British journal of neurosurgery
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Review Meta Analysis
A meta-analysis to determine the effect of anticoagulation on mortality in patients with blunt head trauma.
Patients on warfarin are increasingly common in an ageing population. Previously published case series and cohort studies have resulted in conflicting conclusions with regard to the risk of fatal intracranial haemorrhage. The aim of this study was to undertake a meta-analysis in order to compare the mortality rate of anticoagulated head injured patients against the mortality rate of head injured patients not on coumarin anticoagulation. ⋯ The results of this meta-analysis has shown that the cohort of patients who are anticoagulated and suffer blunt head trauma appear to have an increased risk of death compared to a similar cohort of head injured patients who are not anticoagulated.
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Chiari-syringomyelia is a heterogeneous condition that may be treated by decompression of the foramen magnum. Raised intracranial pressure (ICP) and/or hydrocephalus is a rare complication of this treatment. We aim to describe the incidence, clinical presentation, radiographic findings, management and outcome of patients developing raised ICP and/or hydrocephalus after hindbrain decompression for Chiari I malformation. ⋯ There is a risk of requiring a permanent VP shunt associated with decompression for Chiari I even in the absence of ventriculomegaly or signs of raised ICP pre-operatively. Patients presenting with new symptoms or CSF wound leak following FMD mandate investigation to exclude hydrocephalus, raised ICP or subdural hygroma.
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Physical outcomes following surgery for degenerative spine disease have been well studied whereas the importance of psychological factors has only recently been acknowledged. Previous studies suggest that pre-operative psychological distress predicts poor outcome from spinal surgery. In the drive to identify patients who will not benefit, these patients risk being denied surgery. ⋯ Poor physical function pre-operatively correlates with psychological distress. Both physical and psychological symptoms improve after surgery. Physical outcome after surgery is strongly influenced by pre-operative physical functioning but not independently by psychological distress. Anxious and depressed patients should continue to be offered surgery if clinically indicated.
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Papaverine (P) and nimodipine (N) are the most widely used vasodilators when angiographic and symptomatic vasospasm is present after subarachnoid aneurysmatic hemorrhage (SAH). Their effect is only short-lived and no direct comparisons have been undertaken to evaluate the action of both substances directly. We retrospectively assessed the effect of either P or N on angiographic diameter reduction and capillary blood flow. ⋯ P and N seem to differ in the effect on cerebral diameter reduction in patients with vasospasm after SAH. The clinical implications remain to be established. A multimodal approach, perhaps combining different agents for intraarterial infusion in such patients, needs to be evaluated.
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We report a simple observation to ensure that adequate decompression has been achieved intra-operatively during multi-level anterior cervical spinal decompression for degenerative spondylotic myelopathy.