Dr. Diringer is the Director of the Neurology-Neurosurgery Intensive Care Unit and Head of the Neurological Critical Care Section.

Dr. Diringer is a fellow of the American Heart Association (Stroke) and the American College of Critical Care Medicine. He has been repeatedly listed as one of the "Best Doctor's in America" and "Best Doctor's in St. Louis." In 2004 Dr. Diringer was installed as the president of the Neurocritical Care Society.

The Neurology/Neurosurgery Intensive Care Unit serves as our "clinical laboratory." It is the only unit of its type in the U.S. with on-site PET scanning facilities. The goal of our research efforts is to improve the quality of care delivered to critically ill patients with neurological and neurosurgical disease by focusing on the impact of therapeutic regimes on cerebrovascular hemodynamics and metabolism. It is our hope to settle some of the major controversies presently surrounding the treatment of our patients. These include such therapies as hyperventilation, manipulating blood pressure and the use of osmotic agents.

Medical Training

Dr. Diringer joined the faculty at Washington University in 1992 to become the Director of the Neurology- Neurosurgery Intensive Care Unit. His undergraduate training in psychology was completed at SUNY at Stony Brook. He received a masters degree in Neuropsychopharmacology from the University of Louisville and his M.D. from the University of Kentucky. Following a Neurology residency at SUNY at Stony Brook, Dr. Diringer completed a Fellowship in Critical Care Neurology at the Johns Hopkins Medical Institution where he was a Charles A. Dana Neuroscience Fellow, as well as recipient of the W. M. Keck Foundation Clinician Scientists Award and a National Stroke Foundation Fellowship Award. He remained on the faculty at Johns Hopkins Medical Institution for 4 years prior to moving to Washington University.

Selected Publications

Diringer MN, Skolnick BE, Mayer SA, Steiner T, Davis SM, Brun NC, Broderick JP. Risk of thromboembolic events in controlled trials of rFVIIa in spontaneous intracerebral hemorrhage. Stroke. 2008 Mar;39(3):850-6. Epub 2008 Jan 31. PMID: 18239180 [PubMed - in process]

Dhar R, Diringer MN. The Burden of the Systemic Inflammatory Response Predicts Vasospasm and Outcome after Subarachnoid Hemorrhage. Neurocrit Care. 2008 Jan 15; [Epub ahead of print] PMID: 18196475 [PubMed - as supplied by publisher]

Keyrouz SG, Diringer MN. Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage. Crit Care. 2007;11(4):220. PMID: 17705883 [PubMed - in process]

Diringer MN, Ferran JM, Broderick J, Davis S, Mayer SA, Steiner T, Brun NC, Skolnick BE, Christensen MC. Impact of recombinant activated factor VII on health-related quality of life after intracerebral hemorrhage. Cerebrovasc Dis. 2007;24(2-3):219-25. Epub 2007 Jun 28. PMID: 17630481 [PubMed - indexed for MEDLINE

Aiyagari V, Diringer MN. Fever control and its impact on outcomes: what is the evidence? J Neurol Sci. 2007 Oct 15;261(1-2):39-46. Epub 2007 May 29. Review. PMID: 17537459 [PubMed

Steiner T, Diringer MN, Schneider D, Mayer SA, Begtrup K, Broderick J, Skolnick BE, Davis SM.
Dynamics of intraventricular hemorrhage in patients with spontaneous intracerebral hemorrhage: risk factors, clinical impact, and effect of hemostatic therapy with recombinant activated factor VII.
Neurosurgery. 2006 Oct;59(4):767-73; discussion 773-4.

Elsayed AA, Moran CJ, Cross DT 3rd, Derdeyn CP, Pilgram TK, Milburn JM, Dacey RG Jr, Diringer MN Jr.
Effect of intraarterial papaverine and/or angioplasty on the cerebral veins in patients with vasospasm after subarachnoid hemorrhage due to ruptured intracranial aneurysms.
Neurosurg Focus. 2006 Sep 15;21(3):E16.

Terry A, Zipfel G, Milner E, Cross DT 3rd, Moran CJ, Diringer MN, Dacey RG, Jr, Derdeyn CP.
Safety and technical efficacy of over-the-wire balloons for the treatment of subarachnoid hemorrhage-induced cerebral vasospasm. Neurosurg Focus. 2006 Sep 15;21(3):E14.

Rabinstein AA, Mueller-Kronast N, Maramattom BV, Zazulia AR, Bamlet WR, Diringer MN, Wijdicks EF.
Factors predicting prognosis after decompressive hemicraniectomy for hemispheric infarction.
Neurology. 2006 Sep 12;67(5):891-3.

Kim-Han JS, Kopp SJ, Dugan LL, Diringer MN.
Perihematomal mitochondrial dysfunction after intracerebral hemorrhage.
Stroke. 2006 Oct;37(10):2457-62. Epub 2006 Sep 7.

Jost SC, Diringer MN, Zazulia AR, Videen TO, Aiyagari V, Grubb RL, Powers WJ.
Effect of normal saline bolus on cerebral blood flow in regions with low baseline flow in patients
with vasospasm following subarachnoid hemorrhage. J Neurosurg. 2005 Jul;103(1):25-30.

Aiyagari V, Menendez JA, Diringer MN. Treatment of severe coagulopathy after gunshot
injury to the head using recombinant activated factor VII. J Crit Care. 2005 Jun;20(2):176-9.

Mayer SA, Brun NC, Begtrup K, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T;
Recombinant Activated Factor VII Intracerebral Hemorrhage Trial Investigators. Recombinant activated
factor VII for acute intracerebral hemorrhage. N Engl J Med. 2005 Feb 24;352(8):777-85.

