• Journal of Neurocritical Care
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• v.11 no.2
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• pp.119-123
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• 2018

Background: Since the first report of a rapidly resolved subdural hemorrhage (SDH) in 1986, few additional case reports have been presented in the literature. Case Report: An 82-year-old female patient presented with a SDH over the left convexity. The SDH was removed via catheter drainage through a burr hole trephination. Post-operative computed tomography (CT) following 300 mL drainage from the chronic SDH demonstrated a newly developed SDH along the right convexity. A follow-up CT performed 2 hours later revealed an unexpected significant resolution of the acute SDH. Conclusion: The spontaneous resolution of acute SDH is believed to result from redistribution by washout of the hematoma by cerebrospinal fluid dilution. However, its exact pathophysiology is not well understood. When surgical evacuation is considered in acute SDH, conservative management should also be considered because spontaneous resolution of hemorrhage remains a possibility.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.124-128
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• 2018

Background: Secundum atrial septal defect (ASD) is a common congenital heart defect in adults. Patients with ASDs at high risk of cardiovascular complications undergo either surgical repair or percutaneous device closure. Case Report: We report the case of an 85-year-old male with unusual recurrent cerebral infarctions. The patient has undergone repair of secundum ASD 12 years ago. Evaluation by transesophageal echocardiography revealed a mobile mass at the patch repair site in the left atrium. The mass was surgically removed due to recurrent stroke during the anticoagulation. Conclusion: This case emphasizes the importance of regular cardiac checkup and the need to consider cardioembolic source as being part of the etiology of stroke recurrence, even if the event occurs many years after intracardiac shunt closures.

• Journal of Neurocritical Care
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• v.7 no.2
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• pp.104-110
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• 2014

Background: Cefepime is a fourth-generation cephalosporin widely used for empiric treatment of severe infections. Neurotoxicity by cefepime have been reported due to γ-aminobutyric acid A receptor inhibition or other mechanisms. The aim of this study was to evaluate the risk factors for cefepime-induced neurotoxicity between group showing cefepime-induced neurotoxicity and group without neurotoxicity. Methods: From Jan 2005 to June 2010, a total of 2,461 patients (older than 20) who used cefepime were considered in this study. We compared patients who developed cefepime-induced neurotoxicity (patient group, n=21) to patients who had no cefepime-induced neurotoxicity (control group, n=31). We analyzed demographic, underlying diseases, and metabolic parameters before cefepime treatment and during cefepime treatment between the two groups. Statistical analysis was performed using SPSS 18 software. Results: Of the total 2461 patients, 21 (0.85%) were diagnosed with cefepime-induced neurotoxicity. Impaired glomerular filtration rate (GFR at 15-30 ml/min) before cefepime use were significantly (P<0.05) higher risk for developing cefepime-induced neurotoxicity in patient group compared to that in the control group. Age, sex, and other metabolic parameters except GFR before and during, usage of cefepime did not show any statistical difference between the two groups. Conclusion: The present study revealed that cefepime-induced neurotoxicity was prone to develop in patients with impaired renal function before cefepime usage.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.86-92
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• 2018

Background: A delay of transfer for patients with acute stroke needing emergent revascularization is a huge hurdle for efficacy of revascularization. The objective of this study was to investigate changes of transportation time calculated by image to door (ITD) time (from checking brain images at first contact hospital to arriving at our emergency center) before and after 2015. Methods: This study was performed in a retrospective manner from 2013 into 2017. Acute ischemic stroke (AIS) patients having intravenous thrombolysis and/or mechanical thrombectomy during the observation period were enrolled. Among them, those who had revascularization under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm were selected. Results: During the observation period, 225 patients were treated under 'Drip-and-Ship' or 'Ship-and-Drip' paradigm. Twenty-three were excluded due the lack of detailed data. Among 202 patients, 73 and 129 were treated under Drip-and-Ship and Ship-and-Drip paradigms, respectively. In 2013, 35 patients from 18 hospitals (median distance, 25 km) were transferred to our regional stroke center and their median ITD time was 116 minutes. It was gradually decreased after 2015. In 2017, ITD time was significantly (P<0.01) shortened to 85 minutes without significant changes in transfer distance. The median onset to puncture time was also significantly (P=0.03) decreased from 365 minutes in 2013 to 270 minutes in 2017. Conclusion: Our results implicate that many hospitals in our stroke region might have recognized the importance of rapid transportation for AIS after 2015.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.102-109
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• 2018

Background: A sians were known to have a relatively lower incidence of venous thromboembolism (VTE), and there is insufficient evidence to suggest a specific D-dimer threshold level for screening VTE in patients with acute stroke. Methods: We prospectively enrolled patients with acute ischemic stroke admitted to Jeju National University Hospital. The inclusion criteria were: 1) aged ${\geq}18$ years, 2) admission within seven days of symptom onset, and 3) an initial National Institute of Health Stroke Scale (NIHSS) score >1 for the affected lower limb. Ultrasound scans of the lower limbs and plasma D-dimer assays were performed on days 7-14 and 15-28 after stroke onset. Results: Of 285 patients admitted during the study period, 52 patients met inclusion criteria (mean age 74.5, male 40.4%, median initial NIHSS score 12, and unable to walk unassisted at discharge 76.9%). During 7-14 days, 23 of 52 patients (44.2%) had a D-dimer level above 1.57 mg/L, and 9.6% had a level above 5.50 mg/L. Proximal deep vein thrombosis (DVT) was detected in 3 patients (5.8%, 95% confidence Interval 1.2-16.0%) on ultrasound examination. All DVTs were found in elderly female patients with severe leg weakness. No patient was diagnosed with pulmonary embolism during the study period. Conclusion: The incidence of VTE seems to be very low among Korean patients with acute ischemic stroke. Advanced age, female sex, and severe leg weakness were important risk factors for developing DVT in this study.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.137-142
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• 2018

