Eelco F M Wijdicks

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (573)3329.44 Total impact

  • Eelco F M Wijdicks
    09/2015; DOI:10.1001/jamaneurol.2015.2223
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    ABSTRACT: To report the clinical and laboratory characteristics, clinical courses, and outcomes of Mayo Clinic, Rochester, MN, ICU-managed autoimmune encephalitis patients (January 1st 2003-December 31st 2012). Based on medical record review, twenty-five patients were assigned to Group 1 (had ≥1 of classic autoimmune encephalitis-specific IgGs, n = 13) or Group 2 (had ≥3 other characteristics supporting autoimmunity, n = 12). Median admission age was 47 years (range 22-88); 17 were women. Initial symptoms included ≥1 of subacute confusion or cognitive decline, 13; seizures, 12; craniocervical pain, 5; and personality change, 4. Thirteen Group 1 patients were seropositive for ≥1 of VGKC-complex-IgG (6; including Lgi1-IgG in 2), NMDA-R-IgG (4), AMPA-R-IgG (1), ANNA-1 (1), Ma1/Ma2 antibody (1), and PCA-1 (1). Twelve Group 2 patients had ≥3 other findings supportive of an autoimmune diagnosis (median 4; range 3-5): ≥1 other antibody type detected, 9; an inflammatory CSF, 8; ≥1 coexisting autoimmune disease, 7; an immunotherapy response, 7; limbic encephalitic MRI changes, 5; a paraneoplastic cause, 4; and diagnostic neuropathological findings, 2. Among 11 patients ICU-managed for ≥4 days, neurological improvements were attributable to corticosteroids (5/7 treated), plasmapheresis (3/7), or rituximab (1/3). At last follow-up, 10 patients had died. Of the remaining 15 patients, 6 (24 %) had mild or no disability, 3 (12 %) had moderate cognitive problems, and 6 (24 %) had dementia (1 was bed bound). Median modified Rankin score at last follow-up was 3 (range 0-6). Good outcomes may occur in ICU-managed autoimmune encephalitis patients. Clinical and testing characteristics are diverse. Comprehensive diagnostics should be pursued to facilitate timely treatment.
    Neurocritical Care 08/2015; DOI:10.1007/s12028-015-0196-8 · 2.44 Impact Factor
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    ABSTRACT: Strict maintenance of normovolemia is standard of care in the treatment of aneurysmal subarachnoid hemorrhage (aSAH), and induced hypervolemia is often used to treat delayed cerebral ischemia from vasospasm. We tested the hypothesis that positive fluid balance could adversely affect clinical outcomes in aSAH. We reviewed 288 patients with aSAH admitted to the Neuroscience Intensive Care Unit (NICU) from October 2001 to June 2011. We collected data on fluid balance during NICU stay, clinical and radiographic evidence of vasospasm, cardiopulmonary complications, and functional outcomes by modified Rankin Scale (mRS) on follow-up (mean 8 ± 8 months). Poor functional outcome was defined as an mRS score 3-6. Associations of variables of interest with outcome were assessed using univariable and multivariable logistic regression. Propensity scores were estimated to account for imbalances between patients with positive versus negative fluid balance and were included in multivariable models. Average net fluid balance during the NICU stay was greater in patients with poor functional outcome (3.52 ± 5.51 L versus -.02 ± 5.30 L in patients with good outcome; P < .001). On multivariate analysis, positive fluid balance (P = .002) was independently associated with poor functional outcome along with World Federation of Neurosurgical Societies grade (P < .001), transfusion (P = .003), maximum glucose (P = .005), and radiological evidence of cerebral infarction (P = .008). After regression adjustment with propensity scores, the association of positive fluid balance with poor functional outcome remained significant (odds ratio, 1.18; 95% confidence interval, 1.08-1.29; P < .001). Greater positive net fluid balance is independently associated with poorer functional outcome in patients with aSAH. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 08/2015; DOI:10.1016/j.jstrokecerebrovasdis.2015.05.027 · 1.67 Impact Factor
