Neurological Updates in Neurocritical Care

Topic Information

Dear Colleagues,

Neurocritical care is a developing multidisciplinary field that combines neurology, critical care, and advanced therapies to enhance the management and outcomes of critically ill patients with acute neurological and neurosurgical disorders. Conditions such as traumatic brain injury, stroke, intracranial hemorrhage, status epilepticus, central nervous system infections, and neurodegenerative crises require rapid, precise, and innovative approaches. Recent advancements in neurocritical care have significantly improved our understanding of these conditions, allowing clinicians and researchers to refine diagnostic, monitoring, and treatment strategies. Technological innovations such as advanced neuroimaging, multimodal neuromonitoring, and the integration of artificial intelligence have transformed our ability to assess and manage critically ill neurological patients. The emergence of biomarkers, neuroprotective agents, and individualized treatment protocols highlights the significance of personalized care in enhancing patient outcomes. Additionally, advancements in ventilatory strategies, temperature management, and hemodynamic optimization have changed the landscape of intensive care for neurological emergencies.

We invite submissions of high-quality original research, reviews, and case reports focusing on the latest developments and future directions in neurocritical care. Topics of interest include, but are not limited to, the following:

• Innovations in neuroimaging and neuromonitoring techniques;
• Biomarkers in prognosis and therapeutic responses;
• Neuroprotective strategies and pharmacological advancements;
• Advances in stroke, traumatic brain injury, and seizure management;
• Artificial intelligence and machine learning in neurocritical care;
• Ethical considerations and quality-of-life outcomes;
• Brain death and organ donation;
• Anesthesia and neuro-anesthesia;
• Pain management.

Join us in exploring the cutting-edge trends and challenges that define this rapidly evolving field. Contribute to the collective effort of advancing knowledge and improving the standard of care for critically ill neurological patients.

Dr. Gabriele Melegari
Dr. Elisabetta Bertellini
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Brain Sciences brainsci	2.8	5.6	2011	16.2 Days	CHF 2200	Submit
Clinical and Translational Neuroscience ctn	1.1	-	2017	21.9 Days	CHF 1000	Submit
Neurology International neurolint	3.0	4.8	2009	21.4 Days	CHF 1800	Submit
NeuroSci neurosci	2.0	-	2020	27.1 Days	CHF 1200	Submit

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Published Papers (6 papers)

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All Brain Sciences CTN Neurology International NeuroSci

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Open AccessSystematic Review

Cerebral Perfusion Pressure in Severe Traumatic Brain Injury Survivors and Non-Survivors: A Meta-Analysis

by Maria Karagianni, Alexandros G. Brotis, Charikleia S. Vrettou, Kerasia Goupou, George Stranjalis and Kostas N. Fountas

Brain Sci. 2025, 15(11), 1161; https://doi.org/10.3390/brainsci15111161 - 29 Oct 2025

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Abstract

Background: Severe traumatic brain injury (sTBI) is a leading cause of death and disability worldwide. Cerebral perfusion pressure (CPP), the difference between mean arterial and intracranial pressure, is crucial for maintaining cerebral blood flow. However, the optimal CPP threshold for improving outcomes remains [...] Read more.

Background: Severe traumatic brain injury (sTBI) is a leading cause of death and disability worldwide. Cerebral perfusion pressure (CPP), the difference between mean arterial and intracranial pressure, is crucial for maintaining cerebral blood flow. However, the optimal CPP threshold for improving outcomes remains uncertain. Objective: To identify CPP levels associated with favorable outcomes following sTBI through a systematic review and meta-analysis. Methods: Following PRISMA guidelines, we systematically searched PubMed, Scopus, and Web of Science up to February 2024 for studies involving adult sTBI patients admitted to intensive care units. Studies reporting CPP in relation to outcomes measured by the Glasgow Outcome Scale (GOS) were included. Pooled mean CPP differences between outcome groups were calculated using a random-effects model. Study quality was assessed using the Newcastle–Ottawa Scale, and evidence certainty was evaluated with GRADE. Results: Twenty-two studies with 2986 patients met inclusion criteria. Patients with good outcomes (GOS > 3) had higher CPP (77.5 mmHg; 95% CI: 73.8–81.2) than those with poor outcomes (67.2 mmHg; 95% CI: 60.4–74.1), with a mean difference of 10.01 mmHg (95% CI: 4.23–15.80; p < 0.05). Survivors also demonstrated higher CPP than non-survivors (mean difference 8.15 mmHg; 95% CI: 3.28–13.02). Evidence quality ranged from low to very low due to study heterogeneity. Conclusions: Higher CPP levels (~75–80 mmHg) are associated with better survival and functional outcomes after sTBI, supporting individualized, multimodal CPP management rather than a fixed 60 mmHg threshold. Full article

