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Journal of clinical neuroscience
Churchill Livingstone
Journal of clinical neuroscience

Churchill Livingstone

0967-5868

Journal of clinical neuroscience/Journal Journal of clinical neuroscienceSSCISCIISTPAHCI
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    The role of tranexamic acid in traumatic brain injury

    Honeybul, StephenHo, Kwok M.Rosenfeld, Jeffrey, V
    4页
    查看更多>>摘要：Evidence from recent trials evaluating efficacy of antifibrinolytic agents in the context of traumatic brain injury may lead to changes in the management of patients with traumatic brain injury. Tranexamic acid (TXA) reduces the proteolytic action of plasmin on fibrin clots, resulting in an inhibition of fibrinolysis and stabilisation of established blood clots. There has been significant interest in use of the drug as a therapeutic agent in the context of severe haemorrhage; however, considerable controversies regarding its efficacy remain. A number of trials have demonstrated a small but significant decrease in mortality following its administration, but the results have been somewhat inconsistent and may not be generalisable. The results of the CRASH-3 trial were that there was no statistical difference in the number of traumatic brain injury related deaths (18.5% with TXA and 19.8% with placebo; relative risk [RR] 0.94; 95% confidence interval [CI] 0.86-1.02). Nonetheless, there was a subgroup of patients for whom TXA appeared to provide benefit, and this was in patients with mild and moderate injury (with a Glasgow Coma Score > 8). This is potentially a very important finding that may have huge potential impli-cations; however, we believe it does not currently provide indisputable evidence to support the administration of TXA to all patients with TBI. Further work is required to better define the subset of patients who may benefit as well as to evaluate the long-term functional benefit in order to determine which types of severe traumatic brain injury patients would derive more benefits than harms from TXA.
      原文链接:
    • NSTL
    • Elsevier

    Comparing hematoma characteristics in primary intracerebral hemorrhage versus intracerebral hemorrhage caused by structural vascular lesions

    Kahan, JoshuaOng, HanleyCh'ang, JudyMerkler, Alexander E....
    5页
    查看更多>>摘要：Intracerebral hemorrhage (ICH) caused by structural vascular lesions is associated with better outcomes than primary ICH, but this relationship is poorly understood. We tested the hypothesis that ICH from a vascular lesion has more benign hematoma characteristics compared to primary ICH. We performed a retrospective study using data from our medical center. The SMASH-U criteria were used to adjudicate the etiology of ICH. The co-primary outcomes were admission parenchymal hematoma volume and hematoma expansion at 24 h. Linear and logistic regression analyses were performed to test associations. A total of 231 patients were included of whom 42 (18%) had a vascular lesion. Compared to primary ICH patients, those with structural vascular lesions were younger (49 vs. 68 years, p < 0.001), less likely to have hypertension (29% vs. 74%, p < 0.001), had lower mean admission systolic blood pressure (140 +/- 23 vs. 164 +/- 35, p < 0.001), less frequently had IVH (26% vs. 44%, p = 0.03), and had mostly lobar or infratentorial hemorrhages. The median admission hematoma volume was smaller with vascular lesions (5.9 vs. 9.7 mL, p = 0.01). In regression models, ICH from a vascular lesion was associated with smaller admission hematoma volume (beta,-0.67, 95% CI,-1.29 to-0.05, p = 0.03), but no association with hematoma expansion was detected when assessed as a continuous (OR, 0.93; 95% CI,-4.46 to 6.30, p = 0.73) or dichotomous exposure (OR, 1.86; 95% CI, 0.40 to 8.51, p = 0.42). In a single-center cohort, patients with ICH from vascular lesions had smaller hematoma volumes than patients with primary ICH.
      原文链接:
    • NSTL
    • Elsevier

    Intracranial ependymal cyst-A modern systematic review with a pathway to diagnosis

