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Author Mario Kofler

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Invasive neuromonitoring and neurological intensive care unit management in life-threatening central nervous system infections.

Verena Rass, Mario Kofler, Ronny Beer, Raimund Helbok,

<h4>Purpose of review</h4>Patients with infectious diseases of the central nervous system (CNS) commonly require treatment in the intensive care unit (ICU). In a subset of patients with a life-threatening course, a more aggressive and invasive management is required. Treatment relies on the expertise of the intensivists as most recommendations are ... Read more >>

Curr Opin Neurol (Current opinion in neurology)
[2021, 34(3):447-455]

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Individualized blood pressure targets in the postoperative care of patients with intracerebral hemorrhage.

Anna Lindner, Verena Rass, Bogdan-Andrei Ianosi, Alois Josef Schiefecker, Mario Kofler, Max Gaasch, Alberto Addis, Paul Rhomberg, Bettina Pfausler, Ronny Beer, Erich Schmutzhard, Claudius Thomé, Raimund Helbok,

<h4>Objective</h4>Recent guidelines recommend targeting a systolic blood pressure (SBP) < 140 mm Hg in the early management of patients with spontaneous intracerebral hemorrhage (ICH). The optimal SBP targets for ICH patients after hematoma evacuation (HE) remain unclear. Here, the authors aimed to define the optimal SBP range based on multimodal ... Read more >>

J Neurosurg (Journal of neurosurgery)
[2021, :1-10]

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Neurological outcome and quality of life 3 months after COVID-19: A prospective observational cohort study.

Verena Rass, Ronny Beer, Alois Josef Schiefecker, Mario Kofler, Anna Lindner, Philipp Mahlknecht, Beatrice Heim, Victoria Limmert, Sabina Sahanic, Alex Pizzini, Thomas Sonnweber, Ivan Tancevski, Christoph Scherfler, Laura Zamarian, Rosa Bellmann-Weiler, Günter Weiss, Atbin Djamshidian, Stefan Kiechl, Klaus Seppi, Judith Loeffler-Ragg, Bettina Pfausler, Raimund Helbok,

<h4>Background and purpose</h4>To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19.<h4>Methods</h4>In this prospective, multicenter, observational cohort study we systematically evaluated neurological signs and diseases by detailed neurological examination and a predefined test battery assessing smelling disorders (16-item Sniffin Sticks test), cognitive deficits (Montreal Cognitive Assessment), QoL ... Read more >>

Eur J Neurol (European journal of neurology)
[2021, :]

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Hyperactive delirium in patients after non-traumatic subarachnoid hemorrhage.

Fabian Reimann, Thomas Rinner, Anna Lindner, Mario Kofler, Bogdan-Andrei Ianosi, Alois Josef Schiefecker, Ronny Beer, Erich Schmutzhard, Bettina Pfausler, Raimund Helbok, Verena Rass,

<h4>Purpose</h4>Hyperactive delirium is common after subarachnoid hemorrhage (SAH). We aimed to identify risk factors for delirium and to evaluate its impact on outcome.<h4>Methods</h4>We collected daily Richmond Agitation Sedation Scale (RASS) and Intensive Care Delirium Screening Checklist (ICDSC) scores in 276 SAH patients. Hyperactive delirium was defined as ICDSC ≥4 when ... Read more >>

J Crit Care (Journal of critical care)
[2021, 64:45-52]

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Brain Exposure to Piperacillin in Acute Hemorrhagic Stroke Patients Assessed by Cerebral Microdialysis and Population Pharmacokinetics.

Sami Ullah, Ronny Beer, Uwe Fuhr, Max Taubert, Markus Zeitlinger, Alexander Kratzer, Christoph Dorn, Usman Arshad, Mario Kofler, Raimund Helbok,

<h4>Background</h4>The broad antibacterial spectrum of piperacillin/tazobactam makes the combination suitable for the treatment of nosocomial bacterial central nervous system (CNS) infections. As limited data are available regarding piperacillin CNS exposure in patients without or with low-grade inflammation, a clinical study was conducted (1) to quantify CNS exposure of piperacillin by ... Read more >>

Neurocrit Care (Neurocritical care)
[2020, 33(3):740-748]

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The Effect of Temperature Increases on Brain Tissue Oxygen Tension in Patients with Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Substudy.

