Eelco F M Wijdicks

Mayo Clinic - Rochester, Rochester, Minnesota, United States

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Publications (516)2909.39 Total impact

  • 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;
  • Eelco F M Wijdicks, David K Menon, Martin Smith
    Intensive care medicine. 11/2014;
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    ABSTRACT: Impaired consciousness has been incorporated in prediction models that are used in the ICU. The Glasgow Coma Scale has value but is incomplete and cannot be assessed in intubated patients accurately. The Full Outline of UnResponsiveness score may be a better predictor of mortality in critically ill patients.
    Critical care medicine. 11/2014;
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    ABSTRACT: Abstract Neurological complications are common in general medical and surgical intensive care units (ICU); they can prolong ICU and hospital stay and worsen outcome, including mortality. We performed a descriptive analysis of neurological consultations in non-neurological ICUs to determine the frequency of various neurological complications and to assess the diagnostic yield, therapeutic implications and prognostic benefit of these consultations. This is a retrospective single group cohort study of all neurological consultations for patients admitted to non-neurological (medical, respiratory care unit, cardiac, cardiothoracic, surgical, and trauma) ICUs at Saint Marys Hospital (Mayo Clinic, Rochester) over a 24- month period (January 1st 2010 to December 31st 2011). Equal numbers of neurological consultations (174, 50% each) were requested from medical ICUs and surgical ICUs. Altered consciousness (158, 45%), seizure (76, 22%), and focal deficits (75, 22%) were the most common reasons for consultations. Diagnostic, prognostic, and therapeutic benefit was considered present in 89%, 38%, and 39% patients respectively. Treatment change following neurological consultation occurred in 48% patients. Encephalopathy, stroke, seizure, and anoxic brain injury were the most common causes of neurological complications in non-neurological ICUs with sedatives and opiates being the most common cause of encephalopathy. Almost half of the patients had change in treatment following neurological consultation. Neurological consultations in non-neurological ICU's are beneficial for patient's care in terms of diagnosis, treatment, and prognosis.
    The International journal of neuroscience. 09/2014;
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    ABSTRACT: Research to improve outcomes from acute central nervous system (CNS) injury has progressed little, although limited examples (eg, induced hypothermia for out-of-hospital ventricular fibrillation cardiac arrest and birth asphyxia and tissue plasminogen activator for ischemic stroke) have proved that it is possible to favorably alter outcome.
    JAMA Neurology 08/2014; · 7.58 Impact Factor
  • Sumedh S Hoskote, Jennifer E Fugate, Eelco F M Wijdicks
    Journal of cardiothoracic and vascular anesthesia. 08/2014; 28(4):1039-1041.
  • Christopher L Kramer, Eelco F M Wijdicks
    Neurology 07/2014; 83(4):376. · 8.30 Impact Factor
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    ABSTRACT: Electroencephalography in the setting of hypothermia and anoxia has been studied in humans since the 1950s. Specific patterns after cardiac arrest have been associated with prognosis since the 1960s, with several prognostic rating scales developed in the second half of the twentieth century. In 2002, two pivotal clinical trials were published, demonstrating improved neurologic outcomes in patients treated with therapeutic hypothermia (TH) after cardiac arrest of shockable rhythms. In the following years, TH became the standard of care in these patients. During the same time period, the use of continuous EEG monitoring in critically ill patients increased, which led to the recognition of subclinical seizures occurring in patients after cardiac arrest. As a result of these changes, greater amounts of EEG data are being collected, and the significance of specific patterns is being re-explored. We review the current role of EEG for the identification of seizures and the estimation of prognosis after cardiac resuscitation.
    Neurocritical Care 07/2014; · 3.04 Impact Factor
  • Sara E Hocker, Eelco F M Wijdicks
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    ABSTRACT: This article reviews the current understanding of sepsis, a critical and often fatal illness that results from infection and multiorgan failure and impacts the brain, peripheral nervous system, and muscle.