    Chaves, Jennyfer Paulla GaldinoGallo, Bruno Henrique DalloGoncalves Souza e Silva, Nicolle Louiseda Silva, Larissa Luvison Gomes...
    7页
    查看更多>>摘要：Background: Intracranial ependymal cysts (IECs) are rare, histologically benign neuroepithelial cysts that mostly occur in the cerebral parenchyma. The majority of these cysts are clinically silent and discovered incidentally, but when symptomatic they may compress surrounding structures, thus surgical intervention is needed. The current data in the literature about ECs is very scarce, and many are misdiagnosed, once they share many radiological characteristics with a variety of intracranial benign cysts. Also their terminology is confusing, and its definitive diagnosis can only be made through a thorough histopathological study, hence a detailed description about these uncommon lesions is necessary. The correct identification of the lesion lead to our better under -standing of the condition and further improvement of the patient's prognosis. Methods: A descriptive case is presented; moreover, a detailed PubMed search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was performed. The data found was analyzed by various criteria in order to correctly describe the characteristics of this lesion. Results: The literature review gathered 9 descriptions of patients with IECs with a diverse range anatomopa-thological and clinical manifestations. All of the included studies found were case reports. Moreover, the authors suggest an updated classification of the lesion, involving their immunohistochemical characteristics.Conclusions: The information obtained from this study highlights IECs rarity and their inaccurately classification. We propose that the definitive diagnosis of IECs shall be made upon histopathological confirmation of an ependyma-lined cyst along with a positive glial fibrillary acidic protein (GFAP).
      原文链接:
    • NSTL
    • Elsevier

    Functional magnetic resonance imaging of brain activity during hybrid assistive limb intervention in a chronic spinal cord injury patient with C4 quadriplegia

    Marushima, AikiMasumoto, TomohikoKoda, MasaoTakahashi, Hiroshi...
    5页
    查看更多>>摘要：Hybrid assistive limb (HAL) is a wearable robot, which has recently been used for the treatment of patients with movement disorders including spinal cord injury (SCI). Although several studies have indicated the effectiveness of HAL for SCI patients, changes in brain activity during the HAL intervention have not yet been fully characterized. A 19-year-old man with a chronic SCI resulting in complete C4 quadriplegia underwent five weeks of HAL training for a total of ten sessions. We evaluated his brain activity using task-induced functional MRI (fMRI) after the fourth, sixth and tenth HAL sessions. We also assessed the spasticity of this patient using the modified Ashworth scale (mAs). As controls for the task-induced fMRI, we examined the brain activity in two healthy subjects. The fMRI findings indicated an increased response to a motor imagery task in the patient's cerebral cortex compared to controls. In addition, the activation pattern in his cortex changed during the five weeks of HAL intervention. We observed increased cerebral lateralization in his primary motor cortex. We also found that the laterality index calculated for the precentral gyrus had a significant negative correlation with the total mAs score over the course of the HAL treatment. Our results indicate that the cerebral cortex of the present SCI patient was hyperactive during the imagery task, and the cortical activation was reduced with progression of the HAL treatment.
      原文链接:
    • NSTL
    • Elsevier

    A meta-analysis of the effectiveness and safety of microvascular decompression in elderly patients with trigeminal neuralgia

    Sun, JunweiWang, MingyuZhang, LiYu, Yanbing...
    13页
    查看更多>>摘要：Background: Microvascular decompression (MVD) has been increasingly performed in elderly patients with trigeminal neuralgia (TN). We conducted a meta-analysis to compare the effectiveness and safety of MVD in elderly and young patients with TN. Methods: Databases such as PubMed, EMBASE, and Cochran Library were utilized to collect relevant literatures prior to February 2020. Two researchers independently screened the literature, extracted the data, and evaluated the quality. Finally, the review manager software was used to conduct meta-analysis. Results: Overall, 12 studies were included in this analysis. The immediate efficacy, long-term efficacy, and complication rate of 681 elderly patients and 1538 young patients were compared after MVD. Results indicated that there were no significant differences in immediate postoperative effects between elderly and younger patients (92.7%: 90.1%, P = 0.13), while the postoperative long-term efficacy of elderly patients were significantly better than young patients (77.5%: 71.2 %, P = 0.04). There were no significant differences in the incidence of intracranial hemorrhage, bacterial meningitis, cerebrospinal fluid leakage, facial hypoesthesia, hearing impairment, and facial paralysis between the two age groups. Conclusion: MVD is an effective and safe treatment in the elderly patient population. Older patients tend to achieve better long-term results and advanced age should not be a contraindication for MVD treating TN.
      原文链接:
    • NSTL
    • Elsevier

    Alterations of inflammatory cytokines in super-acute stroke patients and the potential pathogenesis

