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  1. Article ; Online: Acute Coma.

    Sakusic, Amra / Rabinstein, Alejandro A

    Neurologic clinics

    2021  Volume 39, Issue 2, Page(s) 257–272

    Abstract: An acutely comatose patient constitutes a medical emergency until proved otherwise. Managing these emergencies requires organized teamwork to recognize and treat life-threatening situations and reversible causes of coma. Once vital functions have been ... ...

    Abstract An acutely comatose patient constitutes a medical emergency until proved otherwise. Managing these emergencies requires organized teamwork to recognize and treat life-threatening situations and reversible causes of coma. Once vital functions have been stabilized, information from the history and physical examination should be used to rationally guide subsequent testing. Identifying causes of coma for which emergency treatment is possible should be the priority. The treatment and prognosis depend on the cause.
    MeSH term(s) Coma/diagnosis ; Coma/physiopathology ; Coma/therapy ; Humans
    Language English
    Publishing date 2021-04-24
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1013148-6
    ISSN 1557-9875 ; 0733-8619
    ISSN (online) 1557-9875
    ISSN 0733-8619
    DOI 10.1016/j.ncl.2021.01.001
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  2. Article ; Online: Neurological Complications in Patients with Heart Transplantation.

    Sakusic, Amra / Rabinstein, Alejandro A

    Seminars in neurology

    2021  Volume 41, Issue 4, Page(s) 447–452

    Abstract: Neurological complications after heart transplantation are common and include cerebrovascular events (ischemic strokes, hemorrhagic strokes, and transient ischemic attacks), seizures, encephalopathy, central nervous system (CNS) infections, malignancies, ...

    Abstract Neurological complications after heart transplantation are common and include cerebrovascular events (ischemic strokes, hemorrhagic strokes, and transient ischemic attacks), seizures, encephalopathy, central nervous system (CNS) infections, malignancies, and peripheral nervous system complications. Although most neurological complications are transient, strokes and CNS infections can result in high mortality and morbidity. Early recognition and timely management of these serious complications are crucial to improve survival and recovery. Diagnosing CNS infections can be challenging because their clinical presentation can be subtle in the setting of immunosuppression. Immunosuppressive medications themselves can cause a broad spectrum of neurological complications including seizures and posterior reversible encephalopathy syndrome. This article provides a review of the diagnosis and management of neurological complications after cardiac transplantation.
    MeSH term(s) Central Nervous System Infections ; Heart Transplantation/adverse effects ; Humans ; Immunosuppressive Agents ; Posterior Leukoencephalopathy Syndrome ; Stroke
    Chemical Substances Immunosuppressive Agents
    Language English
    Publishing date 2021-04-13
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603165-1
    ISSN 1098-9021 ; 0271-8235
    ISSN (online) 1098-9021
    ISSN 0271-8235
    DOI 10.1055/s-0041-1726285
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  3. Article ; Online: The authors reply.

    Sakusic, Amra / Rabinstein, Alejandro A

    Critical care medicine

    2019  Volume 47, Issue 6, Page(s) e532

    MeSH term(s) Case-Control Studies ; Cognitive Dysfunction ; Critical Illness ; Humans ; Risk Factors
    Language English
    Publishing date 2019-05-29
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000003758
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  4. Article: Neurological Complications in Patients with Heart Transplantation

    Sakusic, Amra / Rabinstein, Alejandro A.

    Seminars in Neurology

    (Neurology of Cardiovascular Disease)

    2021  Volume 41, Issue 04, Page(s) 447–452

    Abstract: Neurological complications after heart transplantation are common and include cerebrovascular events (ischemic strokes, hemorrhagic strokes, and transient ischemic attacks), seizures, encephalopathy, central nervous system (CNS) infections, malignancies, ...

    Series title Neurology of Cardiovascular Disease
    Abstract Neurological complications after heart transplantation are common and include cerebrovascular events (ischemic strokes, hemorrhagic strokes, and transient ischemic attacks), seizures, encephalopathy, central nervous system (CNS) infections, malignancies, and peripheral nervous system complications. Although most neurological complications are transient, strokes and CNS infections can result in high mortality and morbidity. Early recognition and timely management of these serious complications are crucial to improve survival and recovery. Diagnosing CNS infections can be challenging because their clinical presentation can be subtle in the setting of immunosuppression. Immunosuppressive medications themselves can cause a broad spectrum of neurological complications including seizures and posterior reversible encephalopathy syndrome. This article provides a review of the diagnosis and management of neurological complications after cardiac transplantation.
    Keywords neurological complications ; heart transplantation ; cerebrovascular events ; central nervous system infections ; seizures
    Language English
    Publishing date 2021-04-13
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 603165-1
    ISSN 1098-9021 ; 0271-8235
    ISSN (online) 1098-9021
    ISSN 0271-8235
    DOI 10.1055/s-0041-1726285
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  5. Article ; Online: Cognitive outcomes after critical illness.

