Clinical neurology and neurosurgery
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Refractory pain syndromes often have far reaching effects and are quite a challenge for primary care providers and specialists alike to treat. With the help of site-specific neuromodulation and appropriate patient selection these difficult to treat pain syndromes may be managed. In this article, we focus on supraspinal stimulation (SSS) for treatment of intractable pain and discuss off-label uses of deep brain stimulation (DBS) and motor cortex stimulation (MCS) in context to emerging indications in neuromodulation. ⋯ Overall, a review of the literature demonstrates that DBS should be considered for refractory conditions including nociceptive/neuropathic pain, phantom limb pain, and chronic cluster headache (CCH). MCS should be considered primarily for trigeminal neuropathic pain (TNP) and central pain. DBS outcome studies for post-stroke pain as well as MCS studies for complex regional pain syndrome (CRPS) show more modest results and are also discussed in detail.
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Clin Neurol Neurosurg · Aug 2014
The incidence of postoperative thromboembolic complications following surgical resection of intracranial meningioma. A retrospective study of a large single center patient cohort.
Patients with meningiomas carry an increased risk for postoperative venous thromboembolic complications (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE). ⋯ The major risk factors for postoperative VTE found in our single center study are patient weight and a bedridden status postoperatively. Prophylactic intervention for this potentially fatal complication should be evaluated against the relative lower risk of postoperative hemorrhages.
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Clin Neurol Neurosurg · Aug 2014
ReviewThe relation of early hypernatremia with clinical outcome in patients suffering from aneurysmal subarachnoid hemorrhage.
Sodium dysregulation in the course after aneurysmal subarachnoid hemorrhage (aSAH) has been identified as one contributor to adverse clinical outcome. However, the correlation of acute dysnatremia and early brain injury (EBI) remains unclear. We investigated the early course and prognostic relevance of changes in serum sodium concentrations and its relation to EBI after aSAH. ⋯ The occurrence of hypernatremia within 56h after aSAH was shown to be an independent predictor for poor neurological outcome. Early serum sodium levels after aSAH can be considered as surrogate markers to predict outcome after aSAH irrespective to the occurrence of DCI. However, prospective studies are necessary to validate this concept.
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Clin Neurol Neurosurg · Aug 2014
Therapeutic hypothermia for adult community-acquired bacterial meningitis-historical control study.
Despite advances in antibiotic therapy and critical care, community-acquired bacterial meningitis (CABM) continues to have poor outcome in a significant portion of patients. This study was designed to assess the efficacy of therapeutic hypothermia (TH) in the treatment of CABM. ⋯ The new therapeutic concept based on hypothermia significantly improves the outcome in adult patients with severe CABM.
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Clin Neurol Neurosurg · Aug 2014
ReviewChemoprophylaxis for venous thromboembolism in traumatic brain injury: a review and evidence-based protocol.
Venous thromboembolism (VTE) is a recognized source of morbidity and mortality in patients suffering traumatic brain injury (TBI). While traumatic brain injury is a recognized risk factor for the development of VTE, its presence complicates the decision to begin anticoagulation due to fear of exacerbating the intracranial hemorrhagic injury. ⋯ The review reveals robust evidence regarding the safety and efficacy of chemoprophylaxis in the setting of TBI following demonstration of a stable intracranial injury. In light of this data, a protocol is assembled that, in the absence of predetermined exclusion criteria, will initiate chemoprophylaxis within 24h after the demonstration of a stable intracranial injury by computed tomography (CT).