Blood pressure variability and prognosis in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.

INTRODUCTION: The subarachnoid hemorrhage due to a ruptured brain aneurysm is a neurological emergency with high mobility and mortality. Hypertensive states are related to a bad prognosis and a higher risk of a ruptured aneurysm. However, the relationship between the blood pressure variability with the aneurysmal subarachnoid hemorrhage and its prognosis is quite unknown. EVIDENCE ACQUISITION: A systematic review was performed across the databases. The following descriptors and related were used for the search: blood pressure, arterial pressure, variability, subarachnoid hemorrhage, hemorrhage, aneurysmal, aneurysmal subarachnoid hemorrhage. The following data were extracted: Glasgow Outcome Scale or Modified Rankin Scale, and blood pressure variabilities to categorize the prognosis. EVIDENCE SYNTHESIS: Five studies were selected. The blood pressure variability and the related outcome were assessed by mean systolic blood pressure and minimum systolic blood. The meta-analysis of mean systolic blood pressure (cut-off >95.3 mmHg) showed an odds ratio of 11.23 (95% CI: 4.423 to 28.537) (P≤0.001), predicting the good outcome after the aneurysmal subarachnoid hemorrhage. The pooled analysis revealed AUC of the ROC predicting the good outcome was statistically significant (AUC: 0.85, P<0.001). The pooled data analysis of minimum systolic blood pressure revealed an odds ratio of 6.43 (95% CI: 2.834-14.589, P<0.001) and AUC of the pooled ROC 0.931 (95% CI: 0.851 to 1.000, P<0.001) to predict poor outcome. The funnel plot through Egger's test for the analysis showed different grades of asymmetry. CONCLUSIONS: The blood pressure variability (mean and minimum systolic blood pressure) is a good predictor and parameter in the aneurysmal subarachnoid hemorrhage prognosis and outcome prediction.

An update of predictors of cerebral infarction after aneurysmal subarachnoid hemorrhage: systematic review and meta-analysis.

INTRODUCTION: Evidence about predictors of poor outcomes such as cerebral infarction (CI) after aneurysmal subarachnoid hemorrhage (aSAH) has not been fully elucidated. EVIDENCE ACQUISITION: We performed a systematic review and meta-analysis on studies with adults with aSAH considering RCT and non-RCT, prospective, and retrospective cohort studies describing clinical, imaging as well as angiographic studies in patients with aSAH. EVIDENCE SYNTHESIS: After reviewing the complete text, 11 studies were considered eligible, out of which four were ruled out. Degree of clinical severity was the most predictive factor with a higher degree at the presentation on different severity scales being associated with a statistically significant increasing the risk of suffering a CI following aSAH (OR 2.49 [95% CI 1.38-4.49] P=0.0003). Aneurysm size increased the risk of CI (OR 1.49 [95% CI 1.20-1.85] P=0.0003; I2=4%). In six studies analyzed, it was found that an important factor for the subsequent development of CI is vasospasm (OR 7.62 [2.19, 26.54], P=0.0001). CONCLUSIONS: The development of vasospasm is a risk factor for CI development after aSAH. In our review, three factors were associated with an increased risk of CI: clinical severity at presentation, vasospasm, and aneurysm size. The major limitation of this meta-analysis is that included studies were conducted retrospectively or were post hoc analyses of a prospective trial.

Pulmonary injury as a predictor of cerebral hypoxia in traumatic brain injury: from physiology to physiopathology.

Traumatic brain injury is caused by mechanical forces impacting the skull and its internal structures and constitutes one of the main causes of morbidity and mortality in the world. Clinically, severe traumatic brain injury is associated with the development of acute lung injury and so far, few studies have evaluated the cellular, molecular and immunological mechanisms involved in this pathophysiological process. Knowing and investigating these mechanisms allows us to correlate pulmonary injury as a predictor of cerebral hypoxia in traumatic brain injury and to use this finding in decision making during clinical practice. This review aims to provide evidence on the importance of the pathophysiology of traumatic brain injury-acute lung injury, and thus confirm its role as a predictor of cerebral hypoxia, helping to establish an appropriate therapeutic strategy to improve functional outcomes and reduce mortality.

[¿Conflictos de intereses ocultos en publicaciones científicas en tiempos de COVID-19?]

Hemos leído con sumo interés el artículo publicado por Diéguez-Campa, et al.1, titulado The 2020 research pandemic: a bibliometric analysis of publications on COVID-19 and their scientific impact during the first months, en el que los autores hacen un excelente e innovador análisis bibliométrico sobre la publicación científica médica en los primeros meses de desarrollo de la pandemia de COVID-19.

Achenbach's syndrome: a rare condition.

Achenbach's syndrome corresponds to a pathology characterized by the appearance of ecchymoses and bruises on the fingers of the hands and eventually on the feet. It is a benign and self-limited disease, which is accompanied by pain. It generates great concern because its sudden appearance leads women who are the most affected to consult the emergency services. At present, its pathophysiology is unknown and requires knowledge of the disease to diagnose it. It is a must for poorly trained professionals.