    Continuum (Minneapolis, Minn.). 06/2014; 20(3, Neurology of Systemic Disease):598-613.
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    ABSTRACT: A 62-year-old man with severe traumatic brain injury developed postsurgical anisocoria in which there was a discrepancy between pupillometer and manual testing.
    Neurocritical Care 05/2014; · 3.04 Impact Factor
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    ABSTRACT: Because coma has many causes, physicians must develop a structured, algorithmic approach to diagnose and treat reversible causes rapidly. The three main mechanisms of coma are structural brain lesions, diffuse neuronal dysfunction, and, rarely, psychiatric causes. The first priority is to stabilise the patient by treatment of life-threatening conditions, then to use the history, physical examination, and laboratory findings to identify structural causes and diagnose treatable disorders. Some patients have a clear diagnosis. In those who do not, the first decision is whether brain imaging is needed. Imaging should be done in post-traumatic coma or when structural brain lesions are probable or possible causes. Patients who do not undergo imaging should be reassessed regularly. If CT is non-diagnostic, a checklist should be used use to indicate whether advanced imaging is needed or evidence is present of a treatable poisoning or infection, seizures including non-convulsive status epilepticus, endocrinopathy, or thiamine deficiency.
    The Lancet 04/2014; · 39.21 Impact Factor
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    ABSTRACT: The apnea test is a crucial component of the clinical diagnosis of brain death. Apprehension about hypoxemia, hypotension, and/or cardiac arrhythmias may sometimes lead clinicians to avoid performing or prematurely terminate the apnea test. The purpose of this study was to perform a contemporary re-evaluation of the safety of the apnea test. We performed a detailed chart review of consecutive brain dead patients who underwent an apnea test from 2008 to 2012. Out of 63 patients, 33 were men (52.4 %). Mean age was 46.4 years. In all but four patients (93.7 %), the apnea test was performed by a neurointensivist. Infiltrates on chest radiographs were present in 34 (54 %). Seven patients (11.1 %) had chest tubes, six of which were associated with polytrauma. Echocardiograms were obtained in 47 patients (74.6 %), and 18 patients (38.3 %) had regional wall motion abnormalities (IQR 41-65 %). Fifty patients (79.4 %) were on vasopressors prior to apnea test. Median FiO2 was 0.5 (IQR 0.4-0.6), and PEEP was 5 cm H2O (IQR 5-10). After apnea test, median pO2 was 306 mmHg (IQR 121-389). Apnea test was aborted in only one patient; this patient had required FiO2 0.9-1.0 prior to the test and desaturated during the test. Mild hypoxemia occurred in three others without any consequences. Mild hypotension occurred in 11 patients (17.4 %) and was easily managed by an increase in the vasopressor infusion. There were no instances of major cardiac arrhythmias. Apnea determined using the oxygenation diffusion method during brain death testing is very safe, provided appropriate prerequisites are met. We found a major decrease in the number of aborted or not attempted apnea tests compared to previous studies.
