About

Fernando Goldenberg, MD, is a professor at the University of Chicago in the Department of Neurology. He specializes in critical care medicine with a sub-specialization in neurocritical care. Dr. Goldenberg is part of a multidisciplinary team working in the Neurosciences Intensive Care Unit (Neuro-ICU), focusing on the diagnosis and management of patients with ischemic and hemorrhagic stroke, brain aneurysms, brain tumors, cerebral edema, status epilepticus, Guillain-Barre syndrome, and respiratory failure associated with myasthenia gravis. He contributes to research related to the care of critically ill neurological patients, including the formal diagnosis of brain death. Dr. Goldenberg is actively involved in teaching and administration of the Neurocritical Care Fellowship training program, and he teaches neurology and neurosurgery residents, critical care medicine and anesthesia fellows, as well as medical students. His expertise and contributions extend to lecturing at medical meetings across the United States and South America.

Research topics

• Medicine
• Psychiatry
• Internal medicine
• Sociology
• Emergency medicine
• Intensive care medicine
• Pathology
• Surgery
• Virology
• Pediatrics
• Anesthesia
• Radiology
• Demography
• Engineering

Selected publications

• Abstract DP286: Lack of Fibrinolysis May Explain Tranexamic Acid's Lack of Efficacy in Reducing Hematoma Expansion

  Stroke · 2026-01-29

  article

  Introduction: Intracerebral hemorrhage (ICH) is a severe stroke subtype associated with high mortality and disability. Hematoma expansion (HE) is a major determinant of poor outcomes in ICH, yet effective treatments to limit HE remain elusive. Tranexamic acid, an antifibrinolytic agent, has been proposed to reduce ongoing bleeding in ICH, based on its success in trauma and surgical settings. The STOP-MSU trial tested whether tranexamic acid within 2 hours of symptom onset could reduce HE in spontaneous ICH. However, no effect was found. We hypothesized that fibrinolysis would explain the results. Methods: We conducted a prospective, multicenter observational study across six medical centers in the United States. Eligible patients were adults aged 21 or older who presented with a radiologically confirmed spontaneous ICH within 12 hours of symptom onset. Whole blood samples were collected within 12 hours of ICH symptom onset and analyzed with thromboelastography (TEG). TEG is a non-invasive, point-of-care assay that assesses coagulation factors, fibrinogen, platelets, and fibrinolysis in a single waveform. Fibrinolysis is measured as the percentage of accelerated fibrinolysis within 30 minutes (LY30), with hyperfibrinolysis defined as >8%. Results: A total of 110 patients with spontaneous ICH had readable TEG results. The median time from symptom onset to first blood draw was 6.3 hours [IQR 4.6–9.4 hours], and from hospital admission to first blood draw was 2.6 hours [1.6–4.3 hours]. The TEG results showed inactive fibrinolysis with a median LY30 value of 0.1% [IQR 0.0%–0.6%] at first blood draw for this cohort. Only one patient exhibited hyperfibrinolysis with a LY30 of 16%. Most patients (n = 87, 79.1%) had LY30 values less than 1%. Using a more liberal threshold of >3% for hyperfibrinolysis, only 3 patients (2.7%) in our cohort would have met the requirements for tranexamic acid treatment. Conclusion: There is little fibrinolysis to correct in patients with acute spontaneous ICH. Thus, tranexamic acid seems unlikely to have a biologically plausible mechanism to reduce hematoma expansion and improve patient outcomes. These results suggest that alternative therapeutic mechanisms, such as agents promoting coagulation cascade activation, may be more effective in preventing hematoma expansion in ICH patients.

  PublisherDOI

• Abstract A153: Thromboelastography Predicts Hematoma expansion and Disability in Spontaneous Intracerebral Hemorrhage – A Multi-Center Study