Verena Rass, Lukas Huber, Bogdan-Andrei Ianosi, Mario Kofler, Anna Lindner, Edoardo Picetti, Fabrizio Ortolano, Ronny Beer, Sandra Rossi, Peter Smielewski, Nino Stocchetti, Raimund Helbok, ,

Fever may aggravate secondary brain injury after traumatic brain injury (TBI). The aim of this study was to identify episodes of temperature increases through visual plot analysis and algorithm supported detection, and to describe associated patterns of changes in on brain tissue oxygen tension (P<sub>bt</sub>O<sub>2</sub>). Data derive from the high-resolution ... Read more >>

Ther Hypothermia Temp Manag (Therapeutic hypothermia and temperature management)
[2020, :]

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Neurological Outcome and Quality of Life Three Months after COVID-19: A Prospective Observational Cohort Study

Verena Rass, Ronny Beer, Alois Josef Schiefecker, Mario Kofler, Anna Lindner, Philipp Mahlknecht, Beatrice Heim, Victoria Limmert, Sabina Sahanic, Alex Pizzini, Thomas Sonnweber, Ivan Tancevski, Judith Loeffler-Ragg, Christoph Scherfler, Laura Zamarian, Rosa Bellman-Weiler, Günter Weiss, Atbin Djamshidian, Stefan Kiechl, Bettina Pfausler, Klaus Seppi, Raimund Helbok,

BACKGROUND: Increasing evidence suggests the involvement of the central and peripheral nervous system in patients with coronavirus disease 2019 (COVID-19). Little is known about neurological outcomes and quality of life (QoL) after recovery from acute infection.<br><br>METHODS: In this prospective, multicentre, observational cohort study we systematically evaluated neurological signs and diseases ... Read more >>

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Early alterations in heart rate are associated with poor outcome in patients with intracerebral hemorrhage.

Verena Rass, Anna Lindner, Bogdan-Andrei Ianosi, Alois Josef Schiefecker, Sebastian Loveys, Mario Kofler, Sofia Rass, Bettina Pfausler, Ronny Beer, Erich Schmutzhard, Raimund Helbok,

<h4>Purpose</h4>Cardiac complications are common after spontaneous intracerebral hemorrhage (ICH). In this study we intended to investigate factors associated with higher alterations in heart rate and their impact on outcome.<h4>Methods</h4>Eighty-eight ICH patients were included. A simplified approach to calculate heart rate variability (HR<sub>SD</sub>) in analogy to systolic blood pressure variability (SBP<sub>SD</sub>) ... Read more >>

J Crit Care (Journal of critical care)
[2021, 61:199-206]

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The Importance of PbtO2 Probe Location for Data Interpretation in Patients with Intracerebral Hemorrhage.

Anna Lindner, Verena Rass, Bogdan-Andrei Ianosi, Alois J Schiefecker, Mario Kofler, Paul Rhomberg, Bettina Pfausler, Ronny Beer, Erich Schmutzhard, Claudius Thomé, Raimund Helbok,

<h4>Background/objective</h4>Monitoring of brain tissue oxygen tension (P<sub>bt</sub>O<sub>2</sub>) provides insight into brain pathophysiology after intracerebral hemorrhage (ICH). Integration of probe location is recommended to optimize data interpretation. So far, little is known about the importance of P<sub>bt</sub>O<sub>2</sub> catheter location in ICH patients.<h4>Methods</h4>We prospectively included 40 ICH patients after hematoma evacuation (HE) ... Read more >>

Neurocrit Care (Neurocritical care)
[2020, :]

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Risk Factors for Dysphagia and the Impact on Outcome After Spontaneous Subarachnoid Hemorrhage.

Tobias Keser, Mario Kofler, Mariella Katzmayr, Alois J Schiefecker, Verena Rass, Bogdan A Ianosi, Anna Lindner, Maxime Gaasch, Ronny Beer, Paul Rhomberg, Erich Schmutzhard, Bettina Pfausler, Raimund Helbok,

<h4>Background</h4>Despite the tremendous impact of swallowing disorders on outcome following ischemic stroke, little is known about the incidence of dysphagia after subarachnoid hemorrhage (SAH) and its contribution to hospital complications, length of intensive care unit stay, and functional outcome.<h4>Methods</h4>This is a retrospective analysis of an ongoing prospective cohort study. Swallowing ... Read more >>

Neurocrit Care (Neurocritical care)
[2020, 33(1):132-139]

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Hemodynamic response during endotracheal suctioning predicts awakening and functional outcome in subarachnoid hemorrhage patients.

