Possible association of trichorhinophalangeal syndrome I and intracranial subependymoma.

Trichorhinophalangeal syndromes (TRPSs) are rare hereditary syndromes with autosomal dominant inheritance. Patients exhibit abnormalities including bulbous pear-shaped nose, broad columella, and long and flat philtrum, fine, sparse, brittle, slow-growing scalp hair, skeletal abnormalities, and short stature. Three families; age at subependymoma surgery, pathogenic TRPS1(NM_014112.5) variant, and subependymoma number are described.

Validity and Reliability of a Motorized Sprint Resistance Device.

ABSTRACT: Rakovic, E, Paulsen, G, Helland, C, Haugen, T, and Eriksrud, O. Validity and reliability of a motorized sprint resistance device. J Strength Cond Res 36(8): 2335-2338, 2022-An increasing number of sprint-related studies have used motorized devices to provide resistance while sprinting. The aim of this study was to establish within-session reliability and criterion validity of sprint times obtained from a motorized resistance device. Seventeen elite, female, handball players (22.9 ± 3.0 years; 176.5 ± 6.5 cm; 72.7 ± 5.5 kg; training volume 9.3 ± 0.7 hours per week) performed two 30-m sprints under 3 different resistance loading conditions (50, 80 and 110 N). Sprint times (t0-5m, t5-10m, t10-15m, t15-20m, t20-30m, and t0-30m) were assessed simultaneously by a 1080 Sprint motorized resistance device and a postprocessing timing system. The results showed that 1080 Sprint timing was equivalent to the postprocessing timing system within the limits of precision (±0.01 seconds). A systematic bias of approximately 0.34 ± 0.01 seconds was observed for t0-5m caused by different athlete location and velocity at triggering point between the systems. Coefficient of variation was approximately 2% for t0-5 and approximately 1% for the other time intervals, although standard error of measurement ranged from 0.01 to 0.05 seconds, depending on distance and phase of sprint. Intraclass correlation ranged from 0.86 to 0.95. In conclusion, the present study shows that the 1080 Sprint is valid and reliable for sprint performance monitoring purposes.

Dyslipidemia and rupture risk of intracranial aneurysms-a systematic review.

Dyslipidemia is a well-established risk factor for coronary artery disease. However, the effect on cerebral artery disease, and more specifically the rupture risk of intracranial aneurysms, is unclear and has not yet been reviewed. We therefore performed a systematic review to investigate associations between different types of dyslipidemia and incidence of aneurysmal subarachnoid hemorrhage (aSAH). We used the MEDLINE, Embase, and Web of Science databases to identify clinical trials that compared the rupture risk among SAH patients with or without dyslipidemia. The risk of bias in each included study was evaluated using the Critical Appraisal Skills Program (CASP). Of 149 unique citations from the initial literature search, five clinical trials with a case-control design met our eligibility criteria. These studies compared aSAH patients to patients with unruptured aneurysms and found an overall inverse relationship between hypercholesterolemia and rupture risk of intracranial aneurysms. The quality assessment classified all included studies as high risk of bias. The evidence indicates that hypercholesterolemia is associated with a reduced rupture risk of intracranial aneurysms. However, it is not clear whether this relation is due to the dyslipidemic condition itself or the use of antihyperlipidemic medication.

Correction to: Force-velocity profiling of sprinting athletes: single-run vs. multiple-run methods.

The author would like to correct the errors in the publication of the original article. The corrected details are given below for your reading.

Force-velocity profiling of sprinting athletes: single-run vs. multiple-run methods.

