Swarna Rajagopalan MD MS FCCM

Initiation of VPA was associated with a significant decrease in adjunctive sedative agent requirements, positive RASS scores, and number of patients requiring physical restraints.🧠 shorturl.at/K4UIj #SCCMNeuro #NeuroICU #NeuroX #NeuroTwitter

Proud of our work. Thanks to @DanHarrisonMD for leading this project and to @AANmember for funding. A Modified Delphi Consensus-Based Comprehensive Checklist for assessment of competency in Brain Death/DNC Determination: @CritCareMed journals.lww.com/ccmjournal/abs…

@stephanamayer Makes sense...treating the microcirculation in addition to the big pipes. Have to figure out more targeted microcirculation therapy for AIS, aSAH etc

This finding has been replicated over and over. Case closed: “Among patients treated within 4.5 hours of symptom onset, TNK + EVT was associated with better functional outcome than EVT alone, without safety concerns. This benefit does not seem to be time dependent. These findings support the routine use of tenecteplase before EVT in the early time window.” neurology.org/doi/10.1212/WN…

@stephanamayer Yes. We do it for small and large ICHs and have had a similar experience, less PHE, a unique trajectory where PHE peaks earlier! pubmed.ncbi.nlm.nih.gov/41416863/.

A single center non-randomized real world look at Minimally invasive surgery for large #ICH • 38 underwent MIS • 61 had open surgery Those treated with MIS had: • Better outcomes (favorable 6 mo mRS 40% at 15%) • Lower mortality (0% vs 15%) • Higher excellent clot evacuation (90% vs 80%) • Shorter ICU length of stay (5.5 vs 7.0 days) Do you perform MIS for ICH at your site? #codeich #curingcoma sciencedirect.com/science/articl…

@rkchoi @NeurocritCareJ Thought provoking for sure. I think perhaps studying a multimodal approach including bedside monitors (EEG, AP, NIRS) would be superior than a single modality and would consider including TCDs.

1/ 👋 there #neurotwitter #neurosky #neurocritcare, as part of my @neurocritcarej #SoMeAmbassador role, today we will be breaking down the following article: link.springer.com/article/10.100… about #covertconsciousness and #NIRS! #CuringComa

Neuroscience Section members - don't forget to vote in our Section elections for Secretary/Treasurer and Member-at-Large. Ballots close on March 30 - make sure your voices are heard!🧠 #SCCMNeuro

@drmohansai @BharatJagiasi @rkchoi @neurona_critica Great ❓Evidence (TRAIN, HEMOTION) suggests hb ≥9 may improve neuro outcomes vs restrictive 7. Suspect autoreg status is a big driver here, ideally can individualize care with MMM but no high level evidence for it in aSAH. Plt ≥75-100K reasonable as plt dysfunction coexists.

Interesting clinical scenario shared by @BharatJagiasi sir. To all Neurocritical Care enthusiasts, kindly share your thoughts on this ? @rkchoi @SwarnaRMD @neurona_critica

@KMeierNSICU Neat work! Did this patient have clinical decline? If so did the data show treatment response adequately?

I gave 15 days worth of raw TCD data from an L MCA aneurysm rupture to six different AI models and asked each to interpret and visually represent Every model correctly identified severe vasospasm on days 14-15. That's the easy part. By day 15 the data screams at you. The differences were in interpretive depth, visualization quality, epistemic honesty, and the clinical nuances each model surfaced or missed.

This is the future 👇🏽. Knowing what to do with the data real-time in clinical context becomes the real question.

Ready to strengthen your foundation in transcranial ultrasound? This webinar will cover: ➡️ Core principles of TCD & TCCD ➡️Cranial B-mode anatomy & cerebrovascular landmarks ➡️Color Doppler basics for accurate insonation ➡️Intro to noninvasive ICP estimation Register today: bit.ly/4rVFnWv

@ross_prager Yes! A sign of good brain perfusion. I've had patients scream "ow" or even "get off me." Awkward, and had to give sedative for retrograde amnesia/ trauma during resus.

I had patient in cardiac arrest who was receiving CPR and was mouthing "stop" only to have us stop and find he was asystolic but then wake up when we re-started compressions. Has anyone else encountered this? (We gave him sedation)

Get ready for this. These Chinese investigators report a cohort of 121 malignant MCA infarction patients age >60, 47 of whom underwent drill-assisted sterotactic aspiration of the infarcted tissue from 24-72 hrs after onset. Check out the CT images and the 70 mL of nectrotic brain tissue in the image below to give you an idera of what they were doing. Retrospective, not randomized -- but the results were great. Herniation: 47% vs 9% Death: 65% vs 9% Favorable mRS (0-3): 3% vs 26% Not only #curingcoma –– cheating death. pmc.ncbi.nlm.nih.gov/articles/PMC12…

So much to learn in Neurocritical Care. Yes… it’s a survey. And yes… we know nobody loves surveys 😅 But your responses actually help shape NCC research priorities nationally and globally. Please take a minute to fill it out, especially the 2 on POCUS patterns 👇🏽

Excited to share our latest in Critical Connections: Normothermic Regional Perfusion in DCD-clinical & ethical considerations. NRP is expanding globally and improving transplant outcomes but raises important ethical questions. 👉🏽flipsnack.com/sccmedicine/cr… #SCCM #OrganDonation

@NeuroIRdoc For broader HA, not migraines only, I think a good bet is if they already have an indication for DSA. We have done IA lido in refractory HA pts with aneurysms for example.

From our experience, MMA lidocaine/steroids work for migraine.. But how to RCT 🤔 -- subjective pt reporting -- hard to blind providers -- unwillingness of young pts to undergo DSA for sham arm ❓ Key Q: do one time or rpt like Botox every few months? jnis.bmj.com/content/18/3/6…

Attention SCCM Neuroscience Section members!🧠 Vote now for Secretary/Treasure and Member-at-Large positions. The link to the election ballot can be found on @SCCM Connect.🗳️☑️ #SCCMNeuro #NeuroICU #NeuroX #NeuroTwitter

New findings show that Transcranial Doppler (TCD) can help predict future ischemic events in patients with moyamoya arteriopathy. The study highlights TCD as a valuable, non‑invasive tool for early risk stratification and long‑term monitoring. nature.com/articles/s4139…

In patients with non–large-vessel occlusion stroke and salvageable tissue, tenecteplase extended to 24 hours improved outcomes compared with standard care but increased bleeding risk. #ISC26 @AHAScience bit.ly/4tj2lrJ

EMBOLISE -2 presented at #ISC26 MMA Embo for non-surgical #SDH Half the frequency of ultimate surgery, neuroworsening, or poor functional outcome at 90 days

Chase that successful TICI-2B thrombectomy with IA alteplase to treat downstream incomplete microvascular reperfusion! #ISC26