Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Oct 1999
Randomized Controlled Trial Clinical TrialComparative double blind clinical trial of phenytoin and sodium valproate as anticonvulsant prophylaxis after craniotomy: efficacy, tolerability, and cognitive effects.
To determine the efficacy, tolerability, and impact on quality of life and cognitive functioning of anticonvulsant prophylaxis with phenytoin or sodium valproate in patients after craniotomy. ⋯ For efficacy, tolerability, impact on cognitive functioning, and quality of life, no major differences were found between phenytoin and valproate prophylaxis. Valproate is an alternative for anticonvulsant prophylaxis in patients after craniotomy.
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J. Neurol. Neurosurg. Psychiatr. · Oct 1999
Bacterial meningitis associated with lumbar drains: a retrospective cohort study.
The infective potential of lumbar drainage is an important topic deserving particular study. The aetiology, incidence, and clinical findings associated with bacterial meningitis are described in patients having continuous lumbar CSF drainage to treat communicating hydrocephalus after subarachnoid haemorrhage or CSF leaks after traumatic dural rents. ⋯ External lumbar drainage seems to carry a low risk of infectious meningitis and offers a safe alternative to ventriculostomy or serial lumbar punctures. Antibiotics do not seem to protect completely against developing the infection. The infection happens most often with skin organisms. The meningitis often appears within 24 hours after lumbar drain placement. Daily CSF samples should include bacterial cultures but cell counts may not offer any additional useful information in diagnosing the complication. Lumbar drain insertion and management need not be confined to the intensive care unit.
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J. Neurol. Neurosurg. Psychiatr. · Oct 1999
Night time versus daytime transient ischaemic attack and ischaemic stroke: a prospective study of 110 patients.
Ischaemic stroke occurs only in 20%-40% of patients at night. The aim of the study was to compare sleep and stroke characteristics of patients with and without night time onset of acute ischaemic cerebrovascular events. ⋯ Patients with night time and daytime transient ischaemic attack/stroke are similar in sleep and stroke characteristics. Diastolic hypotension may predispose to night time cerebrovascular events. Factors not assessed in this study probably account for the circadian variation in the frequency of transient ischaemic attack and acute ischaemic stroke.