Permeability of the Blood-Brain Barrier after Traumatic Brain Injury: Radiological Considerations.

Traumatic brain injury (TBI) is a leading cause of death and disability, especially in young persons, and constitutes a major socioeconomic burden worldwide. It is regarded as the leading cause of mortality and morbidity in previously healthy young persons. Most of the mechanisms underpinning the development of secondary brain injury are consequences of disruption of the complex relationship between the cells and proteins constituting the neurovascular unit or a direct result of loss of integrity of the tight junctions (TJ) in the blood-brain barrier (BBB). A number of changes have been described in the BBB after TBI, including loss of TJ proteins, pericyte loss and migration, and altered expressions of water channel proteins at astrocyte end-feet processes. There is a growing research interest in identifying optimal biological and radiological biomarkers of severity of BBB dysfunction and its effects on outcomes after TBI. This review explores the microscopic changes occurring at the neurovascular unit, after TBI, and current radiological adjuncts for its evaluation in pre-clinical and clinical practice.

Derivation of a Clinical Score for Prediction of Recurrence Following Evacuation of Chronic Subdural Hematoma: A Retrospective Cohort Study at a National Referral Centre.

BACKGROUND: Chronic subdural hematoma (cSDH) is a common pathology, and recurrence is a common complication, which may be predicted by certain patient and radiologic factors. Empiric radiologic surveillance has been shown to convey no benefit. METHODS: A retrospective review of a prospectively collated database was performed. Preoperative and postoperative noncontrast computed tomography scans were reviewed. Radiologic appearance, preoperative hematoma volume, patient age, presence of bilateral hematomas, maximal hematoma thickness, and therapeutic coagulopathy were assessed as predictors. Receiver operating characteristic curve analysis, logistic regression, and LASSO regression were used to select potential predictors. A multivariate model was then fitted, and a score was derived. RESULTS: A total of 142 patients were included. Maximal hematoma thickness >12 mm (P = 0.02) and age >65 years (P = 0.01) were found to correlate with the likelihood of recurrence. Bilateral hematomas and a hyperdense or mixed density appearance were also identified on LASSO regression. Bilateral hematomas (P = 0.19), hyperdense or mixed density (P = 0.66), maximum thickness >12 mm (P = 0.01), and age >65 years (P = 0.02) were included in the multivariate model. A 6-point score was derived. A score of >3 had a sensitivity of 89% (95% confidence interval [CI] 78%-97%) and specificity of 26% (95% CI, 17%-34%) for predicting recurrence, with recurrence significantly more likely in patients with a score of 4-6 versus those with a score of 0-3 (P = 0.02). CONCLUSIONS: Certain radiologic findings may predict the recurrence of cSDH following evacuation. The score derived may be useful in identifying patients who might benefit from routine postoperative surveillance imaging.

Retraction: Staged Surgical Management in the Treatment of Primary Epidural Hydatidosis of the Spine: A Case Series and Review.

[This retracts the article DOI: 10.7759/cureus.401.].

Staged Surgical Management in the Treatment of Primary Epidural Hydatidosis of the Spine: A Case Series and Review.

Hydatid disease is a parasitic infection linked to the Echinococcus granulosus tapeworm. Infected cysts can present anywhere in the human body, but the liver is the most frequently involved organ, followed by the lungs. The prognosis is generally poor and may be comparable to that of neoplastic disease. Primary spinal hydatidosis accounts for less than 1% of all cases and virtually all these cases have extradural involvement. We describe a case review consisting of two patients who presented over a three week period with primary spinal extradural hydatidosis in the Western Cape region of South Africa. Both patients presented with lower limb paraparesis and were treated aggressively with two-stage surgical procedures, resulting in a dramatic improvement in their neurological status.