PURPOSE: This study explored the agreement between a single-run and a multiple-run method for force-velocity (Fv) profiling of sprinting athletes; we evaluated both absolute values and changes over time caused by sprint training. METHODS: Seventeen female handball players (23 ± 3 years, 177 ± 7 cm, 73 ± 6 kg) performed 30 m un-resisted and resisted sprints (50, 80 and 110 N resistance) before and after an 8-week sprint training intervention. Two approaches were used to calculate theoretical maximal velocity (v0), horizontal force (F0), power (Pmax), and the force-velocity slope (SFv): (1) the single-run method, based on inverse dynamics applied to the centre-of-mass movement, was calculated from anthropometric and sprint split time data; and (2) the multiple-run method, where peak velocity from un-resisted and resisted sprints were plotted against the horizontal resistances. RESULTS: Trivial differences in v0 (0.7%) were observed between the two calculation methods. Corresponding differences for F0, Pmax and SFv were 16.4, 15.6 and 17.6%, respectively (most likely; very large effect size). F0 showed poor agreement between the methods (r = 0.26 and 0.16 before and after the intervention). No substantial correlation between the changes (from pre- to post-training tests) in SFV calculated with the single-run and the multiple-run methods were observed (r = 0.03) [corrected]. CONCLUSIONS: This study revealed poor agreement between the Fv relationships of the investigated calculation methods. In practice, both methods may have a purpose, but the single-run and the multiple-run methods appear to measure somewhat different sprint properties and cannot be used interchangeably.

Surgical decompression of arachnoid cysts leads to improved quality of life: a prospective study-long-term follow-up.

BACKGROUND: In a previous study, we reported a short-term (6 months) postoperative improvement of health-related quality of life (Qol) in patients operated for an arachnoid cyst (AC). The aim was to investigate whether this initial improvement was permanent. METHODS: A long-term (5 ± 2 years) prospective study comparing Qol and complaints before and 5 ± 2 years after surgical fenestration for AC in 76 adult patients, using the Short Form 36 (SF-36) scores, Glasgow Benefit Inventory (GBI) questionnaires, and Visual Analogue Scales (VAS) for headache and dizziness, similarly to what they did at short-term follow-up. RESULTS: At short-term and long-term follow-ups, 73.4% and 82%, respectively, of the patients were better from their headache compared with preoperative scores. The corresponding improvement rates for dizziness were 61.7% (short-term) and 67.9 (long-term). Preoperatively, the mean headache VAS score was 45.6; at short-term follow-up, this was reduced to 25.7, and at long-term follow-up, this further reduced to 24.8. The preoperative mean VAS score for dizziness (35.2) was reduced to 12.2 (short-term) and 13.9 (long-term). The significant postoperative improvement of patient-reported Qol at short-term follow-up remained at long-term follow-up across seven out of eight SF-36 dimensions and three out of four GBI subscale scores. Similar to at short-term follow-up, the Qol improvement is correlated to improvement in headache and/or dizziness. CONCLUSIONS: The previously reported postoperative, short-term improvement in Qol and complaints appears stable, as the improvement remains at long-term follow-up. This suggests that the beneficial effects of surgical treatment are long-lasting.

The effect of individualised sprint training in elite female team sport athletes: A pilot study.

This study aimed to evaluate whether an individualised sprint-training program was more effective in improving sprint performance in elite team-sport players compared to a generalised sprint-training program. Seventeen elite female handball players (23 ± 3 y, 177 ± 7 cm, 73 ± 6 kg) performed two weekly sprint training sessions over eight weeks in addition to their regular handball practice. An individualised training group (ITG, n = 9) performed a targeted sprint-training program based on their horizontal force-velocity profile from the pre-training test. Within ITG, players displaying the lowest, highest and mid-level force-velocity slope values relative to body mass were assigned to a resisted, an assisted or a mixed sprint-training program (resisted sprinting in the first half and assisted sprinting in the second half of the intervention period), respectively. A control group (CG, n = 8) performed a generalised sprint-training program. Both groups improved 30-m sprint performance by ~1% (small effect) and maximal velocity sprinting by ~2% (moderate effect). Trivial or small effect magnitudes were observed for mechanical outputs related to horizontal force- or power production. All between-group differences were trivial. In conclusion, individualised sprint-training was no more effective in improving sprint performance than a generalised sprint-training program.

Massive parallel sequencing provides new perspectives on bacterial brain abscesses.

