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Continuum Audio: June 2024 Neurocritical Care

Continuum Audio June 2024 (Neurocritical Care)

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Neurocritical Care issue, participants will be able to:
  • Develop a structured approach to recognizing and localizing acute “must not miss” neurologic emergencies and perform a focused examination and workup to identify critical findings that would prompt urgent changes in management
  • Minimize secondary brain injury for patients after cardiac arrest, resulting in improved outcomes for these patients
  • Describe the multidimensional aspects of neurologic intensive care unit treatment, from preadmission to rehabilitation and secondary prevention, for patients with stroke due to large vessel occlusion
  • Manage patients with a spontaneous intracerebral hemorrhage in the hyperacute and acute periods
  • Describe the guidelines for and the emergent management of patients with subarachnoid hemorrhage
  • Discuss a structured approach to the management of status epilepticus that emphasizes early and aggressive intervention to achieve seizure control and prevent associated complications
  • Describe the mechanisms, grading, complications, and management of acute traumatic injuries to the brain and spinal cord
  • Categorize various neurologic emergencies related to infections and discuss their management
  • Describe the central nervous system demyelinating disorders that may require care in the intensive care unit, their differential diagnosis, their workup, and their management
  • Describe the clinical approach, diagnostic considerations, and treatment strategies for patients presenting with abrupt-onset or acutely worsening neuromuscular disorders
  • Identify key aspects of epidemiology, diagnosis, and management of acute neurologic complications in primary central nervous system malignancies and systemic cancer
  • Summarize potential causes for the variability in withdrawal of life-sustaining therapies in patients with severe acute brain injuries and identify examples of recommendations for practicing family- and patient-centered prognostication in the presence of uncertainty

Core Competencies

This Continuum: Lifelong Learning in Neurology Neurocritical Care issue covers the following core competencies:
  • Patient Care and Procedural Skills
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism

Contributorsa

Ariane Lewis, MD, FAAN, FNCS
Guest Editor
Professor of Neurology and Neurosurgery, Director of the Division of Neurocritical Care, NYU Langone Medical Center, New York, New York

Relationship Disclosure: Dr Lewis has received personal compensation in the range of $500 to $4999 for serving as an editor, associate editor, or editorial advisory board member for Seminars in Neurology and in the range of $10,000 to $49,999 for serving as an editor, associate editor, or editorial advisory board member for the Journal of Clinical Neuroscience.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Lewis reports no disclosure.

Catherine S. W. Albin, MD
Assistant Professor of Neurology and Neurosurgery, Division of Neurocritical Care, Emory University School of Medicine, Atlanta, Georgia

Relationship Disclosure: Dr Albin has received personal compensation in the range of $500 to $4999 for serving as an instructor with the Resuscitation Leadership Academy and in the range of $5000 to $9999 for serving as an editor, associate editor, or editorial advisory board member for Continuum, research support from the American Academy of Neurology, and royalties from a publication relating to health care.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Albin discusses the unlabeled use of the high-dose steroids methylprednisolone, methotrexate, and rituximab for the treatment of immune-mediated necrotizing myopathies.

Katharina M. Busl, MD, MS, FAAN
Chief, Division of Neurocritical Care, Associate Chair, Clinical Operations, Department of Neurology; Professor of Neurology and Neurosurgery, Department of Neurology, University of Florida College of Medicine, Gainesville, Florida

Relationship Disclosure: Dr Busl reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Busl reports no disclosure.

Barry M. Czeisler, MD, MS, MHPE, FAAN
Neurointensivist, Providence Specialty Medical Group and Providence Little Company of Mary Medical Center, Torrance, California; Adjunct Assistant Professor of Neurology and Neurosurgery, NYU Grossman School of Medicine, New York, New York

Relationship Disclosure: Dr Czeisler has received personal compensation in the range of $10,000 to $49,999 for serving as an expert witness for NeuroStat Consulting LLC and has stock in BrainSpace.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Czeisler discusses the unlabeled/investigational use of rituximab, cyclophosphamide, plasma exchange, and IV IgG for immunosuppressive treatment of acute demyelinating disorders.

Nicholas J. Johnson, MD
Associate Professor and Section Head of Critical Care, Department of Emergency Medicine; Associate Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington

Relationship Disclosure: Dr Johnson has received personal compensation in the range of $500 to $4999 for serving as a consultant for NeurOptics, Inc, and in the range of $5000 to $9999 for serving as an expert witness for Mullin, Allen & Steiner PLLC. The institution of Dr Johnson has received research support from the National Institutes of Health (NIH) and the University of Washington Royalty Research Fund.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Johnson reports no disclosure.