  • Sara Hocker · Steven K Feske · Eelco F M Wijdicks · Frank W Drislane
    Annals of Neurology 07/2015; 78(3). DOI:10.1002/ana.24473 · 9.98 Impact Factor
  • Sara Hocker · Eelco F M Wijdicks
    07/2015; 72(7):832-833. DOI:10.1001/jamaneurol.2015.0479
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    ABSTRACT: Focal ventricular obstruction-trapped ventricle-results in cerebrospinal fluid accumulation, mass effect and possible clinical deterioration. There are no systematic studies on the benefit of surgical decompression in adults. We reviewed patients admitted with acutely trapped ventricle on brain imaging to assess their prognosis and the effect of surgical intervention on 30-day mortality. Of the 392 patients with trapped ventricle, the most common causes were brain tumor (45 %), intracerebral hemorrhage (ICH) (20 %), and subdural hematoma (SDH) (14 %). Lateral ventricle trapping accounted for 97 % of cases. Two hundred and twenty-one patients (56 %) received a surgical intervention for trapped ventricle or its causes; 126 (83 %) were treated with craniotomy, 26 (17 %) with craniectomy, 30 (14 %) with external ventricular drain (EVD) alone, 23 (10 %) with ventriculoperitoneal shunt alone, and 16 (7 %) with endoscopic fenestration of the septum pellucidum. Surgical intervention was associated with mortality reduction from 95 % (n = 54) to 48 % (n = 11) in the ICH group, from 47 % (n = 27) to 12 % (n = 15) in the tumor group and from 90 % (n = 18) to 20 % (n = 7) in the SDH group (p < 0.001 for all comparisons). Univariate logistic analysis showed that surgical intervention and tumor etiology were associated with decreased mortality while age, ICH etiology, intraventricular hemorrhage, midline shift, and anticoagulation were associated with increased mortality. On multivariate logistic regression, surgical intervention remained associated with decreased mortality (p < 0.0001; OR 0.20, 95 % CI 0.09-0.42). On subgroup analysis of the ICH cohort, surgical intervention was also associated with decreased mortality (p = 0.028). Neurosurgical intervention for decompression in patients with trapped ventricle can have a measurable beneficial effect on early mortality.
    Neurocritical Care 05/2015; DOI:10.1007/s12028-015-0145-6 · 2.44 Impact Factor
  • Sara Hocker · Donna Schumacher · Jay Mandrekar · Eelco F M Wijdicks
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    ABSTRACT: Given the rarity of brain death in clinical practice, trainees may complete their training without ever performing a brain death exam. Little is known about the performance of trainees in the evaluation of brain death. The accuracy of brain death determination can be audited and improved through simulation models. A simulated brain death scenario was designed to incorporate numerous potential confounders. We utilized a SimMan 3G mannequin, registered nurse, simulation technician, and a facilitator. Critical care and neurology trainees were evaluated using a 24-point checklist based on the AAN guidelines. Trainees rated their confidence (5 point scale with 1 = novice, 3 = competent, and 5 = fully confident) in the evaluation of brain death and apnea testing before and after completing the scenario. Following the simulation, trainees participated in debriefing sessions involving a review of the checklist and playback of simulation videos. Forty-one trainees completed the simulation. Trainees successfully completed 352/492 (71.5 %) tasks pertaining to the evaluation of prerequisites and 262/369 (71.0 %) tasks pertaining to the clinical examination. Trainee confidence in the evaluation of brain death (2.12 ± 0.74 vs 3.29 ± 0.62, p = 0.0001) and apnea testing (2.10 ± 0.74 vs 3.59 ± 0.77, p = 0.001) significantly improved. We successfully tested a new simulation model which emphasized training in crucial pitfalls. More than one in four trainees performed poorly in the evaluation of prerequisites and the clinical examination. Few trainees considered the possibility of drug or alcohol ingestion. Simulation training improved clinical performance and trainee confidence in the evaluation of brain death.
