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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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    Association of in-hospital depression and anxiety symptoms following stroke with 3 months- depression, anxiety and functional outcome

    Ambrosius W.T.Bishop L.Gesell S.Prvu-Bettger J....
    4页
    查看更多>>摘要：? 2022 Elsevier LtdBackground: Post-stroke depression and anxiety are common and are associated with worse post-stroke outcomes. Even though checking for depression during stroke hospitalization has become a common practice, the prognostic value of a positive in-hospital depression screen following stroke remains unclear. Methods: This is a retrospective cohort study of patients with stroke or TIA discharged home from a tertiary care center. We examined the association between premorbid history of depression and in-hospital anxiety/depressive symptoms, with anxiety/depressive symptoms and functional outcome at 3-months post-stroke. Logistic regression models were generated using two different main predictors: 1) pre-hospital history of depression (N = 117) and 2) in-hospital depression/anxiety measured by the EQ-5D-3L (N = 66). Results: In the cohort of 117 patients, the mean age was 66 years, with median NIHSS 2;44% were women and 70% White. A history of pre-stroke depression was reported by 7% (8/117). Anxiety/depression on ED-5D-3L was reported by 29/66 (43%) in the hospital and by 22/66 (33%) at three months’ post-stroke. In the first adjusted model, previous history of depression was associated with 3 months EQ-5D-3L anxiety/depression (OR = 10.2;95%CI:1.12–90.9, p = 0.038). In the second adjusted model, in-hospital anxiety/depression was associated with 3-month EQ-5D-3L anxiety/depression (OR = 3.9; 95% CI:1.16–13.1, p = 0.027). In-hospital anxiety/depression was associated with a higher mRS at 3 months but not after adjusting for covariates. Conclusion: A previous history of depression and in-hospital anxiety/depression symptoms are associated with anxiety/depression symptoms 3-months post-stroke but not with functional outcome. Screening stroke patients for both during hospitalization is warranted because of the association with later symptoms.
      原文链接:
    • NSTL
    • Elsevier

    Mechanical thrombectomy of acute occlusions of individual distal anterior cerebral artery branches

    Miszczuk M.Kleine J.F.Riegler C.Bauknecht H.C....
    5页
    查看更多>>摘要：? 2022 Elsevier LtdTo describe our experience with mechanical thrombectomy (MT) in distal anterior cerebral artery (ACA) occlusions regarding recanalization rates, MT techniques and procedural safety. From a prospectively maintained thrombectomy database all patients with distal ACA occlusions treated with MT between April 2013 and February 2021 were retrospectively identified. Imaging data and angiographic features as well as clinical data were collected. 41 patients were included in the study, including 23 patients (56.1%) with distal main stem occlusions (occlusions distal to the anterior communicating artery but proximal to the origin of the pericallosal and callosomarginal arteries) and 18 patients (46.3%) with distal individual branch occlusions (occlusions of the pericallosal or callosomarginal arteries and their ramifications).
      原文链接:
    • NSTL
    • Elsevier

    Statin pretreatment combined with intravenous thrombolysis for ischemic stroke patients: A meta-analysis

    Cui C.Li Q.Li C.Zhao S....
    7页
    查看更多>>摘要：? 2022 Elsevier LtdPurpose: For ischemic stroke patients, thrombolysis therapy combined statins might have a better benefit. But difference studies had a debate. The meta-analysis wants to make clear about whether statins could increase effect of therapy or decrease side effect for these patients. Methods objectives: To evaluate the effect and safety about using statins in ischemic stroke patients receiving thrombolysis. Data sources: Databases including PubMed, Web of Science, Embase and Cochrane Library. Eligibility criteria: original observational cohort studies. Participants: ischemic stroke patients receiving thrombolysis. Interventions: pretreatment statins. Appraisal and synthesis methods: forest plot to show pooled results; I-squared test to evaluate the heterogeneity. Results: Of 87 selected, 8 were eligible. The 8 studies included 10,344 patients (with statins: 2048; without statins: 8296). For clinical recovery at 24 h, pooled OR (odds ratios) was 1.82 (95% CI: 1.49–2.21). For excellent outcome, pooled OR was 1.03 (95% CI: 0.80–1.12). For favorable outcome, pooled OR was 0.99 (95% CI: 0.85–1.16). For ICH (intracranial hemorrhage), pooled OR was 1.16 (95% CI: 0.97–1.40). For sICH (symptomatic intracranial hemorrhage), pooled OR was 1.40 (95% CI: 1.02–1.91). For mortality, overall pooled OR was 0.96 (95% CI: 0.74–1.25). Conclusion: In conclusion, the meta-analysis found that for ischemic stroke patients receiving thrombolysis, pretreatment statins were related to a better clinical recovery and a lower short-term mortality. Pretreatment statins had no significant relationship with mRS at 90 days and ICH. Pretreatment high dose statins may be related to the occurrence of sICH.
      原文链接:
    • NSTL
    • Elsevier