    Sakusic, Amra / Rabinstein, Alejandro A

    Current opinion in critical care

    2018  Volume 24, Issue 5, Page(s) 410–414

    Abstract: Purpose of review: There is an increasing realization in the critical care community that persistent cognitive impairment is a common and disabling complication after ICU care. In this review, we discuss the best available information on the magnitude ... ...

    Abstract Purpose of review: There is an increasing realization in the critical care community that persistent cognitive impairment is a common and disabling complication after ICU care. In this review, we discuss the best available information on the magnitude of the problem, its possible mechanisms, risk factors, management strategies and prognosis.
    Recent findings: Estimates of the incidence of persistent cognitive impairment after critical illness vary widely across studies but the most solid prospective information indicates that it may occur in 20-40% of patients discharged from the ICU. From the available evidence, it is difficult to discriminate between de novo cognitive impairment and exacerbation of preexistent cognitive decline. The pathogenesis is multifactorial but inflammatory mechanisms causing derangements of endothelial function and blood-brain barrier integrity might play an important role. Brain atrophy and white matter tract disruption can be structural correlates of the cognitive decline. Prolonged delirium in the ICU is the strongest risk factor for the development of subsequent persistent cognitive impairment. Management strategies are currently limited to those designed to prevent and improve delirium. Cognitive trajectories may vary but a substantial proportion of patients with cognitive impairment 3 months after ICU discharge are still cognitively impaired at 12 months.
    Summary: Persistent cognitive impairment is a major complication of critical illness. Our knowledge of this problem remains incomplete. Collaborative research is indispensable to improve our understanding of this disabling sequel and to identify ways to prevent it.
    MeSH term(s) Cognitive Dysfunction/etiology ; Cognitive Dysfunction/physiopathology ; Critical Care ; Critical Illness/psychology ; Critical Illness/rehabilitation ; Endothelium/injuries ; Endothelium/physiopathology ; Executive Function/physiology ; Humans ; Inflammation/complications ; Inflammation/physiopathology ; Intensive Care Units ; Survivors/psychology
    Language English
    Publishing date 2018-08-17
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1235629-3
    ISSN 1531-7072 ; 1070-5295
    ISSN (online) 1531-7072
    ISSN 1070-5295
    DOI 10.1097/MCC.0000000000000527
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    Zs.A 4999: Show issues Location:
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  6. Article ; Online: Chronic critical illness: unintended consequence of intensive care medicine.

    Sakusic, Amra / Gajic, Ognjen

    The Lancet. Respiratory medicine

    2016  Volume 4, Issue 7, Page(s) 531–532

    Language English
    Publishing date 2016-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 2686754-0
    ISSN 2213-2619 ; 2213-2600
    ISSN (online) 2213-2619
    ISSN 2213-2600
    DOI 10.1016/S2213-2600(16)30066-2
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  7. Article ; Online: Case Studies in Neurocritical Care.

    Sakusic, Amra / Rabinstein, Alejandro A

    Neurologic clinics

    2016  Volume 34, Issue 3, Page(s) 683–697

    Abstract: The practice of neurocritical care encompasses multiple acute neurologic and neurosurgical diseases and requires detailed knowledge of neurology and critical care. This article presents 5 cases that illustrate just some of the conditions encountered in ... ...

    Abstract The practice of neurocritical care encompasses multiple acute neurologic and neurosurgical diseases and requires detailed knowledge of neurology and critical care. This article presents 5 cases that illustrate just some of the conditions encountered in the daily practice of neurocritical care and exemplify some of the common diagnostic, therapeutic, and prognostic challenges facing the neurointensivist. Life-threatening medical complications after severe acute ischemic stroke, seizures and extreme agitation from autoimmune encephalitis, refractory seizures after subdural hemorrhage, neurologic and systemic complications related to aneurysmal subarachnoid hemorrhage, and status epilepticus after cardiac arrest are discussed in this article.
    MeSH term(s) Aged ; Critical Care ; Encephalitis/diagnosis ; Encephalitis/therapy ; Female ; Hashimoto Disease/diagnosis ; Hashimoto Disease/therapy ; Humans ; Intracranial Hemorrhages/diagnosis ; Intracranial Hemorrhages/therapy ; Male ; Middle Aged ; Nervous System Diseases/diagnosis ; Nervous System Diseases/etiology ; Nervous System Diseases/therapy ; Prognosis ; Seizures/therapy ; Stroke/diagnosis ; Stroke/therapy ; Subarachnoid Hemorrhage/diagnosis ; Subarachnoid Hemorrhage/therapy ; Young Adult
    Language English
    Publishing date 2016-08
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 1013148-6
    ISSN 1557-9875 ; 0733-8619
    ISSN (online) 1557-9875
    ISSN 0733-8619
    DOI 10.1016/j.ncl.2016.04.007
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  8. Article ; Online: Timing of ARDS Onset. A Neglected Confounder.

