL ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Warfarin (5Q7ZVV76EI)
    Language English
    Publishing date 2010-08-24
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 605507-2
    ISSN 1558-3597 ; 0735-1097
    ISSN (online) 1558-3597
    ISSN 0735-1097
    DOI 10.1016/j.jacc.2009.12.072
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Bicaudate infarcts in the setting of congenital absence of A

    Tahsili-Fahadan, Pouya / Yahyavi-Firouz-Abadi, Noushin / Keyrouz, Salah G / Pestronk, Alan

    Neurology. Clinical practice

    2015  Volume 5, Issue 6, Page(s) 540–541

    Language English
    Publishing date 2015-11-17
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2645818-4
    ISSN 2163-0933 ; 2163-0402
    ISSN (online) 2163-0933
    ISSN 2163-0402
    DOI 10.1212/CPJ.0000000000000163
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Cervical artery dissection: risk factors, treatment, and outcome; a 5-year experience from a tertiary care center.

    Yaghi, Shadi / Maalouf, Nancy / Keyrouz, Salah G

    The International journal of neuroscience

    2012  Volume 122, Issue 1, Page(s) 40–44

    Abstract: Background: Cervical artery dissection (CAD) is a common cause of stroke in young individuals. Risk factors, treatment, and outcome of CAD are not well established. Our aim is to identify risk factors, outcome, and discuss treatment of CAD.: Methods: ...

    Abstract Background: Cervical artery dissection (CAD) is a common cause of stroke in young individuals. Risk factors, treatment, and outcome of CAD are not well established. Our aim is to identify risk factors, outcome, and discuss treatment of CAD.
    Methods: We reviewed medical records of patients seen at our institution between 2004 and 2009, using ICD-9 codes for CAD, for risk factors, treatment, type, and outcome. Poor outcome was defined as modified Rankin Scale (mRS) score within 6 months of >1 or recurrent stroke or transient ischemic attack (TIA).
    Results: A total of 47 patients were identified. Twenty-four patients had spontaneous dissections (52%); 30 (63%) involved the carotid. As compared with spontaneous dissections, traumatic dissections occurred in younger patients (mean age 41.0 vs. 47.7 years, p = .064), were more likely to involve the vertebral artery (52% vs. 21%, p = .036, and caused less neurological deficits on presentation (48% vs. 75%, p = .075). Conversely, spontaneous dissections were more likely to occur in patients with hypertension (63% vs. 30%, p = .041) and hypercholesterolemia (46% vs. 9%, p = .008). Patients having no stroke had better outcomes (100% vs. 54%, p < .001). Anticoagulation was used in 17 patients (36%) and antiplatelets in 31 (64%). Outcome and adverse events were similar in the two groups.
    Conclusion: Hypertension and hypercholesterolemia were risk factors in spontaneous dissections, speaking for vascular wall abnormalities as potential contributors to pathophysiology of CAD. There was no evidence supporting one type of treatment over the other. A large ongoing prospective study should quell this controversy.
    MeSH term(s) Adult ; Arkansas/epidemiology ; Carotid Artery, Internal, Dissection/diagnosis ; Carotid Artery, Internal, Dissection/epidemiology ; Carotid Artery, Internal, Dissection/therapy ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Neck Injuries/diagnosis ; Neck Injuries/epidemiology ; Retrospective Studies ; Risk Factors ; Stroke/etiology ; Stroke/physiopathology ; Stroke/prevention & control ; Treatment Outcome ; Vertebral Artery Dissection/diagnosis ; Vertebral Artery Dissection/epidemiology ; Vertebral Artery Dissection/therapy
    Language English
    Publishing date 2012-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 3061-2
    ISSN 1563-5279 ; 1543-5245 ; 0020-7454
    ISSN (online) 1563-5279 ; 1543-5245
    ISSN 0020-7454
    DOI 10.3109/00207454.2011.622453
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  9. Article ; Online: An unusual presentation of a vein of Galen thrombosis.

    Yaghi, Shadi / Amole, Adewumi / Akdol, Mehmet S / Keyrouz, Salah G

    Acta neurologica Belgica

    2012  Volume 112, Issue 4, Page(s) 419–420

    MeSH term(s) Cerebral Angiography ; Cerebral Veins/diagnostic imaging ; Humans ; Male ; Middle Aged ; Venous Thrombosis/diagnostic imaging
    Language English
    Publishing date 2012-12
    Publishing country Italy
    Document type Case Reports ; Journal Article
    ZDB-ID 127315-2
    ISSN 2240-2993 ; 0300-9009
    ISSN (online) 2240-2993
    ISSN 0300-9009
    DOI 10.1007/s13760-012-0088-z
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  10. Article ; Online: Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage.

    Keyrouz, Salah G / Diringer, Michael N

    Critical care (London, England)

    2007  Volume 11, Issue 4, Page(s) 220

    Abstract: Vasospasm is one of the leading causes of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Radiographic vasospasm usually develops between 5 and 15 days after the initial hemorrhage, and is associated with clinically apparent ... ...

    Abstract Vasospasm is one of the leading causes of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Radiographic vasospasm usually develops between 5 and 15 days after the initial hemorrhage, and is associated with clinically apparent delayed ischemic neurological deficits (DID) in one-third of patients. The pathophysiology of this reversible vasculopathy is not fully understood but appears to involve structural changes and biochemical alterations at the levels of the vascular endothelium and smooth muscle cells. Blood in the subarachnoid space is believed to trigger these changes. In addition, cerebral perfusion may be concurrently impaired by hypovolemia and impaired cerebral autoregulatory function. The combined effects of these processes can lead to reduction in cerebral blood flow so severe as to cause ischemia leading to infarction. Diagnosis is made by some combination of clinical, cerebral angiographic, and transcranial doppler ultrasonographic factors. Nimodipine, a calcium channel antagonist, is so far the only available therapy with proven benefit for reducing the impact of DID. Aggressive therapy combining hemodynamic augmentation, transluminal balloon angioplasty, and intra-arterial infusion of vasodilator drugs is, to varying degrees, usually implemented. A panoply of drugs, with different mechanisms of action, has been studied in SAH related vasospasm. Currently, the most promising are magnesium sulfate, 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors, nitric oxide donors and endothelin-1 antagonists. This paper reviews established and emerging therapies for vasospasm.
    MeSH term(s) Angioplasty, Balloon/methods ; Calcium Channel Blockers/therapeutic use ; Cerebral Angiography ; Endothelin-1/antagonists & inhibitors ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Neuroprotective Agents/therapeutic use ; Nimodipine/therapeutic use ; Nitric Oxide Donors/therapeutic use ; Pregnatrienes/therapeutic use ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/physiopathology ; Subarachnoid Hemorrhage/therapy ; Thrombolytic Therapy/methods ; Ultrasonography, Doppler, Transcranial ; Vasodilator Agents/therapeutic use ; Vasospasm, Intracranial/diagnosis ; Vasospasm, Intracranial/etiology ; Vasospasm, Intracranial/physiopathology ; Vasospasm, Intracranial/prevention & control
    Chemical Substances Calcium Channel Blockers ; Endothelin-1 ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Neuroprotective Agents ; Nitric Oxide Donors ; Pregnatrienes ; Vasodilator Agents ; Nimodipine (57WA9QZ5WH) ; tirilazad (YD064E883I)
    Language English
    Publishing date 2007-08-20
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/cc5958
    Database MEDical Literature Analysis and Retrieval System OnLINE

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