Post Music Session Real-Time EEG Changes in Patients who Underwent Neurosurgical Intervention for Neuronal Dysfunction.

Music is universal and is present in all cultures and capable of conveying emotions irrespective of verbal content. The present study was conducted to understand the impact of music on brain with real-time monitoring of EEG changes in patients with moderate-to-severe neuronal dysfunction. In this prospective study, adult patients who had brain trauma and unconscious were considered for the study. Two different music pieces were selected to give music experience. One is Revathi raga with Upanishads' stands. Another is Ragamalika, an instrumental music piece comprising various Carnatic ragas. For EEG recording, electrode montage was done according to international 10-20 system. After music experience, again EEG recording was done without music. Comparison of EEG activity during different musical pieces was not considered. A total of six adults were studied. During the time of music session, there was no change in the EEG at other channels, but at T6 electrode, EEG did not have the arc like fast theta. That fast theta was disappeared in T6 electrode and it was suppressed like a contralateral sided electrode. After the music session (post music session), the EEG is back to baseline, but the temporal arc like fast theta speed was decreased (2-4 seconds per page). In this case series, we observed that in one case, there was appearance of slow activity in EEG. However, there is a need for larger studies to confirm these findings.

Prognostic Value of Age and Early Magnetic Resonance Imaging in Patients with Cervical Subaxial Spinal Cord Injuries.

BACKGROUND AND OBJECTIVE: The predictive role of a patient's age in spinal cord injury (SCI) is still unclear given the coexistence of potential confounding factors, whether clinical or radiological. Thus, it is the aim of this work to assess the prognostic role of a patient's age against initial radiological features in a traumatic cervical SCI population. METHODS: Clinical and radiological data from patients with acute traumatic cervical SCI and a first MRI performed within 48 h of trauma were retrospectively reviewed. Patients were dichotomized according to the length intramedullary lesion, and associations between age and other clinical or radiological prognostic variables were analyzed. The receiver-operating characteristic (ROC) curve was used to test the discriminative capacity of the patient age to predict neurological and functional outcomes. Poor functional outcome was defined as a Walking Index Spinal Cord Injury score <1 and poor neurological outcome as the lack of neurological improvement between admission and follow up. RESULTS: 134 patients fulfilled the inclusion criteria and were analyzed. The mean age was 43 years, with a male/female ratio of 4:1. polytrauma and soft tissue injuries were inversely proportional to patient age (P < 0.001). A critical value of 55-year-old was established as a threshold for determining poor functional and neurological outcomes. Across the group of patients with minor intramedullary lesions, older age was correlated with poor functional and neurological outcomes (P < 0.001 and P = 0.04, respectively). CONCLUSIONS: Patient age is an important prognostic factor in patients with traumatic cervical SCI. Fifty-five years is the critical cutoff associated with poor prognostic outcome.

The Prion-like Properties of Amyloid-beta Peptide and Tau: Is there Any Risk of Transmitting Alzheimer's Disease During Neurosurgical Interventions?

Recent studies have recognized similarities between the peptides involved in the neuropathology of Alzheimer's disease and prions. The Tau protein and the Amyloid ß peptide represent the theoretical pillars of Alzheimer's disease development. It is probable that there is a shared mechanism for the transmission of these substances and the prion diseases development; this presumption is based on the presentation of several cases of individuals without risk factors who developed dementia decades after a neurosurgical procedure. This article aims to present the role of Aß and Tau, which underlie the pathophysiologic mechanisms involved in the AD and their similarities with the prion diseases infective mechanisms by means of the presentation of the available evidence at molecular (in-vitro), animal, and human levels that support the controversy on whether these diseases might be transmitted in neurosurgical interventions, which may constitute a wide public health issue.

Usefulness of 24-hour ambulatory blood pressure monitoring in a population with high cardiovascular risk.

BACKGROUND: High blood pressure is considered a disease and at the same time a cardiovascular risk factor, mainly involved in ischemic heart disease, cerebrovascular disease and kidney failure, causing high mortality worldwide. OBJECTIVE: The objective was to follow up with 24-hour ambulatory blood pressure monitoring in patients with high blood pressure belonging to a population with high cardiovascular risk. METHOD: Descriptive, observational, retrospective study, which analyzes 24-hour outpatient pressure controls of 1858 patients, in Cartagena, Colombia. RESULTS: 1173 exams were validated and included in the study. The median age was 66 years. 66.8% (783) were women and 33.2% (390) were men. The main changes occurred during the night, when 79.1% of the patients had high systolic pressure loads, 65.6% recorded diastolic pressure averages and 83.7% had abnormal circadian patterns. Only 11% of the studies were normal in all parameters. CONCLUSIONS: 24-hour ambulatory blood pressure monitoring proved to be a useful tool to identify uncontrolled hypertensive patients, detect nocturnal hypertension and abnormal circadian patterns, which are risk markers for cardiovascular morbidity and mortality.

