Over decades of development, the management of diagnosis and treatment in neurocritical care medicine has evolved from single - parameter monitoring to multimodal neuromonitoring. Through the integration of intracranial pressure (ICP), cerebral blood flow, brain function and other multi-parameter monitoring data, combined with artificial intelligence (AI) and big data model, it can realize the risk early warning of multiple complications. Digital and intelligent technologies are driving innovations in diagnosis and treatment. Although facing challenges such as difficult data standardization and model adaptation, it will continue to develop towards precision, individualization, digital intelligence and networking in the future.

Intracranial pressure (ICP) monitoring serves as a critical component in the management of neurocritical care patients. Hydraulic-coupled intracranial pressure monitoring via external ventricular drainage (EVD-ICP) monitoring offers a clinically practical approach that enables both dynamic physiological assessment and therapeutic intervention, and has gained widespread adoption. However, the significant variability persists across healthcare institutions regarding the procedural standardization and the implementation of systematic management protocols. Building upon evidence-based medical principles and multidisciplinary expert consensus, this "Chinese expert consensus on the management of hydraulic-coupled intracranial pressure monitoring via external ventricular drainage" synthesizes key aspects of EVD-ICP monitoring, including clinical indications, procedural workflows, trouble shooting strategies, monitoring duration, complication prevention and management. The expert consensus aims to standard the technique and management of EVD-ICP monitoring, enhance diagnostic and therapeutic outcomes in the neurocritical care patients, and promote the standardized, precise and efficient application of this technology across clinical settings.

The monitoring, evaluation and critical care management of neurological complications after endovascular treatment for acute ischemic stroke are essential components in optimizing patient outcomes and reducing both disability and mortality rates. Neurological complications, such as hemorrhagic transformation, vessel reocclusion, malignant brain edema and post-stroke epilepsy, which occur after endovascular treatment can significantly influence the overall effectiveness of the treatment. However, current critical care management of neurological complications are often hindered by inconsistencies in management standards and lack of standardized protocols. This expert consensus, grounded in evidence-based medicine and incorporating the clinical insights of professionals from multiple disciplines, provides a systematic approach to key areas including the identification of risk factors, appropriate monitoring and evaluation, and effective critical care management strategies for the most common postoperative neurological complications. Together, these elements form a comprehensive and standardized management framework. The primary goal of this consensus is to deliver scientifically sound and clinically applicable guidance for neurological complications management after endovascular treatment in patients with acute ischemic stroke.

Supratentorial and infratentorial combined injuries is a rare but particularly type of severe traumatic brain injury (sTBI), characterized by high rates of morbidity and mortality. The injury spans the tentorium of cerebellum, involving key structures such as the supratentorial cerebral hemispheres, the infratentorial cerebellum and brain stem. Its pathophysiological mechanism is complex, progression is rapid, and diagnosis and treatment are extremely challenging. Currently, there is no unified clinical consensus established for its management, either domestically or internationally. This article systematically reviews recent research advances in the pathophysiological basis, injury characteristics, clinical manifestations, diagnostic evaluation, treatment strategies, and perioperative management of supratentorial and infratentorial combined injuries, aiming to provide a basis for clinical diagnosis and treatment.

The emotional disorders after traumatic brain injury (TBI) are significant sequelae that affect patient rehabilitation and quality of life. Clinical manifestations primarily include depression, anxiety, and cognitive dysfunction, with mechanisms involving brain structural and functional changes. Functional neuroimaging techniques provide key biological evidence to unveil the pathophysiological mechanisms. Currently treatments focus on medication, psychological interventions, and neuroregulatory technologies, while interdisciplinary comprehensive treatment strategies can significantly improve symptoms. This article aims to conduct a review on the epidemiology, clinical manifestations, pathogenesis, diagnosis and treatment of emotional disorders after TBI, and prospect the future development directions, so as to promote the optimization and innovation of diagnosis and treatment strategies.

