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Editors' note: Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence

Lewis, Ariane; Galetta, Steven
PMID: 33020201
ISSN: 1526-632x
CID: 4631532

Ocular movements preclude brain death determination: Response to Fattal et al [Letter]

Lewis, Ariane; Greer, David
PMID: 33023791
ISSN: 1532-8511
CID: 4650542

Benefits of the Subdural Evacuating Port System (SEPS) Procedure Over Traditional Craniotomy for Subdural Hematoma Evacuation

Golub, Danielle; Ashayeri, Kimberly; Dogra, Siddhant; Lewis, Ariane; Pacione, Donato
Background/UNASSIGNED:There remains no consensus on the optimal primary intervention for subdural hematoma (SDH). Although historically favored, craniotomy carries substantial morbidity and incurs significant costs. Contrastingly, the subdural evacuating port system (SEPS) is a minimally invasive bedside procedure. We assessed the benefits of SEPS over traditional craniotomy for SDH evacuation. Methods/UNASSIGNED:A single-center retrospective cohort study of SDH patients receiving craniotomy or SEPS between 2012 and 2017 was performed. Information regarding demographics, medical history, presentation, surgical outcomes, cost, and complications was collected. Pre- and postoperative hematoma volumes were calculated using 3D image segmentation using Vitrea software. Multivariate regression models were employed to assess the influence of intervention choice. Results/UNASSIGNED:= 1.000). Conclusion/UNASSIGNED:In this retrospective cohort, SEPS was noninferior to craniotomy at reducing SDH hematoma volume. The SEPS procedure was also associated with decreased length of stay hospitalization costs, and postoperative seizures and demonstrated a comparable recurrence rate to craniotomy for chronic SDH in particular.
PMCID:7495698
PMID: 32983343
ISSN: 1941-8744
CID: 4615802

Allied Muslim Healthcare Professional Perspectives on Death by Neurologic Criteria

Lewis, Ariane; Kitamura, Elizabeth; Padela, Aasim I
BACKGROUND:We sought to evaluate how Muslim allied healthcare professionals view death by neurologic criteria (DNC). METHODS:We recruited participants from two listservs of Muslim American health professionals to complete an online survey questionnaire. Survey items probed views on DNC and captured professional and religious characteristics. Comparative statistical analyses were performed after dichotomizing the sample based on religiosity, and Chi-squared, Fisher's exact tests, likelihood ratios and the Kruskal-Wallis test were used to assess differences between the two cohorts. RESULTS:There were 49 respondents (54%) in the less religious cohort and 42 (46%) in the more religious cohort. The majority of respondents (84%) believed that if the American Academy of Neurology guidelines are followed and a person is declared brain dead, they are truly dead; there was no difference on this view based on religiosity. Less than a quarter of respondents believed that outside of organ donation, mechanical ventilation, hydration, nutrition or medications should be continued after DNC; again, there was no difference based on religiosity of the sample. Importantly, half of all respondents believed families should be able to choose whether an evaluation for DNC is performed (40% of the less religious cohort and 60% of the more religious cohort, p = 0.09) and whether organ support is discontinued after DNC (49% of both cohorts, p = 1). CONCLUSIONS:Although the majority of allied Muslim healthcare professionals we surveyed believe DNC is death, half believe that families should be able to choose whether an evaluation for DNC is performed and whether organ support should be discontinued after DNC. This provides insight that can be helpful when making medical practice policy and addressing legal controversies surrounding DNC.
PMID: 32556858
ISSN: 1556-0961
CID: 4494642

Post-COVID-19 inflammatory syndrome manifesting as refractory status epilepticus

Carroll, Elizabeth; Neumann, Henry; Aguero-Rosenfeld, Maria E; Lighter, Jennifer; Czeisler, Barry M; Melmed, Kara; Lewis, Ariane
There have been multiple descriptions of seizures during the acute infectious period in patients with COVID-19. However, there have been no reports of status epilepticus after recovery from COVID-19 infection. Herein, we discuss a patient with refractory status epilepticus 6 weeks after initial infection with COVID-19. Extensive workup demonstrated elevated inflammatory markers, recurrence of a positive nasopharyngeal SARS-CoV-2 polymerase chain reaction, and hippocampal atrophy. Postinfectious inflammation may have triggered refractory status epilepticus in a manner similar to the multisystemic inflammatory syndrome observed in children after COVID-19.
PMID: 32944946
ISSN: 1528-1167
CID: 4593452

Delayed SARS-COV-2 leukoencephalopathy without Severe Hypoxia [Letter]

Kumar, Arooshi; Olivera, Anlys; Mueller, Nancy; Howard, Jonathan; Lewis, Ariane
PMCID:7500274
PMID: 32977227
ISSN: 1878-5883
CID: 4615762

Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project

Greer, David M; Shemie, Sam D; Lewis, Ariane; Torrance, Sylvia; Varelas, Panayiotis; Goldenberg, Fernando D; Bernat, James L; Souter, Michael; Topcuoglu, Mehmet Akif; Alexandrov, Anne W; Baldisseri, Marie; Bleck, Thomas; Citerio, Giuseppe; Dawson, Rosanne; Hoppe, Arnold; Jacobe, Stephen; Manara, Alex; Nakagawa, Thomas A; Pope, Thaddeus Mason; Silvester, William; Thomson, David; Al Rahma, Hussain; Badenes, Rafael; Baker, Andrew J; Cerny, Vladimir; Chang, Cherylee; Chang, Tiffany R; Gnedovskaya, Elena; Han, Moon-Ku; Honeybul, Stephen; Jimenez, Edgar; Kuroda, Yasuhiro; Liu, Gang; Mallick, Uzzwal Kumar; Marquevich, Victoria; Mejia-Mantilla, Jorge; Piradov, Michael; Quayyum, Sarah; Shrestha, Gentle Sunder; Su, Ying-Ying; Timmons, Shelly D; Teitelbaum, Jeanne; Videtta, Walter; Zirpe, Kapil; Sung, Gene
Importance/UNASSIGNED:There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries. Objective/UNASSIGNED:To formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel. Process/UNASSIGNED:Relevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery. Evidence Synthesis/UNASSIGNED:Based on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed. Recommendations/UNASSIGNED:Prior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability. Conclusions and Relevance/UNASSIGNED:This report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in the revision or development of protocols and procedures for determination of brain death/death by neurologic criteria, leading to greater consistency within and between countries.
PMID: 32761206
ISSN: 1538-3598
CID: 4581302

Editors' note: Outcomes of patients with stroke treated with thrombolysis according to prestroke Rankin Scale scores

Lewis, Ariane; Galetta, Steven
PMID: 32934159
ISSN: 1526-632x
CID: 4617572

Editors' note: Prospective validation of the PML risk biomarker l-selectin and influence of natalizumab extended intervals

Lewis, Ariane; Galetta, Steven
PMID: 32934156
ISSN: 1526-632x
CID: 4617562

Editors' note: Miller Fisher syndrome and polyneuritis cranialis in COVID-19 [Comment]

Lewis, Ariane; Galetta, Steven
PMID: 32839298
ISSN: 1526-632x
CID: 5092792