RESUMEN
OBJECTIVES: This study aimed to investigate the association between intracerebral aneurysms and cranial nerve (CN) palsies, focusing on nerves other than the oculomotor nerve. It sought to determine the prevalence, risk factors, and clinical outcomes of these nerve palsies and compare the effectiveness of microsurgical clipping versus endovascular coiling in restoring nerve function. METHODOLOGY: Following PRISMA guidelines, a comprehensive literature search was conducted using databases like PubMed, Scopus, and Google Scholar, covering studies from 1975 to April 2024. The inclusion criteria targeted patients with non-oculomotor nerve palsies diagnosed with cerebral aneurysms. Studies published before 1975 and non-English studies were excluded. Data extraction included study design, patient characteristics, and intervention outcomes. The Joanna Briggs Institute and Newcastle-Ottawa scales were used to assess study quality. Data were synthesized narratively and statistically analysed using SPSS v27. RESULTS: The analysis included 47 patients (53.2% female, mean age 44.8 years). The internal carotid artery (ICA) was the most common aneurysm site (44.7%), and the abducent nerve (CN VI) was most frequently affected. Ruptured aneurysms had better recovery outcomes (88.9%) than unruptured ones (66.7%). Hypertension was present in 9.2%. Unilateral aneurysms were seen in 80.9%, with 76.6% having a single nerve palsy. Non-ruptured aneurysms accounted for 58.1%, and ruptured for 41.9% of associated cranial nerve palsies. Treatment included microsurgical approaches (42.6%), endovascular approaches (34%), combined approaches (6.4%), and conservative management (17%). Recovery of the palsy was observed in 75.6%, with endovascular procedures showing higher recovery (93.3%) compared to conservative treatment (28.6%). CONCLUSION: Intracerebral aneurysms are significantly associated with non-oculomotor CN palsies. Endovascular procedures yield higher recovery rates than conservative management, particularly in ruptured aneurysms. Timely and appropriate treatment is crucial for improving nerve function recovery in these patients.
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Enfermedades de los Nervios Craneales , Aneurisma Intracraneal , Humanos , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/complicaciones , Enfermedades de los Nervios Craneales/epidemiología , Femenino , Procedimientos Endovasculares/métodos , Masculino , Adulto , Persona de Mediana Edad , Aneurisma Roto/cirugía , Aneurisma Roto/complicacionesRESUMEN
Background and Objective: Understanding whether cranial nerve palsy (CNP) acts as an independent risk factor for kidney cancer could have important implications for patient care, early detection, and potentially the development of preventive strategies for this type of cancer in individuals with CNP. This study aimed to examine the risk of kidney cancer following the onset of ocular motor CNP and assess whether CNP could be considered an independent risk factor for kidney cancer. Materials and Methods: A population-based cohort study was conducted using data from the National Sample Cohort (NSC) database of Korea's National Health Insurance Service which was collected from 2010 to 2017. Follow-up was until kidney cancer development, death, or 31 December 2018. Cox proportional hazard regression analysis was performed to determine hazard ratios (HRs) for kidney cancer according to CNP status. Participants aged 20 years or more diagnosed with CNP from 2010 to 2017 were included. Exclusions comprised individuals with specific pre-existing conditions, inability to match a control group, and missing data, among others. CNP patients were age-sex matched in a 1:5 ratio with control cases. The primary outcome was incidence of kidney cancer during the follow-up period. Results: This study comprised 118,686 participants: 19,781 in the CNP group, and 98,905 in the control group. Compared to the control group, participants with CNP had a higher risk of kidney cancer (adjusted HR in model 4, 1.599 [95% CI, 1.116-2.29]). After a 3-year lag period, the CNP group had a significantly higher risk (adjusted HR in model 4, 1.987 [95% CI, 1.252-3.154]). Conclusions: Ocular motor CNP may be an independent risk factor for kidney cancer, as indicated by a higher incidence of kidney cancer in CNP patients. Further research is needed to elucidate the underlying mechanisms and explore potential preventive measures for kidney cancer in patients with ocular motor CNP.
