Background: Charles Bonnet syndrome (CBS) is a condition characterized by vivid, complex visual hallucinations in individuals with visual impairment. Despite its prevalence among the elderly and those with degenerative eye diseases, CBS remains underdiagnosed and undertreated due to a lack of awareness and misconceptions surrounding its etiology and management.Case Report: A 51-year-old man presented to the emergency room after falling off his bicycle without wearing a helmet. Head imaging revealed a small right frontoparietal traumatic subarachnoid hemorrhage with an associated trace subdural hematoma along the right parietal convexity. Subsequently, he developed non-light perceiving vision loss, after which he began experiencing visual hallucinations. Conclusion CBS is frequently overlooked or left untreated. Research on diagnosing and managing CBS following head trauma is limited. Therefore, clear diagnostic criteria for CBS and a better understanding of its underlying mechanisms are needed to improve diagnosis and management strategies.

Rapid versus gradual external ventricular drain (EVD) weaning methods have been widely debated, aiming to establish a standard clinical practice. The techniques used in each approach offer their own set of benefits and associated risks. Many published works continue to deliberate and dispute each other on the topic, as many believe gradual weaning is preferable due to its perceived potential to decrease ventriculoperitoneal shunt (VPS) dependency. In contrast, rapid weaning is known to have benefits such as a reduction in ventriculostomy-associated infections. Additionally, both weaning methods have been further debated due to the perception of the risks associated, which for gradual weaning includes a longer hospital stay. This literature review explores both sides of this debate, providing pros and cons to each weaning method to better unify the disconnect within the field. Based on the current research available, it is clear that due to a lengthy and more consistent list of benefits as well as overall decreased associated risks, rapid weaning is the superior form of EVD treatment method and should become the standard for clinical practice when performing EVDs on patients suffering from aneurysmal subarachnoid hemorrhages.

Background: Branch retinal artery occlusion (BRAO) is characterized by a sudden, painless monocular visual loss. The condition usually has a favorable prognosis but can sometimes cause severe visual loss. Currently, no clinical guidelines are available for the treatment of BRAO.Case Report: A 38-year-old man presented with vision loss. Initial visual acuity was 0.08/1.0 and a lower-altitudinal visual field defect was detected in the right eye. Occlusion of the superior temporal branch of the retinal artery was observed using fluorescein angiography. The patient was diagnosed with BRAO, and intra-arterial thrombolysis (IAT) was performed 11 hours after the first abnormality. The patient demonstrated rapid improvement after IAT. Visual acuity recovered to 0.8/1.0 and only the cecocentral scotoma remained at 5-month follow-up. Conclusion For patients with BRAO and severe vision loss, IAT may be an effective treatment. However, owing to potential complications, this procedure should be reserved for selected patients.

Background: Monitoring the cerebral blood flow (CBF) is crucial when caring for patients in neurological intensive care units (NICU). Changes in CBF, either due to hypo- or hyperperfusion, have been associated with neurological deterioration. By using a non-invasive continuous CBF monitor, we aimed to assess whether cerebral flow index (CFI) fluctuations could correlate with neurological deterioration. Methods: We prospectively collected data from patients with acute brain injury (subarachnoid hemorrhage [SAH], Moyamoya disease [MMD], and ischemic stroke), who were at a high risk for CBF disturbance between May 2017 and June 2019. Non-invasive CBF measurements were performed in the bilateral prefrontal cortex using a c-FLOW device. Continuous CBF was assessed using CFI. The delta value and percent change in the CFI were compared between patients with and without neurological deterioration. Results: A total of 45 patients (mean age, 51.6 years; male, 48.9%) were included in our analysis (SAH, 13; MMD, 17; ischemic stroke,15). The mean monitoring duration was approximately 52 hours. Nine patients (20.0%) had neurologic worsening during c-FLOW monitoring in NICU. The delta value (median, 10.4; interquartile range [IQR], 3.9–14.3 vs. median, 3.4; IQR, 2.5–5.6; P=0.008) and percent change in CFI (28.5% vs. 9.0%, P<0.001) was significantly higher in groups with neurological deterioration. In two patients with neurological deterioration, no CFI change was observed because aggravation of cerebral perfusion occurred outside the area of CFI monitoring. Conclusion Continuous non-invasive CBF monitoring with c-FLOW may be useful for patients with acute brain injury at high risk for CBF alterations.

Background: This study investigated the impact of premorbid functional dependency on post-stroke mortality in patients with anterior circulation stroke (ACS) and posterior circulation stroke (PCS). Methods: This study enrolled 9,698 patients who experienced ischemic stroke between January 2011 and December 2022. The patients were classified into the ACS and PCS groups. Premorbid functional dependency was defined as modified Rankin Scale of ≥3. The risks of premorbid functional dependency and mortality at 3 months and 1-year post-stroke were assessed. A subgroup analysis was further performed to evaluate the risk of premorbid functional dependency in patients who underwent intravenous thrombolysis and endovascular treatment (EVT). Results: Among 6,358 patients with ACS and 3,340 with PCS, those with premorbid dependency were older, predominantly female, and had a higher proportion of vascular risk factors and stroke severity. Premorbid functional dependency was associated with increased mortality at both 3 months and 1 year in the PCS (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.00–3.13; P=0.04 and OR, 2.87; 95% CI, 1.86–4.38; P<0.001, respectively), but not in the ACS (OR, 1.08; 95% CI, 0.77–1.51; P=0.639 and OR, 1.22; 95% CI, 0.93–1.59; P=0.140, respectively) group. Among patients who underwent EVT, premorbid functional dependency increased the risk of mortality at 1 year in the ACS group (OR, 1.80; 95% CI, 1.04–3.08; P=0.034), but was not associated with the risk in the PCS group (OR 2.56; 95% CI 0.64–10.15; P=0.176). Conclusion Premorbid functional dependency increases the risk of mortality in patients with PCS.

Intravenous fluid therapy is a fundamental treatment in intensive care units (ICUs). Although most clinical trials have focused on patients requiring active resuscitation of the intravascular volume, such as those experiencing shock or sepsis, neurocritically ill patients may also benefit from intravenous fluid therapy during crises involving elevated intracranial pressure or reduced cerebral perfusion pressure. This review provides a comprehensive history of the evolution of intravenous fluid therapy, highlighting the development of crystalloids and the challenges associated with colloids. Previously favored for their theoretical advantages in sustaining intravascular volume, colloids have recently come under scrutiny due to safety concerns, including adverse renal outcomes. In contrast, crystalloids, particularly balanced crystalloids, are now preferred. Balanced crystalloids improve acid-base status and pose a lower risk of hyperchloremic metabolic acidosis than 0.9% saline. This review summarizes the key findings of recent clinical trials comparing the efficacy and safety profiles of crystalloids and colloids in ICU settings with a specific focus on neurocritical care populations.