(This article belongs to the Topic Neurological Updates in Neurocritical Care)

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28 pages, 3179 KB  

Open AccessArticle

Incidence, Risk Factors, and Prevention of Deep Vein Thrombosis in Acute Ischemic Stroke Patients (IRIS-DVT Study): A Systematic Review and Meta-Analysis

by Yuxiang Yang, Darryl Chen and Sonu M. M. Bhaskar

Clin. Transl. Neurosci. 2025, 9(4), 49; https://doi.org/10.3390/ctn9040049 - 9 Oct 2025

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Abstract

Background: Deep vein thrombosis (DVT) is a serious thromboinflammatory complication of acute ischemic stroke (AIS). The true incidence, mechanistic risk factors, and optimal prophylactic strategies remain uncertain, particularly in the era of reperfusion therapy. Methods: This systematic review and meta-analysis (IRIS-DVT) searched PubMed, [...] Read more.

Background: Deep vein thrombosis (DVT) is a serious thromboinflammatory complication of acute ischemic stroke (AIS). The true incidence, mechanistic risk factors, and optimal prophylactic strategies remain uncertain, particularly in the era of reperfusion therapy. Methods: This systematic review and meta-analysis (IRIS-DVT) searched PubMed, Embase, Cochrane, Scopus, and Web of Science for studies reporting DVT incidence, risk factors, or prophylaxis in AIS (2004–2025). Random-effects models were used to generate pooled prevalence and effect estimates, and the certainty of evidence was graded using the GRADE framework. Results: Forty-two studies (n = 6,051,729 patients) were included. The pooled prevalence of DVT was 7% (95% CI, 6–9%), approximately seventy-fold higher than in the general population, with wide heterogeneity influenced by screening timing and diagnostic modality. Pathophysiological risk factors included higher stroke severity (NIHSS; SMD 0.41; 95% CI, 0.38–0.43), older age (SMD 0.32; 95% CI, 0.18–0.46), elevated D-dimer (SMD 0.55; 95% CI, 0.38–0.72), female sex (OR 1.33; 95% CI, 1.19–1.50), and malignancy (OR 2.69; 95% CI, 1.56–5.22), supported by moderate-certainty evidence. Respiratory infection and admission hyperglycemia showed weaker, low-certainty associations. Traditional vascular risk factors (hypertension, diabetes, atrial fibrillation, dyslipidemia) were not significantly related to DVT risk. Evidence for prophylaxis with low-molecular-weight heparin, direct oral anticoagulants, or intermittent pneumatic compression was limited and graded very low certainty. Conclusions: DVT complicates approximately one in fourteen AIS cases, reflecting a distinct thromboinflammatory process driven more by acute neurological severity, systemic hypercoagulability, and malignancy than by conventional vascular risk factors. Early systematic screening (≤72 h) and consistent use of mechanical prophylaxis are warranted. Dedicated AIS-specific mechanistic and interventional trials are urgently needed to refine prevention strategies and improve post-stroke outcomes. Full article

(This article belongs to the Topic Neurological Updates in Neurocritical Care)

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16 pages, 278 KB  

Open AccessArticle

Exploring Physiotherapists’ Perspectives on Gaps in Care Continuity and Their Training Needs to Address These Gaps for People with Stroke in Saudi Arabia: A Qualitative Study

by Basema Temehy, Andrew Soundy, Ahmad Sahely and Sheeba Rosewilliam

Clin. Transl. Neurosci. 2025, 9(3), 42; https://doi.org/10.3390/ctn9030042 - 16 Sep 2025

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Abstract

Background: Continuity of care is critical for optimal stroke rehabilitation, yet gaps in post-stroke services in Saudi Arabia may undermine long-term patient outcomes and recovery. The therapists who care for people with stroke should be aware of patients’ needs post discharge and possess [...] Read more.