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Enfermedades de los Nervios Craneales , Neoplasias Renales , Humanos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Renales/epidemiología , Adulto , Factores de Riesgo , República de Corea/epidemiología , Anciano , Estudios de Cohortes , Enfermedades de los Nervios Craneales/epidemiología , Enfermedades de los Nervios Craneales/etiología , Incidencia , Modelos de Riesgos ProporcionalesRESUMEN
OBJECTIVE: Diabetes mellitus (DM) is a major global health concern and is associated with high morbidity and mortality as well as poor quality of life. This health burden is mostly due to complications associated with DM. Cranial nerve neuropathy is not a well-studied complication of DM. In this study, we aimed to study the prevalence and risk factors for the development of cranial neuropathy in diabetic patients. PATIENTS AND METHODS: This is a cross-sectional study among diabetics who are attending Almanhal Primary Healthcare Center, Abha, Aseer Province, Saudi Arabia. A total of 714 subjects were included, 238 of them were in the study group and 476 were controls chosen randomly from the same community. SPSS program was used to calculate demographic, clinical, and biochemical parameters as well as to measure the statistically significant differences. Analysis was conducted using the SPSS statistical package and p-value lower than or equal to 0.05 was considered statistically significant. RESULTS: The diabetic patients were significantly older than the control group; the mean standard deviation (SD) age was 59.78 (8.26), and 34.04 (9.45) for both study and control groups, respectively. The prevalence of cranial neuropathy was higher in diabetic patients. Among diabetic patients, hyperlipidemia, gestational DM, compliance with DM treatment, and the presence of microvascular complications of DM are significant risk factors for the development of cranial neuropathy. CONCLUSIONS: Our results indicate that the prevalence of cranial neuropathy is higher in the diabetic population than in the non-diabetic population. The oculomotor and trigeminal nerves were the most commonly affected nerves in diabetic patients compared to the abducent and facial nerves in non-diabetic patients.
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Enfermedades de los Nervios Craneales , Diabetes Mellitus , Humanos , Prevalencia , Estudios Transversales , Calidad de Vida , Diabetes Mellitus/epidemiología , Factores de Riesgo , Enfermedades de los Nervios Craneales/epidemiologíaRESUMEN
INTRODUCTION: Headache and hypothyroidism are common comorbidities. This is a cross-sectional study of the prevalence of hypothyroidism in headache patients in the largest Mexican headache registry. PATIENTS AND METHODS: PREMECEF is an e-database for patients with headaches. Data was recollected from July 2017-April 2019 in three centers of Monterrey, Mexico. RESULTS: Of 869 patients, 35 (4%) had hypothyroidism. Four had two different headache diagnoses; of the 39 individual diagnoses, 23 were primary, 1 secondary, 13 cranial neuralgias, and 2 unspecified headaches. Hypothyroidism prevalence: 8.3% in unspecified, 6.5% in cranial neuralgias, 3.4% in primary, and 1.9% in secondary headaches; in tension-type headache (TTH) was 3.9%, in migraines 3.2%, in trigeminal neuralgia 6.1%, and in occipital neuralgia 6.3%. CONCLUSION: This is the first report on the prevalence of hypothyroidism in occipital and trigeminal neuralgia. The prevalence of hypothyroidism in migraine and TTH is higher than the general population.
TITLE: Comorbilidad entre hipotiroidismo y cefalea en la población mexicana.Introducción. Cefalea e hipotiroidismo son comorbilidades comunes. Éste es un estudio transversal de la prevalencia del hipotiroidismo en pacientes con cefalea en el registro de cefalea más grande de México. Pacientes y métodos. PREMECEF es una base de datos electrónica para pacientes con cefalea. La información se recolectó de julio de 2017 a abril de 2019 en tres centros médicos de Monterrey, México. Resultados. De 869 pacientes, 35 (4%) tenían hipotiroidismo y cuatro tenían diagnósticos de dos diferentes cefaleas. De los 39 diagnósticos individuales, 23 fueron primarias; una, secundaria; 13, neuralgias craneales; y dos, cefaleas no especificadas. La prevalencia de hipotiroidismo fue del 8,3% en las no especificadas, del 6,5% en las neuralgias craneales, del 3,4% en las cefaleas primarias y del 1,9% en las secundarias. En la cefalea de tipo tensional fueron del 3,9%; en las migrañas, del 3,2%; en la neuralgia trigeminal, del 6,1%; y en la neuralgia occipital, del 6,3%. Conclusión. Éste es el primer informe de la prevalencia de hipotiroidismo en la neuralgia occipital y la trigeminal. La prevalencia de hipotiroidismo en la migraña y la cefalea de tipo tensional es mayor que en la población general.
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Enfermedades de los Nervios Craneales , Hipotiroidismo , Trastornos Migrañosos , Neuralgia , Cefalea de Tipo Tensional , Neuralgia del Trigémino , Comorbilidad , Enfermedades de los Nervios Craneales/epidemiología , Estudios Transversales , Cefalea/diagnóstico , Cefalea/epidemiología , Cefalea/etiología , Humanos , Hipotiroidismo/complicaciones , Hipotiroidismo/epidemiología , México/epidemiología , Trastornos Migrañosos/complicaciones , Trastornos Migrañosos/epidemiología , Cefalea de Tipo Tensional/epidemiologíaRESUMEN
BACKGROUND: 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.