    Sakusic, Amra / Gajic, Ognjen

    Annals of the American Thoracic Society

    2015  Volume 12, Issue 9, Page(s) 1261–1262

    MeSH term(s) Acute Lung Injury/diagnosis ; Acute Lung Injury/etiology ; Erythrocyte Transfusion/adverse effects ; Female ; Humans ; Male ; Respiratory Distress Syndrome, Adult/etiology
    Language English
    Publishing date 2015-09
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 2717461-X
    ISSN 2325-6621 ; 1943-5665 ; 2325-6621
    ISSN (online) 2325-6621 ; 1943-5665
    ISSN 2325-6621
    DOI 10.1513/AnnalsATS.201507-416ED
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    Zs.A 5828: Show issues Location:
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  9. Article: Balamuthia mandrillaris

    Sakusic, Amra / Chen, Baibing / McPhearson, Kimberly / Badi, Mohammed / Freeman, William D / Huang, Josephine F / Siegel, Jason L / Jentoft, Mark E / Oring, Justin M / Verdecia, Jorge / Meschia, James F

    Open forum infectious diseases

    2023  Volume 10, Issue 3, Page(s) ofad094

    Abstract: We present the case of a 61-year-old woman with a history of orthotopic heart transplant who was hospitalized with new-onset headache. Magnetic resonance imaging (MRI) of the brain revealed T2 hyperintense signal involving the left occipital lobe with ... ...

    Abstract We present the case of a 61-year-old woman with a history of orthotopic heart transplant who was hospitalized with new-onset headache. Magnetic resonance imaging (MRI) of the brain revealed T2 hyperintense signal involving the left occipital lobe with leptomeningeal enhancement and mild vasogenic edema. Initial neurologic examination was normal; however, after 7 days she developed imbalance, visual disturbances, night sweats, bradyphrenia, alexia without agraphia, and right hemianopsia. Brain MRI showed enlargement of the left occipital mass and worsening edema. Stereotactic needle biopsy showed nondiagnostic necrosis. The patient continued to deteriorate despite dexamethasone. Cerebrospinal fluid (CSF) suggested infection, and cytomegalovirus CSF polymerase chain reaction (PCR) was positive. The patient received vancomycin, imipenem, and ganciclovir. After obtaining a positive serum beta-D-glucan (Fungitell), amphotericin was added. Despite best medical efforts, the patient died. Postmortem broad-range PCR sequencing of the brain tissue was positive for rare amoeba
    Language English
    Publishing date 2023-02-21
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2757767-3
    ISSN 2328-8957
    ISSN 2328-8957
    DOI 10.1093/ofid/ofad094
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  10. Article ; Online: Novel grading system for CADASIL severity: A multicenter cross-sectional study.

    Anisetti, Bhrugun / Greco, Elena / Stojadinovic, Eldina / Goldstein, Eric D / Sakusic, Amra / Badi, Mohammed K / Liu, Michael D / Lin, Michelle P / Chiang, Chia-Chun / Elahi, Fanny M / Worrall, Bradford B / Petrosian, Derek / Ross, Owen / Meschia, James F

    Cerebral circulation - cognition and behavior

    2023  Volume 5, Page(s) 100170

    Abstract: Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited progressive cerebral microangiopathy with considerable phenotypic variability. The purpose of this study was to describe the ...

    Abstract Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited progressive cerebral microangiopathy with considerable phenotypic variability. The purpose of this study was to describe the generalizability of a recently proposed grading system of CADASIL across multiple centers in the United States.
    Methods: Electronic medical records (EMR) of an initial neurological assessment of adult patients with confirmed CADASIL were reviewed across 5 tertiary referral medical centers with expertise in CADASIL. Demographic, vascular risk factors, and neuroimaging data were abstracted from EMR. Patients were categorized into groups according to the proposed CADASIL grading system: Grade 0 (asymptomatic), Grade 1 (migraine only), Grade 2 (stroke, TIA, or MCI), Grade 3 (gait assistance or dementia), and Grade 4 (bedbound or end-stage). Inter-rater reliability (IRR) of grading was tested in a subset of cases.
    Results: We identified 138 patients with a mean age of 50.9 ± 13.1 years, and 57.2% were female. The IRR was acceptable over 33 cases (κ=0.855, SD 0.078,
    Conclusion: The CADASIL severity grading system is a pragmatic, reliable system for characterizing CADASIL phenotype that does not require testing beyond that done in standard clinical practice. Higher severity grades tended to have a higher vascular risk factor burden. This system offers a simple method of categorizing CADASIL patients which may help to describe populations in observational and interventional studies.
    Language English
    Publishing date 2023-06-11
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2666-2450
    ISSN (online) 2666-2450
    DOI 10.1016/j.cccb.2023.100170
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