    Li, FangfangMa, QingfengLi, LingzhiZhang, Lin...
    9页
    查看更多>>摘要：Background: Sufficient understanding of the systemic inflammatory response after stroke will make the therapeutic strategy targeting inflammation more feasible. Here, we aimed to identify the globally alterations of circulating cytokines in super-acute ischemic stroke (AIS). Methods: A broad panel of 65 cytokines was measured in the plasma of twenty-eight AIS patients within 6 h after stroke onset (n = 28), cerebral hemorrhagic patients (n = 28) and healthy controls (n = 18). The diagnostic power of the candidate cytokines and their relationship with the number of lymphocytes and neutrophils were analyzed by receiver operating characteristic (ROC) and spearman rank correlation respectively. Results: The expression level of plasma IL-1beta, IL-2, IL-2R, IL-5, IL-10, CD40L, HGF, MIP-3alpha and MMP-1 were obviously up-regulated, while IL-16 was down-regulated in AIS patients compared to healthy controls. Among them, IL-2R, IL-10, IL-16, MIP-3alpha, and MMP-1 were specially altered in AIS patients, while IL-1beta, IL-2, IL-5, CD40L and HGF were elevated simultaneously in AIS and hemorrhagic stroke patients. Interestingly, IL-6 and TNF-beta were found to be key facytors among the 65 cytokines to distinguish hemorrhage from ischemia. Furthermore, IL-1beta, IL-16, CD40L and HGF were obviously correlated with the number of lym-phocytes, and IL-1beta and IL-16 were significantly associated with the number of neutrophils in AIS patients. These results suggest that lymphocytes and neutrophils associated inflammation may play a pivotal role in AIS. Conclusions: Importantly, except for some mutual pathological processes, AIS and hemorrhage had their own distinctive pathogenesis, and transformation of this knowledge to further research may provide novel treatment strategy for AIS.
      原文链接:
    • NSTL
    • Elsevier

    Incidence of dysphagia following posterior cervical spine surgery

    Zabat, Michelle A.Mottole, Nicole A.Patel, HershilNorris, Zoe A....
    5页
    查看更多>>摘要：Abundant literature exists describing the incidence of dysphagia following anterior cervical surgery; however, there is a paucity of literature detailing the incidence of dysphagia following posterior cervical procedures. Further characterization of this complication is important for guiding clinical prevention and management. Patients >= 18 years of age underwent posterior cervical fusion with laminectomy or laminoplasty between C1-T1. Pre-and post-operative dysphagia was assessed by a speech language pathologist. The patient cohort was categorized by approach: Laminectomy + Fusion (LF) and Laminoplasty (LP). Patients were excluded from radiographic analyses if they did not have both baseline and follow-up imaging. The study included 147 LF and 47 LP cases. There were no differences in baseline demographics. There were three patients with new-onset dysphagia in the LF group (1.5% incidence) and no new cases in the LP group (p = 1.000). LF patients had significantly higher rates of post-op complications (27.9% LF vs. 8.5% LP, p = 0.005) but not intra-op compli-cations (6.1% LF vs. 2.1% LP, p = 0.456). Radiographic analysis of the entire cohort showed no significant changes in cervical lordosis, cSVA, or T1 slope. Both group comparisons showed no differences in incidence of dysphagia pre and post operatively. Based on this study, the likelihood of developing dysphagia after LF or LP are similarly low with a new onset dysphagia rate of 1.5%.
      原文链接:
    • NSTL
    • Elsevier

    Rational therapy with lamotrigine or levetiracetam: Which one to select?

    Asadi-Pooya, Ali A.Farazdaghi, Mohsen
    4页
    查看更多>>摘要：The aim of the current study was to investigate the seizure outcome and also factors associated with that in patients with epilepsy [i.e., idiopathic generalized epilepsies (IGEs), symptomatic generalized epilepsies (SGEs), and focal epilepsies], who received either lamotrigine (LTG) or levetiracetam (LEV). This was a retrospective longitudinal study. All patients with a diagnosis of IGE, focal epilepsy, or SGE, who received either LTG or LEV, were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran from 2008 until 2020. All patients had to be followed at our center for at least 14 months. Two hundred and thirty-six patients were studied (101 IGE, 98 focal epilepsy, and 37 SGE). At the first visit, LTG was prescribed for 159 patients; 40 people (25.2%) became seizure-free, and LEV was prescribed for 77 people; 23 persons (29.9%) became seizure-free (p = 0.438). Patients who were not taking any drug at the time of their first visit, or were receiving fewer drugs, and those who had received fewer drugs in their drug history were more likely to enjoy a seizure-free state at the follow-up. Among the patients, who received LTG at the first visit, taking any Na-channel blocking drug (e.g., carbamazepine) in the drug history was associated with a poor seizure outcome; this was not the case for LEV. Implementation of appropriate personalized treatment plans in patients with epilepsy is of paramount significance. Rational selection of appropriate drug(s) is the mainstay of this process.
      原文链接:
    • NSTL
    • Elsevier