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Enfermedades de los Nervios Craneales , Ataque Isquémico Transitorio , Accidente Cerebrovascular , Enfermedades de los Nervios Craneales/complicaciones , Enfermedades de los Nervios Craneales/epidemiología , Humanos , Isquemia/complicaciones , Ataque Isquémico Transitorio/etiología , Modelos de Riesgos Proporcionales , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiologíaRESUMEN
INTRODUCTION: A number of neurological complications of COVID-19 have been identified, including cranial nerve paralyses. We present a series of 10 patients with lower cranial nerve involvement after severe COVID-19 infection requiring hospitalization in an intensive care unit. METHODS: We conducted a retrospective, observational study of patients admitted to the post-intensive care unit (p-ICU) of Besançon University Hospital (France) between March 16 and May 22, 2020. We included patients with confirmed COVID-19 and cranial neuropathy at admission to the p-ICU. All these patients were treated by orotracheal intubation, and all but one underwent prone-position ventilation therapy. RESULTS: Of the 88 patients admitted to the p-ICU, 10 patients (11%) presented at least 1 cranial nerve palsy. Of these 10 patients, 9 had a hypoglossal nerve palsy and 8 of these also had a deficit in another cranial nerve. The most frequent association was between hypoglossal and vagal palsies (5 patients). None of the patients developed neurological signs related to a global neuropathy. We found no correlation between the intensity of the motor limb weakness and the occurrence of lower cranial nerve palsies. All but 2 of the patients recovered within less than a month. CONCLUSION: The mechanical compressive hypothesis, linked to the prone-position ventilation therapy, appears to be the major factor. The direct toxicity of SARS-CoV-2 and the context of immune dysfunction induced by the virus may be involved in a multifactorial etiology.
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COVID-19 , Enfermedades de los Nervios Craneales , COVID-19/complicaciones , Enfermedades de los Nervios Craneales/epidemiología , Enfermedades de los Nervios Craneales/etiología , Humanos , Unidades de Cuidados Intensivos , Pandemias , Estudios Retrospectivos , SARS-CoV-2RESUMEN
This study aimed to assess the associations between liver enzymes including γ-glutamyl transferase (GGT) and the development of ocular motor cranial nerve palsy (CNP) using the National Sample Cohort database from Korea's National Health Insurance Service. We analyzed data from 4,233,273 medical screening examinees aged 20 years or more in 2009. Study participants were followed up until December 31, 2018. A Cox proportional hazard regression analysis was performed for quartiles of liver enzymes to determine the linkage between each value and ocular motor CNP using quartile 1 as a reference after adjusting for potential confounders. A total of 5,807 (0.14%) patients developed ocular motor CNP during the follow-up period of 8.22 ± 0.94 years. The incidence of ocular motor CNP gradually increased as the GGT levels increased. The highest quartile of the GGT group had hazard ratio (HR) of 1.245 (95% confidence interval [CI], 1.136-1.365). Regarding alanine aminotransferase (ALT), the highest quartile of the ALT group had HR of 1.141 (95% CI, 1.049-1.241). However, the incidence of ocular motor CNP did not gradually increase as the ALT levels increased. The coexistence of the increased level of GGT, metabolic syndrome, and obesity showed a stronger association with ocular motor CNP development (HR, 1.331; 95% CI, 1.173, 1.511) compared to having a single factor or two factors. In conclusion, our population-based cohort study demonstrated a significant association between serum GGT level and the incidence of ocular motor CNP, suggesting that GGT could be a new clinical marker for predicting the occurrence of ocular motor CNP.
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Enfermedades de los Nervios Craneales , gamma-Glutamiltransferasa , Alanina Transaminasa , Estudios de Cohortes , Enfermedades de los Nervios Craneales/complicaciones , Enfermedades de los Nervios Craneales/epidemiología , Humanos , Hígado , Factores de RiesgoRESUMEN
INTRODUCTION: The COVID-19 disease emerged in Wuhan province of China in November 2019 and spread across the world in a short time, resulting in a pandemic. The first case in Turkey was detected on March 11, 2020. The aim of the current study was to reveal the effects of COVID-19 on cranial nerves by monitoring people infected with the disease based on repeated examinations and surveys. MATERIAL AND METHOD: The data of 356 patients with a positive COVID-19 polymerase chain reaction (PCR) test who received treatment between June 2020 and August 2020 in our hospital were prospectively evaluated after the study was approved by the relevant ethics committee. RESULTS: Of the 356 patients included in the study, 47 under the age of 18 years were excluded due to their unreliable examination and anamnesis findings. In addition, seven patients that died while in hospital were excluded from the study due to the lack of examination and survey records during their hospitalization. The data of the remaining 302 patients were statistically analyzed. Symptoms of cranial nerve involvement were observed in 135 patients. CONCLUSION: The COVID-19 disease caused by the SARS-CoV2 virus commonly results in cranial nerve symptoms. The fact that these findings are more common and severe in COVID-19 than previous SARS and MERS outbreaks suggests that it has a more neurotrophic and more aggressive neuroinvasion. While the negative effects of the virus on sensory functions resulting from cranial nerve involvement are evident, motor functions are rarely affected.
