Retrospective Evaluation of Patients with Spontaneous Intracerebral Hematomas

AIM: To investigate the relationship among the modified Rankin scores of patients who had intracerebral hematomas at discharge, demographic characteristics of the patients, and the characteristics of the hematoma. MATERIAL AND METHODS: In this study, patients diagnosed with intracerebral hematoma and treated at the Ministry of Health Ankara Training and Research Hospital Neurosurgery Clinic between January 2010 and December 2020 were examined retrospectively. The age, gender, comorbidity, anticoagulant?antiaggregant use, and Glasgow Coma Scale score of the patients were obtained from hospital records. The modified Rankin scale (mRS) was used to assess patients at discharge. RESULTS: Herein, a total of 114 patients with supratentorial intracerebral hematoma were evaluated. The modified Rankin score ranged from 0 to 6, with a mean score of 3.47 ± 2.26. When the patients were evaluated based on their discharge status, the mortality rate was 33.3% (n=38). Fifty percent of the patients who used anticoagulant?antiaggregant died. High mRS scores were seen more frequently in advanced age. Among the other diseases of the patients, hypertension and the use of anticoagulant? antiaggregant were found to be statistically significant with high mRS scores (p < 0.001). Patients with low Glasgow Coma Scale score at the time of admission had significantly higher mRS scores (p < 0.001). CONCLUSION: Patients with advanced age, hypertension, and anticoagulant?antiaggregant use had a higher mRS score after hematoma formation. Preventable risk factors for spontaneous intraparenchymal hematomas are among the leading causes of disability, and early detection and treatment of underlying diseases are critical for hematoma prevention. Awareness about risk factors should be the priority to improve early diagnosis and reduce treatment disability rates.

The Comparison of Autologous Bone, Methyl-Methacrylate, Porous Polyethylene, and Titanium Mesh in Cranioplasty.

AIM: To discuss four different materials that are frequently used in cranioplasty, and to reveal their advantages and disadvantages. MATERIAL AND METHODS: We retrospectively reviewed 85 of our cranioplasty surgeries between 2016 and 2019. Reconstruction surgeries were excluded from our study due to craniofacial trauma. RESULTS: Of the materials used in cranioplasty, 33 are autologous bone, 32 are methyl-methacrylate, 12 are porous polyethylene, and 8 are titanium mesh. Complications developed in 16 patients. Of these, 10 are infection, 3 are flap collapse, 2 are wound healing disorders, and 1 is reactive effusion complications due to the used material. The highest complication rate was 21.9% in cranioplasty with methyl-methacrylate. No major complications were observed in cranioplasty with titanium mesh. CONCLUSION: Cranioplasty, which are among the surgeries with high complications in neurosurgery, maintain their importance today. As technology is developed and cost problems are resolved, cranioplasty takes its place among the safer and standard neurosurgical operations.

Healthcare personnel's attitude and coverage about tetanus vaccination in Turkey: a multicenter study.

The tetanus vaccine is not routinely given to Turkish adults. Protective tetanus immunity decreases with age. Health-care personnel (HCPs), who are role models in the field of health, are a target group in order to achieve a higher rate of tetanus vaccination in the community. This study was designed to evaluate attitudes and coverage regarding tetanus vaccination among a large sample of Turkish HCPs. This cross-sectional epidemiologic study was conducted from July to August 2019. A questionnaire was sent to HCPs using social media. Of the 10,644 HCPs included in the study, 65% were female. Overall, the tetanus vaccination coverage (TVC) among HCPs was 78.5% (95% CI: 77.7%-79.3%). TVC was significantly higher among physicians [83.4% (95% CI: 82%-84.6%); p < .001] compared with all other HCPs except nurses. Older age (≥40 years) and length of professional experience were significantly correlated with TVC. Of the 8353 HCPs who received tetanus vaccines during their lifetime, 73.03% received tetanus vaccination in the past 10 years. The self-vaccination rate for protection against tetanus was 13.1%. Acute injuries (25.42%) and pregnancy (23.9%) were the most common reasons for having the tetanus vaccine. One-third (33.7%) of HCPs did not have information about whether pregnant women could receive tetanus vaccinations. This survey study provided excellent baseline information about HCPs' coverage rates and attitudes regarding tetanus vaccination. The present results suggested that tetanus boosters for HCPs should be established as soon as possible, and revealed that the HCPs younger than 30 years with relatively less professional experience and all other HCPs except nurses and physicians should be identified as the target population for future intervention programs.

The Role of Cerebrospinal Fluid Biomarkers in the Diagnosis of Post-Neurosurgical Meningitis.

