Deborah Pugin's research while affiliated with University of Geneva and other places

Publications (36)

Article
Practical Implications Acute awareness impairment, confusion or other neurologic symptoms occurring in supine position should raise the possibility of transient intracranial hypertension, notably through the compression of a possible pseudomeningocele.
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Background: A fatal outcome occurs in 2% of patients with Reversible Cerebral Vasoconstriction Syndrome (RCVS). Due to its rarity, guidelines for the management of the most severe forms of RCVS are lacking. Case presentation: Here, we describe the case of a 55 year-old woman who died from complications of RCVS and reviewed patients with fatal outco...
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Background: Responsible for the coronavirus disease 2019 pandemic that began in December 2019, severe acute respiratory syndrome coronavirus 2 mainly causes respiratory insult. Few cases were reported of extrapulmonary involvement, many of which were neurologic. Case summary: In this case report, we present two cases of prolonged coma after wean...
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Aim Generalized periodic discharge (GPD) is an EEG pattern of poor neurological outcome, frequently observed in comatose patients after cardiac arrest. The aim of our study was to identify the neuronal network generating ≤2.5 Hz GPD using EEG source localization and connectivity analysis. Methods We analyzed 40 comatose adult patients with anoxic-...
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Objectives: In many countries, large numbers of critically ill patients with coronavirus disease 2019 are admitted to the ICUs within a short period of time, overwhelming usual care capacities. Preparedness and reorganization ahead of the wave to increase ICU surge capacity may be associated with favorable outcome. The purpose of this study was to...
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BACKGROUND AND PURPOSE Covid‐19, initially described as a respiratory system's infection, is currently more and more recognized as a multiorganic disease, including neurological manifestations. There is growing evidence about a potential neuroinvasive role of SARS‐CoV‐2. The purpose of this study is to describe new findings, in the form of cerebral...
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BACKGROUND AND PURPOSE: Early outcome prediction of postanoxic patients in a coma after cardiac arrest proves challenging. Current prognostication relies on multimodal testing, using clinical examination, electrophysiologic testing, biomarkers, and structural MR imaging. While this multimodal prognostication is accurate for predicting poor outcome...
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Introduction Early prediction of neurological outcome of post-anoxic comatose patients after cardiac arrest(CA) is challenging. Prognosis of comatose patient relies on multimodal testing: clinical examination, electrophysiological testing and structural neuroimaging (mainly diffusion MRI DWI). This multimodal prognostication is accurate for predict...
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Objective: To assess the relationship between seizure burden on continuous EEG (cEEG) and functional as well as cognitive outcome 3 months after subarachnoid hemorrhage (SAH). Methods: The study included all consecutive patients with a spontaneous SAH admitted to the Columbia University Medical Center Neurological Intensive Care Unit and monitor...
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Subarachnoid hemorrhage (SAH) still carries a high morbidity and mortality, despite improvement in surgical and medical management. Seizures and delayed cerebral ischemia (DCI) secondary to vasospasm or cortical spreading depression are frequent after SAH. Continuous EEG allows early detection of non-convulsive seizures or delayed cerebral ischemia...
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Background: In subarachnoid hemorrhage (SAH), brain injury visible within 48 h of onset may impact on admission neurological disability and 3-month functional outcome. With volumetric MRI, we measured the volume of brain injury visible after SAH, and assessed the association with admission clinical grade and 3-month functional outcome. Methods:...
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Introduction Seizures refractory to third-line therapy are also labeled super-refractory status epilepticus (SRSE). These seizures are extremely difficult to control and associated with poor outcome. We aimed to characterize efficacy and side-effects of continuous infusions of pentobarbital (cIV-PTB) treating SRSE. Methods We retrospectively revie...
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Objective: Nonconvulsive seizures (NCSz) are frequent following acute brain injury and have been implicated as a cause of secondary brain injury, but mechanisms that cause NCSz are controversial. Proinflammatory states are common after many brain injuries, and inflammation-mediated changes in blood-brain barrier permeability have been experimental...
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Tonic-clonic activity (TCA) at onset complicates 3% to 21% of cases of subarachnoid hemorrhage (SAH). The impact of onset TCA on in-hospital complications, including seizures, remains unclear. One study associated onset TCA with poor clinical outcome at 6 weeks after SAH, but to our knowledge no other studies have confirmed this relationship. This...
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The French Society of Intensive Care (SRLF) requested medical experts to publish recommendations on the managment of stroke in the ICU for adult and pediatric patients. The following article describes the underlying evidence used by the experts to elaborate recommendations for general supportive treatment. Such treatment is fundamental for victims...
Article
The French Society of Intensive Care (SRLF) requested medical experts to publish recommendations on the management of stroke in the ICU for adult and pediatric patients. The following article describes the underlying evidence used by the experts to elaborate recommendations for general supportive treatment. Such treatment is fundamental for victims...

