Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Based on the Corticosteroid Randomisation after Significant Head Injury (CRASH) trial database, a prognosis calculator has been developed for the prediction of outcome in an individual patient with a head injury. In 47 patients with severe traumatic brain injury (sTBI) prospectively treated using an intracranial pressure (ICP) targeted therapy, the individual prognosis for mortality at 14 days and unfavourable outcome at 6 months was calculated and compared with the actual outcome. An overestimation of the risk of mortality and unfavourable outcome was found. ⋯ The CRASH prognosis calculator overestimates the risk of mortality and unfavourable outcome in patients with sTBI treated with an ICP-targeted therapy based on the Lund concept. We do not advocate the use of the calculator for treatment decisions in individual patients. We further conclude that patients with blunt sTBI admitted within 8 hours of trauma should be treated regardless of their clinical status as long as the initial cerebral perfusion pressure is >10 mmHg.
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The nociceptive flexion reflex (NFR) has become a popular tool in experimental and clinical pain research. However, the gradual decrease of the reflex size during repeated application of stimuli, which is termed habituation, may reduce its validity and the comparability of studies. We investigated the degree of habituation at different inter-stimulus intervals (ISI) commonly used in clinical studies and the dependency of habituation on stimulus intensity. ⋯ We conclude that habituation of the NFR is dependent on ISI and stimulus intensity. Lower stimulus intensities and shorter ISI lead to stronger habituation. Therefore, to ensure habituation is avoided during repeated elicitation of the NFR, stimulation should be conducted according to the ISI for the respective stimulus intensities presented here.
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Surgical outcomes for large and giant intracranial aneurysms are suboptimal. Two important reasons for higher complication rates are either occlusion of perforators or parent arteries during aneurysm clipping, or prolonged temporary occlusion of the main arteries. Somatosensory-evoked potential (SSEP) monitoring and transcranial motor-evoked potential (TcMEP) monitoring are standard techniques for monitoring ischemia either during temporary arterial occlusion or after permanent clipping. ⋯ In addition to this, the inclusion of FCoMEP improved the sensitivity of extremity muscle motor-evoked potential (ExMEP, which included TcMEP) monitoring (from 80% to 100%). In the long-term assessment, a favorable outcome was achieved in 16 of the 21 patients (76%). In conclusion, FCoMEP provides complementary corticobulbar tract information for detecting perforating vessel compromise that may lead to motor impairment and that is not identified by ExMEP.
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Ventricular enlargement is a common finding after severe head injury and has a poor prognosis if associated with post-traumatic hydrocephalus (PTH). We retrospectively reviewed our head injury database and identified patients who suffered from severe head injury and subsequently had shunt insertion after a diagnosis of PTH. A total of 871 patients with severe head injury were admitted from April 1999 to December 2006. ⋯ PTH is a condition that has an insidious onset with varying clinical and radiological presentations. The incidence is low but there is a significant benefit from ventricular shunt insertion. The use of cerebrospinal fluid dynamic studies, in addition to clinical and radiological findings, has the potential for better diagnosis and management of these patients.