Objective: To investigate the predictive value of mismatch negativity (MMN) combined with P300 for cognitive dysfunction at 6 months after traumatic brain injury (TBI) in adult patients. Methods: A total of 75 adult TBI patients admitted to Xiangya Hospital, Central South University from January 2021 to January 2024 were enrolled. MMN and P300 were monitored within 7 d after TBI. Cognitive function was assessed at 6 months after TBI using the Telephone Interview for Cognitive Status (TICS), with a score of < 27 indicating cognitive dysfunction. Univariate and multivariate Logistic regression analyses were used to identify influencing factors for cognitive dysfunction at 6 months after TBI. Receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was calculated to evaluate the predictive performance of the identified factors. Results: Lower absolute value of Fz MMN amplitude (OR = 0.426, 95%CI: 0.188-0.968; P = 0.041) and Cz P300 amplitude (OR = 0.399, 95%CI: 0.188-0.847; P = 0.017) were identified as risk factors for cognitive dysfunction at 6 months after TBI. ROC curve showed that the AUC for the absolute value of Fz MMN amplitude was 0.713 (95%CI: 0.595-0.830, P = 0.002), with an optimal cutoff value of 2.37 μV. The AUC for the absolute value of Cz P300 amplitude was 0.752 (95%CI: 0.641-0.863, P = 0.000), with an optimal cutoff value of 3.28 μV. When these 2 indicators were combined for ROC curve, the combined indicator yielded an AUC of 0.781 (95%CI: 0.676-0.886, P = 0.000). Delong test revealed no statistically significant differences in AUC between the combined indicator and the absolute value of Fz MMN amplitude (Z = 1.574, P = 0.115) or the absolute value of Cz P300 amplitude (Z = 0.939, P = 0.348), suggesting comparable predictive performance among the 3 indicators. Conclusions: MMN combined with P300 may serve as a favorable indicator for predicting cognitive dysfunction at 6 months after TBI.

Objective: To explore the clinical effect of external ventricular drainage combined with lumbar cistern drainage under intracranial pressure (ICP) monitoring in severe aneurysmal subarachnoid hemorrhage (SaSAH). Methods: From March 2019 to March 2023, 106 patients with SaSAH admitted to Department of Neurosurgical Intensive Care Unit of He'nan Provincial People's Hospital were randomly divided into ICP monitoring group (n = 52) and without ICP monitoring group (n = 54). The ICP monitoring group was treated with external ventricular drainage combined with lumbar cistern drainage under ICP monitoring, while without ICP monitoring group was treated with external ventricular drainage combined with lumbar cistern drainage under non-ICP monitoring. Cerebrospinal fluid drainage volume, the incidence of in-hospital and long-term complications were recorded. The modified Rankin Scale (mRS) and Glasgow Outcome Scale-Extended (GOS-E) were used to evaluate the neurological prognosis, and the good prognosis rate was calculated. Results: The cerebrospinal fluid drainage volume between ICP monitoring group and without ICP monitoring group was statistically significant (F = 59.843, P = 0.000), and the cerebrospinal fluid drainage volume at different measurement times was also statistically significant (F = 5.352, P = 0.000), and there was interaction between treatment factors and measurement time (F = 19.800, P = 0.000). There was no significant difference of cerebrospinal fluid drainage volume between the 2 groups on the 1-3 d (P > 0.05, for all), and the cerebrospinal fluid drainage volume of ICP monitoring group on the 4-7 d was lower than that of the without ICP monitoring group (P = 0.000, for all). In without ICP monitoring group, postoperative cerebrospinal fluid drainage volume gradually decreased, with drainage on postoperative 4-7 d being lower than on 1 d (P = 0.000, 0.000, 0.000, 0.000), 2 d (P = 0.000, 0.000, 0.000, 0.000) and 3 d (P = 0.004, 0.036, 0.000, 0.007). In ICP monitoring group, the incidence of cerebral vascular spasm (χ² = 4.850, P = 0.028), hydrocephalus (χ² = 5.804, P = 0.016), delayed cerebral infarction (χ² = 6.722, P = 0.010), brain hernia (χ² = 5.681, P = 0.017), renal failure (χ² = 5.903, P = 0.015), electrolyte disturbance (χ² = 6.389, P = 0.011) and shunt dependent hydrocephalus (χ² = 6.286, P = 0.012) were lower than without ICP monitoring group. At 6 months postoperatively, the ICP monitoring group had a lower mRS score (Z =-2.484, P = 0.013) and a higher GOS-E score (Z =-3.018, P = 0.003) than without ICP monitoring group. The good prognosis rate of ICP monitoring group was higher than that of without ICP monitoring group (χ² = 5.403, P = 0.020). Conclusions: External ventricular drainage combined with lumbar cistern drainage under ICP monitoring for SaSAH can reduce the incidence of complications and improve the prognosis.