    Treatment with RehaCom computerized rehabilitation program improves response control, but not attention in children with attention-deficit/hyperactivity disorder (ADHD)

    Mozaffari M.Hassani-Abharian P.Kholghi G.Vaseghi S....
    5页
    查看更多>>摘要：? 2022 Elsevier LtdAttention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder in children. ADHD impairs attention, response control, emotion regulation, and other cognitive functions. On the other hand, RehaCom is a cognitive rehabilitation software that has therapeutic effects on cognitive dysfunctions in many diseases such as stroke, multiple sclerosis, and schizophrenia. The goal of the present study was to investigate the effect of treatment with RehaCom on auditory and visual response control, and auditory and visual attention in children with ADHD. Forty patients were selected. The participants were assigned to control (n = 20) and experimental (n = 20) groups, while only the participants in the experimental group were trained by RehaCom for five weeks (ten 45-min sessions, two sessions per week). At weeks 0 and 5, performance of the participants of experimental group was compared with the participants of control group. The results showed that treatment with RehaCom significantly improved auditory and visual response control in children with ADHD, with no effect on auditory and visual attention. In conclusion, RehaCom may alter brain's structural and functional properties that are related to response control. We suggest that attention deficit in ADHD may be a result of more complicated dysfunctions in the brain, that are not affected by RehaCom.
      原文链接:
    • NSTL
    • Elsevier

    Usage of image registration and three-dimensional visualization tools on serial computed tomography for the analysis of patients with traumatic intraparenchymal hemorrhages

    Shih Y.-J.Liu Y.-L.Zhou J.T.Zhang Y....
    8页
    查看更多>>摘要：? 2022 Elsevier LtdThe aim of this study was to apply registration and three-dimensional (3D) display tools to assess the evolution of intraparenchymal hemorrhage (IPH) in patients with traumatic brain injury (TBI). We identified 109 TBI patients who had two computed tomography (CT) scans within 4 days retrospectively. The IPH was manually outlined. The registration was performed in 39 lesions from 29 patients with lesion volume < 1.5 cm on both baseline and follow-up CT. The center of mass (COM) of each lesion was calculated, and the distance between baseline and follow-up CT was used to evaluate the registration effect. The mean distances of COM before registration in the XYZ, XY, and YZ coordinates were 20.5 ± 10.2 mm, 17.8 ± 9.4 mm, and 15.9 ± 9.4 mm, respectively, which decreased significantly (p < 0.001) to 7.9 ± 4.9, 7.8 ± 5.0, and 6.1 ± 4.1 mm after registration. A 3D short video displaying the rendering view of all lesions in 34 randomly selected patients from baseline and follow-up scans were presented side-by-side for comparison. The detection rate of new IPH lesions increased in 3D videos (100%) as compared with axial CT slices (78.6–92.9%). A very high interrater agreement (k = 0.856) on perceiving IPH lesion progression upon viewing 3D video was noted, and the absolute volume increase was significantly higher (p < 0.001) for progressive lesions (median 7.36 cc) over non-progressive lesions (median 0.01 cc). Compared to patients with spontaneous hemorrhagic stroke, evaluation of multiple small traumatic hemorrhages in TBI is more challenging. The applied image analysis and visualization methods may provide helpful tools for comparing changes between serial CT scans.
      原文链接:
    • NSTL
    • Elsevier

    Early versus standard tracheostomy in ventilated patients in neurosurgical intensive care unit: A randomized controlled trial

