Brain injury

Acquired Brain Injury

Anoxic brain injury

Early brain injury

Pediatric Brain Injury

Traumatic brain injury

Ischemic brain injury

Primary Brain injury

Secondary Brain injury.

Diffuse brain injury means that instead of occurring in a specific area, like a focal brain injury, it occurs over a more widespread area.

Apolipoprotein E (APOEε4) may induce cerebral perfusion impairment in the early phase, contributing to early brain injury (EBI) following aneurysmal subarachnoid hemorrhage (aSAH), and assessment of APOE genotypes could serve as a useful tool in the prognostic evaluation and therapeutic management of aSAH 1).

see Quality of Life after Brain Injury.

Following acute brain injury, patients in the intensive care unit often undergo hourly or every-other-hour exams (“neurochecks”) to monitor for neurodeterioration. LaBuzetta et al. assessed health care provider attitudes towards neurocheck frequency and evaluated providers' ideal neurocheck frequency.

This was a cross-sectional, online survey distributed in Spring 2021 at a tertiary care academic medical center. Providers from multiple intensive care unit and neuroscience clinical specialties including attending faculty, medical trainees, advanced practice providers, and bedside nurses were invited to participate.

Among 177 participants, 61 (34%) and 116 (66%) were self-identified as ordering and performing providers, respectively. The survey response rate was 58% among physicians and 51% among bedside nurses with neurological expertise. The most common medical and non-medical reasons for ordering hourly neurochecks were “a specific diagnosis with anticipated course” and “standard of care”, respectively. Compared with ordering providers, performing providers felt guidelines regarding neurocheck frequency (P<0.01) and duration (P<0.01) should be proscriptive. Conversely, ordering providers felt hourly neurochecks were detrimental to patients with acute brain injury (P=0.02) and believed they would not utilize hourly neurochecks if there was another mode of monitoring available (P=0.03). Performing providers identified multiple patient-related factors impacting the difficulty of and their willingness to perform frequent neurochecks, and only 70% of neurochecks were perceived to be performed as ordered. Both ordering and performing providers preferred every-other-hour neurochecks following acute brain injury.

This survey revealed clinically relevant differences in ordering versus performing provider attitudes about frequent neurochecks. Providers preferred every-other-hour rather than hourly neurochecks 2).

Cheng C, Jiang L, Yang Y, Wu H, Huang Z, Sun X. Effect of APOE Gene Polymorphism on Early Cerebral Perfusion After Aneurysmal Subarachnoid Hemorrhage. Transl Stroke Res. 2015 Sep 14. [Epub ahead of print] PubMed PMID: 26370543.
LaBuzetta JN, Kazer MR, Kamdar BB, Owens RL, Evans JH, Stone L, Malhotra A. Neurocheck Frequency: Determining Perceptions and Barriers to Implementation of Evidence-Based Practice. Neurologist. 2022 Aug 16. doi: 10.1097/NRL.0000000000000459. Epub ahead of print. PMID: 35981307.
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