Verena Rass, Bogdan-Andrei Ianosi, Anna Lindner, Mario Kofler, Alois J Schiefecker, Bettina Pfausler, Ronny Beer, Erich Schmutzhard, Raimund Helbok,

<h4>Background</h4>Endotracheal suctioning (ES) provokes a cumulative hemodynamic response by activation of sympathetic and parasympathetic circuits in the central nervous system. In this proof-of-concept study, we aimed to analyze hemodynamic changes during ES in ventilated subarachnoid hemorrhage (SAH) patients and investigated whether the associated hemodynamic changes relate to the time to ... Read more >>

Crit Care (Critical care (London, England))
[2020, 24(1):432]

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Brain temperature regulation in poor-grade subarachnoid hemorrhage patients - A multimodal neuromonitoring study.

Alberto Addis, Maxime Gaasch, Alois J Schiefecker, Mario Kofler, Bogdan Ianosi, Verena Rass, Anna Lindner, Gregor Broessner, Ronny Beer, Bettina Pfausler, Claudius Thomé, Erich Schmutzhard, Raimund Helbok,

Elevated body temperature (T<sub>core</sub>) is associated with poor outcome after subarachnoid hemorrhage (SAH). Brain temperature (T<sub>brain</sub>) is usually higher than T<sub>core</sub>. However, the implication of this difference (T<sub>delta</sub>) remains unclear. We aimed to study factors associated with higher T<sub>delta</sub> and its association with outcome. We included 46 SAH patients undergoing ... Read more >>

J Cereb Blood Flow Metab (Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism)
[2021, 41(2):359-368]

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A Young Woman Presenting with Encephalopathy: A Case Report.

Mario Kofler, Stefan Kiechl, Raimund Helbok,

Neurocrit Care (Neurocritical care)
[2020, 32(2):630-632]

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Subarachnoid Hemorrhage is Followed by Pituitary Gland Volume Loss: A Volumetric MRI Observational Study.

Verena Rass, Elisabeth Schoenherr, Bogdan-Andrei Ianosi, Anna Lindner, Mario Kofler, Alois J Schiefecker, Lukas Lenhart, Max Gaasch, Marie-Theres Pertl, Christian F Freyschlag, Bettina Pfausler, Margarete Delazer, Ronny Beer, Claudius Thomé, Astrid Ellen Grams, Christoph Scherfler, Raimund Helbok,

<h4>Background</h4>Subarachnoid hemorrhage (SAH) is a devastating disease associated with high mortality and morbidity. Besides neurological sequelae, neuropsychological deficits largely contribute to patients' long-term quality of life. Little is known about the pituitary gland volume (PGV) after SAH compared to healthy referents and the association of PGV with long-term outcome including ... Read more >>

Neurocrit Care (Neurocritical care)
[2020, 32(2):492-501]

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The Importance of Probe Location for the Interpretation of Cerebral Microdialysis Data in Subarachnoid Hemorrhage Patients.

Mario Kofler, Maxime Gaasch, Verena Rass, Alois J Schiefecker, Bogdan Ianosi, Anna Lindner, Ronny Beer, John F Stover, Paul Rhomberg, Bettina Pfausler, Claudius Thomé, Erich Schmutzhard, Raimund Helbok,

<h4>Background</h4>There is no uniform definition for cerebral microdialysis (CMD) probe location with respect to focal brain lesions, and the impact of CMD-probe location on measured molecule concentrations is unclear.<h4>Methods</h4>We retrospectively analyzed data of 51 consecutive subarachnoid hemorrhage patients with CMD-monitoring between 2010 and 2016 included in a prospective observational cohort ... Read more >>

Neurocrit Care (Neurocritical care)
[2020, 32(1):135-144]

Cited: 3 times

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Early Predictors for Infectious Complications in Patients With Spontaneous Intracerebral Hemorrhage and Their Impact on Outcome.

