Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2013
Psychiatric side-effects of bilateral deep brain stimulation for movement disorders.
The effects of deep brain stimulation (DBS) on cognitive functions, and its psychiatric side-effects, are still controversial. The present study investigated psychiatric comorbidity and postoperative effects of DBS of different targets on mood and psychological functions in 81 patients with a mean follow-up of 37 months. ⋯ A wide range of behavioural changes may be seen following DBS. Depression was the most common side-effect after DBS, and occurred independently of the target. PD patients, in contrast to dystonia and tremor patients, developed complications in all tested subgroups, with varying frequencies. Preoperative evaluation for psychiatric and cognitive dysfunction is crucial to identify patients who are at specific risk for psychiatric complications.
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Acta Neurochir. Suppl. · Jan 2013
ReviewThe roles of early brain injury in cerebral vasospasm following subarachnoid hemorrhage: from clinical and scientific aspects.
Cerebral vasospasm research has been focused on investigating the mechanisms of prolonged delayed vasoconstriction of cerebral arteries following subarachnoid hemorrhage (SAH). However, it has been clarified that induction of significant vasodilation of such arteries does not lead to better overall outcomes in SAH patients. ⋯ It is of utmost importance to investigate whether early brain injury and delayed cerebral vasospasm correlate with each other following SAH or are independent. Recent results of cerebral vasospasm research indicates future directions, and such investigations would lead to better outcome for SAH patients.
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Acta Neurochir. Suppl. · Jan 2013
Cerebral hemodynamic and metabolic effects of remote ischemic preconditioning in patients with subarachnoid hemorrhage.
Remote ischemic preconditioning (RIPC) is a form of endogenous neuroprotection induced by transient, subcritical ischemia in a distant tissue. RIPC effects on cerebral hemodynamics and metabolism have not been explored in humans. This study evaluates hemodynamic and metabolic changes induced by RIPC in patients with aneurysmal subarachnoid hemorrhage (SAH). ⋯ This study demonstrated cerebrovascular effects induced by RIPC consistent with transient vasodilation. Cerebral metabolic effects suggest protection from ischemia and cell membrane preservation lasting up to 2 days following RIPC.
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Acta Neurochir. Suppl. · Jan 2013
COSBID-M3: a platform for multimodal monitoring, data collection, and research in neurocritical care.
Neuromonitoring in patients with severe brain trauma and stroke is often limited to intracranial pressure (ICP); advanced neuroscience intensive care units may also monitor brain oxygenation (partial pressure of brain tissue oxygen, P(bt)O(2)), electroencephalogram (EEG), cerebral blood flow (CBF), or neurochemistry. For example, cortical spreading depolarizations (CSDs) recorded by electrocorticography (ECoG) are associated with delayed cerebral ischemia after subarachnoid hemorrhage and are an attractive target for novel therapeutic approaches. However, to better understand pathophysiologic relations and realize the potential of multimodal monitoring, a common platform for data collection and integration is needed. ⋯ Selected events identified in raw (e.g., ICP) or processed (e.g., CSD) measures are displayed graphically, can trigger alarms, or can be sent to researchers or clinicians via text message. For instance, algorithms for automated detection of CSD have been incorporated, and processed ECoG signals are projected onto three-dimensional (3D) brain models based on patient magnetic resonance imaging (MRI) and computed tomographic (CT) scans, allowing real-time correlation of pathoanatomy and cortical function. This platform will provide clinicians and researchers with an advanced tool to investigate pathophysiologic relationships and novel measures of cerebral status, as well as implement treatment algorithms based on such multimodal measures.
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Acta Neurochir. Suppl. · Jan 2013
Decompressive craniectomy with hematoma evacuation for large hemispheric hypertensive intracerebral hemorrhage.
Hemispheric hypertensive intracerebral hemorrhage (ICH) has a high mortality rate. Decompressive craniectomy (DC) has generally been used for the treatment of severe traumatic brain injury, aneurysmal subarachnoid hemorrhage, and hemispheric cerebral infarction. However, the effect of DC on hemispheric hypertensive ICH is not well understood. ⋯ The mortality rate was 10 %. A statistical analysis showed that the GCS score at admission was significantly higher in the favorable outcome group than that in the poor outcome group (P = 0.029). Our results suggest that DC with hematoma evacuation might be a useful surgical procedure for selected patients with large hemispheric hypertensive ICH.