Zurasky JA, Aiyagari V, Zazulia AR, Shackelford A, Diringer MN. Early mortality following
spontaneous intracerebral hemorrhage. Neurology. 2005 Feb 22;64(4):725-7.

Diringer MN. What do we really understand about head injury? Neurocrit Care. 2005;2(1):3.
Brody DL, Aiyagari V, Shackleford AM, Diringer MN. Use of recombinant factor VIIa in patients
with warfarin-associated intracranial hemorrhage. Neurocrit Care. 2005;2(3):263-7.

Mayer SA, Brun NC, Broderick J, Davis S, Diringer MN, Skolnick BE, Steiner T; Europe/AustralAsia
NovoSeven ICH Trial Investigators. Safety and feasibility of recombinant factor VIIa for acute intracerebral
hemorrhage. Stroke 2005 Jan;36(1):74-9.

Diringer MN, Reaven NL, Funk SE, Uman GC. Elevated body temperature independently contributes
to increased length of stay in neurologic intensive care unit patients. Crit Care Med. 2004 Jul;32(7):1489-95.
Erratum in: Crit Care Med. 2004 Oct;32(10):2170.

Garcia-Morales EJ, Cariappa R, Parvin CA, Scott MG, Diringer MN. Osmole gap in neurologic-
neurosurgical intensive care unit: Its normal value, calculation, and relationship with mannitol serum concentrations.
Crit Care Med. 2004 Apr;32(4):986-91.

Diringer MN; Neurocritical Care Fever Reduction Trial Group. Treatment of fever in the neurologic intensive
care unit with a catheter-based heat exchange system. Crit Care Med. 2004 Feb;32(2):559-64.

Diringer MN, Zazulia AR. Osmotic therapy: fact and fiction. Neurocrit Care. 2004;1(2):219-34.
D

iringer M. Hyperventilation in head injury: what have we learned in 43 years? Crit Care Med. 2002
Sep;30(9):2142-3.

Diringer MN, Videen TO, Yundt K, Zazulia AR, Aiyagari V, Dacey RG Jr, Grubb RL, Powers WJ. Regional
cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury.
J Neurosurg. 2002 Jan;96(1):103-8.

Videen TO, Zazulia AR, Manno EM, Derdeyn CP, Adams RE, Diringer MN, Powers WJ. Mannitol bolus preferentially
shrinks non-infarcted brain in patients with ischemic stroke. Neurology. 2001 Dec 11;57(11):2120-2.

Diringer MN, Edwards DF, Aiyagari V, Hollingsworth H. Factors associated with withdrawal of mechanical ventilation
in a neurology/neurosurgery intensive care unit. Crit Care Med. 2001 Sep;29(9):1792-7.

Powers WJ, Zazulia AR, Videen TO, Adams RE, Yundt KD, Aiyagari V, Grubb RL Jr, Diringer MN. Autoregulation
of cerebral blood flow surrounding acute (6 to 22 hours) intracerebral hemorrhage. Neurology. 2001 Jul 10;57(1):18-24.

Zazulia AR, Diringer MN, Videen TO, Adams RE, Yundt K, Aiyagari V, Grubb RL Jr, Powers WJ. Hypoperfusion
without ischemia surrounding acute intracerebral hemorrhage. J Cereb Blood Flow Metab. 2001 Jul;21(7):804-10.

Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced
mortality rate after intracerebral hemorrhage. Crit Care Med. 2001 Mar;29(3):635-40.

Paczynski RP, Venkatesan R, Diringer MN, He YY, Hsu CY, Lin W. Effects of fluid management on edema volume
and midline shift in a rat model of ischemic stroke. Stroke. 2000 Jul;31(7):1702-8.

Diringer MN, Yundt K, Videen TO, Adams RE, Zazulia AR, Deibert E, Aiyagari V, Dacey RG Jr, Grubb RL Jr, Powers
WJ. No reduction in cerebral metabolism as a result of early moderate hyperventilation following severe traumatic brain
injury. J Neurosurg. 2000 Jan;92(1):7-13.

Edwards DF, Hollingsworth H, Zazulia AR, Diringer MN. Artificial neural networks improve the prediction of mortality
in intracerebral hemorrhage. Neurology. 1999 Jul 22;53(2):351-7.

Zazulia AR, Diringer MN, Derdeyn CP, Powers WJ. Progression of mass effect after intracerebral hemorrhage.
Stroke. 1999 Jun;30(6):1167-73.

Gujjar AR, Deibert E, Manno EM, Duff S, Diringer MN. Mechanical ventilation for ischemic stroke and intracerebral
hemorrhage: indications, timing, and outcome. Neurology. 1998 Aug;51(2):447-51.

Diringer MN, Edwards DF, Zazulia AR. Hydrocephalus: a previously unrecognized predictor of poor outcome from
supratentorial intracerebral hemorrhage. Stroke. 1998 Jul;29(7):1352-7.

Yundt KD, Grubb RL Jr, Diringer MN, Powers WJ. Autoregulatory vasodilation of parenchymal vessels is impaired
during cerebral vasospasm. J Cereb Blood Flow Metab. 1998 Apr;18(4):419-24.

Paczynski RP, He YY, Diringer MN, Hsu CY. Multiple-dose mannitol reduces brain water content in a rat model of
cortical infarction. Stroke. 1997 Jul;28(7):1437-43.

Yundt KD, Grubb RL Jr, Diringer MN, Powers WJ. Cerebral hemodynamic and metabolic changes caused by brain
retraction after aneurysmal subarachnoid hemorrhage. Neurosurgery. 1997 Mar;40(3):442-50.