    Neurocritical Care 04/2015; DOI:10.1007/s12028-015-0130-0 · 2.44 Impact Factor
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    ABSTRACT: To assess the practices and perceptions of brain death determination worldwide and analyze the extent and nature of variations among countries. An electronic survey was distributed globally to physicians with expertise in neurocritical care, neurology, or related disciplines who would encounter patients at risk of brain death. Most countries (n = 91, response rate 76%) reported a legal provision (n = 63, 70%) and an institutional protocol (n = 70, 77%) for brain death. Institutional protocols were less common in lower-income countries (2/9 of low [22%], 9/18 lower-middle [50%], 22/26 upper-middle [85%], and 37/38 high-income countries [97%], p < 0.001). Countries with an organized transplant network were more likely to have a brain death provision compared with countries without one (53/64 [83%] vs 6/25 [24%], p < 0.001). Among institutions with a formalized brain death protocol, marked variability occurred in requisite examination findings (n = 37, 53% of respondents deviated from the American Academy of Neurology criteria), apnea testing, necessity and type of ancillary testing (most commonly required test: EEG [n = 37, 53%]), time to declaration, number and qualifications of physicians present, and criteria in children (distinct pediatric criteria: n = 38, 56%). Substantial differences in perceptions and practices of brain death exist worldwide. The identification of discrepancies, improvement of gaps in medical education, and formalization of protocols in lower-income countries provide first pragmatic steps to reconciling these variations. Whether a harmonized, uniform standard for brain death worldwide can be achieved remains questionable. © 2015 American Academy of Neurology.
    Neurology 04/2015; 84(18). DOI:10.1212/WNL.0000000000001540 · 8.29 Impact Factor
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    The Lancet 04/2015; 385(9974). DOI:10.1016/S0140-6736(15)60631-6 · 45.22 Impact Factor
  • Eelco F M Wijdicks
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    ABSTRACT: Brain death is diagnosed in the minority of patients with acute severe brain injury. Guidelines have been developed in many countries in the world and physicians usually work through a set of criteria. The clinical evaluation starts with determination of futility of any medical or surgical intervention and an unmistakable certainty that the underlying diagnosis is correct. The actual neurologic evaluation in a patient suspected of being brain dead requires 25 tests and verifications. Brain death determination demands perfect diagnostic accuracy and thus requires skill and expertise. The overriding principle is simple: establish cause, exclude confounders, determine futility of interventions, examine brainstem reflexes, and test for apnea. In this review, the author revisits the American Academy of Neurology guidelines, and examines the details behind the guidelines. The 2010 guidelines have eliminated unnecessary tests and observation delays, and maintain a principle of simplicity. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    Seminars in Neurology 04/2015; 35(2):105-115. DOI:10.1055/s-0035-1547532 · 1.79 Impact Factor
  • Sara Hocker · Eelco F M Wijdicks
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    ABSTRACT: Skill in the determination of brain death is traditionally acquired during training in an apprenticeship model. Brain death is not frequently determined, and thus exposure to the techniques used is marginal. Brain death is therefore ideally suited for competency-based education models such as simulation. Simulation can ensure that all trainees have direct experience in brain death determination irrespective of their specialty, program design, or institutional protocol. In this review, the authors discuss the advantages and barriers to simulation and how to develop simulation scenarios for instruction in the determination of brain death. Future research should focus on validation of brain death simulation methods and assessment tools as well as the impact of simulation on performance in clinical practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
    Seminars in Neurology 04/2015; 35(2):180-188. DOI:10.1055/s-0035-1547535 · 1.79 Impact Factor
  • Jennifer E Fugate · Alejandro A Rabinstein · Eelco F M Wijdicks
    Critical Care Medicine 04/2015; 43(4):e120-e121. DOI:10.1097/CCM.0000000000000873 · 6.31 Impact Factor
  • Eelco F M Wijdicks
    Seminars in Neurology 04/2015; 35(2):103-104. DOI:10.1055/s-0035-1547531 · 1.79 Impact Factor
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    ABSTRACT: In late 2013, two women from North America gained attention after sustaining catastrophic brain injuries while pregnant. After Marlise Muñoz-who was at 14weeks of pregnancy when she developed a pulmonary embolism-was pronounced brain dead, hospital officials initially refused to withdraw support, citing a Texas state law requiring them to maintain life-sustaining treatment for a pregnant patient to help to save the fetus. By contrast, when Robyn Benson was pronounced brain dead after a brain hemorrhage at 22weeks of pregnancy, both her husband and the physicians agreed to continue support until a viable child could be delivered. The Muñoz and Benson cases offer an opportunity to explore the medical, legal, and ethical issues surrounding catastrophic brain injury in pregnant women. It is hoped that the present article will enable clinicians to better appreciate the history and present state of issues involving advance directives for pregnant women, maternal versus fetal interests, and the impact of fetal viability on medical decision making, as well as offer a practical assessment of the various US state laws concerning the rare, yet catastrophic event of brain injury in a pregnant woman. Copyright © 2015. Published by Elsevier Ireland Ltd.