    Neurocritical Care 02/2014; · 3.04 Impact Factor
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    ABSTRACT: There are uncertainties surrounding the optimal management of patients with brain swelling after an ischemic stroke. Guidelines are needed on how to manage this major complication, how to provide the best comprehensive neurological and medical care, and how to best inform families facing complex decisions on surgical intervention in deteriorating patients. This scientific statement addresses the early approach to the patient with a swollen ischemic stroke in a cerebral or cerebellar hemisphere. The writing group used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. The panel reviewed the most relevant articles on adults through computerized searches of the medical literature using MEDLINE, EMBASE, and Web of Science through March 2013. The evidence is organized within the context of the American Heart Association framework and is classified according to the joint American Heart Association/American College of Cardiology Foundation and supplementary American Heart Association Stroke Council methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive American Heart Association internal peer review. Clinical criteria are available for hemispheric (involving the entire middle cerebral artery territory or more) and cerebellar (involving the posterior inferior cerebellar artery or superior cerebellar artery) swelling caused by ischemic infarction. Clinical signs that signify deterioration in swollen supratentorial hemispheric ischemic stroke include new or further impairment of consciousness, cerebral ptosis, and changes in pupillary size. In swollen cerebellar infarction, a decrease in level of consciousness occurs as a result of brainstem compression and therefore may include early loss of corneal reflexes and the development of miosis. Standardized definitions should be established to facilitate multicenter and population-based studies of incidence, prevalence, risk factors, and outcomes. Identification of patients at high risk for brain swelling should include clinical and neuroimaging data. If a full resuscitative status is warranted in a patient with a large territorial stroke, admission to a unit with neurological monitoring capabilities is needed. These patients are best admitted to intensive care or stroke units attended by skilled and experienced physicians such as neurointensivists or vascular neurologists. Complex medical care includes airway management and mechanical ventilation, blood pressure control, fluid management, and glucose and temperature control. In swollen supratentorial hemispheric ischemic stroke, routine intracranial pressure monitoring or cerebrospinal fluid diversion is not indicated, but decompressive craniectomy with dural expansion should be considered in patients who continue to deteriorate neurologically. There is uncertainty about the efficacy of decompressive craniectomy in patients ≥60 years of age. In swollen cerebellar stroke, suboccipital craniectomy with dural expansion should be performed in patients who deteriorate neurologically. Ventriculostomy to relieve obstructive hydrocephalus after a cerebellar infarct should be accompanied by decompressive suboccipital craniectomy to avoid deterioration from upward cerebellar displacement. In swollen hemispheric supratentorial infarcts, outcome can be satisfactory, but one should anticipate that one third of patients will be severely disabled and fully dependent on care even after decompressive craniectomy. Surgery after a cerebellar infarct leads to acceptable functional outcome in most patients. Swollen cerebral and cerebellar infarcts are critical conditions that warrant immediate, specialized neurointensive care and often neurosurgical intervention. Decompressive craniectomy is a necessary option in many patients. Selected patients may benefit greatly from such an approach, and although disabled, they may be functionally independent.
    Stroke 01/2014; · 6.16 Impact Factor
  • Eelco F M Wijdicks
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    ABSTRACT: Reviewers make a peer-reviewed journal. It is a considerable time commitment, and recommendations about quality and timeliness guide the editors. Our reviewers are all experts in the topic and are carefully chosen. Most papers are selected for review. There are no good or bad reviewers, but some are extraordinarily prompt and particularly good at identifying problems. Being asked is hopefully a privilege for the reviewers—for us it is imperatively important. Papers are mostly reviewed by ad hoc reviewers and they are listed below.We greatly appreciate the effort and goodwill.List of ReviewersNicholas AbendJacques AbrainiOpeolu AdeoyeVenkatesh AiyagariPaul AkinsGeorge AlexiouSafdar AnsariMarcel AriesFahad AzizWilliam BaekSaikat BandyopadhyayHelen BarkanMustafa BaskayaAntoine BaumannRonny BeerMichael BellFrancis BernardEric BershadKerim BeseogluFederico BilottaKathleen BledsoeMichel BojanowskiGregor BroessnerGretchen BrophyRaf BrounsKatharina BuslPeter CampbellRaphael Carandang ...
    Neurocritical Care 01/2014; · 3.04 Impact Factor
  • Eelco F M Wijdicks, Caterina Giannini
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    ABSTRACT: A 59-year-old man with alcoholic liver disease became comatose from a left acute subdural hematoma. He developed a fixed dilated right pupil but with the left pupil responsive to light. Oculovestibular responses were normal. He had right extensor posturing. At autopsy, uncal herniation was not found, but there was a diagonally shifted and rotated brainstem likely tethering or compressing the contralateral third nerve against the tentorium ridge or clivus (figure). In the pre-CT era, a false localizing fixed pupil led to negative exploratory burr holes. Presently, this phenomenon is still a confusing, inadequately understood curiosity.(1,2.)
