Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Intracerebral hemorrhage (ICH) is a devastating and common admitting diagnosis to intensive care units in the USA. Despite advances in critical care, patients with ICH often experience early neurological deterioration (END) in the first 72 hours after admission due to a variety of factors, including hematoma and cerebral edema evolution. The purpose of this study was to determine factors associated with END after ICH. ⋯ Patients with ICH are prone to END within the first few days after hemorrhage. Elevated WBC count appears predictive of deterioration. These data demonstrate that heightened inflammatory state after ICH may be related to early deterioration after injury.
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Although there have been improvements in treatment, neuropathic pain often remains unresponsive to all treatment modalities. This pilot study assessed the efficacy of combination therapy with isoniazid for the treatment of intractable neuropathic pain. We conducted this prospective, open-label, add-on study in 45 consecutive patients who suffered from treatment-refractory neuropathic pain. ⋯ There was a significant decrease in the mean VAS score following eight weeks of treatment compared with the baseline. In addition, PGIC and mean sleep score also improved. This study suggests that combination therapy with isoniazid has potent analgesic properties and may therefore be useful in the management of intractable neuropathic pain.
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Ventriculoperitoneal shunt placement is the standard of care for idiopathic normal pressure hydrocephalus (iNPH). Studies have reported shunt complication rates up to 38%, with subdural hemorrhage rates as high as 10%. Lumboperitoneal (LP) shunts with horizontal-vertical valves (HVV) are an alternative for cerebrospinal fluid (CSF) diversion that avoids direct cerebral injury and may reduce the risk of overdrainage. ⋯ There were no neurologic complications, including no hemorrhages. Thus, LP-HVV shunt placement is a safe and effective alternative to ventriculoperitoneal shunting for iNPH, resulting in significant symptomatic improvement with a low risk of overdrainage. It should be considered as an option for the treatment of patients with iNPH who demonstrate clinical improvement following lumbar drainage.
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A retrospective study was performed to compare the safety and efficacy in elderly patients of endovascular coiling, with clipping, for cerebral aneurysms. In total, 198 patients over 60 years of age with ruptured intracranial aneurysms were treated by microsurgical clipping (n=122) or endovascular coiling (n=76). Endovascular coiling achieved favorable outcome in 88.2% of patients, which was significantly higher than for the microsurgical clipping group. ⋯ Intraoperative time for microsurgical clipping was significantly longer than that for endovascular coiling. Length of hospitalization was shorter for the coiling group than for the clipping group. Our results suggest that endovascular coiling should be considered as the first-choice therapy in elderly patients with ruptured aneurysms, as it may reduce duration of both the operation and hospitalization.