Background/Objectives Assessing consciousness at the bedside in the neurocritical care unit is complicated by sedation and other treatment effects. While electroencephalogram (EEG) is commonly used, it offers a limited view of the neurovascular unit. We evaluated whether combining cerebral blood flow (CBF) features with EEG improves binary classification of consciousness in patients with severe brain injury. Methods We retrospectively analyzed 26 adults who underwent multimodal neuromonitoring. Signals were segmented into 30-min windows after each probe recalibration. We used parameters including CBF low-frequency bands (band IV 0.027-0.073 Hz, band V 0.01-0.027 Hz, and band all 0-0.5 Hz) and EEG band powers (delta-beta), alpha-delta ratio (ADR), alpha/(delta + theta) (ADTR), total power. A random forest (RF) model trained using K-fold cross-validation achieved optimal classification. Highly correlated features (r > 0.8) were excluded from simultaneous use. Performance was summarized with receiver operating characteristic-area under the curve (ROC-AUC) and accuracy, with confusion matrices shown for the best combinations. Results Multimodal feature combinations significantly improved classification compared with EEG features alone. The best-performing combination (EEG ADR, total EEG power, and CBF B and V) achieved a ROC-AUC of 0.86 and an accuracy of 82%, outperforming EEG-only models. In two exploratory cases with noninvasive diffuse correlation spectroscopy (DCS) monitoring, the same feature framework produced predictions concordant with those obtained using invasive CBF features. Conclusions Combining EEG and CBF metrics, particularly low-frequency oscillations in perfusion fluctuations, enhances classification of consciousness in critically ill patients and may support future bedside tools for real-time neurovascular monitoring and decision making about treatment and rehabilitation.
Management of the neurocritical patient has undergone an unprecedented conceptual and technological metamorphosis over the last seven decades. What was once understood as a simple, passive hydrostatic relationship between the heart and the brain has evolved into a discipline of precision, where individual dynamic physiology supersedes standardized protocols. For much of the 20th century, clinical practice was anchored in the dogma that cerebral blood flow (CBF) remained constant within broad and fixed blood pressure limits. Recent advances in bioengineering and signalprocessing technologies have demonstrated that the limits of cerebrovascular autoregulation (CA) are not fixed physiological constants, but dynamic boundaries that vary considerably between patients and over time. This recognition has prompted a paradigm shift away from standardized perfusion targets toward individualized cerebrovascular management. In this context, CA is no longer viewed solely as a physiological phenomenon; it has emerged as a measurable and actionable clinical variable. Continuous bedside assessment of autoregulatory function now offers the opportunity to tailor hemodynamic interventions to the individual patient, with the goal of preserving cerebral perfusion and minimizing secondary brain injury.
Traumatic cerebral venous sinus thrombosis (tCVST) is a rare complication of head trauma associated with increased mortality. Unlike in non-traumatic CVST, there are no consensus guidelines to direct the management of tCVST. Anticoagulation is often used to prevent intracranial complications; however, concurrent traumatic brain injury (TBI) and other injuries complicate treatment decisions, and its clinical benefit remains uncertain. This study describes the epidemiology, management, and clinical and radiographic outcomes of tCVST. This is a retrospective single-center cohort study from a level 1 trauma center in Melbourne, Australia. Patients were identified from the Alfred Health Trauma Registry and hospital coding data between 1 January 2010 and 30 June 2024. Venous imaging was reviewed by two neuroradiologists to confirm tCVST diagnosis and thrombus characteristics. Primary outcomes were defined as discharge destination, with sinus recanalization on follow-up imaging as a secondary outcome. tCVST was confirmed in 138 patients with an incidence of 0.9