Rapid development within the field of massive parallel sequencing (MPS) is about to bring this technology within reach for diagnostic microbiology laboratories. We wanted to explore its potential for improving diagnosis and understanding of polymicrobial infections, using bacterial brain abscesses as an example. We conducted a prospective nationwide study on bacterial brain abscesses. Fifty-two surgical samples were included over a 2-year period. The samples were categorized as either spontaneous intracerebral, spontaneous subdural, or postoperative. Bacterial 16S rRNA genes were amplified directly from the specimens and sequenced using Ion Torrent technology, with an average of 500,000 reads per sample. The results were compared to those from culture- and Sanger sequencing-based diagnostics. Compared to culture, MPS allowed for triple the number of bacterial identifications. Aggregatibacter aphrophilus, Fusobacterium nucleatum, and Streptococcus intermedius or combinations of them were found in all spontaneous polymicrobial abscesses. F. nucleatum was systematically detected in samples with anaerobic flora. The increased detection rate for Actinomyces spp. and facultative Gram-negative rods further revealed several species associations. We suggest that A. aphrophilus, F. nucleatum, and S. intermedius are key pathogens for the establishment of spontaneous polymicrobial brain abscesses. In addition, F. nucleatum seems to be important for the development of anaerobic flora. MPS can accurately describe polymicrobial specimens when a sufficient number of reads is used to compensate for unequal species concentrations and principles are defined to discard contaminant bacterial DNA in the subsequent data analysis. This will contribute to our understanding of how different types of polymicrobial infections develop.

Body composition and rupture risk of intracranial aneurysms.

BACKGROUND: Rupture of an intracranial aneurysm resulting in a subarachnoid hemorrhage (SAH) is a life-threatening situation. Obesity is an increasing health challenge associated with numerous comorbidities. However, recent studies have shown a surprising decreased risk of SAH with increasing body mass index (BMI). The aim was to explore associations between other anthropometric variables and the rupture risk of an intracranial aneurysm, which to our knowledge is lacking in present literature. METHODS: Using a bioelectrical impedance analysis device, we performed body composition analyses on 31 patients admitted with aneurysmal SAH (aSAH) and 28 patients with planned intervention on their unruptured aneurysm. We also collected information on comorbidities and relevant risk factors. Logistic regression was used to explore associations between anthropometric variables and patients with ruptured versus unruptured aneurysms. RESULTS: Unadjusted estimates showed a significant inverse relationship between body fat percent and aneurysmal rupture (OR [95% CI]: 0.92 [0.86, 0.97], P = 0.009), and between body fat mass and aneurysmal rupture (OR [95% CI]: 0.95 [0.90, 0.99], P = 0.047). These risk relationships remained significant in age- and sex-adjusted analyses for body fat percent (OR [95% CI]: 0.93, [0.87, 0.97], P = 0.028), and body fat mass (OR [95% CI]: 0.95 [0.90, 0.99], P = 0.041). CONCLUSIONS: In recent studies showing a paradoxical relation between aSAH and obesity, BMI was the only parameter investigated. We further explored this "obesity paradox" and found lower body fat in aSAH patients compared to UIA. Future studies should investigate these relationships in larger samples. Clinical Trial Registration NCT04613427, November 3, 2020, retrospectively registered.

Maze learning in patients with intracranial arachnoid cysts.

BACKGROUND: The temporal lobe is of importance for visuospatial orientation. Intracranial arachnoid cysts have a predilection for the temporal fossa, and might therefore affect visuospatial orientation. The aim was to find out whether temporal cysts affect maze learning and if surgical cyst decompression improves maze performance. METHODS: Forty-five patients with a temporal arachnoid cyst and 17 control patients with cervical disc disease were tested in a labyrinth route in the hospital corridors the day before surgery and at least 3 months postoperatively. RESULTS: Thirty-five cyst patients (78 %) experienced postoperative improvement of their preoperative complaints. The cyst patients spent significantly longer time than the controls navigating through the maze in the preoperative test, 161 s and 127 s, respectively, but there was no difference in number of errors between the two groups. However, the cyst patients improved significantly in the postoperative test, both with regards to number of errors they made and time spent, contrary to the control patients, whose postoperative performance equalled that of the preoperative test. For the cyst patients, postoperative improvement in the labyrinth test correlated with the clinical outcome-but not the neuroradiological outcome-after the operation. CONCLUSIONS: Thus, temporal arachnoid cysts may affect visuospatial orientation and learning in a reversible manner.