ANTECEDENTES: La hipertensión arterial es considerada una enfermedad y al mismo tiempo un factor de riesgo cardiovascular, involucrada principalmente en la cardiopatía isquémica, la enfermedad cerebrovascular y la insuficiencia renal, causando una elevada mortalidad. OBJETIVO: Realizar seguimiento con monitoreo ambulatorio de la presión arterial de 24 horas en pacientes con hipertensión arterial pertenecientes a una población con alto riesgo cardiovascular. MÉTODO: Estudio descriptivo, observacional, retrospectivo, en el que se analizaron los monitoreos ambulatorios de presión de 24 horas de 1858 pacientes, en Cartagena, Colombia. RESULTADOS: Se incluyeron 1173 registros. La mediana de edad fue de 66 años. El 66.8% (783) fueron mujeres y el 33.2% (390) fueron hombres. Las principales alteraciones ocurrieron durante la noche, cuando el 79.1% de los pacientes tuvieron cargas elevadas de presión sistólica, el 65.6% registraron promedios elevados de presión diastólica y el 83.7% tuvieron patrones circadianos anormales. Solo el 11% de los estudios fueron normales en todos los parámetros. CONCLUSIONES: El monitoreo ambulatorio de la presión arterial de 24 horas demostró ser una herramienta útil para identificar a los pacientes hipertensos no controlados, detectando hipertensión nocturna y patrones circadianos anormales, los cuales son marcadores de riesgo para morbilidad y mortalidad cardiovascular.

Refractory traumatic intracranial hypertension: the role of decompressive craniectomy.

Traumatic brain injury according to the World Health Organization estimates that by 2020 will be the third leading cause of morbidity and mortality worldwide. Intracranial hypertension refractory to medical management is the cause of increased mortality in neurotrauma. There are various measures to control intracranial hypertension, including surgical. Decompressive craniectomy has been routinely used to treat intracranial hypertension secondary to cerebral infarction, subarachnoid hemorrhage, intracerebral hemorrhage and trauma. We review the literature to describe the mechanisms, types and indications for this procedure.

El trauma craneoencefálico, según la Organización Mundial de la salud, se estima que para el año 2020 será la tercera causa de morbimortalidad en el mundo. La hipertensión intracraneal refractaria al manejo médico es la causante de la mayor mortalidad en esta población de pacientes. Existen diversas medidas para el control de la hipertensión intracraneal, entre ellas las quirúrgicas. La craniectomía descompresiva ha sido utilizada sistemáticamente para tratar la hipertensión intracraneal secundaria al infarto cerebral, la hemorragia subaracnoidea, la hemorragia intracerebral y el trauma. Se hace una revisión de la literatura para describir los mecanismos fisiopatológicos de la lesión cerebral traumática, así como también los tipos y las indicaciones de este procedimiento.

Ventriculitis associated with extraventricular drainage: etiology, diagnosis and treatment focused on neurocritic care units.

Ventriculitis after extraventricular drainage is a very important neurosurgical complication in neurocritical care units. It is necessary to make an early diagnosis, given that the morbidity and mortality secondary to it can be variable, and complicate the evolution of neurocritical patients. Despite this, ventriculostomy continues to be an important pillar in monitoring and treatment. Given the urgency of ventriculitis associated with multiresistant germs, new antimicrobial drugs have emerged as part of the treatment, as intraventricular routes have been proposed within the new investigations. However, the foregoing does not yet have sufficient bases to be able to support it. The present review was carried out with the aim of contributing to an early diagnosis and treatment of ventriculitis associated with extra ventricular drainage in neurocritical patients, and in this way to contribute to improve survival and prevent fatal outcomes in these patients.

La ventriculitis posterior a un drenaje extraventicular constituye una complicación neuroquirúrgica muy importante en las unidades de cuidados neurocríticos. Se hace necesario realizar un diagnóstico precoz, dado que la morbimortalidad secundaria a esta puede ser variable y complicar la evolución de los pacientes neurocríticos. A pesar de esto, la ventriculostomía continúa siendo un pilar importante en el monitoreo y el tratamiento. Ante la urgencia de ventriculitis asociadas a gérmenes multirresistentes han surgido nuevos fármacos antimicrobianos como parte del tratamiento, al igual que se han propuesto vías intraventriculares dentro de las nuevas investigaciones. Sin embargo, lo anterior aún no tiene bases suficientes para poder ­sustentarlo. La presente revisión se realizó con el objetivo de contribuir a un diagnóstico precoz y al tratamiento de la ventriculitis asociada a drenaje extraventricular en pacientes neurocríticos, y de esta forma poder mejorar la sobrevida y prevenir desenlaces fatales en estos pacientes.