Citations

... 3 RCVS in the background of COVID infection has responded favourably to nimodipine and aspirin. 2 However, fulminant RCVS shows poor response to nimodipine. 8 Fulminant RCVS has not been previously published in the setting of COVID-19 infection. This patient developed RCVS after developing COVID following completion of vaccination. ...
... In order to better understand the nature of low-frequency GPDs, an EEG connectivity and source analysis study suggests a hyperactivity of the thalamo-cortical circuit taking the form of an oscillatory thalamic activity capable of inducing periodic cortical discharges, similarly to what happens in convulsive or NCSE. A limitation of this retrospective study is that 37/40 patients died early after withdraw of life sustaining treatment (WLST) and no antiepileptic drug was tested, not allowing to confirm the epileptic nature of GPDs (De Stefano et al., 2020). ...
... Among the 2137 patients analyzed, 1504 (70.4%) patients were subjected to prone positioning during the ICU stay with a median number of 4 [2-6] PP sessions and a median duration of 20 [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] h in the first 48 h. ...
... Score differences were used to distinguish patients with an improvement in the clinical outcome (GOS score difference of at least +1 point between T0 and T1) from those with a lack of improvement in the clinical outcome (i.e., those who did not show any change in the GOS score between T0 and T1 or an impairment) [21,50]. As the GOS directly assesses the functional outcome in terms of consciousness and disability, it is a suitable clinical test to reach our goal to predict clinical outcome in DoC patients [14,48,[51][52][53][54][55]. ...
... Some authors propose that cytokine-mediated edema may underlie this finding [20] which would be in agreement with this prevalence in children with MIS-C. Hemorrhagic foci, such as seen in this case, are not frequently associated with these transitory lesions, but have been previously described in COVD-19 patients [21]. ...
... Neuroimaging methods may be of use in this regard, as they can be used to map changes in the functional and structural integrity of the brain following injury and relate that directly to behavioral outcome. Indeed, a growing number of neuroimaging studies have demonstrated the positive prognostic potential of fMRI, but these results remain to be validated with a larger cohort of patients (17,(47)(48)(49). The pressing need for improved prognostic tools is further highlighted by the high variability in the withdrawal of life-sustaining measures across medical centers (50). ...
... As described by Bruno et al. [24], MCS+ patients are those who can express non-functional communication and are able to follow commands whereas MCS-patients are those who can pursue eye following, react to emotional stimuli, and are able to localize painful stimuli. Pugin et al. [25] used resting state fMRI and machine learning to predict the outcome of post-anoxic comatose patients after cardiac arrest. Besides neuroimaging, heart rate variability entropy can also be used for discriminating scDOC patients using machine learning techniques [26]. ...
... For this reason, authors have stated for a predictive model to be useful in practice, an improvement in predictive ability is required compared to what has been achieved up to now (Pugin et al. 2017). ...
... Un syndrome tardif peut se manifester par des tics [2] et est en général efficacement traité par les inhibiteurs du transporteur vésiculaire 2 des monoamines (acronyme anglais: VMAT2), tel que la tétrabénazine [3]. Pareillement, un syndrome de sevrage des neuroleptiques peut se manifester par des tics [4]; son traitement repose habituellement sur la reprise du traitement neuroleptique [5,6]. Puisque la plupart des troubles hyperkinétiques du mouvement, et notamment la chorée de Huntington, les dyskinésies tardives, et le tourettisme sont efficacement traités par les inhibiteurs du VMAT2 [3,7], l'amélioration sous tétrabénazine ne nous permet pas de trancher absolument entre ces trois hypothèses (B, C et D). ...
... As previously described, the development of ncSE dramatically increases the risk of a poor cognitive and neurological outcome in adults [30], as well as in neurological critical care patients with ICH [31]. Because the SDH is supposed to be the underlying condition for the ncSE, an aggressive antiepileptic drug treatment is performed in accordance with already published data [22,32]. ...