    Neurology 01/2014; 82(2):187. · 8.30 Impact Factor
  • Sudhir Datar, Eelco F M Wijdicks
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    ABSTRACT: Fulminant hepatic failure presents with a hepatic encephalopathy and may progress to coma and often brain death from cerebral edema. This natural progression in severe cases contributes to early mortality, but outcome can be good if liver transplantation is appropriately timed and increased intracranial pressure (ICP) is managed. Neurologists and neurosurgeons have become more involved in these very challenging patients and are often asked to rapidly identify patients who are at risk of cerebral edema, to carefully select the patient population who will benefit from invasive ICP monitoring, to judge the correct time to start monitoring, to participate in treatment of cerebral edema, and to manage complications such as intracranial hemorrhage or seizures. This chapter summarizes the current multidisciplinary approach to fulminant hepatic failure and how to best bridge patients to emergency liver transplantation.
    Handbook of Clinical Neurology 01/2014; 120:645-59.
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    ABSTRACT: The expertise required for proper electroencephalography (EEG) setup can make the 10-20 array unwieldy in the hospital setting. There may be a role for an EEG array with reduced leads to improve the efficiency of inpatient practice. Clips from 100 EEG records, 50 ictal and 50 non-ictal, in adult inpatients from January 1, 2007, to January 1, 2012, were retrospectively reviewed and selected for digital lead reduction and blind review. Two epileptologists reviewed these tracings and documented the presence of seizures and severe disturbance of background. The reduced array included 7 leads spanning the scalp. Three different montages were available. Sensitivity and specificity of the reduced array were calculated using the formal EEG report as the comparison standard. For the detection of any seizure, the reduced array EEG had a sensitivity of 70% and specificity of 96%. Sensitivity for identifying encephalopathic patterns was 62% and specificity was 86%. Focal seizures were more readily identified by the reduced array (20 of 25) than were generalized ictal patterns (13 of 25). The reduced electrode array was insufficiently sensitive to seizure detection. Reducing EEG leads might not be a preferred means of optimizing hospital EEG efficiency.
    The Neurohospitalist. 01/2014; 4(1):6-8.
  • Eelco F M Wijdicks, Sara E Hocker
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    ABSTRACT: A new spectrum of neurologic complications has appeared with treatment of the organ transplant recipient. There are specific problems in liver recipients. Most pertinent is the management of acute fulminant hepatic failure and emerging brain edema that can only be definitively treated with acute liver transplantation. In some patients neurologic complications appear as a result of immunosuppressive drugs or due to infectious complications in immunocompromised patients. Neurologists seeing patients in a transplant unit should be prepared to see confused or obtunded critically ill patients with multiple medical problems, procedures, and polypharmacy. This chapter discusses the challenges of the transplant team and the consulting neurologist.
    Handbook of Clinical Neurology 01/2014; 121:1257-66.
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    ABSTRACT: Introduction Therapeutic hypothermia (TH) is standard of care after ventricular fibrillation cardiac arrest (CA). Continuous EEG monitoring (cEEG) is increasingly used during TH. Analysis regarding value of cEEG utilization in this population in the context of cost and outcome has not been performed. We compared outcome and EEG charges in CA patients with selective versus routine cEEG. Methods A protocol for TH after CA without routine cEEG was implemented in December 2005, comprising our TH-pre-cEEG cohort. In November 2009, this protocol was changed to include cEEG in all CA-TH patients, comprising our TH-cEEG cohort. Clinical outcome using the Cerebral Performance Category (CPC) at discharge and estimated EEG charges were calculated retrospectively for both cohorts, based on National Charge Data 50th percentile charges expressed in USD per the CMS 2010 Standard Analytical File as reported in Code Correct by MedAssets, Inc. Results Our TH-pre-cEEG cohort comprised 91 patients, our TH-cEEG cohort 62. In the TH-pre-cEEG cohort, 19 patients (21%) had rEEGs, 4 (4%) underwent cEEG. The mean estimated EEG charges for the TH-pre-cEEG cohort was $1571.59/patient, and TH-cEEG cohort was $4214.93/patient (p <0.0001). Two patients (2.1%) in the TH-pre-cEEG cohort had seizures, compared to five (8.1%) in the TH-cEEG cohort (p = 0.088). There was no difference in mortality or clinical outcome in these cohorts. Conclusions Routine use of cEEG during TH after CA improved seizure detection, but not outcomes. There was a three-fold increase in EEG estimated charges with routine use of cEEG.