Background: New-onset refractory status epilepticus (NORSE) occurs in people without a history of seizures. In these cases, the seizure causes are unclear, and the seizures are not controlled by standard treatment. Autoimmune encephalitis (AIE) can be a cause of NORSE. Cryptogenic NORSE may be associated with AIE, but antibodies associated with the condition have not yet been identified. Primary immunotherapy may not be effective for AIE. Rituximab has improved the prognosis in some cases. Case Report: We treated a cryptogenic NORSE patient with a combination of antiepileptic drugs and immunotherapy. On the 13th hospital day, the seizures were controlled, but the patient remained in a coma. The patient rapidly recovered after administration of rituximab started on the 26th hospital day. Conclusion: Rituximab may be helpful for cryptogenic NORSE patients in whom primary immunotherapy controls seizures, but fails to improve consciousness.

• Journal of Korean Neurosurgical Society
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• v.67 no.4
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• pp.451-457
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• 2024

Objective : Exploring protein requirements for critically ill patients has become prominent. On the other hand, considering the significant impact of coma therapy and targeted temperature management (TTM) on the brain as well as systemic metabolisms, protein requirements may plausibly be changed by treatment application. However, there is currently no research on protein requirements following the application of these treatments. Therefore, the aim of this study is to elucidate changes in patients' protein requirements during the application of TTM and coma therapy. Methods : This study is a retrospective analysis of prospectively collected data from March 2019 to May 2022. Among the patients admitted to the intensive care unit, those receiving coma therapy and TTM were included. The patient's treatment period was divided into two phases (phase 1, application and maintenance of coma therapy and TTM; phase 2, tapering and cessation of treatment). In assessing protein requirements, the urine urea nitrogen (UUN) method was employed to estimate the nitrogen balance, offering insight into protein utilization within the body. The patient's protein requirement for each phase was defined as the amount of protein required to achieve a nitrogen balance within ±5, based on the 24-hour collection of UUN. Changes in protein requirements between phases were analyzed. Results : Out of 195 patients, 107 patients with a total of 214 UUN values were included. The mean protein requirement for the entire treatment period was 1.84±0.62 g/kg/day, which is higher than the generally recommended protein supply of 1.2 g/kg/day. As the treatment was tapered, there was a statistically significant increase in the protein requirement from 1.49±0.42 to 2.18±0.60 in phase 2 (p<0.001). Conclusion : Our study revealed a total average protein requirement of 1.84±0.62 g during the treatment period, which falls within the upper range of the preexisting guidelines. Nevertheless, a notable deviation emerged when analyzing the treatment application period separately. Hence, it is recommended to incorporate considerations for the type and timing of treatment, extending beyond the current guideline, which solely accounts for the severity by disease.

• Journal of Neurocritical Care
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• v.11 no.2
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• pp.93-101
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• 2018

Background: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). Methods: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. Results: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was $55.5{\pm}12.6$ years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. Conclusion: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.6
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• pp.275-279
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• 2018

A brain abscess is caused by an infection in the central nervous system and leads to significant neurological sequelae. Despite advances in neurocritical care, high morbidity and mortality rates are still associated with brain abscess, especially in certain high-risk patients. Thus, a brain abscess is a medical emergency requiring prompt diagnosis and treatment with antibacterial therapy. However, the recurrence of brain abscess is rare. A 59-year-old man presented at our neurology clinic with a headache and was found to have chronic otitis media. Serial brain magnetic resonance imaging (MRI) scans of the patient demonstrated a brain abscess in the right frontal lobe. Following stereotactic aspiration of the brain abscess and proper antimicrobial treatment, the patient recovered completely. Five months after discharge, the patient revisited our clinic with a headache and seizure symptoms, and recurrence of the brain abscess was confirmed by brain MRI. Recurrent brain abscess has been documented in patients with predisposing conditions such as retained foreign bodies, chronic sinusitis, arteriovenous fistula, and right-to-left shunt.

• Journal of Korean Clinical Nursing Research
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• v.15 no.3
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• pp.129-141
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• 2009

Purpose: This descriptive survey was aimed to investigate the ICU nurses' job stress, the way of coping, and the turnover intention and to identify the correlation among them. Methods: A 58 items-questionnaire composed of 7 sub-dimensions revised by Park, J. S. (2003) was used to measure the ICU nurses' job stress, and an questionnaire by Han, J. S. and Oh, G. S. (1990) which has 34 items from 6 sub-dimensions were used to measure the ICU nurses' way of coping. To figure out the ICU nurses' turnover intention, a 3 items-questionnaire used. A total of 456 nurses were participated in the study. Results: The participants' job stress was 2.86(4-point scale), and the way of stress coping was 2.27. Job stress had a positive correlation with the way of coping (r=.134, p=.004) and the turnover intention. The 54.1% of nurses addressed that they had some level of turnover intention. The turnover intention had a significant difference according to job stress(t=-2.041, p=.042), the type of hospital (${\chi}^2=8.052$, p=.005) and the total number of hospital beds (${\chi}^2=9.232$, p=.010). Conclusion: The findings of the study illustrated that the ICU nurses had at least moderate-high level of stress. The subjects' job stress showed a positive correlation with the way of coping and the turnover intention. These findings demonstrate necessity to develop an intervention for ICU nurses' stress management.