Objective: To explore and evaluate the application value of pressure reactivity index (PRx) based on invasive intracranial pressure (ICP) and mean flow index (Mx) based on transcranial Doppler ultrasonography (TCD) noninvasive monitoring in severe traumatic brain injury (sTBI). Methods: The clinical data of 64 patients with sTBI treated in He'nan Provincial People's Hospital from January 2024 to February 2025 were included. According to the Glasgow Outcome Scale (GOS), the patients were divided into the good prognosis (GOS score 3-5) group (n = 31) and the poor prognosis (GOS score 1-2) group (n = 33). All patients received ICP monitoring immediately after surgery for 3-7 d. The ICP-related indicators including average ICP, cerebral perfusion pressure (CPP) and PRx were collected, and the ICP dose with a threshold of 20 mm Hg (D_ICP20) was obtained. All patients were monitored by TCD with an interval of ≥ 3 d immediately after operation, and the specific value of Mx was obtained. Univariate and multivariate Logistic regression analyses were used to analyze of influencing factors for 6-month post-discharge prognostic outcomes in patients with sTBI. The receiver operating characteristic (ROC) curve was further drawn, and the area under the curve (AUC) was calculated to evaluate the ability of each parameter to predict poor prognosis. Pearson correlation analysis was used to further analyze the correlation between PRx and Mx. Results: Logistic regression analysis showed that higher ICP (OR = 2.439, 95%CI: 1.077-5.526; P = 0.033), higher PRx (OR = 14.932, 95%CI: 2.215-100.666; P = 0.005) and higher Mx (OR = 3.087, 95%CI: 1.145-8.324; P = 0.026) were risk factors for 6-month post-discharge prognostic outcomes in patients with sTBI. The AUC of ICP, PRx and Mx was 0.912 (95%CI: 0.814-0.968, P = 0.033), 0.958 (95%CI: 0.876-0.992, P = 0.005) and 0.859 (95%CI: 0.749-0.933, P = 0.026), and the prediction efficiency of the three was the same (Z = 0.850, P = 0.396; Z = 1.128, P = 0.259; Z = 1.856, P = 0.063). Pearson correlation analysis showed that the overall correlation between the mean values of all records of PRx and Mx was moderate (r = 0.521, P = 0.000). Conclusions: ICP, PRx and Mx were the risk factors for 6-month post-discharge prognostic outcomes in patients with sTBI. Mx can be used as a noninvasive way to evaluate the cerebral autoregulation (CA) function of patients with sTBI, and has a certain predictive ability for the prognosis. There was a moderate correlation between PRx and Mx, suggesting that they provide different information of CA function.

Objective: To analyze the relationship between lymphocyte to high-density lipoprotein cholesterol ratio (LHR) and 28 d all-cause mortality after admission in moderate-severe traumatic brain injury (TBI) patients, and evaluate the predictive value of indicator for mortality risk in moderate-severe TBI patients. Methods: Clinical data and initial LHR after admission of total 163 patients with moderate-severe TBI, who were first diagnosed at The First Affiliated Hospital of Zhengzhou University between January 1, 2020 and August 31, 2024, were collected. Univariate and multivariate stepwise Cox proportional hazards regression analyses were used to identify the influencing factors for 28 d all-cause mortality after admission in moderate-severe TBI patients. The predictive value of LHR was further validated by plotting receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Results: By the 28 d after admission, 128 patients (78.53%) survived, and 35 patients (21.47%) died. Multivariate stepwise Cox proportional hazards regression analysis: Model 1 (unadjusted for any confounding factors), Model 2 [adjusted for age, time from injury to admission, diabetes, and Glasgow Coma Scale (GCS) score at admission], and Model 3 (further adjusted for all potential confounding factors such as sex, cause of injury, and hypertension) all showed that a lower LHR was a risk factor for increased 28 d all-cause mortality after admission in moderate-severe TBI patients (HR = 0.028, 95%CI: 0.005-0.156, P = 0.000; HR = 0.048, 95%CI: 0.008-0.289, P = 0.000; HR = 0.032, 95%CI: 0.004-0.234, P = 0.000). The predictive value of LHR was further validated using the ROC curve, with AUC of 0.767 (95%CI: 0.681-0.854, P = 0.000). The optimal cutoff value was 0.460, with a sensitivity of 80.50% and a specificity of 62.90%. Conclusions: The initial LHR after admission is a simple and easily accessible early predictor of 28 d all-cause mortality after admission in moderate-severe TBI patients.

