Neurophysiological monitoring is important for the assessment and prediction of regression in patients with severe neurocritical illnesses due to various etiologies. At present, the popularity of neuroelectrophysiological monitoring technology for severe neurocritical patients in China is not widespread enought, the level of monitoring varies, and there is a lack of relevant consensus and norms. This expert consensus combines the opinions of national experts in neuroelectrophysiology and neurocritical care medicine, and providess 13 expert opinions on neuroelectrophysiology technology and application. Commonly used Neurophysiologic monitoring in the Neuro-Intensive Care Unit (NICU) includes three categories: electroencephalogram, evoked potentials and electromyography. The main applications include assessment of coma level and prognosis prediction, reflection of intracranial pressure level, identification of nonconvulsive status epilepticus, assessment of sedation level, determination of brain death, and monitoring of severe peripheral neuropathy. It is recommended that NICU at all levels apply neurophysiologic monitoring techniques to severe neurocritical patients according to the expert consensus.
神经电生理监测对各种病因所致的神经重症患者的病情评估和转归预测有重要意义。目前，国内神经重症患者的神经电生理监测技术普及不够广泛，监测水平存在差异，缺乏相关的共识和规范。本专家共识结合了全国神经电生理及神经重症医学专家意见，从神经电生理技术和应用两个方面给出了13条专家意见。神经重症监护病房（NICU）常用的神经电生理监测包括脑电图、诱发电位和肌电三类。主要应用范围包括：昏迷程度评估与转归预测、反映颅内压水平、非惊厥性癫痫持续状态鉴定、镇静水平评估、脑死亡判定和重症周围神经病监测。推荐各级NICU对神经重症患者应用神经电生理监测技术参照该专家共识。.

The aim of this panel was to develop consensus recommendations on targeted temperature control (TTC) in patients with severe traumatic brain injury (TBI) and in patients with moderate TBI who deteriorate and require admission to the intensive care unit for intracranial pressure (ICP) management.
A group of 18 international neuro-intensive care experts in the acute management of TBI participated in a modified Delphi process. An online anonymised survey based on a systematic literature review was completed ahead of the meeting, before the group convened to explore the level of consensus on TTC following TBI. Outputs from the meeting were combined into a further anonymous online survey round to finalise recommendations. Thresholds of ≥ 16 out of 18 panel members in agreement (≥ 88%) for strong consensus and ≥ 14 out of 18 (≥ 78%) for moderate consensus were prospectively set for all statements.
Strong consensus was reached on TTC being essential for high-quality TBI care. It was recommended that temperature should be monitored continuously, and that fever should be promptly identified and managed in patients perceived to be at risk of secondary brain injury. Controlled normothermia (36.0-37.5 °C) was strongly recommended as a therapeutic option to be considered in tier 1 and 2 of the Seattle International Severe Traumatic Brain Injury Consensus Conference ICP management protocol. Temperature control targets should be individualised based on the perceived risk of secondary brain injury and fever aetiology.
Based on a modified Delphi expert consensus process, this report aims to inform on best practices for TTC delivery for patients following TBI, and to highlight areas of need for further research to improve clinical guidelines in this setting.

OBJECTIVE: Headaches are a common, oftentimes debilitating symptom in patients with leptomeningeal metastases.
RESULTS: The third edition of the International Classification of Headache Disorders provides a useful diagnostic framework for headaches secondary to leptomeningeal metastases based on the temporal relationship of headache with disease onset, change in headache severity in correlation with leptomeningeal disease burden, and accompanying neurologic signs such as cranial nerve palsies and encephalopathy. However, headaches in patients with leptomeningeal metastases can be further defined by a wide range of varying cancer- and treatment-related pathophysiologies, each requiring a tailored approach. A thorough review of the literature and expert opinion on five observed headache sub-classifications in patients with leptomeningeal metastases is provided, with attention to necessary diagnostic testing, recommended first-line treatments, and prevention strategies.

