Neurocritical Care (2016) 25:S1–S310 DOI 10.1007/s12028-016-0301-7 NEUROCRITICAL CARE SOCIETY 14TH ANNUAL MEETING ABSTRACT SUPPLEMENT September 15-18, 2016 Gaylord National Resort & Convention Center y National Harbor, MD S2 Neurocrit Care (2016) 25:S1–S310 Table of Content Oral Platform …………………………………………………………... 4 - 21 Presentations Sessions I and III platform presentations will take place in Prince George Exhibit Hall A. Session II will be in the main symposium room. Session I Friday, September 16 4:30pm – 5:30 pm Session II Saturday, September 17 11:00am – 12:00 pm Session III Saturday, September 17 4:30pm – 5:30 pm Poster Sessions …………………………………………………………... 22 - 302 Posters can be viewed in Prince George Exhibit Hall A on Friday and Saturday from 5:30pm- 6:30pm. Basic Science……………………………………………………….22-34 Head and Spine Trauma…………………………………………………………………… 24 ICU Organization and Technology……………………………………………….………. 25 - 27 Ischemic Stroke…………………………………………………………………….……..… 28 - 29 Other……………………….……………………………………………………………. …… 30 - 32 Seizures……………………………………………………………………………….. ……… 33 Subarachnoid hemorrhage…………………………………………………………. ……… 34 Clinical…………………………………………………………….... 35-256 Disorders of Consciousness………………………………………………………….…. … 45 - 51 Head and Spine Trauma…………………………………………………………………… 52 - 78 ICU Organization and Technology……………………………………………….…….… 79 - 92 Intracerebral hemorrhage……………………………………………..…………….….. … 93 - 118 Ischemic Stroke…………………………………………………………………….…….. … 119 - 134 Medical Issues in the NeuroICU…………………………………………….…………. … 135 - 154 Muscle and Nerve Disorders…………………………………………………………..…… 155 -156 Other……………………….……………………………………………………………. …… 157 - 187 Pediatric NeuroICU………………………………………………………………………… 188 - 193 Peri-Operative Management………………………………………………………. ……… 194 - 197 Seizures……………………………………………………………………………….. ……… 198 - 213 Subarachnoid hemorrhage…………………………………………………………. ……… 214 - 249 Temperature Modulation……………………………………………………………. ……… 250 - 256 Neurocrit Care (2016) 25:S1–S310 S3 Case Reports………………………………………………….... 257-302 Disorders of Consciousness………………………………………………………….… 260 - 261 Head and Spine Trauma………………………………………………………………… 262 - 264 ICU Organization and Technology……………………………………………….……. 265 - 266 Intracerebral hemorrhage……………………………………………..…………….….. 267 - 270 Ischemic Stroke…………………………………………………………………….……. 271 - 273 Medical Issues in the NeuroICU…………………………………………….…………. 274 - 278 Muscle and Nerve Disorders………………………………………………………….... 279 Other……………………….……………………………………………………………. .. 280 - 289 Peri-Operative Management……………………………………………………….….. 290 - 292 Seizures………………………………………………………………………………..… 293 - 298 Subarachnoid hemorrhage………………………………………………………….…. 299 - 301 Temperature Modulation…………………………………………………………….…. 302 ORAL PLATFORM PRESENTATIONS PLATFORM ORAL S4 Neurocrit Care (2016) 25:S1–S310 ORAL PLATFORM PRESENTATIONS I Friday, September 16භ4:30 pm – 5:30 pm Prince George Exhibit Hall A Santosh Murthy Factors Associated with Permanent Cerebrospinal Fluid Shunting In Patients with Spontaneous Intraventricular Hemorrhage- Results from the Clot Lysis: Evaluating Kyle Hobbs MRI Characteristics of Early Seizures after Intracerebral Hemorrhage Stuart Fraser Race is a Predictor of Withdrawal of Life Support from Patients with Intracerebral Hemorrhage Wesley Baker Noninvasive Monitoring of Critical Closing Pressure with Near-infrared Light Lynze Franko Subdural Hematoma Patient Characteristics Associated with Unexpected 30-Day Readmission ORAL PLATFORM PRESENTATIONS PLATFORM ORAL Neurocrit Care (2016) 25:S1–S310 S5 ORAL PLATFORM PRESENTATIONS II Saturday, September 17 භ11:00 am – 12:00 pm Main Symposia Hall (Translational Science Session) Ivan da Silva- Best Abstract Award Zika Virus Associated Neurological Complications in Adults Vahid Eslami- Young Investigator Award Influence of Intracerebral Hemorrhage Location in Patients with Spontaneous Intraventricular Hemorrhage- Results from the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage (CLEAR) III trial Stephen Trevick Decision Making and Palliative Care in the Neurosciences Intensive Care Unit: Family Experiences and Outcomes Michael Reznik Long-Term Risk of Seizures in Survivors of Sepsis Ava Puccio Comparison of Progesterone Cerebrospinal and Serum Levels in Severe TBI Enrolled in SyNAPSE Trial ORAL PLATFORM PRESENTATIONS PLATFORM ORAL S6 Neurocrit Care (2016) 25:S1–S310 ORAL PLATFORM PRESENTATIONS III ^ĂƚƵƌĚĂLJ͕^ĞƉƚĞŵďĞƌϭϳභϰ:30 pm – 5:30 pm Prince George Exhibit Hall A Thomas Quinn “The wrong decision is the one you can’t live with.” - A mixed-methods study of surrogate decision-making in the Neuro-ICU Stefan Wolf Does Early Lumbar Cerebrospinal Fluid Drainage Lead To A Better Outcome In Aneurysmal Subarachnoid Hemorrhage? Daniel Hänggi Safety, Tolerability, Pharmacokinetics