Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jul 2011
Incidence, treatment, and case-fatality of non-traumatic subarachnoid haemorrhage in the Netherlands.
Non-traumatic subarachnoid haemorrhage (SAH) is a devastating disorder and in the majority of cases it is caused by rupture of an intracranial aneurysm. No actual data are available on the incidence of non-traumatic SAH and aneursymal SAH (aSAH) in the Netherlands and little is known about treatment patterns of aSAH. Our purpose was therefore to assess the incidence, treatment patterns, and case-fatality of non-traumatic (a)SAH within the Dutch general population. ⋯ Non-traumatic SAH is a rare disease with substantial case-fatality; rates in the Netherlands are similar to other countries. Case-fatality is also similar as well as age and sex patterns in incidence.
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Clin Neurol Neurosurg · Jul 2011
Risk factors for late-onset seizures related to cerebral contusions in adults with a moderate traumatic brain injury.
This prospective study compares the characteristics of patients with a moderately severe traumatic brain injury (TBI) and cerebral contusions who develop late-onset seizures to those who do not. ⋯ Seizures after non-complicated cerebral contusions are difficult to treat. Vascular risk factors and alcohol abuse may also predispose to their occurrence. The EEG findings after the TBI are highly predictive.
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Clin Neurol Neurosurg · Jun 2011
Inaccuracy and misjudged factors of Glasgow Coma Scale scores when assessed by inexperienced physicians.
Appropriate triage of a large number of patients with head injury is crucial in the emergency department (ED) as well as in the field. Traumatic brain injury (TBI) is primarily assessed using the Glasgow Coma Scale (GCS) to evaluate consciousness. However, GCS score assignment is far from sufficiently reliable for correct assessment, especially with inexperienced users. The purpose of this study was to reveal what factors are misjudged when assessed by inexperienced medical personnel. ⋯ Additional instruction regarding the specific misjudged factors identified in this study may help inexperienced medical personnel improve the reliability of GCS score assignment to casualties with TBI.
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Clin Neurol Neurosurg · Jun 2011
Analysis of multiple factors affecting surgical outcomes of proximal middle cerebral artery aneurysms.
We analyzed multiple factors including anatomical characteristics that influence the surgical outcomes of proximal middle cerebral artery (M1) aneurysms. ⋯ In patients with M1 aneurysms, clinical status on admission and the presence of ICH were significant factors for surgical outcome. Surgical morbidity seems to be related to the direction of the aneurysm. It is critical to save the lenticulostriate arteries and their branches in patients with superior-wall type aneurysms. Thorough preoperative angiographic evaluation, careful brain retraction, and meticulous inspection for hidden small branches are crucial to successful outcomes.
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Clin Neurol Neurosurg · May 2011
Comparative StudyFacial sensibility of patients with trigeminal neuralgias.
Idiopathic trigeminal neuralgia (ITN) is an excruciating shock-like paroxysmal pain restricted to the trigeminal area of innervation, with discrete loss of sensibility (thermal, tactile and painful). Trigeminal postherpetic neuralgia (PHN) is a neuropathic pain at the trigeminal territory that persists after Herpes zoster infection, which also is associated to sensorial compromise. The objective of this study was to evaluate the somesthetic facial sensibility (pain, thermal and tactile) and to compare the findings between PHN and ITN. ⋯ The trigeminal area affected by the disease had the higher sensorial losses (ophthalmic branch in PHN and maxillary/mandibular branches in ITN). PHN patients had losses in large and small fibers; therefore, ITN patients had the losses mostly in large fibers, which support different peripheral neural mechanisms for these neuropathic diseases.