Elaine C. Jones, MD, FAAN
Neurologist, Clinical Director of Quality, Access TeleCare, Dallas, Texas

Relationship Disclosure: Dr Jones has received personal compensation in the range of $500 to $4999 for serving on a speakers bureau for Medical Education Resources.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Jones reports no disclosure.

Benjamin R. Kummer, MD
Assistant Professor of Neurology, Director of Clinical Informatics in Neurology, and Assistant Professor, Windreich Department of Artificial Intelligence & Human Health, Icahn School of Medicine at Mount Sinai, New York, New York

Relationship Disclosure: Dr Kummer has received personal compensation in the range of $0 to $499 for serving as a consultant for AlphaSights Ltd, Atheneum Partners, Gehrson Lehrman Group, Inc, and NeuraHealth; in the range of $500 to $4999 for serving as a consultant for MD Aware, LLC, and Syapse, Inc, and on a scientifi c advisory or data safety monitoring board for Syntrillo, Inc. Dr Kummer has stock in Syntrillo, Inc. The institution of Dr Kummer has received research support from the Icahn School of Medicine at Mount Sinai.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Kummer reports no disclosure.

T. M. Leslie-Mazwi, MD
Professor and Chair, Department of Neurology, University of Washington, Seattle, Washington

Relationship Disclosure: Dr Leslie-Mazwi has received personal compensation in the range of $500 to $4999 for serving on a scientific advisory or data safety monitoring board for IQVIA Inc and in the range of $5000 to $9999 for serving on scientific advisory or data safety monitoring boards for Koninklijke Phillips N.V., WorldCare Clinical, and Zoll Medical Corporation.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Leslie-Mazwi reports no disclosure.

Carolina B. Maciel, MD, MSCR, FAAN
Director of Research, Department of Neurology, Division of Neurocritical Care; Associate Professor of Neurology and Neurosurgery, Department of Neurology, University of Florida College of Medicine, Gainesville, Florida; Adjunct Associate Professor of Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut; Adjunct Associate Professor of Neurology, Department of Neurology, University of Utah, Salt Lake City, Utah

Relationship Disclosure: Dr Maciel reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Maciel reports no disclosure.

Nicholas A. Morris, MD, FAAN, FNCS
Associate Professor, Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland

Relationship Disclosure: Dr Morris has received personal compensation in the range of $0 to $499 for serving as a grand rounds speaker with New York University and as a reviewer with the Society of Critical Care Medicine, and in the range of $500 to $4999 for serving as a grand rounds speaker with Mount Sinai Health System and New York Medical College and as a Continuum article author with the American Academy of Neurology. The institution of Dr Morris has received research support from the National Institute of Neurological Disorders and Stroke, the University of Maryland, Baltimore Institute for Clinical and Translational Research through the National Institutes of Health (NIH) National Center for Advancing Translational Sciences’ Clinical and Translational Science Awards grant 1UL1TR003098, and the University of Maryland Medical Center.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Morris discusses the use of ketamine and memantine for the treatment of cortical spreading depolarizations and the use of γ -aminobutyric acid–mediated (GABA-ergic) medications, beta-blockers, bromocriptine, central α-adrenergic agonists, and opioids for the treatment of paroxysmal sympathetic hyperactivity, none of which are approved by the US Food and Drug Administration (FDA).

Susanne Muehlschlegel, MD, MPH, FNCS, FCCM, FAAN
Professor (PAR), Departments of Neurology, Anesthesiology/Critical Care Medicine and Neurosurgery, Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland

Relationship Disclosure: Dr Muehlschlegel has received personal compensation in the range of $500 to $4999 for serving as a consultant for Acasti Pharma Inc. Dr Muehlschlegel has a noncompensated relationship as a member of the board of directors with the Neurocritical Care Society that is relevant to American Academy of Neurology interests or activities. The institution of Dr Muehlschlegel has received research support from the National Institutes of Health (NIH), and the institution of an immediate family member has received research support from NIH.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Muehlschlegel reports no disclosure.

Santosh B. Murthy, MD, MPH, FNCS
Associate Chief and Director of Research, Division of Neurocritical Care; Associate Professor of Neurology and Neuroscience, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York

Relationship Disclosure: Dr Murthy has received personal compensation in the range of $10,000 to $49,999 for serving as an expert witness for stroke and neurologic disorders. The institution of Dr Murthy has received research support from the National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Murthy reports no disclosure.