    Muthusamy K.A.Goo Z.Q.
    6页
    查看更多>>摘要：? 2022 Elsevier LtdIntroduction: Tracheostomy is performed in patients with prolonged mechanical ventilation, who suffered catastrophic neurologic insult or upper airway obstruction. Thus far, there is no consensus on the optimal timing in performing a tracheostomy. This study aims to test whether early tracheostomy in mechanically ventilated patients in a neurosurgical setting would be associated with a shorter time of mechanical ventilation as compared to standard tracheostomy. Methods: This single-center prospective randomized controlled trial was conducted at University Malaya Medical Centre from July 2019 to July 2021. The likelihood of prolonged ventilation was determined objectively using the TRACH score and the patient's clinical presentation. The outcomes measured were days of mechanical ventilation post-tracheostomy, days of neuro-intensive care unit stay, and days of hospital stay. Tracheostomy-related complications were collected. The data collected were analyzed using Statistical Package for the Social Sciences version 25 for Windows (SPSS Inc., Chicago, IL, USA). Results: In all, 39 patients were randomly assigned. Of these, 20 were allocated to the early tracheostomy group (ET) and 19 were allocated to the standard tracheostomy group (ST). The demographic characteristics were similar between the groups. The primary outcome, mean (SD) days of mechanical ventilation post-tracheostomy, was statistically different in the 2 groups- early 11.9 (9.3) days, standard 18.9 (32.5) days; p = 0.014. There were comparable tracheostomy-related complications in both groups. Conclusion: Early tracheostomy is associated with a shorter duration of mechanical ventilation in a neurosurgical intensive care unit setting.
      原文链接:
    • NSTL
    • Elsevier

    Stroke risk after ocular cranial nerve palsy – A systematic review and meta-analysis

    Shew W.Wang M.T.M.Danesh-Meyer H.V.
    7页
    查看更多>>摘要：? 2021Background: Isolated ischemic ocular cranial nerve palsies (OCNP) involving the 3rd, 4th and 6th cranial nerves (CN) are prevalent conditions in ophthalmic practice. However, it is not clearly established whether such patients are at increased risk of stroke after onset of OCNPs. Methods: Medline, PubMed, Embase and Cochrane Central registers were systematically searched for eligible studies comparing isolated ischemic OCNPs against matched controls on the subsequent development of stroke with at least two years of follow up. Case reports and series were excluded. Appropriate studies were entered for meta-analysis to determine hazard ratios. Search and data extraction was completed on 22 Feb 2021. Random effect models were used to generate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Three studies were suitable for meta-analysis (total n = 2,756 OCNP cases and 21,239 matched controls). The meta-analysis demonstrated a hazard ratio of 5.96 (4.20–8.46 95% CI) of subsequent stroke after isolated OCNP within the first year. The hazard ratio reduced to 3.27 (2.61–4.10 95% CI) after five years although remains raised at 2.49 (1.53–4.06 95% CI) up to 12 years. The highest risk was demonstrated with 3rd cranial nerve palsies. Two additional studies assessed the risk of stroke with newly diagnosed diabetics and compared OCNPs against lacunar stroke. These studies did not demonstrate a significant increased risk of stroke, although they may be statistically underpowered. Conclusion: Ischemic OCNPs represent a significant risk factor for development of subsequent stroke in a similar magnitude to transient ischemic attack within the first year.
      原文链接:
    • NSTL
    • Elsevier

    Risk factors for recanalization of dense coil packing for unruptured cerebral aneurysms in endovascular coil embolization: Analysis of a single center's experience

    Fuga M.Tanaka T.Irie K.Kajiwara I....
    7页
    查看更多>>摘要：? 2022 Elsevier LtdIn coil embolization of cerebral aneurysms, inadequate packing is known to increase the probability of recanalization. Even tightly embolized aneurysms may be recanalized, but predictive factors for recanalization have not been fully investigated. This retrospective study aimed to identify risk factors for recanalization of treated aneurysms with a volume embolization ratio (VER) ≥ 25%. A total of 301 unruptured aneurysms in 248 patients who underwent coil embolization between March 2012 and January 2021 were analyzed. Cases involving dissecting aneurysm, intraluminal thrombosis, parent artery occlusion, intraoperative rupture, re-treatment, rupture the day after surgery, postoperative coil migration, and postoperative parent artery occlusion were excluded due to the inaccuracy of VER. A total of 105 aneurysms (34.9%) treated with VER ≥ 25% were extracted. Clinical features (age, sex, medical history, family history), anatomical features (shape, location, aneurysm size, inflow angle, and volume), procedural features (stent-assisted, Raymond-Roy occlusion classification [RROC] immediately after treatment, re-treatment rate), and follow-up period were compared between Recanalization and Non-recanalization groups. Predictors of recanalization were determined using logistic regression and receiver operating characteristic (ROC) curve analyses. Eleven aneurysms were recanalized. In multivariate analysis, RROC class 3 (odds ratio [OR] 11.0; 95% confidence interval [CI] 2.03–59.4) and aneurysm volume (OR 1.005; 95%CI 1.001–1.008) were independent predictors of recanalization. ROC curve analysis showed optimal cutoff values for aneurysm volume of 69.5 mm3 (sensitivity, 81.8%; specificity, 72.3%). In coil embolization of unruptured aneurysms that VER ≥ 25%, cases with RROC class 3 or high aneurysm volume may be associated with a higher risk of recanalization, and should be carefully followed-up.
      原文链接:
    • NSTL
    • Elsevier