    International Journal of Gynecology & Obstetrics 03/2015; 129(3). DOI:10.1016/j.ijgo.2014.12.011 · 1.54 Impact Factor
  • Eelco F M Wijdicks
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 03/2015; 28(1):41. DOI:10.1097/WNN.0000000000000052 · 0.95 Impact Factor
  • Christopher L Kramer · Michael McCullough · Eelco F M Wijdicks
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    ABSTRACT: A 67-year-old man presented with progressive diplopia, dysarthria, dysphagia, and gait imbalance. Neurologic examination revealed ophthalmoplegia, facial diplegia, and areflexia without signs of respiratory failure. CSF showed albuminocytologic dissociation, consistent with Guillain-Barre syndrome. Initial spirometry yielded low values that were rectified by improved seal with facemask attachment (figure, table, video on the Neurology (R) Web site at
    Neurology 02/2015; 84(8):e57-8. DOI:10.1212/WNL.0000000000001296 · 8.29 Impact Factor
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    ABSTRACT: A 26-year-old female with myasthenic crisis developed transfusion-related acute lung injury (TRALI) after she was treated with intravenous immunoglobulin. Case report. Respiratory status markedly worsened with each intravenous immunoglobulin (IVIG) administration and progressing from a need to use bilevel positive airway pressure (BiPAP) to intubation. Pulmonary function tests improved during this episode. IVIG may cause TRALI and due to subtle clinical findings can be mistaken for neuromuscular respiratory failure.
    Neurocritical Care 02/2015; 23(2). DOI:10.1007/s12028-015-0115-z · 2.44 Impact Factor
  • Eelco F M Wijdicks
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    ABSTRACT: This editorial is not a homily on responsibility, but it is imperative for the Neurocritical Care Society membership to publish in Neurocritical Care in order to continue its growth. The unpleasant fact is that many more should contribute to this task. The journal should be the main repository of original articles and review papers that interest us all. Simply put, it should not be a painstaking process to decide where to submit your paper. Its proximity is an opportunity—not an option.Why is this suddenly an urgent matter? First and foremost, there has been an explosion of open-access journals and new advances in digital technology will continue to challenge the whole concept of a journal, its structure, and whether it is the best platform. Open-access journals entice authors with a barrage of emails and often with a hidden fee or other unexpected later discomfort in return of the promise to publish quickly. One can understand that it is human nature to circumnavigate a sometimes frus ...
    Neurocritical Care 12/2014; 22(1). DOI:10.1007/s12028-014-0099-0 · 2.44 Impact Factor
  • Peter J Koehler · Eelco F M Wijdicks
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    ABSTRACT: The aim of this study was to investigate the development of ideas about the nature and mechanism of the fixed dilated pupil, paying particular attention to experimental conditions and clinical observations in the 19th century. Starting from Kocher's standard review in 1901, the authors studied German, English, and French texts for historical information. Medical and neurological textbooks from the 19th and 20th centuries were reviewed to investigate when and how this information percolated through neurological and neurosurgical practices. Cooper experimented with intracranial pressure (ICP) in a dog in the 1830s, but did not mention the pupils. He described dilated pupils in clinical cases without referring to the effect of light. Bright demonstrated to have some knowledge of the pupil sign (clinical observations). Realizing the unreliability of the pupil sign, Hutchinson in 1867-1868 tried to reason in which cases trepanation would be advisable. Von Leyden's 1866 animal experiments, in which he increased CSF volume by injecting protein solutions intracranially, was the first observation in which the association between fixed dilated pupils and increased ICP was established. Along with bradycardia and motor and respiratory effects, he noticed wide pupils were usually present in a comatose state. Asymmetrical dilation could not always be attributed to increased ICP, but to an oculomotor nerve lesion. Pagenstecher in 1871 extended knowledge by meticulously studying consecutive pupil phenomena with increasing pressure. In 1880, von Bergmann emphasized the significance of the ipsilateral dilation in experiments as well as in clinical cases. He distinguished the extent of pressure increase and its duration. Probably confusing irritation (epileptic head turning to the other side with pupil dilation) and lesion effects, he suggested a cortical area responsible for oculomotor phenomena, indicating what is now known as the frontal eye field. Naunyn and Schreiber (1881) understood the relationship between increased ICP with pupil dilation and decreased pulse frequency and blood pressure, warning not to decrease the latter. Concentrating on experimental traumatic effects, Duret (1878) investigated compression and commotion, in which he distinguished two phases, notably pupil constriction by bulbar lesions, due to CSF shock, followed by dilation from congestion and inflammation, due to blood around the oculomotor nerve. The key observation of a fixed dilated pupil as a sign of acute mass effect came gradually and after some localization stumbles. Following the period of extensive experimental research in ICP, the results of which were translated to clinical observations, the prognostic significance was gradually acknowledged by authors of neurological textbooks. It is well known that Cushing did similar experiments in Berne (1900-1901), and later suggested he would not have done so if he had studied the literature.