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COVID-19/complicaciones , Enfermedades de los Nervios Craneales/epidemiología , Enfermedades de los Nervios Craneales/virología , Adulto , COVID-19/diagnóstico , COVID-19/terapia , Enfermedades de los Nervios Craneales/diagnóstico , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Evaluación de Síntomas , Turquía , Adulto JovenRESUMEN
OBJECTIVES: Carotid body tumors (CBTs) are rare head and neck neoplasms, we aimed to propose a modification to the Shamblin's classification of CBTs. MATERIALS AND METHODS: This retrospective study included 105 patients (116 CBTs) operated at our institution from March 2013 to July 2020. CBTs were divided by a modified Shamblin's classification into five subtypes (type I-V) based on the radiographic features. Correlations between modified classification and intraoperative bleeding, internal carotid artery (ICA) bypass and postoperative neural complications, as main outcomes, as well as other outcomes were analyzed. RESULTS: Surgeries for type V and type I CBTs had the most (median: 700 ml, IQR: 375-1575 ml) and least (median: 20 ml, IQR: 20-50 ml) bleeding, respectively. Intraoperatively, ICA bypass was needed in 41.7% (10/24) type V, 18.2% (8/44) type IV and 5.9% (1/17) type III lesions, but not in other subtypes (p = .001). Postoperatively, overall cranial nerve deficits (CND) were found most frequently in type V tumors (17/24, 70.8%) (p = .016). Permanent CND were found in 33.3% (8/24) type V and 4.5% (2/44) type IV lesions, but not in other subtypes (p = .001). Other outcomes including external carotid artery ligation, operation time, blood transfusion, postoperative intensive unit care and postoperative hospitalization also showed significant difference among different subtypes. Patients recovered uneventfully during a follow-up of 23.5 ± 16.2 months except for one ipsilateral recurrence at 42 months after surgery. CONCLUSIONS: The modified classification was correlated with surgical outcomes of CBTs and will be helpful for making surgical plans.
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Arteria Carótida Externa/cirugía , Arteria Carótida Interna/cirugía , Tumor del Cuerpo Carotídeo/cirugía , Enfermedades de los Nervios Craneales/epidemiología , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Transfusión Sanguínea/estadística & datos numéricos , Tumor del Cuerpo Carotídeo/clasificación , Tumor del Cuerpo Carotídeo/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Adulto JovenRESUMEN
Importance: Lower cranial neuropathy (LCNP) is a rare, but permanent, late effect of radiotherapy and other cancer therapies. Lower cranial neuropathy is associated with excess cancer-related symptoms and worse swallowing-related quality of life. Few studies have investigated risk and clinical factors associated with late LCNP among patients with long-term survival of oropharyngeal squamous cell carcinoma (OPSCC survivors). Objective: To estimate the cumulative incidence of and identify clinical factors associated with late LCNP among long-term OPSCC survivors. Design, Setting, and Participants: This single-institution cohort study included disease-free adult OPSCC survivors who completed curative treatment from January 1, 2000, to December 31, 2013. Exclusion criteria consisted of baseline LCNP, recurrent head and neck cancer, treatment at other institutions, death, and a second primary, persistent, or recurrent malignant neoplasm of the head and neck less than 3 months after treatment. Median survival of OPSCC among the 2021 eligible patients was 6.8 (range, 0.3-18.4) years. Data were analyzed from October 12, 2019, to November 13, 2020. Main Outcomes and Measures: Late LCNP events were defined by neuropathy of the glossopharyngeal, vagus, and/or hypoglossal cranial nerves at least 3 months after cancer therapy. Cumulative incidence of LCNP was estimated using the Kaplan-Meier method, and multivariable Cox proportional hazards models were fit. Results: Among the 2021 OPSCC survivors included in the analysis of this cohort study (1740 [86.1%] male; median age, 56 [range, 28-86] years), 88 (4.4%) were diagnosed with late LCNP, with median time to LCNP of 5.4 (range, 0.3-14.1) years after treatment. Cumulative incidence of LCNP was 0.024 (95% CI, 0.017-0.032) at 5 years, 0.061 (95% CI, 0.048-0.078) at 10 years, and 0.098 (95% CI, 0.075-0.128) at 15 years of follow-up. Multivariable Cox proportional hazards regression identified T4 vs T1 classification (hazard ratio [HR], 3.82; 95% CI, 1.85-7.86) and accelerated vs standard radiotherapy fractionation (HR, 2.15; 95% CI, 1.34-3.45) as independently associated with late LCNP status, after adjustment. Among the subgroup of 1986 patients with nonsurgical treatment, induction chemotherapy regimens including combined docetaxel, cisplatin, and fluorouracil (TPF) (HR, 2.51; 95% CI, 1.35-4.67) and TPF with cetuximab (HR, 5.80; 95% CI, 1.74-19.35) along with T classification and accelerated radiotherapy fractionation were associated with late LCNP status after adjustment. Conclusions and Relevance: This single-institution cohort study found that, although rare in the population overall, cumulative risk of late LCNP progressed to 10% during the survivors' lifetime. As expected, clinical factors associated with LCNP primarily reflected greater tumor burden and treatment intensity. Further efforts are necessary to investigate risk-reduction strategies as well as surveillance and management strategies for this disabling late effect of cancer treatment.