    Factors affecting postoperative pulmonary function deterioration in adolescent idiopathic scoliosis: A prospective study using 3-dimensional image reconstruction by biplanar stereoradiography

    Machino M.Kawakami N.Ohara T.Saito T....
    7页
    查看更多>>摘要：? 2022 Elsevier LtdThis study aimed both to evaluate rib cage parameters in patients with adolescent idiopathic scoliosis (AIS) by three-dimensional (3D) image reconstruction using biplanar stereoradiography (EOS) (EOS Imaging, Paris, France) and identify factors associated with postoperative pulmonary function deterioration (PFD). A total of 67 patients with Lenke type 1 or 2 AIS (59 females and 8 males; mean age, 14.4 years) undergoing posterior corrective fusion with a rod rotation maneuver based on segmental pedicle screw fixation were recruited. 3D images and pulmonary function test results were analyzed preoperatively and at 2 years postoperatively. The following parameters were measured: maximum thickness, maximum width, thoracic index, rib hump, rib cage volume (RCV), spinal penetration index (SPI), endothoracic hump ratio (EHR), vertebra-sternum angle (VSA), rib-vertebra angle difference, vertebral lateral decentering (VLD), forced vital capacity (FVC), and percent predicted FVC (%FVC). PFD was defined as a postoperative %FVC decline of 5% or greater. Patients were divided into two groups, namely PFD and non-PFD. FVC increased from 2.62 L to 2.73 L, while %FVC decreased from 88.7% to 82.7%. The maximum width diminished postoperatively in the PFD group. Patients in the PFD group exhibited a significantly smaller increase in RCV and VLD as well as a significantly smaller decrease in SPI, EHR, and VSA than those in the non-PFD group. The rib cage parameters quantified on 3D images reconstructed using EOS are useful in identifying factors affecting PFD in patients with AIS.
      原文链接:
    • NSTL
    • Elsevier

    Racial disparities in the cost of inpatient spinal cord stimulator surgery among patients in the 2016–2018 National Inpatient Sample

    Ovrom E.Hagedorn J.M.Bhandarkar A.Bydon M....
    5页
    查看更多>>摘要：? 2022Introduction: Spinal cord stimulation is a promising therapy for patients with treatment refractory pain syndromes, and a viable alternative to chronic opioid therapy. Racial disparities are well-documented in the field of pain medicine. This study seeks to determine whether racial disparities are present in spinal cord stimulator (SCS) surgery involving inpatient hospital stays in the United States. Objective: The objective of this study was to analyze the effects of race on health care cost and utilization for patients receiving inpatient SCS surgery. We used total charges incurred by the patient to measure cost and length of stay (LOS) to measures hospital utilization for patients undergoing inpatient SCS surgery. We examined cost and utilization for inpatient surgeries involving SCS insertion, removal, and revision across different race demographics. Methods: This retrospective cohort study used ICD-10 procedure codes to query for all patients in the 2016–2018 National Inpatient Sample (NIS) who received SCS insertion, removal, and revision surgeries. Univariate analysis was performed in R-studio to assess the relationship between race, LOS, and total charge. Multivariate analysis was also performed in R-studio to adjust for possible confounders. Results: Hispanic race was associated with higher total charge for inpatient SCS surgery (β=+0.29, p = 3.92e-07). Hospital region was also associated with total charge. The South (β=+0.12, p = 3.7e-03) and the West (β=+0.28, p = 3.8e-09) were associated with higher total charge. The linear model also showed that patients with more comorbidities and complex cases paid higher total charges (β=+0.014, p = 6.2e-04). There was no statistically significant difference in LOS between race demographics. Conclusion: After adjusting for age, gender, type of surgical approach (percutaneous vs. open), household income, insurance coverage, hospital region, and hospital location (urban vs. rural vs. teaching), and comorbidity scores, Hispanic patients had higher total charges for inpatient SCS surgery, but there was no disparity in total charge between white and black patients. White patients were older than minority patients at the time of inpatient SCS surgery.
      原文链接:
    • NSTL
    • Elsevier