  Stroke · 2026-01-29

  article

  Introduction: Hematoma Expansion (HE) is a modifiable cause of disability and death after intracerebral hemorrhage (ICH). Hemostatic biomarkers have the potential to predict HE and identify specific mechanisms of hemostasis for therapeutic intervention; however, many biomarkers, like the International Normalized Ratio (INR), are limited in scope to patients taking warfarin or with hepatic failure. Thromboelastography (TEG) is a rapid, bedside test of clot strength and platelet activity. We prospectively tested the hypothesis that TEG would predict HE and disability outcomes in a large, multi-center cohort, potentially identifying patients for targeted treatment. Methods: We enrolled spontaneous ICH patients at six medical centers across the U.S. between 2019 and 2023. Global hemostasis of whole blood samples was analyzed with TEG. All patients had two CT scans for HE calculation, and a blood draw that occurred prior to follow-up imaging. Patients treated with desmopressin or other interventions that impact coagulation were excluded. Correlations between continuous numerical variables (HE and hemostatic biomarkers) were calculated using Spearman’s correlation. Correlations between the three-month modified Rankin Scale (mRS) and biomarkers were calculated using Kendall’s correlation. Results: We enrolled 82 patients (34.1% women) with a mean age of 61 +/- 13.3 years. None took pre-ICH anticoagulants, and INR was normal. Symptom onset occurred within a median time of 1.8 [1.15 – 4.48] hours before first CT scan imaging, and 5.8 [4.45 – 7.57] hours before blood draw. TEG K, a measure of fibrinogen dependent clot strength, was associated with subsequent HE (rho = 0.19, P =0.048) and the mRS at three months (tau = 0.28, P =0.04). Additionally, TEG MA (tau = -0.32, P = 0.02), a measure of clot strength dependent on platelets, and HE (tau = 0.35, P =0.01) were associated with the mRS at three months. Fibrinogen levels were in the normal range, excluding hypofibrinogenemia as a potential confounder of the association between TEG, hematoma expansion, and outcomes. Conclusions: Hemostatic biomarkers from TEG, particularly related to clot strength and fibrin generation, were associated with subsequent HE and the mRS at three months.

  PublisherDOI

• Forewords to the Brain Trauma Foundation Guidelines for the Management of Penetrating Traumatic Brain Injury, Second Edition

  Neurosurgery · 2026-02-16

  articleOpen access
  PublisherDOI

• AI-Aided Triage for GSWH: Validating an Interpretable HCT-Based Mortality Model

  Journal of Neurotrauma · 2026-03-10

  article

  Civilian gunshot wounds to the head (GSWH) carry high mortality yet lack standardized, imaging-based triage tools. Because initial noncontrast head computerized tomography (HCT) is universally obtained but not leveraged with validated, rapid, and reproducible methods, we developed and evaluated an interpretable, attention-based multiple-instance learning (MIL) model to predict in-hospital mortality from the initial HCT. In a retrospective cohort at a single level I trauma center (May 1, 2018–October 31, 2023), we included consecutive adults (≥16 years) with GSWH who underwent HCT, excluding those dead on arrival or without HCT. Of 222 patients, 106 (47.8%) survived to discharge and 116 (52.2%) died. We used a stratified random split to create a development set ( n = 168, 75.7%) and an independent test set ( n = 54, 24.3%); the development set was repeatedly partitioned 100 times into training and validation subsets to quantify performance uncertainty, and each of the 100 models was evaluated once on the test set. The MIL algorithm produced a prognostic severity score with case-level interpretability via attention maps. On the independent test set, discrimination for mortality was high (area under the curve: 0.92, 95% CI: 0.87–0.94) with sensitivity 0.88 (95% CI: 0.78–0.97) and specificity 0.87 (95% CI: 0.74–0.96) at the optimal operating point. Attention visualizations consistently highlighted brainstem, deep midline, and ventricular injury in high-mortality predictions, aligning with established high-risk neuroanatomy. These findings demonstrate that an interpretable, HCT-based MIL model can deliver objective, reproducible risk estimates and transparent case-level explanations, supporting early prognostication and imaging-first triage in penetrating brain injury.

  PublisherDOI

• Penetrating Brain Injury: Bridging Global Disparities in Care and Advancing Management Strategies

  World Neurosurgery · 2025-05-23 · 3 citations

  articleOpen access

  BACKGROUND: Despite being a global health concern with significant mortality and healthcare costs, particularly in low- and middle-income countries, evidence-based guidelines tailored to penetrating brain injury (PBI) remain scarce. METHODS: The sixth South American Regional Neurocritical Care Society Conference in Buenos Aires, in collaboration with the Argentinian Society of Critical Care and the Latin American Brain Injury Consortium, featured a session highlighting the potential benefits of intracranial pressure monitoring and early decompressive craniectomy, both of which have demonstrated survival advantages in selected patient populations but remain underused in low- and middle-income countries. Additionally, a novel imaging-based phenotyping system, the UChicago PBI Imaging score, was introduced to refine prognostication and guide intervention strategies. RESULTS: These approaches are crucial given PBI's rising global incidence and its mounting toll on healthcare systems. A central theme of the conference was the imperative of comparative effectiveness research to address disparities in PBI management. CONCLUSION: By systematically evaluating diverse patient populations, comparative effectiveness research can identify the most efficacious and cost-effective interventions, ensuring they are adapted to resource-limited environments. This framework holds promise for establishing standardized guidelines and informing scalable practice models across variable resource settings. Moving forward, fostering international partnerships and data-sharing initiatives will be vital for refining existing protocols and ensuring equitable access to interventions associated with improved survival. These efforts aim to advance care in PBI worldwide.