Anna Lindner, Mario Kofler, Verena Rass, Bogdan Ianosi, Max Gaasch, Alois J Schiefecker, Ronny Beer, Sebastian Loveys, Paul Rhomberg, Bettina Pfausler, Claudius Thomé, Erich Schmutzhard, Raimund Helbok,

<b>Background:</b> Infectious complications (IC) commonly occur in patients with intracerebral hemorrhage (ICH) and are associated with increased length of hospitalization (LOS) and poor long-term outcome. Little is known about early ICH-related predictors for the development of IC to allow appropriate allocation of resources and timely initiation of preventive measures. <b>Methods:</b> ... Read more >>

Front Neurol (Frontiers in neurology)
[2019, 10:817]

Cited: 3 times

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Protocolized Brain Oxygen Optimization in Subarachnoid Hemorrhage.

Verena Rass, Daria Solari, Bogdan Ianosi, Max Gaasch, Mario Kofler, Alois J Schiefecker, John-Paul Miroz, Paola Morelli, Claudius Thomé, Ronny Beer, Bettina Pfausler, Mauro Oddo, Raimund Helbok,

<h4>Background</h4>Brain tissue hypoxia (P<sub>bt</sub>O<sub>2</sub> < 20 mmHg) is common after subarachnoid hemorrhage (SAH) and associated with poor outcome. Recent data suggest that brain oxygen optimization is feasible and reduces the time spent with P<sub>bt</sub>O<sub>2</sub> < 20 mmHg from 45 to 16% in patients with severe traumatic brain injury. Here, we intended to quantify the brain tissue ... Read more >>

Neurocrit Care (Neurocritical care)
[2019, 31(2):263-272]

Cited: 2 times

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Fluid Intake But Not Fluid Balance Is Associated With Poor Outcome in Nontraumatic Subarachnoid Hemorrhage Patients.

Verena Rass, Max Gaasch, Mario Kofler, Alois Josef Schiefecker, Bogdan-Andrei Ianosi, Fabian Steinkohl, Ronny Beer, Bettina Pfausler, Elke R Gizewski, Claudius Thomé, Erich Schmutzhard, Raimund Helbok,

<h4>Objectives</h4>Optimal fluid management is important in patients with acute brain injury, including subarachnoid hemorrhage. We aimed to examine the relationship between daily fluid intake and fluid balance with hospital complications and functional outcome.<h4>Design</h4>Retrospective observational cohort study.<h4>Setting</h4>Neurocritical care unit at a tertiary academic medical center.<h4>Patients</h4>Two-hundred thirty-seven consecutive nontraumatic subarachnoid hemorrhage patients ... Read more >>

Crit Care Med (Critical care medicine)
[2019, 47(7):e555-e562]

Cited: 2 times

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Delayed Resolution of Cerebral Edema Is Associated With Poor Outcome After Nontraumatic Subarachnoid Hemorrhage.

Verena Rass, Bogdan-Andrei Ianosi, Andreas Wegmann, Max Gaasch, Alois J Schiefecker, Mario Kofler, Anna Lindner, Alberto Addis, Salma S Almashad, Paul Rhomberg, Bettina Pfausler, Ronny Beer, Elke R Gizewski, Claudius Thomé, Raimund Helbok,

Background and Purpose- Global cerebral edema occurs in up to 57% of patients with subarachnoid hemorrhage (SAH) and is associated with prolonged hospital stay and poor outcome. Recently, admission brain edema was successfully graded using a simplified computed tomography-based semiquantitative score (subarachnoid hemorrhage early brain edema score [SEBES]). Longitudinal evaluation ... Read more >>

Stroke (Stroke)
[2019, 50(4):828-836]

Cited: 4 times

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An Observational Study on the Use of Intravenous Non-Opioid Analgesics and Antipyretics in Poor-Grade Subarachnoid Hemorrhage: Effects on Hemodynamics and Systemic and Brain Temperature.

Bogdan Ianosi, Verena Rass, Max Gaasch, Lukas Huber, Anna Lindner, Werner O Hackl, Mario Kofler, Alois Josef Schiefecker, Salma Almashad, Ronny Beer, Bettina Pfausler, Raimund Helbok,

Intravenous nonsteroidal anti-inflammatory drugs and nonopioid analgesics are used to achieve normothermia or relieve pain in patients with aneurysmal subarachnoid hemorrhage (aSAH). We investigated the effects of paracetamol (1 g), diclofenac (75 mg) and metamizole (1 g) on systemic and cerebral hemodynamics and temperature during febrile and nonfebrile episodes after aSAH. Prospectively collected ... Read more >>

Ther Hypothermia Temp Manag (Therapeutic hypothermia and temperature management)
[2020, 10(1):27-36]

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A reduced concentration of brain interstitial amino acids is associated with depression in subarachnoid hemorrhage patients.