    Journal of Neurosurgery 11/2014; 122(2):1-11. DOI:10.3171/2014.10.JNS14148 · 3.74 Impact Factor
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    Eelco F M Wijdicks · David K Menon · Martin Smith
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    ABSTRACT: Care of the critically ill neurologic patient, more commonly referred to as neurocritical care, has matured through new knowledge [1], policy and administration [2-4], advances in imaging and monitoring techniques, and above all the introduction of neurointensivists and neuroscience intensive care units [5, 6]. Different models of care exist but, whether provided in a specialist unit or within a general intensive care unit (ICU), the principles and standards of neurocritical care are identical. All three of us work in neurocritical care units and provide care for the most challenging patients on the edge of further deterioration. Our expertise is based on each of us having over 1,000 patient contacts annually for the past 1-2 decades. Here we share what we believe is important—and what worries us.1. Create a core groupA well-run neurocritical care program should have several neurointensivists. Neurocritical care demands 24/7 staffing from teams with experience in managing neurological ...
    Intensive Care Medicine 11/2014; 41(2). DOI:10.1007/s00134-014-3544-9 · 7.21 Impact Factor

Publication Stats

14k Citations
3,329.44 Total Impact Points


  • 1995–2015
    • Mayo Clinic - Rochester
      • • Department of Pulmonary and Critical Care Medicine
      • • Department of Neurology
      • • Department of Neurosurgery
      Рочестер, Minnesota, United States
  • 2001–2014
    • Mayo Foundation for Medical Education and Research
      • Department of Neurology
      Рочестер, Michigan, United States
  • 2013
    • Vanderbilt University
      • Department of Neurology
      Нашвилл, Michigan, United States
  • 2011
    • National University of Singapore
      • Division of Neurology
      Singapore, Singapore
  • 2010
    • Universidad Autónoma de Madrid
      Madrid, Madrid, Spain
  • 2008
    • Rush University Medical Center
      • Department of Neurological Sciences
      Chicago, IL, United States
    • Atrium Medisch Centrum Parkstad
      Heerlen, Limburg, Netherlands
  • 1997–2008
    • St. Marys Medical Center
      West Palm Beach, Florida, United States
  • 2006
    • Washington University in St. Louis
      San Luis, Missouri, United States
    • The University of Calgary
      Calgary, Alberta, Canada
  • 2005
    • University of Miami Miller School of Medicine
      • Department of Neurology
      Miami, FL, United States
  • 1998–2003
    • St. Mary's Hospital (WI, USA)
      Madison, Wisconsin, United States
  • 1995–2003
    • St. Mary Medical Center
      Long Beach, California, United States
  • 2002
    • University of Groningen
      Groningen, Groningen, Netherlands
  • 2000
    • Los Angeles Neurosurgical Institute
      Los Angeles, California, United States
  • 1988–1995
    • Utrecht University
      • Department of Neurology
      Utrecht, Utrecht, Netherlands
  • 1994
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
  • 1991–1992
    • University Medical Center Utrecht
      • Department of Neurology
      Utrecht, Provincie Utrecht, Netherlands