World Neurosurg
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Aneurysmal subarachnoid hemorrhage (aSAH) has an incidence of 6-7 per 100,000 person-years. Despite advancements in treatment, 26% of patients die and 19% remain dependent after hemorrhage. Long-term neuropsychological sequelae affect about half of the survivors, significantly affecting their quality of life. This study aims to assess aSAH characteristics and identify predictive factors of clinical outcomes in young patients. ⋯ Young patients with aSAH show distinct characteristics and prognostic factors compared with older patients. Despite higher postoperative complications, young patients generally have better outcomes, emphasizing the need for age-specific management strategies in aSAH.
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Review Meta Analysis
Incidence and Risk Factors of Delayed Intracranial Hemorrhage in Anticoagulated Head Trauma Patients: A Systematic Review and Meta-Analysis.
This study aims to provide a current and comprehensive analysis of the incidence of delayed intracerebral hemorrhage (dICH) in head trauma patients on oral anticoagulants (ACs) and to evaluate various potential risk factors. ⋯ A low incidence of dICH requires neurosurgical intervention; however, further studies are required to assess the need for other medical management in these patients. Furthermore, selective imaging for high-risk patients could improve care and resource allocation.
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Chronic subdural hematoma (cSDH) ranks among the most prevalent neurosurgical conditions, with burr-hole drainage typically yielding favorable prognoses. Nevertheless, perioperative complications may arise, with remote intraparenchymal hemorrhage and subarachnoid hemorrhage occurring infrequently, while acute subdural hematoma (aSDH) remains a relatively common complication post-cSDH removal. The standard treatment for aSDH, typically large craniotomy, substantially elevates surgical risk. ⋯ Urokinase-mediated subdural thrombolysis enhances hematoma clearance rates, suggesting a shift toward minimally invasive treatments to mitigate greater trauma. However, the paucity of evidence necessitates extensive research to validate its safety and efficacy.
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Tuberous sclerosis complex (TSC)-related skeletal abnormalities are understudied. Awareness of skull thickening in patients with TSC is important from the surgical standpoint because a thick skull might complicate craniotomy. This study aimed to discover if patients with TSC are generally prone to skull thickening by retrospectively investigating the frequency and characteristics of skull thickening in these patients. ⋯ Patients with TSC have skull thickening, which is often linked to intracerebral calcification. The presence of skull thickening may require modification of surgical approach during craniotomy. Skull thickening and the underlying intracerebral calcification likely share a common precipitating factor given their relationship. Future studies are warranted to clarify the genetic underpinnings of this relationship and even broader skeletal abnormalities in TSC.
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Severe traumatic brain injury (TBI) is a condition burdened by high morbidity and mortality. Prevention of secondary insults is 1 of the main goals of management and intracranial pressure (ICP) monitoring is a cornerstone in management of TBI. The relationship between ICP and optic nerve sheath is known from the literature. Optic nerve sheath ultrasonography could represent a method added to our armamentarium for monitoring ICP. ⋯ We propose the use of ONSD ultrasound as a screening investigation for post-traumatic intracranial hypertension in the context of an emergency department, especially in contexts where there is limited availability of ICP monitors.