Mechanical properties of the patellar tendon in elite volleyball players with and without patellar tendinopathy.

BACKGROUND: Although differences in mechanical properties between symptomatic and healthy tendons have been observed for the Achilles tendon, the impact of tendinopathy on patellar tendon mechanics is not fully documented. The aim of the present case-control study was to assess the mechanical properties of the tendon and jump performance in elite athletes with and without patellar tendinopathy. METHODS: We identified 17 male volleyball players with patellar tendinopathy and 18 healthy matched controls from a 5-year prospective cohort study on junior elite volleyball players. Outcome variables included three measures of maximal vertical jump performance and ultrasound-based assessments of patellar tendon cross-sectional area, stiffness and Young's modulus. RESULTS: The proximal cross-sectional area of the patellar tendon was significantly larger in the tendinopathic group (133 ± 11 vs 112 ± 9 mm(2), respectively; p < 0.001). Pathological tendons presented lower stiffness (2254 ± 280 vs 2826 ± 603 N/mm, respectively; p = 0.006) and Young's modulus (0.99 ± 0.16 vs 1.17 ± 0.25 GPa, respectively; p = 0.04) than healthy tendons. However, the difference between the countermovement jump height and the squat jump height (3.4 ± 2.2 vs 1.2 ± 1.5 cm, p = 0.005) was significantly higher in the tendinopathic group compared with the control group. CONCLUSIONS: Patellar tendinopathy is associated with a decrease in the mechanical and material properties of the tendon in elite athletes subjected to a high volume of jumping activity. However, compared with their healthy counterparts, tendinopathic volleyball players have a better ability to utilise the stretch-shortening cycle when jumping.

Strength and Power Testing of Athletes: A Multicenter Study of Test-Retest Reliability.

PURPOSE: This study examined the test-retest reliability of common assessments for measuring strength and power of the lower body in high-performing athletes. METHODS: A total of 100 participants, including both male (n = 83) and female (n = 17) athletes (21 [4] y, 182 [9] cm, and 78 [12] kg), were recruited for this study, using a multicenter approach. The participants underwent physical testing 4 times. The first 2 sessions (1 and 2) were separated by ∼1 week, followed by a period of 2 to 6 months, whereas the last 2 sessions (3 and 4) were again separated by ∼1 week. The test protocol consisted of squat jumps, countermovement jumps, jump and reach, 30-m sprint, 1-repetition-maximum squat, sprint cycling, and a leg-press test. RESULTS: The typical error (%) ranged from 1.3% to 8.5% for all assessments. The change in means ranged from -1.5% to 2.5% for all assessments, whereas the interclass correlation coefficient ranged from .85 to .97. The smallest worthwhile change (0.2 of baseline SD) ranged from 1.2% to 5.0%. The ratio between the typical error (%) and the smallest worthwhile change (%) ranged from 0.5 to 1.2. When observing the reliability across testing centers, considerable differences in reliability were observed (typical error [%] ratio: 0.44-1.44). CONCLUSIONS: Most of the included assessments can be used with confidence by researchers and coaches to measure strength and power in athletes. Our results highlight the importance of controlling testing reliability at each testing center and not relying on data from others, despite having applied the same protocol.

Strength and Power Testing of Athletes: Associations of Common Assessments Over Time.

