Neurological research
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Neurological research · Sep 2012
Randomized Controlled TrialPositive and negative predictors for good outcome after decompressive surgery for Chiari malformation type 1 as scored on the Chicago Chiari Outcome Scale.
Posterior fossa decompression (PFD) is commonly applied as treatment for Chiari malformation type 1 (CM1), an entity which is associated with a variety of presenting symptoms but little data correlating symptoms to surgical outcome. We applied the Chicago Chiari Outcome Scale (CCOS), a novel 16-point tool for evaluating outcome, to a consecutive series of CM1 patients to identify specific factors or symptoms that predispose to a better or worse surgical outcome. ⋯ Our results identify specific presenting factors that correlated with a better or worse outcome after CM1 decompression. These data also demonstrate that CCOS scoring allows for a rigorous comparison of outcome in different patient populations and between variable operative techniques. Application of CCOS scoring to a larger patient population undergoing a variety of operative CM1 treatments should allow for better-informed decisions regarding patient selection and treatment options for CM1.
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Neurological research · Sep 2012
Comparative StudyTherapeutic time window of hypothermia is broader than cerebral artery flushing in carotid saline infusion after transient focal ischemic stroke in rats.
Intracarotid cold saline infusion (ICSI) protects against ischemic stroke not only due to the resulting hypothermia, but also as a result of the cerebral artery flushing. To assess the relative benefit of hypothermia and cerebral artery flushing in neuroprotection, hypothermic and normothermic saline infusions were administrated over a serial time points after the initiation of reperfusion in a rat ischemia model. ⋯ The neuroprotection of hypothermia and cerebral artery flushing induced by selective carotid infusion after ischemia weakens as the length of time between the reperfusion and infusion increases. The therapeutic time window of brain hypothermia induced by cold saline infusion is broader than cerebral artery flushing induced by normothermic saline infusion.
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Neurological research · Jul 2012
Combination therapy with glucagon and a novel plasminogen activator inhibitor-1-derived peptide enhances protection against impaired cerebrovasodilation during hypotension after traumatic brain injury through inhibition of ERK and JNK MAPK.
Outcome of traumatic brain injury (TBI) is impaired by hypotension and glutamate, and TBI-associated release of endogenous tissue plasminogen activator (tPA) impairs cerebral autoregulation. Glucagon decreases central nervous system glutamate, lessens neuronal cell injury, and improves neurological score in mice after TBI. Glucagon partially protects against impaired cerebrovasodilation during hypotension after TBI in piglets by upregulating cAMP which decreases release of tPA. Pial artery dilation during hypotension is due to release of cAMP-dependent dilator prostaglandins (PG), such as PGE2 and PGI2. TBI impairs PGE2 and PGI2-mediated pial artery dilation, which contributes to disturbed cerebral autoregulation post-insult, by upregulating mitogen-activated protein kinase (MAPK). This study was designed to investigate relationships between tPA, prostaglandins, and MAPK as a mechanism to improve the efficacy of glucagon-mediated preservation of cerebrovasodilation during hypotension after TBI. ⋯ Glucagon+PAI-1DP act in concert to protect against impairment of cerebrovasodilation during hypotension after TBI via inhibition of ERK and JNK MAPK.
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Neurological research · Jul 2012
Clinical TrialHigh frequency repetitive transcranial magnetic stimulation (rTMS) is effective in migraine prophylaxis: an open labeled study.
To evaluate the effect of high rate repetitive transcranial magnetic stimulation (rTMS) in migraine prophylaxis in medically refractory patients. ⋯ High rate rTMS in left frontal cortex is effective and well tolerated for migraine prophylaxis.
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Neurological research · Jun 2012
Characteristics and prognostic value of acute catecholamine surge in patients with aneurysmal subarachnoid hemorrhage.
The characteristics of serum catecholamine concentration at the hyper-acute phase of aneurysmal subarachnoid hemorrhage (SAH) and its relationship between patient outcome and delayed vasospasm were investigated. ⋯ The present findings suggest that sympathetic activation in patients in the acute phase of SAH reflects the severity of SAH, and is closely related to the development of delayed vasospasm, leading to the subsequent immune response and inflammatory reactions. Strategies for suppressing catecholamine at the hyper-acute phase may contribute to vasospasm prevention and improve patient outcome.