Neuron-specific enolase (NSE) is a dimeric glycolytic enzyme predominantly localized to neurons and neuroendocrine cells. It exists in two isoforms: γγ (neuron-specific) and αγ (neuroendocrine-specific). NSE is a tumor marker in oncology, particularly for small-cell lung cancer (SCLC) and other neuroendocrine tumors (NETs). Serum elevations can assist in diagnosis, staging,…
DuoNeb is an inhalation solution combining ipratropium bromide (an anticholinergic) with albuterol sulfate (β2-agonist) to promote bronchodilation. During nebulization, aerosolized ipratropium can leak to the ipsilateral conjunctiva, causing the pupil to dilate (mydriasis). On exam, one would appreciate unequal pupils (anisocoria) with the blown pupil unreactive to light. Intracranial pathology has…
Brain death is a clinical diagnosis supported by imaging but confirmed by the bedside exam to assess for the irreversible loss of cortical and brainstem functions. The apnea test (AT) is a common method used to evaluate the definitive absence of a brainstem-mediated respiratory drive. To ensure patient safety and…
Cerebrospinal fluid (CSF) is a clear and colorless fluid surrounding the brain and spinal cord, providing cushioning and nutrients to the central nervous system. Xanthochromia (Greek for “yellow color”) refers to the yellow discoloration of the CSF, which can indicate the presence of blood breakdown products such as bilirubin or…
Fosphenytoin (Cerebyx) is a prodrug of phenytoin, an antiepileptic drug used to treat seizures. Unlike phenytoin, which is poorly soluble in water and can cause severe local irritation if injected into the muscle, fosphenytoin is water-soluble and can be administered intravenously without causing tissue damage. Fosphenytoin is rapidly converted to…
Levetiracetam (Keppra) is an oral and intravenous antiepileptic drug (AED) indicated as adjunctive therapy for partial onset seizures, myoclonic seizures, and generalized tonic-clonic (“grand mal”) seizures in adults. The medication is used in the pediatric population as well for various reasons beyond my scope of practice. Most AEDs either enhance…
Alteplase (recombinant tissue plasminogen activator, tPA) is a potent intravenous fibrinolytic (“clot buster”) used for everything from acute ischemic strokes and clearing central line ports (“Cathflo”, a total life saver!) to hemodynamically unstable pulmonary embolism (PE) and even ST elevation myocardial infarctions (STEMIs – “heart attacks”).
Most organ systems have some form of autoregulation to provide a steady supply of blood flow and oxygen to maintain normal physiologic function. This autoregulation is largely driven by chemical mediators to “couple” metabolic demand with blood supply. In other words, if the organ demands less oxygen, then it will…
Managing elevated intracranial pressure (ICP) is of paramount importance in neurocritical care. Placing bedside ICP monitors are contraindicated if the patient is coagulopathic, has a brain abscess, or has an active scalp infection. Otherwise, the procedure is fairly straightforward and usually boils down to two choices: a Codman ICP monitor…
It’s the middle of the month, the Texans got royally owned by the Patriots in the divisional playoff game last night, I submitted my hospital credentialing for fellowship this morning, and I’m so far behind with ITE studying… but I’m still going to reflect on my neuroanesthesia rotation has been thus far.…