PURPOSE: This study examined the associations among common assessments for measuring strength and power in the lower body of high-performing athletes, including both cross-sectional and longitudinal data. METHODS: A total of 100 participants, including both male (n = 83) and female (n = 17) athletes (21 [4] y, 182 [9] cm, 78 [12] kg), were recruited for the study using a multicenter approach. The participants underwent physical testing 4 times. The first 2 sessions (1 and 2) were separated by ∼1 week, followed by a period of 2 to 6 months, whereas the last 2 sessions (3 and 4) were also separated by ∼1 week. The test protocol consisted of squat jumps, countermovement jumps, jump and reach, 30-m sprint, 1-repetition-maximum squat, sprint cycling, and a leg-press test. RESULTS: There were generally acceptable correlations among all performance measures. Variables from the countermovement jumps and leg-press power correlated strongly with all performance assessments (r = .52-.79), while variables from sprint running and squat-jump power displayed more incoherent correlations (r = .21-.82). For changes over time, the correlations were mostly strong, albeit systematically weaker than for cross-sectional measures. CONCLUSIONS: The associations observed among the performance assessments seem to be consistent for both cross-sectional data and longitudinal change scores. The weaker correlations for change scores are most likely mainly caused by lower between-subjects variations in the change scores than for the cross-sectional data. The present study provides novel information, helping researchers and practitioners to better interpret the relationships across common performance assessment methods.

Force-velocity profiling in athletes: Reliability and agreement across methods.

The aim of the study was to examine the test-retest reliability and agreement across methods for assessing individual force-velocity (FV) profiles of the lower limbs in athletes. Using a multicenter approach, 27 male athletes completed all measurements for the main analysis, with up to 82 male and female athletes on some measurements. The athletes were tested twice before and twice after a 2- to 6-month period of regular training and sport participation. The double testing sessions were separated by ~1 week. Individual FV-profiles were acquired from incremental loading protocols in squat jump (SJ), countermovement jump (CMJ) and leg press. A force plate, linear encoder and a flight time calculation method were used for measuring force and velocity during SJ and CMJ. A linear regression was fitted to the average force and velocity values for each individual test to extrapolate the FV-variables: theoretical maximal force (F0), velocity (V0), power (Pmax), and the slope of the FV-profile (SFV). Despite strong linearity (R2>0.95) for individual FV-profiles, the SFV was unreliable for all measurement methods assessed during vertical jumping (coefficient of variation (CV): 14-30%, interclass correlation coefficient (ICC): 0.36-0.79). Only the leg press exercise, of the four FV-variables, showed acceptable reliability (CV:3.7-8.3%, ICC:0.82-0.98). The agreement across methods for F0 and Pmax ranged from (Pearson r): 0.56-0.95, standard error of estimate (SEE%): 5.8-18.8, and for V0 and SFV r: -0.39-0.78, SEE%: 12.2-37.2. With a typical error of 1.5 cm (5-10% CV) in jump height, SFV and V0 cannot be accurately obtained, regardless of the measurement method, using a loading range corresponding to 40-70% of F0. Efforts should be made to either reduce the variation in jumping performance or to assess loads closer to the FV-intercepts. Coaches and researchers should be aware of the poor reliability of the FV-variables obtained from vertical jumping, and of the differences across measurement methods.

Microarray-based gene expression profiling and DNA copy number variation analysis of temporal fossa arachnoid cysts.

BACKGROUND: Intracranial arachnoid cysts (AC) are membranous sacs filled with CSF-like fluid that are commonly found in the temporal fossa. The majority of ACs are congenital. Typical symptoms are headache, dizziness, and dyscognition. Little is known about genes that contribute to the formation of the cyst membranes. METHODS: In order to identify differences in gene expression between normal arachnoid membrane (AM) and cyst membrane, we have performed a high-resolution mRNA microarray analysis. In addition we have screened DNA from AC samples for chromosomal duplications or deletions using DNA microarray-based copy number variation analysis. RESULTS: The transcriptome consisting of 33096 gene probes showed a near-complete similarity in expression between AC and AM samples. Only nine genes differed in expression between the two tissues: ASGR1, DPEP2, SOX9, SHROOM3, A2BP1, ATP10D, TRIML1, NMU were down regulated, whereas BEND5 was up regulated in the AC samples. Three of the AC samples had unreported human DNA copy number variations, all DNA gains. CONCLUSIONS: Extending results of previous anatomical studies, the present study has identified a small subset of differentially expressed genes and DNA alterations in arachnoid cysts compared to normal arachnoid membrane.