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Enfermedades de los Nervios Craneales/epidemiología , Neoplasias Orofaríngeas/terapia , Carcinoma de Células Escamosas de Cabeza y Cuello/terapia , Adulto , Anciano , Anciano de 80 o más Años , Supervivientes de Cáncer , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Texas/epidemiologíaRESUMEN
OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality. METHODS: A total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death. RESULTS: A total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04-1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age- and severity-matched controls. CONCLUSIONS: The incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.
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COVID-19/mortalidad , Confusión/fisiopatología , Trastornos de la Conciencia/fisiopatología , Mortalidad Hospitalaria , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Ageusia/epidemiología , Ageusia/fisiopatología , Anosmia/epidemiología , Anosmia/fisiopatología , Ataxia/epidemiología , Ataxia/fisiopatología , COVID-19/fisiopatología , Confusión/epidemiología , Trastornos de la Conciencia/epidemiología , Enfermedades de los Nervios Craneales/epidemiología , Enfermedades de los Nervios Craneales/fisiopatología , Delirio/epidemiología , Delirio/fisiopatología , Femenino , Cefalea/epidemiología , Cefalea/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Parestesia/epidemiología , Parestesia/fisiopatología , Disautonomías Primarias/epidemiología , Disautonomías Primarias/fisiopatología , Recurrencia , SARS-CoV-2 , Convulsiones/epidemiología , Convulsiones/fisiopatología , Accidente Cerebrovascular/epidemiología , Vértigo/epidemiología , Vértigo/fisiopatologíaRESUMEN
OBJECTIVE: Composite measures may better objectify hospital performance than individual outcome measures (IOM). Textbook outcome (TO) is an outcome measure achieved for an individual patient when all undesirable outcomes are absent. The aim of this study was to assess TO as an additional outcome measure to evaluate quality of care in symptomatic patients treated by carotid endarterectomy (CEA). METHODS: All symptomatic patients treated by CEA in 2018, registered in the Dutch Audit for Carotid Interventions, were included. TO was defined as a composite of the absence of 30 day mortality, neurological events (any stroke or transient ischaemic attack [TIA]), cranial nerve deficit, haemorrhage, 30 day readmission, prolonged length of stay (LOS; > 5 days) and any other surgical complication. Multivariable logistic regression was used to identify covariables associated with achieving TO, which were used for casemix adjustment for hospital comparison. For each hospital, an observed vs. expected number of events ratio (O/E ratio) was calculated and plotted in a funnel plot with 95% control limits. RESULTS: In total, 70.7% of patients had a desired outcome within 30 days after CEA and therefore achieved TO. Prolonged LOS was the most common parameter (85%) and mortality the least common (1.1%) for not achieving TO. Covariates associated with achieving TO were younger age, the absence of pulmonary comorbidity, higher haemoglobin levels, and TIA as index event. In the case mix adjusted funnel plot, the O/E ratios between hospitals ranged between 0.63 and 1.27, with two hospitals revealing a statistically significantly lower rate of TO (with O/E ratios of 0.63 and 0.66). CONCLUSION: In the Netherlands, most patients treated by CEA achieve TO. Variation between hospitals in achieving TO might imply differences in performance. TO may be used as an additive to the pre-existing IOM, especially in surgical care with low baseline risk such as CEA.
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Estenosis Carotídea/cirugía , Endarterectomía Carotidea/normas , Evaluación de Procesos y Resultados en Atención de Salud/normas , Indicadores de Calidad de la Atención de Salud/normas , Anciano , Anciano de 80 o más Años , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/mortalidad , Enfermedades de los Nervios Craneales/epidemiología , Endarterectomía Carotidea/efectos adversos , Endarterectomía Carotidea/mortalidad , Femenino , Disparidades en Atención de Salud/normas , Humanos , Ataque Isquémico Transitorio/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Readmisión del Paciente , Hemorragia Posoperatoria/epidemiología , Sistema de Registros , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline. OBJECTIVE: This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management. METHODS: A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review. RESULTS: Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately. CONCLUSION: This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.
