Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2019
ReviewBrain death: Radiologic signs of a non-radiologic diagnosis.
Brain death is a clinical diagnosis characterized by the irreversible loss of neurologic function caused by global injury to the brain, including the brain stem. This is often caused by trauma and subarachnoid hemorrhage amongst other etiologies. This injury results in extensive cerebral edema, a rise in intracranial pressure, and eventual cessation of cerebral blood flow. ⋯ Cerebral angiography, transcranial Doppler, and cerebral scintigraphy are the only imaging studies to have been validated by the American Academy of Neurology for diagnosis of brain death. However, characteristic findings on computed tomography, computed tomography perfusion, computed tomography angiography, magnetic resonance imaging, and magnetic resonance angiography may suggest the diagnosis. In this article, the clinical criteria, pathophysiology, pathology, and variations in current practice of brain death diagnosis are discussed, and the imaging findings of brain death are reviewed.
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Clin Neurol Neurosurg · Oct 2019
Radiographic and clinical outcomes of huge lumbar disc herniations treated by transforaminal endoscopic discectomy.
Large Central disc herniations (occupying more than 50% of canal area) are notorious as they are generally associated with worse outcomes and are technically difficult to manage. Transforaminal endoscopy (TELD) has evolved to become an interesting alternative for lumbar disc herniations. The aim of the paper is to review our technique of transforaminal endoscopy in large central disc herniations and describe the clinical and radiographic results. We also describe an innovative technique of intraoperative epidurography to assess the adequacy of decompression in some cases with severe canal compromise. ⋯ TELD may be considered as an alternative to microdiscectomy or fusion procedures for huge central disc herniations with favourable outcomes. However, sufficient expertise with the procedure is necessary. Intraoperative decompression may be confirmed with intraoperative epidurography. The patient acceptability of the procedure is good and causes minimal disruption of the normal anatomy.
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Clin Neurol Neurosurg · Sep 2019
Randomized Controlled Trial Comparative StudyComparison of infection rate with tunneled vs standard external ventricular drainage: A prospective, randomized controlled trial.
A prospective, blinded, randomized trial was performed to evaluate the incidence rates of external ventricular drainage (EVD)-related infection (ERI) after tunneled EVD (T-EVD) and standard EVD (S-EVD). ⋯ Compared to S-EVD, T-EVD, when performed according to a previously established perioperative management protocol, resulted in lower infection and CSF leakage rates. We recommend that T-EVD should be preferentially performed when surgeons determine whether a catheter can be removed within 10 days, and the catheter used for EVD should be removed as soon as permitted by the clinical circumstances.
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Clin Neurol Neurosurg · Sep 2019
Influence of nurse's involvement on practices during end-of-life decisions within stroke units.
Decision-making processes concerning end-of-life decisions are not well understood for patients admitted into stroke units with severe stroke. To assess the influence of nurses on the medical perspectives and approaches that lead to withholding and/or withdrawing treatments related to end-of-life (EOL) decisions. ⋯ The involvement of nurses during end-of-life decisions for patients with acute stroke in stroke units seemed to influence neurologists' intensivist practices and behaviors. Nurses supported the physicians' decisions related to forgoing life sustaining treatment for patients with acute stroke and may positively impact on the family's choice to participate in end-of-life decisions.
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Clin Neurol Neurosurg · Sep 2019
The prognostic value of spirometric tests in Amyotrophic Lateral Sclerosis patients.
Amyotrophic lateral sclerosis (ALS) patients tend to develop progressive respiratory muscle weakness, leading to ventilatory failure and ineffective cough, principal causes of morbidity and mortality. Since patients are usually unaware of these symptoms, these are generally not noticed until the advanced stages and are associated with poor prognosis. The monitoring of respiratory function on a regular basis is therefore of great importance. Despite the availability of several pulmonary function tests, none of them was found to be the best indicator of the disease progression throughout the course of this condition. The main aim of our work was to evaluate the prognostic value of these respiratory measures evaluated in a brief period of observation and their correlation with motor functional impairments in an ALS cohort. ⋯ Throughout the course of ALS disease, the monitoring of several respiratory markers, namely FVC, sFVC, PEF and PCEF, plays a critical role in predicting the prognosis of these subjects, both in terms of survival and functional ability. The implementation of monthly cut-offs in the evaluation of FVC and sFVC may allow a faster recognition of those patients with worse prognosis and therefore an optimized tailored clinical care, as well as a better stratification in clinical trials.