    Resuscitation 01/2014; · 4.10 Impact Factor
  • Eelco F M Wijdicks
    Neurocritical Care 12/2013; · 3.04 Impact Factor

Publication Stats

10k Citations
2,909.39 Total Impact Points

Institutions

  • 1994–2014
    • Mayo Clinic - Rochester
      • • Department of Neurology
      • • Department of Neurosurgery
      Rochester, Minnesota, United States
    • University of Minnesota Rochester
      Rochester, Minnesota, United States
  • 2013
    • Vanderbilt University
      Nashville, Michigan, United States
  • 1993–2013
    • Mayo Foundation for Medical Education and Research
      • Department of Neurology
      Rochester, Michigan, United States
  • 2011
    • Henry Ford Hospital
      Detroit, Michigan, United States
    • National University of Singapore
      • Division of Neurology
      Singapore, Singapore
    • Johns Hopkins University
      • Department of Neurology
      Baltimore, MD, United States
  • 2010–2011
    • Erasmus MC
      • Department of Intensive Care
      Rotterdam, South Holland, Netherlands
  • 2009
    • Boston University
      • Department of Neurology
      Boston, MA, United States
  • 2008
    • University of Texas Southwestern Medical Center
      • Division of Digestive and Liver Diseases
      Dallas, TX, United States
    • Massachusetts General Hospital
      Boston, Massachusetts, United States
    • The University of Western Ontario
      London, Ontario, Canada
    • Atrium Medisch Centrum Parkstad
      Heerlen, Limburg, Netherlands
    • Rush University Medical Center
      • Department of Neurological Sciences
      Chicago, IL, United States
  • 2006–2008
    • University of Amsterdam
      • Faculty of Medicine AMC
      Amsterdam, North Holland, Netherlands
    • Mayo Clinic - Scottsdale
      Scottsdale, Arizona, United States
    • Lourdes Hospital
      Edakkulam, Kerala, India
  • 1994–2008
    • St. Marys Medical Center
      West Palm Beach, Florida, United States
  • 2005–2006
    • University of Miami Miller School of Medicine
      • Department of Neurology
      Miami, FL, United States
    • Royal Brisbane Hospital
      • Department of Neurology
      Brisbane, Queensland, Australia
  • 2004
    • Dartmouth–Hitchcock Medical Center
      Lebanon, New Hampshire, United States
  • 1995–2004
    • St. Mary Medical Center
      Long Beach, California, United States
  • 2003
    • Medical College of Wisconsin
      • Department of Neurology
      Milwaukee, WI, United States
  • 2002
    • University of Groningen
      Groningen, Groningen, Netherlands
  • 1989–2002
    • University Medical Center Utrecht
      • Department of Neurology
      Utrecht, Provincie Utrecht, Netherlands
  • 2000
    • Los Angeles Neurosurgical Institute
      Los Angeles, California, United States
  • 1988–1995
    • Universiteit Utrecht
      • Department of Neurology
      Utrecht, Provincie Utrecht, Netherlands
    • Erasmus Universiteit Rotterdam
      • Department of Neurology
      Rotterdam, South Holland, Netherlands