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Conducto Auditivo Externo/microbiología , Necrosis/etiología , Otitis Externa/complicaciones , Manejo de Atención al Paciente/métodos , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Enfermedades de los Nervios Craneales/epidemiología , Enfermedades de los Nervios Craneales/etiología , Enfermedades de los Nervios Craneales/mortalidad , Progresión de la Enfermedad , Humanos , Necrosis/diagnóstico por imagen , Otitis Externa/epidemiología , Otitis Externa/patología , Evaluación de Resultado en la Atención de Salud , Guías de Práctica Clínica como Asunto , Prevalencia , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Estudios Retrospectivos , Escocia/epidemiología , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Hueso Temporal/microbiologíaRESUMEN
OBJECTIVE: To investigate the surgical effects and complications of microvascular decompression (MVD) for hemifacial spasm (HFS) based on different offending vessels, and report our surgical experience of HFS patients related to vertebral artery. PATIENTS AND METHODS: MVDs performed in Nanjing Drum Tower Hospital between January 1, 2014 and December 31, 2017 were retrospectively studied, and 1152 patients with HFS were split into two groups in accordance with the offending vessels. RESULTS: 954 patients with HFS caused by small vascular compression were classified as Group A. 849 patients got cured immediately after MVD, while delayed resolution was identified in 101 patients. 4 patients were not relieved and 4 were relapsed during the follow-up period. We observed 76 cases of delayed facial paralysis, 7 cases of hearing loss, 2 hoarseness and 3 cases of CSF leakage after surgery. In Group B, 198 patients displayed HFS associated with the vertebral artery (VA). 144 cases were spasm free after surgery and 51 patients had a delayed resolution. 3 patients were not significantly ameliorated and 2 were relapsed during the follow-up period. The major postoperative complications included facial paralysis in 28 patients, hearing loss in 4 and hoarseness and dysphagia in 3. The two groups showed no operative death. CONCLUSIONS: For the patients with HFS related to VA, the delayed cure rate and the incidence of postoperative cranial nerve complications were higher than HFS attributed to small vascular compression. And the two groups were not different in the long-term outcome and the incidence of permanent cranial nerve complications.
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Vasos Sanguíneos/patología , Espasmo Hemifacial/patología , Espasmo Hemifacial/cirugía , Cirugía para Descompresión Microvascular/métodos , Adulto , Anciano , Enfermedades de los Nervios Craneales/epidemiología , Enfermedades de los Nervios Craneales/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Recurrencia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Importance: Postviral olfactory loss is a common cause of olfactory impairment, affecting both quality of life as well as overall patient mortality. It is currently unclear why some patients are able to recover fully after a loss while others experience permanent deficit. There is a lack of research on the possible association between postviral olfactory loss and other cranial neuropathies. Objective: To evaluate the incidence of other cranial nerve deficits in patients with postviral olfactory loss and determine if there is an association with neurologic injury in this group. This study also sought to determine if other known risk factors were associated with postviral olfactory loss. Design, Setting, and Participants: A case-control study was conducted at a tertiary care rhinology clinic from January 2015 to January 2018 to review the incidence of cranial neuropathies in 2 groups of patients, those with postviral olfactory loss and those with chronic rhinosinusitis without olfactory loss used as a control group. Exposures: The Stanford Translational Research Integrated Database Environment (STRIDE) system was used for patient identification and data extraction. Patients with a history of olfactory loss or chronic rhinosinusitis as well as incidence of cranial neuropathies were identified by using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes. Main Outcomes and Measures: This study reviewed incidence of postviral or idiopathic cranial neuropathies in both patient groups, while also evaluating for any difference in demographic characteristics, comorbidities, or other patient-related factors. Results: There were 91 patients in the postviral olfactory loss group and 100 patients in the control group, which were age and sex matched as closely as possible. Of the 91 patients with postviral olfactory loss, mean (SD) age was 56.8 (15.3), and 58 (64%) were women; for the control group, the mean (SD) age was 57.5 (15.6) years, and 63 (63%) were women. Racial breakdown was similar across cases and controls, with white individuals making up 59% to 65%; Asian individuals, 20% to 24%; black individuals, approximately 3%; Hispanic individuals, approximately 1%; and the remaining patients being of other race/ethnicity. The incidence of other cranial neuropathies in the postviral olfactory loss group was 11% compared with 2% within the control group (odds ratio, 6.1; 95% CI, 1.3-28.4). The study also found 2 cases of multiple cranial neuropathies within a single patient within the olfactory group. Family history of neurologic disease was associated with more than 2-fold greater odds of cranial nerve deficit (odds ratio, 3.05; 95% CI, 0.59-15.68). Conclusions and Relevance: Postviral olfactory loss appears to be associated with a higher incidence of other cranial neuropathies. It is possible that there is an inherent vulnerability to nerve damage or decreased ability for nerve recovery in patients who experience this disease process.
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Enfermedades de los Nervios Craneales/virología , Trastornos del Olfato/virología , Rinitis/virología , Sinusitis/virología , Estudios de Casos y Controles , Enfermedades de los Nervios Craneales/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Tailandia/epidemiologíaRESUMEN
OBJECTIVES: Neurological complications of sarcoidosis are uncommon and the natural history and optimal treatments under-researched. With the advent of biological therapies, it is important to define the clinical characteristics and immunopathology of the disease. PATIENTS AND METHODS: Patients referred to and treated within the Centre for Neurosarcoidosis over a 15 year period who had biopsy proven "highly probable" disease of the central nervous system were studied prospectively. RESULTS: Corticosteroids were used effectively in all patients, immunosuppression in 79 % and TNFα antagonists in 23 %. Treatment with steroids alone inevitably led to relapse, and low dose immunosuppression was ineffective in those with severe forms of the disease. Use of biological therapies substantially improved outcome. Patients with cranial neuropathy had an excellent outcome. Those with pachymeningitis had marked radiological abnormalities but less disablement. Those with leptomeningitis had an invasive, destructive disease which responded well to treatment but with residual neurological impairments. Treatment was required for many years, but the risk of relapse following treatment withdrawal was low. Infective complications arose in six. There were two deaths, neither directly related to the neurological disease, nor its treatment. CONCLUSIONS: This prospective study of the natural history and treatment response in neurosarcoidosis provides evidence that the use of high dose immunosuppression and early and prolonged use of biological therapies is associated with greatly improved outcomes and lower mortality. The data may be used to plan further studies and treatment trials, and provide class IV evidence for the effectiveness of biological agents in the treatment of Neurosarcoidosis.
