Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Review Meta Analysis
Efficacy and safety of etanercept in the treatment of sciatica: A systematic review and meta-analysis.
Etanercept might be promising to alleviate sciatica caused by lumbar disc herniation and spinal stenosis. However, the results remained controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy of etanercept in patients with sciatica. ⋯ Etanercept showed no increase in Oswestry Disability Index (ODI) compared with placebo (Std. mean difference=-0.83; 95% CI=-2.03 to 0.37; P=0.18) and steroids (Std. mean difference=-0.19; 95% CI=-1.15 to 0.77; P=0.70). Etanercept treatment was associated with a significantly reduced pain in leg and back compared to placebo and may possibly improve leg pain relief compared to steroids, but failed to improve ODI. Etanercept should be recommended for sciatica with caution because of heterogeneity.
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Bidirectional co-morbidity between migraine and depression has been observed. Mood disorders are associated with an increased risk of both migraine and irritable bowel syndrome (IBS). The aim of this study was to evaluate the risk of developing IBS in patients with migraine and to compare the risks between those with and without anxiety or depression. ⋯ When separating the cohort into those with mood disorder and without it, migraine is a significant risk factor of IBS in patients without mood disorders, but not in patients with co-existed mood disorders. The findings of this study suggest that migraine is a risk factor of future IBS development for those without comorbid anxiety or depression. However, migraine does not contribute significantly additional risk to IBS development in patients with comorbid anxiety or depression.
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Stroke is a devastating complication after intracranial aneurysm clipping. Understanding the risk factors that prognosticate perioperative stroke may help to identify patients that would benefit from neuroprotective therapy. This study assesses patient-specific independent predictors of perioperative stroke in relation to surgical aneurysm clipping. ⋯ In the absence of aneurysm rupture, patients presenting with new-onset stroke were more likely to suffer postoperative complications, stay in the intensive care unit longer, and be discharged to in-patient rehabilitation compared to patients without new-onset stroke. This study suggests that severity of subarachnoid hemorrhage based on the patient's clinical condition increases the risk of perioperative stroke in patients with surgical aneurysm clipping. SSEP changes and high-grade H/H scores can serve as independent predictors of perioperative stroke, with the latter having the greatest predictive value.
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The introduction of flow diverting stents, particularly for treatment of petrous to supraclinoid internal carotid artery aneurysms, has greatly impacted endovascular treatment of intracranial aneurysms. Despite their high efficacy, complications, such as ischemic events, distal hemorrhage, or problems with stent deployment, remain a significant concern. We present the first reported case of acute distal migration of a Pipeline Embolization Device (PED). ⋯ Repeat angiography revealed acute distal migration of the PED and an occlusive thrombus. Thought to be secondary to chronic in-stent thrombosis, distal migration has been previously described in a delayed fashion over weeks to months. However, to our knowledge, this is the first reported case of distal flow diverter migration in an acute setting immediately following the procedure.