Arachnoid cysts do not contain cerebrospinal fluid: A comparative chemical analysis of arachnoid cyst fluid and cerebrospinal fluid in adults.

BACKGROUND: Arachnoid cyst (AC) fluid has not previously been compared with cerebrospinal fluid (CSF) from the same patient. ACs are commonly referred to as containing "CSF-like fluid". The objective of this study was to characterize AC fluid by clinical chemistry and to compare AC fluid to CSF drawn from the same patient. Such comparative analysis can shed further light on the mechanisms for filling and sustaining of ACs. METHODS: Cyst fluid from 15 adult patients with unilateral temporal AC (9 female, 6 male, age 22-77y) was compared with CSF from the same patients by clinical chemical analysis. RESULTS: AC fluid and CSF had the same osmolarity. There were no significant differences in the concentrations of sodium, potassium, chloride, calcium, magnesium or glucose. We found significant elevated concentration of phosphate in AC fluid (0.39 versus 0.35 mmol/L in CSF; p = 0.02), and significantly reduced concentrations of total protein (0.30 versus 0.41 g/L; p = 0.004), of ferritin (7.8 versus 25.5 ug/L; p = 0.001) and of lactate dehydrogenase (17.9 versus 35.6 U/L; p = 0.002) in AC fluid relative to CSF. CONCLUSIONS: AC fluid is not identical to CSF. The differential composition of AC fluid relative to CSF supports secretion or active transport as the mechanism underlying cyst filling. Oncotic pressure gradients or slit-valves as mechanisms for generating fluid in temporal ACs are not supported by these results.

A strength-oriented exercise session required more recovery time than a power-oriented exercise session with equal work.

The present randomized cross-over controlled study aimed to compare the rate of recovery from a strength-oriented exercise session vs. a power-oriented session with equal work. Sixteen strength-trained individuals conducted one strength-oriented session (five repetitions maximum (RM)) and one power-oriented session (50% of 5RM) in randomized order. Squat jump (SJ), countermovement jump (CMJ), 20-m sprint, and squat and bench press peak power and estimated 1RMs were combined with measures of rate of perceived exertion (RPE) and perceived recovery status (PRS), before, immediately after and 24 and 48 h after exercise. Both sessions induced trivial to moderate performance decrements in all variables. Small reductions in CMJ height were observed immediately after both the strength-oriented session (7 ± 6%) and power-oriented session (5 ± 5%). Between 24 and 48 h after both sessions CMJ and SJ heights and 20 m sprint were back to baseline. However, in contrast to the power-oriented session, recovery was not complete 48 h after the strength-oriented session, as indicated by greater impairments in CMJ eccentric and concentric peak forces, SJ rate of force development (RFD) and squat peak power. In agreement with the objective performance measurements, RPE and PRS ratings demonstrated that the strength-oriented session was experienced more strenuous than the power-oriented session. However, these subjective measurements agreed poorly with performance measurements at the individual level. In conclusion, we observed a larger degree of neuromuscular impairment and longer recovery times after a strength-oriented session than after a power-oriented session with equal total work, measured by both objective and subjective assessments. Nonetheless, most differences were small or trivial after either session. It appears necessary to combine several tests and within-test analyses (e.g., CMJ height, power and force) to reveal such differences. Objective and subjective assessments of fatigue and recovery cannot be used interchangeably; rather they should be combined to give a meaningful status for an individual in the days after a resistance exercise session.

Differences in anatomical distribution, gender, and sidedness between ruptured and unruptured intracranial aneurysms in a defined patient population.