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Terapia Biológica/métodos , Enfermedades del Sistema Nervioso Central/terapia , Sarcoidosis/terapia , Corticoesteroides/uso terapéutico , Adulto , Anciano , Biopsia , Enfermedades del Sistema Nervioso Central/tratamiento farmacológico , Enfermedades del Sistema Nervioso Central/mortalidad , Terapia Combinada , Enfermedades de los Nervios Craneales/epidemiología , Enfermedades de los Nervios Craneales/etiología , Enfermedades del Nervio Facial/epidemiología , Enfermedades del Nervio Facial/etiología , Femenino , Humanos , Inmunosupresores/uso terapéutico , Masculino , Meningitis/complicaciones , Persona de Mediana Edad , Enfermedades del Nervio Óptico/epidemiología , Enfermedades del Nervio Óptico/etiología , Estudios Prospectivos , Sarcoidosis/tratamiento farmacológico , Sarcoidosis/mortalidad , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/antagonistas & inhibidoresRESUMEN
OBJECTIVE: Despite the rise of studies in the neurosurgical literature suggesting that patients with Medicaid insurance have inferior outcomes, there remains a paucity of data on the impact of insurance on outcomes after endonasal endoscopic transsphenoidal surgery (EETS). Given the increasing importance of complications in quality-based healthcare metrics, the objective of this study was to assess whether Medicaid insurance type influences outcomes in EETS for pituitary adenoma. METHODS: The authors analyzed a prospectively acquired database of EETS for pituitary adenoma from 2005 to 2018 at NewYork-Presbyterian Hospital, Weill Cornell Medicine. All patients with Medicaid insurance were identified. As a control group, the clinical, socioeconomic, and radiographic data of all other patients in the series with non-Medicaid insurance were reviewed. Statistical significance was determined with an alpha < 0.05 using Pearson chi-square and Fisher's exact tests for categorical variables and the independent-samples t-test for continuous variables. RESULTS: Of 584 patients undergoing EETS for pituitary adenoma, 57 (10%) had Medicaid insurance. The maximum tumor diameter was significantly larger for Medicaid patients (26.1 ± 12 vs 23.1 ± 11 mm for controls, p < 0.05). Baseline comorbidities including diabetes mellitus, hypertension, smoking history, and BMI were not significantly different between Medicaid patients and controls. Patients with Medicaid insurance had a significantly higher rate of any complication (14% vs 7% for controls, p < 0.05) and long-term cranial neuropathy (5% vs 1% for controls, p < 0.05). There were no statistically significant differences in endocrine outcome or vision outcome. The mean postoperative length of stay was significantly longer for Medicaid patients compared to the controls (9.4 ± 31 vs 3.6 ± 3 days, p < 0.05). This difference remained significant even when accounting for outliers (5.6 ± 2.5 vs 3.0 ± 2.7 days for controls, p < 0.05). The most common causes of extended length of stay greater than 1 standard deviation for Medicaid patients were management of perioperative complications and disposition challenges. The rate of 30-day readmission was 7% for Medicaid patients and 4.4% for controls, which was not a statistically significant difference. CONCLUSIONS: The authors found that larger tumor diameter, longer postoperative length of stay, higher rate of complications, and long-term cranial neuropathy were significantly associated with Medicaid insurance. There were no statistically significant differences in baseline comorbidities, apoplexy, endocrine outcome, vision outcome, or 30-day readmission.
