Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Post-operative cerebrospinal fluid (CSF) fistula following neurosurgery is associated with increased morbidity and mortality. This prospective study evaluates the efficacy of a new bioadhesive--BioGlue, as a dural sealant in preventing CSF fistula. The complications associated with its use are investigated and the literature regarding dural closure reviewed. ⋯ BioGlue reduced the incidence of complications associated with neurosurgery. It is an effective adjunct in dural closure to prevent CSF fistula with enhanced bonding properties and is simple to use. In this study there were no complications associated with its use.
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A moving correlation index (Mx-ABP) between arterial blood pressure (ABP) and mean middle cerebral artery blood flow velocity (CBFV) can be used to monitor dynamic cerebrovascular autoregulation (CA) after traumatic brain injury (TBI). In this study we examined hemispheric CA asymmetry and temporal CA profiles, their relationship with ABP and CBFV, and their prognostic relevance. Mx-ABP was calculated for each hemisphere in 25 TBI patients second-daily for as long as they were receiving sedation and analgesia. ⋯ It does not bear significant clinical or predictive relevance, and it is unrelated to CBFV or ABP. CA is most profoundly disturbed during the immediate postinjury phase and improves gradually during the ICU course. Further studies are needed to investigate CA during post ICU recovery and rehabilitation.
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Excessive release of glutamate from nerve terminals following diffuse brain injury (DBI) is thought to contribute to neuronal calcium overload leading to calcium-mediated cell damage. Metabotropic glutamate receptor subtype 4 (mGluR4) is regarded as one of the neuroprotective receptors in mammalian brains. Therefore, the mGluR4 specific agonists might exert neuroprotective effects after DBI. The focus of this study is to examine the changes of expression of mGluR4 after DBI and the role of its specific agonist L-AP4 in vivo. ⋯ The increased expression of mGluR4 is an important process in the pathophysiological of DBI and its specific agonist L-AP4 can provide a remarkable neuroprotection against DBI not only at the histopathological level but also in the motor and cognitive performance.
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This study examined predictors of prolonged hospitalisation (>30 days) and significant disability (modified Rankin Scale >2) in 257 patients with acute ischaemic stroke. These patients were assessed prospectively regarding stroke severity, comorbidities and complications in hospital. Multivariate logistic regression was used to select variables that best predicted prolonged hospital stay and significant disability on discharge. ⋯ Significant disability on discharge was in turn associated with diabetes, infection, premorbid disability, stroke in progression and atrial fibrillation. Diabetes and in-hospital infection, together with other factors, can significantly predict prolonged hospital stay and disability in stroke patients. These two potentially modifiable factors are possible targets for interventions to reduce the burden of illness and healthcare costs of stroke.