Acute and Critical Care

Original Article

Neurology
Continuous heart rate variability and electroencephalography monitoring in severe acute brain injury: a preliminary study: Hyunjo Lee, Sang-Beom Jeon, Kwang-Soo Lee; Acute Crit Care. 2021;36(2):151-161. Published online March 18, 2021; DOI: https://doi.org/10.4266/acc.2020.00703

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Background
Decreases in heart rate variability have been shown to be associated with poor outcomes in severe acute brain injury. However, it is unknown whether the changes in heart rate variability precede neurological deterioration in such patients. We explored the changes in heart rate variability measured by electrocardiography in patients who had neurological deterioration following severe acute brain injury, and examined the relationship between heart rate variability and electroencephalography parameters.
Methods
Retrospective analysis of 25 patients who manifested neurological deterioration after severe acute brain injury and underwent simultaneous electroencephalography plus electrocardiography monitoring.
Results
Eighteen electroencephalography channels and one simultaneously recorded electrocardiography channel were segmented into epochs of 120-second duration and processed to compute 10 heart rate variability parameters and three quantitative electroencephalography parameters. Raw electroencephalography of the epochs was also assessed by standardized visual interpretation and categorized based on their background abnormalities and ictalinterictal continuum patterns. The heart rate variability and electroencephalography parameters showed consistent changes in the 2-day period before neurological deterioration commenced. Remarkably, the suppression ratio and background abnormality of the electroencephalography parameters had significant reverse correlations with all heart rate variability parameters.
Conclusions
We observed a significantly progressive decline in heart rate variability from the day before the neurological deterioration events in patients with severe acute brain injury were first observed.

Citations

Citations to this article as recorded by

Association of Depressive and Somatic Symptoms with Heart Rate Variability in Patients with Traumatic Brain Injury
Seung Don Yoo, Eo Jin Park
Journal of Clinical Medicine.2022; 12(1): 104. CrossRef
Influencing Cardiovascular Outcomes through Heart Rate Variability Modulation: A Systematic Review
Alexandru Burlacu, Crischentian Brinza, Iolanda Valentina Popa, Adrian Covic, Mariana Floria
Diagnostics.2021; 11(12): 2198. CrossRef

Case Reports

Neurology/Obstetric
A Critical Case of Wernicke's Encephalopathy Induced by Hyperemesis Gravidarum: Byung Ju Kang, Min Gu Kim, Jwa Hoon Kim, Mingee Lee, Sang-Beom Jeon, Ha Il Kim, Jin Won Huh; Korean J Crit Care Med. 2015;30(2):128-131. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.128

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Abstract PDF

Wernicke’s encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke’s encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke’s encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.

Citations

Citations to this article as recorded by

Wernicke's Encephalopathy in Acute and Chronic Kidney Disease: A Systematic Review
Erik Oudman, Jan W. Wijnia, David Severs, Misha J. Oey, Mirjam van Dam, Maaike van Dorp, Albert Postma
Journal of Renal Nutrition.2024; 34(2): 105. CrossRef
Intrauterine Fetal Demise: A Rare Complication of Wernicke's Encephalopathy Secondary to Hyperemesis Gravidarum
Anthony Pham, Robin Okpara, Nancy Rollins, Roy Jacob
Cureus.2023;[Epub] CrossRef
Wernicke’s encephalopathy in hyperemesis gravidarum: A systematic review
Erik Oudman, Jan W. Wijnia, Misha Oey, Mirjam van Dam, Rebecca C. Painter, Albert Postma
European Journal of Obstetrics & Gynecology and Reproductive Biology.2019; 236: 84. CrossRef

Neurology
Posterior Reversible Encephalopathy Syndrome in a Critically Ill Postoperative Patient: Min Ae Keum, Hyo Keun No, Choong Wook Lee, Sang-Beom Jeon, Suk-Kyung Hong; Korean J Crit Care Med. 2015;30(1):46-51. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.46

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Abstract PDF: Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.

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