  PublisherDOI

• Prophylactic Antiseizure Medication in Patients with Lobar Intracerebral Hemorrhage

  Neurocritical Care · 2025-12-17

  articleOpen access

  BACKGROUND: Early seizures are a common complication after acute intracerebral hemorrhage (ICH). We tested the hypothesis of whether prophylactic antiseizure medication is associated with lower incidence of early seizures in patients with elevated risk of ICH. METHODS: This study involved a retrospective analysis of a prospective observational cohort, including five academic medical centers with a focus on patients presenting spontaneous ICH on hospital admission in the years 2006 through 2023. We assessed the characteristics of acute ICH and the administration of antiseizure medication. In this observational cohort, the administration of antiseizure medication was at the discretion of the treating physician. We focused on the 300 patients with lobar hematoma location. Age, hematoma volume, and sex were included as covariates in an adjusted regression model to evaluate seizure occurrence. We prospectively recorded the use of antiseizure medications and identified the occurrence of early seizures. Additionally, we conducted an exploratory analysis defining patients who were at risk as those with lobar hematomas, age < 65 years, and hematoma volume ≥ 10 mL. Functional outcomes were assessed using modified Rankin Scale scores three months after event. RESULTS: The median age was 72.0 (interquartile range 62.0-80.0) years, and 158 (53%) were female. An early seizure occurred in 43 (14.3%). In patients who did not receive antiseizure prophylaxis, 34 of 157 (21.6%) had an early seizure, whereas in patients who did receive antiseizure prophylaxis, 9 of 143 (6.3%) had an early seizure. Prophylactic antiseizure medication was associated with a reduced incidence of early seizures (adjusted odds ratio 0.25, 95% confidence interval 0.11-0.54, P = 0.0005) in patients at high risk for early seizures. There was no association between prophylactic medication use and modified Rankin Scale scores at three-month follow-up. CONCLUSIONS: In a retrospective analysis of a multicenter cohort of patients at elevated seizure risk after ICH, prophylactic antiseizure medication was associated with a reduced likelihood of an early seizure.

  PublisherOA PDFDOI

• Pretest Probability in Determining Brain Death via Brain Blood Flow Studies

  The Linacre Quarterly · 2025-11-12

  articleSenior author
  PublisherDOI

• Biomarkers of Thromboelastography Platelet Mapping Predict Hematoma Expansion After Spontaneous Intracerebral Hemorrhage

  Stroke · 2025-07-18 · 2 citations

  articleOpen access

  BACKGROUND: Hematoma expansion (HE) is a preventable cause of disability and death in patients with acute intracerebral hemorrhage (ICH). Platelet activity is essential for coagulation, and antiplatelet medications (eg, aspirin, clopidogrel) increase HE risk. General markers of platelet activity are associated with later HE, but specific biomarkers of platelet activity could enhance our understanding. We hypothesized that hemostatic biomarkers of platelet activity would correlate with later HE. METHODS: We conducted a tri-center observational cohort study of spontaneous ICH patients with multiple imaging scans for HE calculation. The thromboelastography 6s Platelet Mapping assay assessed platelet activity with 3 biomarkers: (1) adenosine diphosphate receptor-induced platelet activation, (2) platelet-fibrin network clot strength measured by heparinized kaolin with heparinase, and (3) fibrinogen-only clot strength measured by activator F (ActF). Spearman rank measured the correlation between HE and platelet activity. A linear regression model predicted HE from ActF. We tested whether the relationship between ActF and HE interacted with pre-ICH antiplatelet medication. RESULTS: Thirty-five patients were included. Eleven (35.48%) took pre-ICH antiplatelet medication. Heparinized kaolin with heparinase negatively correlated with HE ( ρ =−0.34, P =0.02), indicating that stronger platelet-fibrin clots were associated with less subsequent HE. ActF’s association with HE depended on pre-ICH antiplatelet medication use (interaction P =0.005). More ActF (fibrinogen) was associated with less HE in patients who did not take pre-ICH antiplatelet medication. CONCLUSIONS: Hemostatic biomarkers from the thromboelastography 6s Platelet Mapping assay predicted subsequent HE and may aid in determining neurosurgical need. Strengthening platelet-mediated coagulation may be a target for reducing HE and improving ICH outcomes.