    The Prevalence of Degenerative Cervical Myelopathy-Related Pathologies on Magnetic Resonance Imaging in Healthy/Asymptomatic Individuals: A Meta-Analysis of Published Studies and Comparison to a Symptomatic Cohort

    Banerjee, ArkaprabhaMowforth, Oliver D.Budu, AlexandruNewcombe, Virginia...
    9页
    查看更多>>摘要：Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine. It is typically diagnosed on clinical symptoms and examination findings together with MRI findings. In this study, we explore the significance of these degenerative pathology to onset of DCM by performing the first meta-analysis on the prevalence of degenerative features reported on MRI amongst healthy and asymptomatic populations and compare this to the prevalence of degenerative features reported on MRI amongst a symptomatic population calculated in a previous review. We conducted a systematic review and meta-analysis in accordance with PRISMA guidelines, cognizant of their adaptation for epidemiological studies. A search strategy was used to identify original research carrying out MRI screening of cervical spines of asymptomatic patients in MEDLINE and Embase from 1985 to present day. The search yielded a total of 1098 studies of which 17 were included in this meta-analysis covering a total of 5059 patients. Ossification of posterior longitudinal ligament (pooled asymptomatic prevalence of 0.4%, 95% Confidence Interval [0.1%, 0.8%]), enlargement of ligamentum flavum (pooled asymptomatic prevalence of 11.8%, 95% Confidence Interval [5.3%, 18.4%]) and degenerative multilevel disc pathology (pooled asymptomatic prevalence of 64.5%, 95% Confidence Interval [48.3%, 80.8%], I2 100%) were found to be significantly lower in asymptomatic populations. Symptomatic populations have a prevalence of 10.5% (95% Confidence Interval [7.7%, 13.3%]) for ossification of posterior longitudinal ligament, 56.8% (95% Confidence Interval [52.3%, 61.3%]) for enlargement of ligamentum flavum and 89.7% (95% Confidence Interval [86.9%, 92.5%]) for degenerative multilevel disc pathology [18]. Understanding the natural history of DCM is a recognised research priority, and whilst these perspectives require further evaluation, they may be of significant relevance to the evolving biomechanical understanding of the disease.
      原文链接:
    • NSTL
    • Elsevier

    Lewy body dementia is associated with an increased risk of atrial fibrillation: A case-control study

    Tabuas-Pereira, MiguelDuraes, JoaoBeato-Coelho, JoseNogueira, Ana Rita...
    4页
    查看更多>>摘要：Background: Lewy bodies are a hallmark of Dementia with Lewy Bodies. They can also be found in the sinoatrial node and may be associated with heart disease. Objectives: We aimed to investigate a possible association between Lewy Body dementia and atrial fibrillation. Methods: We performed a case-control study based on our centre's cohort of degenerative dementia (Dementia with Lewy Bodies and Alzheimer's disease) patients. The possible association between Lewy Body dementia and atrial fibrillation was studied through a binomial logistic regression, which adjusted for comorbidity data. Results: We included 461 patients. 45 of the 398 (11.3%) with Alzheimer's disease and 14 of the 63 with Dementia with Lewy Bodies (22.2%) had atrial fibrillation. Heart failure (OR = 3.345, 95%CI = [1.618, 6.916], p = 0.001), hypertension (OR = 2.547, 95%CI = [1,137, 5.703], p = 0.023), stroke (OR = 2.274, 95%CI = [1.013, 5.103], p = 0.046) and Dementia with Lewy Bodies (OR = 2.536, 95%CI = [1.105, 5.822], p = 0.028) were associated with atrial fibrillation. Conclusions: We found an association between Dementia with Lewy bodies and Atrial Fibrillation.
      原文链接:
    • NSTL
    • Elsevier