Background: Continuity of care is critical for optimal stroke rehabilitation, yet gaps in post-stroke services in Saudi Arabia may undermine long-term patient outcomes and recovery. The therapists who care for people with stroke should be aware of patients’ needs post discharge and possess skills to address them. This study explored physiotherapists’ perspectives on gaps in care continuity for stroke patients in Saudi Arabia and identified the training needs required to address these gaps. Methods: An exploratory qualitative study situated within critical realism was conducted using nine semi-structured interviews and three focus groups. Twenty-six physiotherapists who were working in outpatient stroke rehabilitation services participated. Data was analysed using reflexive thematic analysis. Results: Three major themes emerged. Significant gaps in post-stroke care were identified, including the lack of specialised stroke rehabilitation centres and clinical practice guidelines. Participants described both facilitators and barriers to implementing continuity of care approaches, such as telerehabilitation, self-management and home care. Further, physiotherapists highlighted the need for comprehensive training in stroke assessment and management, along with the development of standardised patient and caregiver educational protocols to support care continuity. Conclusion: The study highlights the need for targeted training programmes to enhance physiotherapists’ competencies in stroke care. It also calls for systemic collaboration among healthcare organisations and policymakers to develop structured post-stroke services. Full article

(This article belongs to the Topic Neurological Updates in Neurocritical Care)

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18 pages, 1471 KB  

Open AccessSystematic Review

Enhanced Recovery After Surgery in Elective Craniotomy: A Systematic Review and Meta-Analysis of Perioperative Outcomes

by Carlos Darcy Alves Bersot, Lucas Ferreira Gomes Pereira, Vitor Alves Felippe, Matheus Reis Rocha Melo Barros, Gustavo Fernandes Nunes, José Eduardo Guimarães Pereira and Luiz Fernando dos Reis Falcão

Clin. Transl. Neurosci. 2025, 9(3), 39; https://doi.org/10.3390/ctn9030039 - 1 Sep 2025

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Abstract

Introduction: Craniotomy, a common neurosurgical procedure, is frequently associated with substantial perioperative challenges and delayed recovery. While Enhanced Recovery After Surgery (ERAS) protocols have demonstrated clear benefits in multiple surgical fields, their application in neurosurgery, particularly elective craniotomy, remains emerging. Objective: This systematic [...] Read more.

Introduction: Craniotomy, a common neurosurgical procedure, is frequently associated with substantial perioperative challenges and delayed recovery. While Enhanced Recovery After Surgery (ERAS) protocols have demonstrated clear benefits in multiple surgical fields, their application in neurosurgery, particularly elective craniotomy, remains emerging. Objective: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of ERAS protocols in adult patients undergoing elective craniotomy, focusing on key outcomes such as length of hospital stay (LOS), postoperative pain, complications, and functional recovery. Methods: Following PRISMA guidelines, a comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up to June 2025. Eligible studies included adult patients (≥18 years) undergoing elective craniotomy and compared ERAS protocols to conventional perioperative care. Primary outcomes were LOS, postoperative complications, pain, early oral intake, and early mobilization. Data extraction and risk of bias assessment (RoB 2.0) were independently performed by two reviewers. Results: Nine randomized controlled trials (RCTs), totaling 1453 patients, were included. Meta-analysis showed that ERAS protocols significantly reduced length of hospital stay (mean difference: −2.17 days; 95% CI: −2.92 to −1.42; p < 0.00001) and decreased the incidence of postoperative nausea and vomiting (odds ratio [OR]: 0.29; 95% CI: 0.19 to 0.44; I² = 0%). ERAS protocols were associated with higher odds of early mobilization (OR: 6.88; 95% CI: 3.46 to 13.68) and early oral intake (OR: 14.04; 95% CI: 7.80 to 25.26). Postoperative complications were significantly reduced in the ERAS group (OR: 0.49; 95% CI: 0.24 to 0.99; p = 0.048; I² = 0%). While early urinary catheter removal showed a favorable trend (OR: 13.48), high heterogeneity (I² = 95.7%) limits interpretability. Postoperative pain on day 1 did not differ significantly between groups (mean difference: −0.37; 95% CI: −2.38 to 1.63; p = 0.72). The overall risk of bias was rated low to moderate across studies. Conclusions: ERAS protocols in elective craniotomy are associated with shorter hospital stays, lower complication rates, reduced PONV, and earlier return to function, without increasing adverse events. These findings support broader implementation of ERAS in neurosurgical practice. Further multicenter RCTs are warranted to standardize and refine ERAS components for craniotomy. Full article