Objective: To screen the risk factors of aspiration of enteral nutrition support in patients with severe intracerebral hemorrhage. Methods: A total of 187 patients with severe intracerebral hemorrhage diagnosed and treated in West China Hospital, Sichuan University from June 2022 to June 2023 were enrolled. All of them received enteral nutrition support and were divided into aspiration group (n = 72) and non-aspiration group (n = 115) according to whether aspiration occurred or not. Univariate and multivariate Logistic regression analyses were used to screen the risk factors of aspiration of enteral nutrition support in patients with severe intracerebral hemorrhage. Results: Logistic regression analysis showed that previous history of aspiration (OR = 1.441, 95%CI: 1.263-1.954; P = 0.033), grade Ⅲ-Ⅴ of the postoperative Wada Drinking Water Test (OR = 2.133, 95%CI: 1.051-4.312; P = 0.000), nasal feeding tube diameter 3.50 mm (OR = 1.861, 95%CI: 1.122-3.474; P = 0.041) and gastric residual amount > 100 ml (OR = 2.582, 95%CI: 1.640-5.911; P = 0.030) were risk factors for aspiration of enteral nutrition support in patients with severe intracerebral hemorrhage. Conclusions: The patients with severe intracerebral hemorrhage with previous history of aspiration, grade Ⅲ-Ⅴ of the postoperative Wada Drinking Water Test, nasal feeding tube diameter 3.50 mm and gastric residual amount > 100 ml were prone to aspiration of enteral nutrition support.

Objective: To retrospectively analyze the clinical, imaging, pathological and genotypic characteristics of one case of mitochondrial cytopathy with rare double mutation of mitochondrial gene. Methods and Results: The 14-year-old male had double eyelid ptosis for 12 years, walking instability for 11 years, and visual acuity loss for 8 years. The clinical manifestations were external ophthalmoplegia, optic atrophy, pyramidal tract damage, and multiple peripheral neuropathy. Serum lactic acid was increased (3.30 mmol/L). The MRI showed abnormal hyperintensity in bilateral basal ganglia region. EMG showed multiple peripheral neuropathy (mainly motor nerve). The pathological examination of the biceps biopsy include HE staining, succiante dehydrogenase (SDH) staining, modified Gomori trichrome (MGT) staining and cytochrome C oxidase (COX) staining all showed no specific change. Genetic testing was performed for the presence of the m.9176T > C mutation in MT-ATP6 gene and the m.11778G > A mutation in MT-ND4 gene, which led to a definitive diagnosis of mitochondrial gene double mutation mitochondrial cytopathy consistent with the clinical manifestations of Leber's hereditary optic neuropathy (LHON) superimposed on Leigh's syndrome (LS). The mother of the patient had no clinical syptoms but also carried the double mutation of mitochondrial gene. Conclusions: Mitochondrial cytopathy is rare and exhibit diverse clinical manifestations, which the diagnosis requires a combination of clinical manifestations, laboratory examination, muscle tissue biopsy, and genetic testing for confirmation.

Objective: To investigate the clinical correlation between hyperhomocysteinemia caused by MTHFR gene mutation and developmental epileptic encephalopathy (DEE), as well as the corresponding intervention strategies. Methods and Results: A female child, aged 2 years and 5 months, presented with infantile spasm (IS) as the initial symptom. Video electroencephalography (VEEG) showed highly irregular, which progressively evolved into generalized multifocal discharges consistent with Lennox-Gastaut syndrome (LGS), accompanied by tonic clonic seizure. MRI showed delayed myelination and leukomalacia. Genetic testing showed the compound heterozygous mutations in the MTHFR gene: c. 154C > T (p. Arg52X) and c. 889T > C (p. Tyr297His). These were inherited from her mother [c. 154C > T (p. Arg52X)] and father [c.889T > C (p.Tyr297His)]. This genetic testing resulted in severely elevated serum homocysteine level of 161 μmol/L. Following treatment with a combination of antiepileptic seizure medication (ASM), betaine and B vitamins, the homocysteine level decreased to 70 μmol/L and seizure frequency was reduced. However, significant neurodevelopmental delay persisted. Conclusions: The novel compound heterozygous mutations of MTHFR gene [c. 154C > T (p. Arg52X) and c. 889T > C (p. Tyr297His)] expand the spectrum of known MTHFR gene mutation. These mutations disrupt folate metabolism, leading to severe hyperhomocysteinemia and DEE. This case underscores the critical importance of early metabolic intervention for improving clinical outcomes.