Soojin Park, MD, FAHA, FNCS
Associate Professor of Neurology (in Biomedical Informatics), Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Medical Director of Critical Care Data Science and Artificial Intelligence, NewYork-Presbyterian Hospital, New York, New York

Relationship Disclosure: Dr Park has received personal compensation in the range of $500 to $4999 for serving as an editor, associate editor, or editorial advisory board member for Neurocritical Care. The institution of Dr Park has received research support from the National Institutes of Health (NIH).

Unlabeled Use of Products/Investigational Use Disclosure: Dr Park reports no disclosure.

Jamie E. Podell, MD
Assistant Professor, Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland

Relationship Disclosure: The institution of Dr Podell has received research support from the R Adams Cowley Shock Trauma Center and the University of Maryland, Baltimore Institute for Clinical and Translational Research.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Podell discusses the use of ketamine and memantine for the treatment of cortical spreading depolarizations and the use of γ-aminobutyric acid–mediated (GABA-ergic) medications, beta-blockers, bromocriptine, central α-adrenergic agonists, and opioids for the treatment of paroxysmal sympathetic hyperactivity, none of which are approved by the US Food and Drug Administration (FDA).

Alexandra S. Reynolds, MD
Associate Professor, Departments of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai Health System, New York, New York

Relationship Disclosure: Dr Reynolds reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Reynolds reports no disclosure.

Clio Rubinos, MD, MS
Assistant Professor of the Department of Neurology, Division of Critical Care Neurology and Division of Epilepsy, Director of the Post-Acute Symptomatic Seizure (PASS) Clinic and Co-Director of the Global Health Neurology Elective Rotation, University of North Carolina, Chapel Hill, North Carolina

Relationship Disclosure: Dr Rubinos has received personal compensation in the range of $0 to $499 for serving on a speakers bureau for the American Epilepsy Society; in the range of $500 to $4999 for serving as a consultant for Qualtrics, for serving on a scientific advisory or data safety monitoring board for Azurity Pharmaceuticals, Inc, and for serving on a speakers bureau for the American Epilepsy Society; and in the range of $5000 to $9999 for serving on a speakers bureau for Marinus Pharmaceuticals, Inc. The institution of Dr Rubinos has received research support from the University of North Carolina.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Rubinos reports no disclosure.

Alexis Steinberg, MD, MS
The institution of Dr Steinberg has received research support from the University of Pittsburgh Clinical and Translational Science Institute.

Relationship Disclosure: The institution of Dr Steinberg has received research support from the University of Pittsburgh Clinical and Translational Science Institute.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Steinberg reports no disclosure.

Sarah Wahlster, MD
Associate Professor of Neurology, Department of Neurology; Department of Neurological Surgery; and Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington

Relationship Disclosure: Dr Wahlster reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Wahlster reports no disclosure.

Jayne R. Wilkinson, MD, MSCE
Professor of Clinical Neurology, Perelman School of Medicine at the University of Pennsylvania; Medical Director, National TeleNeurology Program (NTNP), Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania

Relationship Disclosure: Dr Wilkinson reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Wilkinson reports no disclosure.

Self-Assessment and CME Test Writers

Douglas J. Gelb, MD, PhD, FAAN
Professor of Neurology, University of Michigan, Ann Arbor, Michigan

Relationship Disclosure: Dr Gelb has received personal compensation in the range of $500 to $4999 for serving as a multiple-choice question writer for Continuum with the American Academy of Neurology. Dr Gelb has received publishing royalties from a publication relating to health care.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gelb reports no disclosure.

Allyson R. Zazulia, MD
Professor of Neurology and Radiology and Associate Dean for Continuing Medical Education, Washington University, St. Louis, Missouri

Relationship Disclosure: An immediate family member of Dr Zazulia has received personal compensation in the range of $50,000 to $99,999 for serving as an editor, associate editor, or editorial advisory board member for the Neurocritical Care Society.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Zazulia reports no disclosure.

aAll relevant financial relationships have been mitigated.

Accreditation

Accreditation Statement: The American Academy of Neurology Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. For information on Continuum Audio CME, please visitcontinuum.audio-digest.org.

AMA Credit: The American Academy of Neurology Institute designates this enduring material for a maximum of 20 AMA PRA Category1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished authors who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive continuing medical education (CME) and self-assessment offerings.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Audio interviews with the authors of Continuum articles are published alongside each article, and video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.