and Efficacy of Intraventricular Sustained Release Nimodipine (EG-1962) For Subarachnoid Hemorrhage Pitchaiah Mandava Modeling Outcome after Intracerebral Hemorrhage Indicates No Benefit and Potential Harm from Aggressive Blood Pressure Management TBA – Late Breaking TBA – Late Breaking ORAL PLATFORM PRESENTATIONS PLATFORM ORAL Neurocrit Care (2016) 25:S1–S310 S7 OralPlatform Presentation )ULGD\6HSWHPEHUƔSP– SP Prince George Exhibit Hall A Factors Associated with Permanent Cerebrospinal Fluid Shunting In Patients With Spontaneous Intraventricular Hemorrhage- 5HVXOWVIURPWKH&ORW/\VLV(YDOXDWLQJ$FFHOHUDWHG5HVROXWLRQRI Intraventricular Hemorrhage (CLEAR) III trial Santosh Murthy1, Jharna J. Shah2, Rachel R. Dlugash2, Nichol N. McBee2, Francois F. Aldrich3, Jean- Louis J. Caron4, Daniel D. Hanley2, Wendy W. Ziai2. 1Weill Cornell Medicine, New York, USA, 2Johns Hopkins University, Baltimore, USA, 3University of Maryland, Baltimore, USA, 4University of Texas, San Antonio, USA. ,QWURGXFWLRQ CLEAR III, a randomized, double-blinded, placebo-controlled trial was conducted to determine if pragmatically employed extraventricular drainage (EVD) plus intraventricular alteplase improved outcome by removing IVH and controlling intracranial pressure (ICP) in comparison to EVD plus saline. Given the paucity of data on permanent cerebrospinal fluid (CSF) shunts in primary IVH, we studied predictors of shunting in the CLEAR population. 0HWKRGV CLEAR III randomized 500 subjects to receive up to 12 doses of alteplase or 0.9% saline Q8H via the EVD until 3rd & 4th ventricles opened. Our predictor variable was permanent CSF shunt. Outcome measures were predictors of shunting, and blinded assessment of modified Rankin scale (mRS) at 180 days. 5HVXOWV CSF shunting was performed in 90 patients (18%) at a median of 18 days (Interquartile Range, IQR:13- 30) from IVH onset and was not different between treatment groups. Patient demographics and IVH characteristics were similar amongst patients with and without shunts. In the multivariate analysis, African American race (Odds Ratio[OR]:1.80, 95% Confidence Interval{CI}:1.08-3.08; p=0.024), total doses of study agent (OR:1.07, CI:1.01-1.14; p=0.041), daily drainage CSF per10cc (OR:1.08, CI:1.05- 1.12; p30 mmHg (OR 1.71, CI:1.02-2.85; p=0.043) were significantly associated with increased odds of CSF shunting, while end-of-treatment IVH volume, maximum CSF protein, thalamic obstruction were not. Patients who had CSF shunts had lower 180-day mortality but similar functional outcome, compared to patients without shunts. &RQFOXVLRQV Among patients with primary IVH requiring emergency CSF diversion, those with persistently elevated ICP and high CSF output are at increased odds of developing persistent hydrocephalus, necessitating permanent ventricular shunting. The association with African American race may be more complex. These factors may assist in predicting need for permanent CSF diversion and could improve management of this condition. ORAL PLATFORM PRESENTATIONS PLATFORM ORAL S8 Neurocrit Care (2016) 25:S1–S310 Oral Platform Presentation )ULGD\6HSWHPEHUƔSP– SP Prince George Exhibit Hall A MRI Characteristics of Early Seizures After Intracerebral Hemorrhage Kyle S. Hobbs, Michael M. Mlynash, Soren S. Christensen, Anna A. Finley-Caulfield, Marion M. Buckwalter, Chitra C. Venkatasubramanian. Stanford University / Department of Neurology and Neurological Sciences, Stanford, CA, USA. ,QWURGXFWLRQ We hypothesized that patients who have perihematomal ischemia (PHI) are more likely to have early post-ICH seizures (i.e. < 30 days). 0HWKRGV 277 patients from the prospective NIH funded DASH1 study (> 18 years, spontaneous ICH/IVH) were included. All patients had multimodal MRI. Imaging variables included ICH volume, location and number, etiology, early/delayed IVH, hydrocephalus, midline shift, SAH, microbleeds (lobar/deep), leukoaraiosis, and visible ischemia on ADC scored as perihematomal or remote. EEG monitoring was performed for clinical indications. Comparisons between those who did and did not have seizures (clinical and/or electrographic) was done with t-test or Mann-:KLWQH\WHVWIRUFRQWLQXRXVYDULDEOHVDQGȤRU)LVKHU¶V Exact test for categorical data. 5HVXOWV Eighty-six patients had EEG; thirty-two (12%) had early seizures (29 clinical, 3 electrographic only) at a median of day 2. Patients with early seizures compared to those without were more likely to have lobar (78% vs. 41%) than deep ICH (19% vs. 53%, p=0.001), or SAH (41% vs. 13% p< 0.001). Volume of ICH, leukoariosis, microbleeds and PHI (n=74, 31% vs. 30%) did not differ between groups. Prevalence of diabetes (6% vs. 24% P=0.02), hypertension (57% vs. 72%, p=0.08) and remote ischemia (n=52) was also lower in those with seizures