AIM: To measure cytokine and lactate levels in the cerebrospinal fluid (CSF) of patients with suspected post-neurosurgical meningitis. MATERIAL AND METHODS: Interleukin (IL)-8,-12, and -13, interferon (IFN) gamma, and lactate concentrations were determined in the CSF of patients diagnosed with meningitis, who were undergoing follow-up after neurosurgical procedures at the Neurosurgery Clinic between May 2016 and November 2017. The demographic, clinical, biochemical, CSF cell count, CSF biochemistry, and CSF culture results of 119 patients were recorded. RESULTS: The study group consisted of 39 patients diagnosed with post-neurosurgical meningitis. The control group comprised of 80 patients without pleocytosis, who had undergone lumbar puncture due to various indications. In the study group, 59% of the patients had fever, 66.7% had deterioration in the level of consciousness, and 35.9% had neck stiffness. The levels of IL-8 (96.5 ng/L vs. 86.6 ng/L, p < 0.001), IL-12 (10.1 ng/L vs. 3 ng/L, p < 0.001), and lactate (5.9 mmol/L vs. 2.1 mmol/L, p < 0.001) were higher in the CSF of the patient group compared to the control group. However, IL-13 (32.7 ng/L vs. 42.5 ng/L, p=0.003) and IFN gamma (73.3 ng/L vs. 260.4 ng/L, p < 0.001) levels were lower in patients compared to controls. The mortality rate in post-neurosurgical meningitis patients was estimated to be 35.9%. CONCLUSION: Post-neurosurgical meningitis prolongs the duration of hospital stay and causes long-term sequelae. Therefore, measurement of CSF cytokine and lactate levels alongside meningitis diagnostic processes may facilitate early and accurate diagnosis. Measuring CSF lactate is inexpensive and cost effective, particularly in post-neurosurgical patients.

The Effect of Alpha Lipoic Acid on Cerebrospinal Fluid Biochemistry and Brain Edema After Experimental Traumatic Brain Injury.

AIM: To investigate the effect of alpha lipoic acid on cerebrospinal fluid (CSF) osmolarity and brain tissue water ratio in a rabbit model of traumatic brain injury. MATERIAL AND METHODS: Using a previously established model of traumatic brain injury using liquid nitrogen, 36 New Zealand rabbits were randomized into six groups (three treatment groups, a no trauma/no treatment group, a trauma/no treatment group, and a no trauma/treatment group). The treatment groups were administered intravenous alpha lipoic acid at different times of the experiment. Cerebrospinal fluid was obtained 96 hours after injury/treatment via cisterna magna puncture; glucose, blood urea nitrogen, and sodium levels were measured and osmolarity was calculated. Brain tissue water ratio was determined using wet and dry brain weights. The therapeutic effect of alpha lipoic acid was evaluated by comparing cerebrospinal fluid osmolarity and brain tissue water ratio between study groups. RESULTS: Based on cerebrospinal fluid osmolarity values, alpha lipoic acid treatment effectiveness was greatest in the group that received 3 doses after trauma. CONCLUSION: Alpha lipoic acid is effictive in the treatment of brain edema after experimental traumatic brain injury.

Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarct.

AIM: Decompressive hemicraniectomy for a malignant middle cerebral artery infarct can be a life-saving surgical treatment. We aimed to investigate the surgical treatment results in cases that underwent decompressive hemicraniectomy for a malignant middle cerebral artery infarct in this study. MATERIAL AND METHODS: The clinical condition, radiological findings and surgical treatment results of 42 cases that underwent decompressive hemicraniectomy for a malignant middle cerebral artery infarct were retrospectively evaluated in this study. RESULTS: There were 19 males and 23 females. The age range was 27 to 78 years with a mean age of 57.6 years. The infarct area was the non-dominant hemisphere in 20 cases and the dominant hemisphere in 22 cases. Preoperative Glasgow coma scale (GCS) scores were 5 to 12. The 42 cases with a malignant middle cerebral artery infarct were divided into 2 groups according to the Glasgow outcome scale (GOS) as the unfavorable outcome group (Group 1) with a score of 1 to 3 and the favorable outcome group with a score of 4 to 5 (Group 2). There were 27 cases in Group 1 and 15 in Group 2. There was a statistically significant association between a good result and age, Glasgow coma scale at the time of surgery, duration until surgery, and non-dominant hemisphere involvement. All cases with a Glasgow coma scale score of 7 or below had a poor outcome. CONCLUSION: Decompressive hemicraniectomy in malignant middle cerebral artery infarct can be a life-saving procedure but is not useful in cases with a Glasgow coma scale score of 7 and below.

The Biochemical, Histopathological and Clinical Comparison of the Neuroprotective Effects of Subcutaneous Adalimumab and Intravenous Methylprednisolone in an Experimental Compressive Spinal Cord Trauma Model.

AIM: To evaluate the neuroprotective effects of adalimumab in an experimental spinal cord injury model and compare them with those of the widely-used methylprednisolone. MATERIAL AND METHODS: Forty male Wistar rats were divided into 5 as the sham, trauma, adalimumab, methylprednisolone, and adalimumab+methylprednisolone groups. Only laminectomy was performed in the sham group. Laminectomy and trauma was performed to the trauma group but no treatment was given. A single dose of 40 mg/kg subcutaneous adalimumab was administered after the laminectomy and trauma to group 3. A single dose of intravenous 30 mg/kg methylprednisolone was administered right after laminectomy and trauma to group 4. Single doses of 40 mg/kg adalimumab and 30 mg/kg methylprednisolone were administered together after laminectomy and trauma to group 5. Serum malondialdehyde (MDA), TNF-α, IL-1ß and IL-6 levels were measured and sections were obtained for histopathological study at the end of the 7 < sup > th < /sup > day. RESULTS: MDA, TNF-α, IL-1ß and IL-6 levels in serum were significantly decreased in the adalimumab group with clinical and histopathological improvement not less than the methylprednisolone group. The serum MDA levels were similar when the two drugs were given together or separately but there was a statistically quite significant decrease in TNF-α, IL-1ß and IL-6 levels with concurrent use. Statistically significantly better results were obtained on histopathological evaluation with the use of both drugs together. CONCLUSION: This study revealed that adalimumab is as effective as methylprednisolone in compressive spinal cord injury in rats.