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Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed.
To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion.
We polled the 42 Seattle International Brain Injury Consensus Conference panel members\' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression.
Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations.
Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.

UNASSIGNED: Therapeutic hypothermia (TH), or targeted temperature management (TTM), is a classic treatment option for reducing inflammation and potentially other destructive processes across a wide range of pathologies, and has been successfully used in numerous disease states. The ability for TH to improve neurological outcomes seems promising for inflammatory injuries but has yet to demonstrate clinical benefit in the intracerebral hemorrhage (ICH) patient population. Minimally invasive ICH evacuation also presents a promising option for ICH treatment with strong preclinical data but has yet to demonstrate functional improvement in large randomized trials. The biochemical mechanisms of action of ICH evacuation and TH appear to be synergistic, and thus combining hematoma evacuation with cooling therapy could provide synergistic benefits. The purpose of this working group was to develop consensus recommendations on optimal clinical trial design and outcomes for the use of therapeutic hypothermia in ICH in conjunction with minimally invasive ICH evacuation.
UNASSIGNED: An international panel of experts on the intersection of critical-care TH and ICH was convened to analyze available evidence and form a consensus on critical elements of a focal cooling protocol and clinical trial design. Three focused sessions and three full-group meetings were held virtually from December 2020 to February 2021. Each meeting focused on a specific subtopic, allowing for guided, open discussion.
UNASSIGNED: These recommendations detail key elements of a clinical cooling protocol and an outline for the roll-out of clinical trials to test and validate the use of TH in conjunction with hematoma evacuation as well as late-stage protocols to improve the cooling approach. The combined use of systemic normothermia and localized moderate (33.5°C) hypothermia was identified as the most promising treatment strategy.
UNASSIGNED: These recommendations provide a general outline for the use of TH after minimally invasive ICH evacuation. More research is needed to further refine the use and combination of these promising treatment paradigms for this patient population.

暂无摘要。

暂无摘要。

The aim of this study was to provide an overview on advances in intracranial pressure (ICP) protocols for care, moving from traditional to more recent concepts.
Deep understanding of mechanics and dynamics of fluids and solids have been introduced for intracranial physiology. The amplitude or the harmonics of the cerebral-spinal fluid and the cerebral blood waves shows more information about ICP than just a numeric threshold. When the ICP overcome the compensatory mechanisms that maintain the compliance within the skull, an intracranial compartment syndrome (ICCS) is defined. Autoregulation monitoring emerge as critical tool to recognize CPP management. Measurement of brain tissue oxygen will be a critical intervention for diagnosing an ICCS. Surgical procedures focused on increasing the physiological compliance and increasing the volume of the compartments of the skull.
ICP management is a complex task, moving far than numeric thresholds for activation of interventions. The interactions of intracranial elements requires new interpretations moving beyond classical theories. Most of the traditional clinical studies supporting ICP management are not generating high class evidence. Recommendations for ICP management requires better designed clinical studies using new concepts to generate interventions according to the new era of personalized medicine.

Challenges inherent in clinical guideline development include a long time lag between the key results and incorporation into best practice and the qualitative nature of adherence measurement, meaning it will have no directly measurable impact. To address these issues, a framework has been developed to automatically measure adherence by clinicians in neurological intensive care units to the Brain Trauma Foundation\'s intracranial pressure (ICP)-monitoring guidelines for severe traumatic brain injury (TBI).The framework processes physiological and treatment data taken from the bedside, standardises the data as a set of process models, then compares these models against similar process models constructed from published guidelines. A similarity metric (i.e. adherence measure) between the two models is calculated, composed of duration and scale of non-adherence.In a pilot clinical validation test, the framework was applied to physiological/treatment data from three TBI patients exhibiting ICP secondary insults at a local neuro-centre where clinical experts coded key clinical interventions/decisions about patient management.The framework identified non-adherence with respect to drug administration in one patient, with a spike in non-adherence due to an inappropriately high dosage; a second patient showed a high severity of guideline non-adherence; and a third patient showed non-adherence due to a low number of associated events and treatment annotations.