Mario Kofler, Alois Josef Schiefecker, Maxime Gaasch, Barbara Sperner-Unterweger, Dietmar Fuchs, Ronny Beer, Boris Ferger, Verena Rass, Werner Hackl, Paul Rhomberg, Bettina Pfausler, Claudius Thomé, Erich Schmutzhard, Raimund Helbok,

The amino-acids tryptophan, phenylalanine and tyrosine seem to play an important role in the pathophysiology of depressive disorders. We measured daily brain extracellular levels of these amino-acids using cerebral microdialysis (CMD) and high performance liquid chromatography in 26 consecutive subarachnoid hemorrhage (SAH) patients and associated them with the presence of ... Read more >>

Sci Rep (Scientific reports)
[2019, 9(1):2811]

Cited: 4 times

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Systemic Inflammatory Response Syndrome as Predictor of Poor Outcome in Nontraumatic Subarachnoid Hemorrhage Patients.

Verena Rass, Max Gaasch, Mario Kofler, Alois Josef Schiefecker, Bogdan-Andrei Ianosi, Paul Rhomberg, Ronny Beer, Bettina Pfausler, Elke R Gizewski, Claudius Thomé, Erich Schmutzhard, Raimund Helbok,

<h4>Objectives</h4>Subarachnoid hemorrhage is a life-threatening disease associated with high mortality and morbidity. A substantial number of patients develop systemic inflammatory response syndrome. We aimed to identify risk factors for systemic inflammatory response syndrome development and to evaluate the role of systemic inflammatory response syndrome on patients' outcome.<h4>Design</h4>Retrospective observational cohort study ... Read more >>

Crit Care Med (Critical care medicine)
[2018, 46(12):e1152-e1159]

Cited: 5 times

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Brain Extracellular Interleukin-6 Levels Decrease Following Antipyretic Therapy with Diclofenac in Patients with Spontaneous Subarachnoid Hemorrhage.

Alois J Schiefecker, Verena Rass, Maxime Gaasch, Mario Kofler, Claudius Thomé, Christian Humpel, Bogdan Ianosi, Werner O Hackl, Ronny Beer, Bettina Pfausler, Erich Schmutzhard, Raimund Helbok,

In patients with aneurysmal subarachnoid hemorrhage (aSAH), increased brain extracellular interleukin (IL)-6 levels measured by cerebral microdialysis (CMD) were associated with disease severity, early brain injury, delayed cerebral infarction, and axonal injury. In this study, we analyzed brain extracellular IL-6 levels of aSAH patients following parenteral diclofenac. Twenty-four mechanically ventilated ... Read more >>

Ther Hypothermia Temp Manag (Therapeutic hypothermia and temperature management)
[2019, 9(1):48-55]

Cited: 3 times

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Autoantibodies against neuronal surface proteins in spontaneous subarachnoid and intracerebral haemorrhage.

Harald Hegen, Raimund Helbok, Mario Kofler, Bettina Pfausler, Alois Schiefecker, Erich Schmutzhard, Ronny Beer,

<h4>Background</h4>Brain autoimmunity has been reported in patients with preceding infection of the central nervous system by herpesviridae. It has been hypothesized that neuronal damage releasing antigens might trigger secondary immune response. The objective of the study was to investigate whether brain damage due to spontaneous subarachnoid haemorrhage (SAH) or intracerebral ... Read more >>

BMC Neurol (BMC neurology)
[2018, 18(1):89]

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Perifocal metabolism in a patient with brain abscess: insights from cerebral microdialysis.

Verena Rass, Mario Kofler, Alois J Schiefecker, Max Gaasch, Claudia Unterhofer, Claudius Thomé, Paul Rhomberg, Bettina Pfausler, Ronny Beer, Erich Schmutzhard, Raimund Helbok,

J Neurol Neurosurg Psychiatry (Journal of neurology, neurosurgery, and psychiatry)
[2019, 90(2):239-242]

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