Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder.

BACKGROUND: Receiving information that one has a dissected cervical artery, which can cause a stroke at any time, is obviously traumatic, but details about the psychiatric and psychosocial sequelae are not known. We investigated the prevalence of and risk factors for posttraumatic stress disorder (PTSD) in patients with spontaneous cervical artery dissection (CD) and the impact of PTSD on their psychosocial functioning. METHODS: Patients admitted because of CD between 2006 and 2010 were retrospectively examined using a diagnostic PTSD measure (Posttraumatic Diagnostic Scale). Patients between 2011 and 2012 were examined prospectively. To identify potential predictors for PTSD, we examined all patients' stress coping strategies (brief COPE inventory), anxiety and depression (Hospital Anxiety and Depression Scale), impairment by preventive medication, time since diagnosis and their neurologic (modified Rankin Scale) and cognitive status. To identify the psychosocial impact of PTSD, we examined quality of life (Short-Form 36). RESULTS: Data of 47 retrospectively contacted patients and 15 prospectively examined patients were included. Twenty-eight patients (45.2%) met the diagnostic criteria for PTSD. A significantly reduced health-related quality of life (HRQoL) was found in 27 patients (43.5%) for mental health and in 8 patients (12.9%) for physical health. Results of logistic regression analysis revealed that the use of maladaptive coping strategies was predictive of the disorder (P < .0001). Age, sex, mRS score, impairment caused by medication, and time since diagnosis were not predictive for PTSD. The presence of PTSD itself was the only significant predictor for reduced mental HRQol (P = .0004). Age, sex, mRS score, impairment caused by medication, and total Hospital Anxiety and Depression Scale score were not predictive for reduced mental HRQoL. CONCLUSIONS: PTSD seems to occur frequently in patients with CD and is associated with reduced mental HRQoL. Because the presence of a maladaptive coping style is correlated with PTSD, teaching patients better coping skills might be helpful.

Lumbar catheter for monitoring of intracranial pressure in patients with post-hemorrhagic communicating hydrocephalus.

BACKGROUND: We investigated the feasibility and accuracy of intracranial pressure (ICP)-measurement by lumbar drainage (LD) catheter in patients with post-hemorrhagic communicating hydrocephalus (PHCH). METHODS: Patients with subarachnoid hemorrhage (SAH, n = 21) or spontaneous ganglionic hemorrhage (ICH, n = 22) with ventricular involvement and the need for external ventricular drainage (EVD) due to acute hydrocephalus were included. When EVD weaning was not feasible due to persistent hydrocephalus, an additional LD was placed, after which EVD was clamped off. During this overlap period, patients underwent simultaneous pressure recording via EVD ("EVD-ICP") and LD ("LD-ICP"). Testing included manual compression of the jugular veins and body-posture changes from supine to 30° position. After EVD removal, we evaluated sensitivity and specificity of ICP-rise >20 mmHg during continuous monitoring via LD for the detection of persistent PHCH using additional evaluation with computed tomography (CT). RESULTS: A total of 1,806 measurements were performed in 43 patients. "LD-ICP" was strongly correlated to "EVD-ICP", with determination coefficients R(2) for the baseline measurements and each of the maneuvers ranging from 0.95-0.99, and slopes ranging 0.96-1.01. Sensitivity of "LD-ICP" >20 mmHg for detection of persistent PHCH as compared to CT was 81% and specificity was 100%. Two patients with severe SAH developed reversible signs of herniation after gradually increasing differences between "LD-ICP" and "EVD-ICP" indicated a cranio-spinal pressure gradient, likely due to cerebrospinal fluid overdrainage via LD. CONCLUSION: ICP measured via LD highly and reliably correlated to ICP measured via EVD in patients with PHCH.

Altered tactile localization and spatiotemporal integration in complex regional pain syndrome patients.

BACKGROUND: In complex regional pain syndrome (CRPS), altered perception of the affected hand and neglect-like symptoms of the affected body side are common features. In this study, we presented tactile stimuli to the affected hands in CRPS patients and matched healthy controls. METHODS: The participants' task was to point at the perceived positions of the stimuli using a tracking device. The spatial coordinates of the perceived positions were analysed for accuracy and consistency. We also presented patterns consisting of two stimuli at distinct positions with a delay of 100 ms. These patterns are known to induce spatiotemporal integration ("sensory saltation"). RESULTS: CRPS patients were less accurate and less consistent in the spatial perception of tactile stimuli on their hands. Furthermore, they showed increased spatiotemporal integration, although these effects were smaller than expected. These deficiencies were related to the clinically assessed intensity of recurrent pain episodes. Surprisingly, the intensity of clinically assessed ongoing pain was associated with increased precision. CONCLUSIONS: In line with earlier reports, our findings indicate that the representation of the affected hands in CRPS patients is less accurate than in healthy people, probably reflecting reorganization in somatosensory cortices. The exact relationships between these findings and other aspects of CRPS remain to be elucidated. SIGNIFICANCE: CRPS patients performed poorly in localizing positions on their affected hands via pointing and exhibited increased spatiotemporal integration. The presented method may prove useful in diagnostics as well as psychophysical and neurofunctional research on CRPS and other chronic pain disorders.

Early recognition of lumbar overdrainage by lumboventricular pressure gradient.

BACKGROUND: Lumbar drainage (LD) represents a promising treatment strategy for prevention of vasospasm after aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE: To report on transient herniation caused by lumbar overdrainage in 3 patients with severe SAH who were treated with early LD within an ongoing feasibility study. METHODS: Patients with first-time aneurysmal SAH received LD within 72 hours of symptom onset, after aneurysm clipping or coiling. LD, with a target drainage amount of 5 to 10 mL, was continued for 6 to 9 days. External ventricular drainage (EVD) was begun on admission when hydrocephalus was present. With both catheters in place, intracranial pressure (ICP) and lumbar pressure (LP) were monitored simultaneously. RESULTS: Three of 22 patients developed a progressive lumboventricular pressure gradient, likely due to cerebrospinal fluid (CSF) overdrainage. Two patients showed signs of herniation. Clamping of LD resulted in complete reversal of symptoms in those patients. The lumboventricular pressure gradient began to evolve at least 12 hours before clinical symptoms developed, and gradually disappeared in all 3 patients after LD clamping. CONCLUSION: Lumbar overdrainage should be avoided in severe SAH, and lumboventricular pressure measurement may be a useful monitoring tool. Herniation due to lumbar overdrainage is a feared complication that can be avoided by following a strict LD management protocol.