(This article belongs to the Topic Neurological Updates in Neurocritical Care)

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12 pages, 677 KB  

Open AccessReview

Prognostic Utility of Arterial Spin Labeling in Traumatic Brain Injury: From Pathophysiology to Precision Imaging

by Silvia De Rosa, Flavia Carton, Alessandro Grecucci and Paola Feraco

NeuroSci 2025, 6(3), 73; https://doi.org/10.3390/neurosci6030073 - 4 Aug 2025

Viewed by 1595

Abstract

Background: Traumatic brain injury (TBI) remains a significant contributor to global mortality and long-term neurological disability. Accurate prognostic biomarkers are crucial for enhancing prognostic accuracy and guiding personalized clinical management. Objective: This review assesses the prognostic value of arterial spin labeling (ASL), a [...] Read more.

Background: Traumatic brain injury (TBI) remains a significant contributor to global mortality and long-term neurological disability. Accurate prognostic biomarkers are crucial for enhancing prognostic accuracy and guiding personalized clinical management. Objective: This review assesses the prognostic value of arterial spin labeling (ASL), a non-invasive MRI technique, in adult and pediatric TBI, with a focus on quantitative cerebral blood flow (CBF) and arterial transit time (ATT) measures. A comprehensive literature search was conducted across PubMed, Embase, Scopus, and IEEE databases, including observational studies and clinical trials that applied ASL techniques (pCASL, PASL, VSASL, multi-PLD) in TBI patients with functional or cognitive outcomes, with outcome assessments conducted at least 3 months post-injury. Results: ASL-derived CBF and ATT parameters demonstrate potential as prognostic indicators across both acute and chronic stages of TBI. Hypoperfusion patterns correlate with worse neurocognitive outcomes, while region-specific perfusion alterations are associated with affective symptoms. Multi-delay and velocity-selective ASL sequences enhance diagnostic sensitivity in TBI with heterogeneous perfusion dynamics. Compared to conventional perfusion imaging, ASL provides absolute quantification without contrast agents, making it suitable for repeated monitoring in vulnerable populations. ASL emerges as a promising prognostic biomarker for clinical use in TBI. Conclusion: Integrating ASL into multiparametric models may improve risk stratification and guide individualized therapeutic strategies. Full article

(This article belongs to the Topic Neurological Updates in Neurocritical Care)

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8 pages, 515 KB  

Open AccessArticle

Attention Test as a Predictive Marker of Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

by Helaina Lehrer, Ankit Bansal, Nicki Mohammadi, Anmol Mittal, John Liang and Alexandra S. Reynolds

Clin. Transl. Neurosci. 2025, 9(2), 28; https://doi.org/10.3390/ctn9020028 - 18 Jun 2025

Viewed by 765

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) has high morbidity and mortality in part due to vasospasm and delayed cerebral ischemia (DCI). This retrospective, single-center, case–control study evaluates the accuracy of an attention test, counting backwards from twenty to one (TTO), for detecting vasospasm and DCI [...] Read more.

Aneurysmal subarachnoid hemorrhage (aSAH) has high morbidity and mortality in part due to vasospasm and delayed cerebral ischemia (DCI). This retrospective, single-center, case–control study evaluates the accuracy of an attention test, counting backwards from twenty to one (TTO), for detecting vasospasm and DCI in patients admitted to the ICU with aSAH over one year. The odds of symptomatic vasospasm and hospital outcomes were compared between the inattention and control groups. A subgroup analysis included accuracy tests comparing TTO to radiographic vasospasm. Of 44 subjects, 24 had inattention during their ICU course. Compared to controls, the inattention group had increased odds of vasospasm (OR 72 [7.6–677.7], p = 0.001), with significantly longer ICU (5.9 days) and hospital (6.6 days) lengths of stay, and higher odds of discharge to other healthcare facilities (OR 11.4 [2.8 to 46.8], p < 0.001). Errors on TTO testing had a specificity and sensitivity of 78%, and a positive predictive value (PPV) of 91%, for radiographic vasospasm, primarily in the anterior circulation. This study provides support for future prospective research to help elucidate the utility of TTO testing for monitoring and treatment of patients with aSAH. Full article

(This article belongs to the Topic Neurological Updates in Neurocritical Care)

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