BACKGROUND: Working with patients with intracranial aneurysms, we have developed a clinical suspicion that there may be differences in the rupture rate of aneurysms depending on the aneurysm's anatomical location. The aim of the study was to examine the anatomical distribution of ruptured and unruptured intracranial aneurysms in a defined population. METHOD: We retrospectively included all patients with an aneurysm treated in our institution between 1 January 1990 and 31 December 1999, and collected the relevant data from the individual patient files. With the Koivisto categories for aneurysm location, we gathered the aneurysms into four categories: ACA, MCA, ICA, and VBA. FINDINGS: Four hundred forty-four aneurysms were included in the study: 361 in SAH patients and 83 in patients without SAH. ACA aneurysms were over-represented in the ruptured group (36.0% vs. 9.6%, p < 0.0001). MCA aneurysms were more frequent in the unruptured group (51.8% vs. 29.6%, p < 0.0002). Ruptured ACA aneurysms were over-represented among males (p < 0.0001), whereas ruptured ICA aneurysms were more frequent among females (p < 0.0001). Ruptured aneurysms in the posterior circulation were more frequently found on the left side (p < 0.0001). CONCLUSION: This study shows that the anatomical distribution of aneurysms is different in SAH patients compared with patients with unruptured aneurysms. Haemodynamic features of the vessel of origin may explain the differences we have found. Furthermore, this study suggests that it is of particular importance to treat patients with incidentally found ACA aneurysms.

Impaired cerebrovascular reactivity may predict delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

INTRODUCTION: Delayed cerebral ischemia (DCI) is a major cause of disability and death after aneurysmal subarachnoid hemorrhage. The literature suggests that impaired cerebrovascular reactivity (CVR) may be a predictor for DCI; still no CVR based prediction model has been developed. Increased knowledge about possible predictors of DCI can improve patient management in high-risk patients and allow for shorter hospital stay in low-risk patients. METHOD: CVR was examined in 42 patients with aneurysmal subarachnoid hemorrhage and 37 patients treated for unruptured intracranial aneurysm, using acetazolamide test with transcranial Doppler monitoring of blood flow velocities. Patients were followed for development of DCI, separated into clinical deterioration and radiographic infarction. RESULTS: For all patients, regardless of aneurysm rupture status, CVR was on average 5.5 percentage points lower on the ipsilateral side of aneurysm treatment. Patients with clinical deterioration due to DCI had lower CVR than patients without DCI, and the difference was larger on the contralateral side (33.9% vs. 49.2%). Two prediction models were constructed for clinical deterioration due to DCI. The area under the receiver operating characteristic curve was 0.82 in the model using established predictors, and 0.86 in the model that also included CVR. CONCLUSION: Our findings support the hypothesis that impaired CVR may be an independent predictor of clinical deterioration due to DCI, and may assist in identifying patients at risk after aneurysmal subarachnoid hemorrhage. Ipsilateral CVR reduction occurs in all patients after aneurysm treatment, regardless of DCI development, thus highlighting the need to evaluate ipsi- and contralateral CVR separately.

Anxiety and Depression in Patients with Intracranial Arachnoid Cysts-A Prospective Study.

BACKGROUND: Arachnoid cysts yield cognitive deficits that are normalized after surgical cyst decompression. OBJECTIVE: The present study aimed to investigate whether arachnoid cysts also affect symptoms of anxiety and depression, and if surgical cyst decompression leads to reduction of these symptoms. METHODS: Twenty-two adult patients (13 men and 9 women) with symptomatic temporal or frontal cysts were included in this questionnaire (Hospital Anxiety and Depression Scale [HADS])-based prospective study. The mean time between answering the preoperative questionnaire and surgery was 37 days. The patients answered the same HADS questionnaire 3-6 months postoperatively. RESULTS: Preoperatively, both patients with frontal (N = 4) and patients with temporal (N = 18) cyst had higher mean HADS anxiety scores than those found in the general population. For patients with temporal cyst, there was a significant or near-significant difference in anxiety and depression scores and the combined scores between those with right-sided cysts and those with left-sided cysts. Postoperatively, the HADS scores normalized and were no longer different from those of the general population. The difference in scores between patients with right and left temporal cyst also disappeared. CONCLUSIONS: Patients with arachnoid cyst have higher levels of anxiety and depression than do the general population and these scores were normalized after decompressive cyst surgery. We further found a hemispheric asymmetry: patients with a right temporal cyst showed higher anxiety, depression, and combined scores than did patients with a left temporal cyst. Also, this disparity normalized after cyst decompression. Thus, arachnoid cysts seem to affect not only cognition but also the level of affective symptoms.