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Adenoma/cirugía , Endoscopía/economía , Medicaid/estadística & datos numéricos , Procedimientos Neuroquirúrgicos/economía , Neoplasias Hipofisarias/cirugía , Hueso Esfenoides/cirugía , Adulto , Anciano , Índice de Masa Corporal , Comorbilidad , Enfermedades de los Nervios Craneales/epidemiología , Enfermedades de los Nervios Craneales/etiología , Bases de Datos Factuales , Endoscopía/métodos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales , Procedimientos Neuroquirúrgicos/métodos , Nariz , Readmisión del Paciente/economía , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Resultado del Tratamiento , Estados Unidos , Trastornos de la Visión/epidemiología , Trastornos de la Visión/etiologíaRESUMEN
Behçet's disease is a relapsing multisystemic disease. Its highest prevalence is seen along the Silk Road. While several studies reported gender disparities, others didn't. Scarce data are available about the Arabs and the gender differences detected in some ethnicities could not be applied to others. Our study aimed to detect gender differences among a cohort of adult Egyptian patients with Behçet's disease. Medical files of 255 adult patients diagnosed with Behçet's disease at the Rheumatology and Rehabilitation Department of Kasr Al-Aini Hospital, Cairo University and the Internal Medicine Department of Tanta University, between 2002 and 2018, were retrospectively reviewed. The demographic features, the cumulative clinical features, the use, if any, of an intravenous pulse of methylprednisolone and immunosuppressive/biological drugs, and the frequency of the cumulative damage to the different organ systems were described. The disease severity score was calculated as well. The study revealed a prominent male predominance; the male to female ratio was 6.7:1. Acne/pseudofolliculitis was more common in males (28.6% vs 13.2%, p=0.046); the same was observed regarding any vascular involvement and peripheral venous disease (36.3% vs 18.4%, p=0.03 and 30.4% vs 13.2%, p=0.03, respectively). On the other hand, encephalitis and cranial nerve lesions were more prevalent in females (15.8% vs 6%, p=0.03 and 10.5% vs 3.2%, p=0.04, respectively). Severe Behçet's disease equally affects Egyptian males and females. BD should not be considered a benign disease in Egyptian females. The same quality of medical care should be equally offered to both genders.
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Síndrome de Behçet/epidemiología , Acné Vulgar/epidemiología , Adulto , Edad de Inicio , Síndrome de Behçet/tratamiento farmacológico , Enfermedades de los Nervios Craneales/epidemiología , Diagnóstico Tardío/estadística & datos numéricos , Egipto/epidemiología , Encefalitis/epidemiología , Femenino , Foliculitis/epidemiología , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Distribución por Sexo , Enfermedades Vasculares/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Skull base chordomas (SBCs) are rare clinically aggressive neoplasms, developing local recurrences after surgical resection. Although SBCs have traditionally been resected by craniotomy or microscopic transsphenoidal surgery (TSS), the recent development of the endoscopic endonasal approach (EEA) has revolutionized treatment strategies through minimally invasive techniques. This study aimed to evaluate clinical outcomes after traditional microsurgeries or EEAs for SBCs. METHODS: The present retrospective study investigated 66 patients with primary SBCs who underwent surgery between 1977 and 2019. Resection was performed via EEA in 17 cases, craniotomy in 23, transoral approach in 8, TSS in 12, staged surgery in 4, and others in 2. The median follow-up period for progression-free survival (PFS) was 19.5 months. RESULTS: There were no significant differences in preoperative tumor volume or resection rate among these approaches. The incidence of postoperative cranial nerve palsy was significantly lower in EEA than that in craniotomy (P < 0.05). Although total resection was observed in 4 cases of EEA expanding into the superior and inferior part of the clivus, no cases of transoral approach or TSS achieved total resection for both parts. No significant difference in PFS was found among these approaches. Multivariate analysis showed that being female and the absence of radiotherapy were significantly associated with shorter PFS (P < 0.05 and P < 0.001, respectively). The resection rate was not associated with PFS. CONCLUSIONS: EEA is a less invasive surgical approach for SBCs. The development of surgical instruments and postoperative radiotherapy will further improve patients' outcomes.
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Cordoma/cirugía , Craneotomía/métodos , Microcirugia/métodos , Neuroendoscopía/métodos , Neoplasias de la Base del Cráneo/cirugía , Adolescente , Adulto , Anciano , Pérdida de Líquido Cefalorraquídeo/epidemiología , Niño , Cordoma/patología , Enfermedades de los Nervios Craneales/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Boca , Cavidad Nasal , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/epidemiología , Supervivencia sin Progresión , Estudios Retrospectivos , Neoplasias de la Base del Cráneo/patología , Carga Tumoral , Adulto JovenRESUMEN
Tentorial meningiomas (TMs) may challenge the surgeon with their close association to neurovascular structures. We analyzed a consecutive series with regard to surgical and functional outcome following microsurgical resection. We retrospectively reviewed patient charts and imaging data of every patient with a TM resected at a single institution and compared surgical and functional outcomes between groups stratified by choice of approach. 57 consecutive patients from October 2006 to September 2017 were included, of which 75.4% were female; mean age was 60 years (range 31-90), follow-up data was available for 85.4% and reached a mean of 18.3 (range 2-119) months with a median of 14.5 months. 54.4% of TMs were located at the medial compartments of the tentorium, 45.6% at the lateral edges. Complete resection defined as Simpson grades I and II was achieved in 72% of all cases, without statistically significant differences for both subgroups (p = 0.532). 9 patients (15.8%) developed a new cranial nerve palsy postoperatively with the vestibulocochlear nerve affected exclusively in the lateral subgroup (8.8% of total), followed by disturbances of oculomotion (5.4%). After 12 months, 93.0% of patients with available follow-up after 12 months retained fully independent functional status without deficit. Despite providing a surgical challenge due to potentially complicated anatomical relations, the choice of an appropriate surgical strategy overall results in favourable oncological and functional outcome after resection of TMs.