Objective: To analyze the changes in biomarkers associated with sleep disorders in anti-leucine-rich glioma-inactivated 1 (LGI1) antibody- associated encephalitis, and to preliminarily explore the mechanism of sleep disorders. Methods: Fifty patients with anti - LGI1 antibody - associated encephalitis who admitted He'nan Provincial People's Hospital from April 2015 to September 2022 were selected. Serum and cerebrospinal fluid (CSF) samples were collected for biomarkers detection, and Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the presence of sleep disorders. Results: The 50 patients were divided into the sleep disorders (> 7) group (n = 28) and the no sleep disorders (≤ 7) group (n = 22) based on PSQI score. Compared with the no sleep disorders group, the sleep disorders group in serum and CSF showed higher levels of neurofilament light chain (NfL; t = 6.690, P = 0.000; t = 2.356, P = 0.023), glial fibrillary acidic protein (GFAP; t = 3.713, P = 0.000; t = 2.768, P = 0.008), ionized calcium-binding adapter molecule 1 (Iba1; t = 5.042, P = 0.000; t = 3.472, P = 0.001), orexin A (t = 3.250, P = 0.002; t = 5.376, P = 0.000), cortisol (t = 2.487, P = 0.016; t = 5.779, P = 0.000), tumor necrosis factor-α (TNF-α; t = 3.832, P = 0.000; t = 5.122, P = 0.000) and chemokine (C-X-C motif) ligand 13 (CXCL13; t = 2.483, P = 0.017; t = 4.116, P = 0.000), while only interleukin-1β (IL-1β) increased in CSF (t = 2.526, P = 0.015). Conclusions: Sleep disorders associated with anti - LGI1 antibody - associated encephalitis is elevated in levels of neuroinjury markers, neuroendocrine markers and neuroimmune markers, suggesting that sleep disorders associated with anti-LGI1 antibody- associated encephalitis is not a single mechanism and may be related to the extensive involvement of the neuro-endocrine-immune network.

Objective: To explore the safety and feasibility of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass combined encepho-dural-myo-pericranio-synangiosis (EDMPS) in the treatment of moyamoya disease (MMD) in preschool children (≤ 6 years old). Methods: The clinical data of 18 preschool children with MMD treated with STA-MCA + EDMPS surgery at Aviation General Hospital from January 2017 to December 2019 were analyzed. Postoperative one week CTA 3D reconstruction and CT perfusion (CTP) were performed to evaluate the scope of craniotomy, the patency of bypass vessels and improvement of ischemic cerebral tissue perfusion. Postoperative 6 months CT or MRI was performed to evaluate the new ischemic stroke or intracerebral hemorrhage, and CTA or DSA was performed 12 months after the operation to evaluate the patency of bypass vessels. The modified Rankin Scale (mRS) was used to evaluate the patients' neurological recovery. Results: The surgeries on 31 hemispheres of 18 patients were successfully completed. Postoperative one week CTA showed that the bypass vessel was unobstructed. Postoperative one week MRI of one case (Case 9) showed asymptomatic small-area cerebral infarction. All 4 patients who had transient ishchemic attack (TIA) symptoms before surgery had their symptoms disappear after surgery. Only one case (Case 3) developed TIA. One case (Case 17) developed contralateral new ischemic stroke while waiting for contralateral surgery after the first postoperative operation (3-6 months). The follow - up time of 18 patients was (57.28 ± 13.32) months. The new ischemic stroke or intracerebral hemorrhage was no observed in postoperative 6 months. Postoperative 12 months CTA or DSA showed that the STA -MCA bypass unobstructed in 26 sides of 13 patients and not visualized in 5 sides of 5 patients. Collateral vessels due to indirect revascularization were visible in all 18 patients. By the end of the follow-up, the median mRS score was 1.00 (0.25, 1.75). None of the children patients presented with ischemic or hemorrhagic stroke events, cerebral hyperperfusion syndrome (CHS), TIA, epileptic seizure, cognitive dysfunction or poor incision healing. Conclusions: Using STA-MCA + EDMPS to treat preschool children with MMD can not only quickly improve the blood supply of ischemic brain tissue, but also achieve a larger range of indirect revascularization. It is safe and feasible, and has good long-term follow-up results.