| Department of Neurology | The University of Chicago

Research

Legacy

Research at The University of Chicago Neurointensive care unit builds up on a strong and deep legacy for nearly a century.

Clinical Trials

Brain Oxygen Optimization in Severe TBI Phase-3 (BOOST-3)

BOOST3 is a randomized clinical trial to compare two strategies for monitoring/treating Traumatic brain injury (TBI) patients in the ICU. One strategy is based on both intracranial pressure (ICP) and brain tissue oxygen (PbtO2) while the other is guided by treatment goals based on ICP monitoring alone. The results of this study will help doctors discover which method is optimal.

rFVIIa for Acute Hemorrhagic Stroke Administered at Earliest Time (FASTEST)

FASTEST trial is a phase III, randomized, double-blind controlled trial of rFVIIa plus best standard therapy vs. placebo and best standard therapy alone in patients with intracranial hemorrhage. The FASTEST Trial will include approximately 100 hospital sites across the world and key global institutions with large volumes of ICH patients and the ability to treat them within 120 minutes of stroke onset.

Multi-arm Optimization of Stroke Thrombolysis (MOST)

The primary efficacy objective of the MOST trial is to determine if Argatroban or Eptifibatide results in improved 90-day modified Rankin scores (mRS) as compared with placebo in acute ischemic stroke (AIS) patients treated with standard of care thrombolysis within three hours of symptom onset.

Translational Research: Novel Diagnostic and Prognostic Markers

Gut Microbiome in Acute Brain Injury

Growing evidence suggests a role for gut microbiota in modulating central nervous system function, in the modulation of cellular mechanisms that follow an acute brain injury. Our Group, in collaboration with Dr. xx are studying this phenomenon in the acutely ill neurocritical care patients.

Artificial Intelligence for Early Detection of Hypoxic Ischemic Brain Injury on Computed Head Tomography after Cardiac Arrest

Establishing whether a patient who survived a cardiac arrest has suffered hypoxic-ischemic brain injury (HIBI) shortly after return of spontaneous circulation (ROSC) can be of paramount importance for informing families and identifying patients who may benefit the most from neuroprotective therapies. We hypothesize that using deep transfer learning on normal-appearing findings on head computed tomography (HCT) scans performed after ROSC would allow us to identify early evidence of HIBI.

Deep transfer learning used to evaluate normal-appearing findings on HCT scans obtained early after ROSC in comatose survivors of cardiac arrest accurately identifies patients who progress to show radiographic evidence of HIBI on follow-up HCT scans.

https://uchicago.technologypublisher.com/technology/44865

Artificial Intelligence for Prognostication following spontaneous intracranial Hemorrhage, blunt TBI and gunshot wounds to the head

In recognizing the limitations of human based interpretations of brain imaging (HCT and brain MRI), we collaborate with Dr. Maryellen Giger (https://radiology.uchicago.edu/research/maryellen-l-giger-lab), to explore novel radiomics based and A.I. based approaches to brain imaging analysis and neuroprognositication

Porcine Model of Intracranial Hypertension

We examine the role of pulsatility in intracranial hypertension. To that End, we collaborate from researchers in Argentina as well as here at the University of Chicago ( Thoracic surgery, neurosurgery and animal lab) to develop a porcine model of intracranial hypertension and explore the role of pulsatile vs non pulsatile blood flow in intracranial hypertension after acute brain injury.

Unique Areas of Research

Ethics and Brain Death

Fifty years after its inception, the current position on the Neurological Standard for Declaration of Death (NSDD) is subject to a number of persistent concerns and novel criticisms. There remains considerable public confusion both about the meaning of the term “brain dead” and about its relation to the death of a human being. There is persistent dissent by some clinicians, philosophers, and other critical observers who have never been convinced that “brain death” is, indeed, the death of the human being. There are, as well, pressures against insisting that declaring death, or at least “organ donation eligibility,” requires the irreversible loss of function in the whole brain. And, perhaps most important, there are critics who have published evidence of ongoing integrated bodily activities in some patients meeting the criteria of “whole brain death” and who have claimed that this evidence invalidates the rationale for today’s consensus position. These challenges invite—indeed, necessitate—a reexamination of the neurological standard enshrined in law and medical practice. This research project will undertake such a reexamination.

Making Progress on Death: Towards an Updated Normative Framework (YouTube Video)

Gunshot Wounds to the Head

The University of Chicago Medical Center is witness to an astonishing number of gunshots wound (GSW) victims. The neurosciences ICU group is avidly researching all aspects of GSW to the head and partnering with researchers from Trauma Surgery, Neurosurgery and Imaging to accomplish those goals.

J Crit Care - 2020 Apr;56:159-166. DOI: 10.1016/j.jcrc.2019.12.026

Management of civilians with penetrating brain injury: A systematic review

J Neurotrauma - 2021 Jun 1;38(13):1821-1826. DOI: 10.1089/neu.2020.7422. Epub 2021 Jan 20

Coagulopathy as a Surrogate of Severity of Injury in Penetrating Brain Injury

Neurocrit Care - 2021 Jun;34(3):918-926. DOI: 10.1007/s12028-020-01106-y Epub 2020 Oct 6

Cerebrovascular Complications in Early Survivors of Civilian Penetrating Brain Injury

Curr Neurol Neurosci Rep - 2021 Jul 10;21(9):47. DOI: 10.1007/s11910-021-01131-0.

Civilian Firearm-Inflicted Brain Injury: Coagulopathy, Vascular Injuries, and Triage

Abstract

Exploring the Role of MRI in GSW to the head

We collaborate with Researchers from Radiology(https://www.uchicagomedicine.org/find-a-physician/physician/olga-pasternakwise, https://radiology.uchicago.edu/faculty/steffen-sammet-md-phd) to explore the role of MRI imaging in victims of GSW to the head. We utilize portable MRI technology to explore this novel research avenue.

Beyond Classic Decision Making

We aim to redress the gap of not incorporating patient preferences in such value-laden decision making as in the case of decompressive craniectomy for refractory post-traumatic intracranial hypertension or following malignant ischemic stroke. We proposed a decision aid based on principles of Decision Theory, and specifically of Expected Utility Theory.

Neurocrit Care - 2021 Jun;34(3):709-713. DOI: 10.1007/s12028-021-01198-0. Epub 2021 Feb 18.

To Decompress or Not? An Expected Utility Inspired Approach To Shared decision-making For Supratentorial Ischemic Stroke

World Neurosurg - 2022 Jan;157:e327-e332. DOI: 10.1016/j.wneu.2021.10.078. Epub 2021 Oct 12.

Decompressive Craniectomy After Traumatic Brain Injury: Incorporating Patient Preferences into Decision-Making

A Quantitative and Qualitative assessment of the determinants of Organ Donation in family Members of patients who suffer catastrophic brain injury

We explore the psychosocial variables that impact a surrogate decision maker’s decision to proceed with organ donation following catastrophic and irreversible brain injury. We aim to optimize end of life conversations and provide the utmost support to family members suffering through those difficult times.