  PublisherOA PDFDOI

• Brain Imaging Features in Patients with Gunshot Wounds to the Head

  Journal of Neurotrauma · 2025-02-03 · 4 citations

  articleSenior author

  To introduce the UChicago PBI Imaging score, a novel characterization of imaging features using head computed tomography (HCT) in patients with gunshot wounds to the head (GSWH) resulting in penetrating brain injury (PBI) and to quantify the association with mortality. We retrospectively collected and analyzed data from 230 patients with GSWH admitted to our Level 1 trauma center between May 1, 2018, and October 31, 2023. HCT images obtained on hospital arrival were evaluated for predefined imaging features by two blinded readers and arbitrated, when needed, by a third. The average contribution of each radiological feature to mortality at hospital discharge was assessed using a SuperLearner ensemble model trained on ∼77% of the cohort. Each feature's contribution was scaled to ensure the additive final score per patient ranged between 0 and 100. The HCT features predicting in-hospital mortality, ranked from highest to lowest importance, were transhemispheric projectile below the level of the third ventricle (18 [16.8, 19.9]), presence of blood in the lateral ventricles (ventricles casted) (18[16.8, 19.6]), brainstem involvement (14 [12.7, 15.1]), transhemispheric projectile above the level of the third ventricle (11 [9.7, 11.6]), presence of any amount of blood in the ambient cistern (9[8.2, 10]), presence of any amount of blood in the lateral ventricles (9 [7.9, 9.8]), cerebellar involvement (9 [7.9, 9.5]), any evidence of ventricular effacement (4 [3.4, 4.6]), midline shift (MLS) >0 mm (4 [3.4, 4.4]), perforating injury (3 [2.4, 3.2]), and presence of an intracerebral hematoma (ICH) >20 mm in the largest diameter (2 [1.4, 1.9]). The UChicago PBI Imaging score showed a strong performance, achieving an area under the curve (AUC) of 0.86 (95% CI: [0.77, 0.96]) on a test set of 56 patients who were not included in model training. This indicates better prediction accuracy compared to both the Rotterdam score (AUC 0.8, 95% CI: [0.68, 0.96]) and the Marshall score (AUC 0.66, 95% CI: [0.52, 0.81]). Our model performed particularly well for patients with a Glasgow Coma Scale (GCS) score between 5 and 9. In this range, our model's performance (AUC 0.86) remained stable, while the Rotterdam and Marshall Scores showed notably lower predictive accuracy, with AUCs of 0.61 and 0.52, respectively. A dedicated evaluation of GSWH HCT reveals an association between disease burden, as quantified by unique features not native to blunt TBI imaging models, and mortality. Specifically, transhemispheric injury below the level of the third ventricle along with blood-casting bilateral ventricles and brainstem involvement was highly associated with mortality. The model is optimized for intermediate GCS scores where greater prognostic uncertainty exists. This study parallels efforts to refine TBI classification, underscoring the necessity for precise imaging-based classification in PBI to identify imaging biomarkers and ultimately enhance prognostication and targeted treatment.

  PublisherDOI

• In Reply to the Letter to the Editor Regarding “Penetrating Brain Injury: Bridging Global Disparities in Care and Advancing Management Strategies”

  World Neurosurgery · 2025-06-27

  letterOpen access
  PublisherDOI

Frequent coauthors

• Ali Mansour

  48 shared

• Christos Lazaridis

  University of Chicago

  40 shared

• Jeffrey I. Frank

  Mayo Clinic

  30 shared

• Andrea Loggini

  22 shared

• Faten El Ammar

  University of Illinois Chicago

  19 shared

• Christopher L. Kramer

  University of Chicago

  19 shared

• Daniel Refai

  Emory University

  16 shared

• Max C. Lee

  16 shared

Education

• M.D.

  University of Chicago

Awards & honors

• Fellow, Neurocritical Care Society - FNCS (2019)
• Teacher of the Year, Neurology Department, University of Chi…
• Bucksbaum Institute Senior Faculty Scholar, University of Ch…