Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Sep 2020
Clinical and radiological risk factors of autograft cranioplasty resorption after decompressive craniectomy for traumatic brain injury.
The repositioning of an autologous bone flap after decompressive craniectomy (DC) for traumatic intracranial hypertension remains the first-line treatment for cranial reconstruction. Aseptic autologous bone flap resorption (BFR) is the most frequent complication. The identification of possible predictive parameters for BFR would help to improve the management of these patients. ⋯ In this large cohort of patients with autologous cranioplasty, younger age, fragmented autologous bone flap and a wide gap between CP and cranial defect were predictive of bone flap resorption.
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Clin Neurol Neurosurg · Sep 2020
Minimum clinically important difference of major patient-reported outcome measures in patients undergoing decompression surgery for lumbar spinal stenosis.
A minimum clinically important difference (MCID) has been increasingly well known in the current era of patient-centered care because it reflects a smallest change that is meaningful for patients following a clinical intervention. Previous studies suggested MCID values are disease and/or procedure dependent. No MCID values have been reported on the lumbar spinal stenosis (LSS) following decompression surgery despite LSS is the most common spinal disease and the main treatment is decompression surgery. Therefore, this study aimed to determine the MCID values as major outcome measures including the Numeric Rating Scale (NRS) of back pain, leg pain and numbness, Roland-Morris Disability Questionnaire (RMDQ), and Physical Component Summary (PCS) and Mental Component Summary (MCS) of Short Form 8 (SF-8) for patients with LSS undergoing decompression surgery. ⋯ We first identified the MCIDs of the NRS, RMDQ, and SF-8 specific to patients undergoing decompression surgery for LSS.
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Clin Neurol Neurosurg · Sep 2020
Letter Historical ArticleFrom encephalitis lethargica to COVID-19: Is there another epidemic ahead?
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Clin Neurol Neurosurg · Aug 2020
Observational StudyAn 18-month single-center observational study of real-world use of andexanet alfa in patients with factor Xa inhibitor associated intracranial hemorrhage.
Intracranial hemorrhage is a life threatening complication of factor Xa inhibitors. Except for results of the open-label, single-arm ANNEXA-4 study, published real-world utilization of andexanet alfa is limited. We present our experience with andexanet alfa use in factor Xa inhibitor associated intracranial hemorrhage. The objective of this study was to assess the hemostatic efficacy and safety following early implementation of andexanet alfa use in factor Xa inhibitor associated intracranial hemorrhage. ⋯ In this cohort of a real-world utilization of andexanet alfa for reversal of factor Xa inhibitors in patients presenting with intracranial hemorrhage, we observed a high excellent/good hemostatic efficacy rate and lower than reported inpatient mortality and 30-day readmission due to thromboembolism consistent with the findings reported in ANNEXA-4 study. Despite the lack of comparative group, our outcomes, most noticeably hemostatic efficacy and inpatient mortality are consistent with those reported in the literature.
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Clin Neurol Neurosurg · Aug 2020
Review Meta AnalysisMonoclonal antibodies as a preventive therapy for migraine: A meta-analysis.
Calcitonin gene-related peptide (CGRP) antagonists have recently grabbed the attention of clinicians for migraine prophylaxis. The present meta-analysis aimed to assess the efficacy and safety of CGRP monoclonal antibodies (mAbs) in patients with chronic and episodic migraine using a systematic therapeutic regimen. More specifically, double-blind placebo-controlled randomized clinical trials (RCTs) which assessed the therapeutic potential of monthly subcutaneous injections were included. ⋯ No significant differences between groups were noted in TRAEs. CGRP mAbs provide highly efficacious and safe outcomes which start early after the first injection. The tolerability of these medications surpasses that of other small-molecule CGRP antagonists.