Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · May 2014
Multicenter Study Observational StudyInfluence of antiplatelet therapy on postoperative recurrence of chronic subdural hematoma: a multicenter retrospective study in 719 patients.
The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect. ⋯ Antiplatelet therapy significantly influences the recurrence of CSDH.
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Clin Neurol Neurosurg · May 2014
Comparative StudyComparison of CT and MRI findings for cervical spine clearance in obtunded patients without high impact trauma.
Cervical spinal injuries occur in 2.0-6.6% of patients after blunt trauma and can have devastating neurological sequelae if left unrecognized. Although there is high quality evidence addressing cervical clearance in asymptomatic and symptomatic awake patients, cervical spine clearance in patients with altered level of alertness (i.e., obtunded patients with Glasgow coma scale (GCS) of 14 or less) following blunt trauma has been a matter of great controversy. Furthermore, there are no data on cervical spine clearance in obtunded patients without high impact trauma and these patients are often treated based on evidence from similar patients with high impact trauma. This retrospective study was conducted on this specific subgroup of patients who were admitted to a neurointensive care unit (NICU) with primary diagnoses of intracranial hemorrhage with history of minor trauma; the objective being to evaluate and compare cervical spinal computed tomography (CT) and magnetic resonance imaging (MRI) findings in this particular group of patients. ⋯ CT is highly sensitive in detecting unstable injuries in obtunded patients with GCS of 14 or less in the absence of high impact trauma. In the absence of high impact trauma, neurosurgeons should be comfortable to discontinue the cervical collar after a negative, high-quality CT in this patient population. In the presence of focal neurological deficits unexplained by associated intracranial injury, an MRI may help diagnose intrinsic spinal cord injuries which necessarily may not be unstable in the presence of a negative CT and does not precludes clearance of cervical spine.
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Clin Neurol Neurosurg · May 2014
Clinical experience with telemetric intracranial pressure monitoring in a Danish neurosurgical center.
Monitoring of intracranial pressure (ICP) is important in the optimal treatment of various neurological and neurosurgical diseases. Telemetric ICP monitoring allows long-term measurements in the patient's everyday life and the possibility to perform additional measurements without the procedure related risks of repeated transducer insertions. ⋯ Telemetric ICP monitoring is useful in patients with complicated CSF dynamic disturbances who would otherwise require repeated invasive pressure monitoring. It seems to be a feasible method to guide adjustment of programmable valve settings and to identify patients with chronic or repeated shunt problems.
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Clin Neurol Neurosurg · May 2014
Lower complication rates for cranioplasty with peri-operative bundle.
The overall benefits of craniectomy must include procedural risks from cranioplasty. Cranioplasty carries a high risk of surgical site infections (SSI) particularly with antibiotic resistant bacteria. The goal of this study was to measure the effect of a cranioplasty bundle on peri-operative complications. ⋯ The cranioplasty bundle was associated with reduced SSI rates and the need for re-do cranioplasties.