RESUMO
OBJECTIVES: To investigate present established routines and standards in managing minor head-injured children in Danish hospitals, a survey of present management practice was conducted. MATERIALS AND METHODS: A cross-sectional mail survey, detailing clinical and radiological examinations, in-hospital observation, discharge criteria and follow-up, was performed on all 46 hospitals treating children with minor head injury in Denmark. RESULTS: Of the 46 hospitals, 33% report having established written criteria for the referral and management of children with minor head injury. Ten (22%) of the 46 hospitals are so-called injury clinics, where only nurses are employed. All state that they use the Glasgow Coma Scale (GCS) and/or the paediatric GCS to assess the level of consciousness; 15% use the paediatric GCS exclusively. None perform routine radiological examinations. Criteria for early discharge are established in 98% of the hospitals. All hospitals provide written instructions for observations at home before discharge. CONCLUSION: The management of children with minor head injury varies between hospitals in Denmark. Local management guidelines are either lacking or mainly based on those of adults. Hence, there is a need for the development of minor head injury guidelines specifically designed for the management of children.
Assuntos
Traumatismos Craniocerebrais/terapia , Gerenciamento Clínico , Infectologia/métodos , Pediatria , Criança , Estudos Transversais , Dinamarca , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Escala de Coma de Glasgow , Inquéritos Epidemiológicos , Hospitais/estatística & dados numéricos , Humanos , Infectologia/estatística & dados numéricos , Masculino , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Endothelial dysfunction might be involved in the development of cerebral vasospasm after aneurysmal subarachnoid haemorrhage (SAH). METHODS: This prospective observational study of 48 SAH subjects and 23 control subjects examined associations between reactive hyperaemia index (RHI) measured by peripheral arterial tonometry and plasma concentrations of S-100B protein, nitrite/nitrate, arginine, and asymmetric dimethyl arginine (ADMA). Clinical variables were flow velocity in the middle cerebral artery (VMCA), angiographic vasospasm, delayed neurological deficit, and 30 day survival. Five consecutive measurements were obtained at days 0-2, 3-5, 6-8, 9-11, and 12-15. RESULTS: RHI was 1.67 (0.46) at days 0-2 after SAH but increased at days 3-15 to the same levels as in controls (P<0.05 compared with days 0-2). RHI was lower in subjects who died before day 30 (P=0.07), but no trends were observed in relation to angiographic vasospasm or delayed neurological deficit. Both arginine and ADMA increased after SAH compared with days 0-2 (P<0.05). S-100B was highest in non-survivors (P<0.01) and in subjects with neurological deficit (P<0.01). A positive correlation was found between RHI and arginine:ADMA ratio (r=0.43, P<0.005), but not with nitrite/nitrate, VMCA, or S-100B. CONCLUSIONS: Peripheral flow-mediated vasodilation is attenuated in the first days after SAH indicating acute systemic endothelial dysfunction. Impairment of endothelial function after SAH correlates with imbalance of the arginine/ADMA pathway.
Assuntos
Arginina/análogos & derivados , Arginina/sangue , Endotélio/fisiopatologia , Hemorragia Subaracnóidea/sangue , Adulto , Biomarcadores/sangue , Velocidade do Fluxo Sanguíneo/fisiologia , Feminino , Seguimentos , Humanos , Hiperemia/sangue , Hiperemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Vasoespasmo Intracraniano/sangueRESUMO
BACKGROUND: Transcranial Doppler measurements of the middle cerebral artery flow velocity are widely used as an indicator of vasospasm after aneurysmal subarachnoid haemorrhage (SAH). We investigated inter- and intraoperator agreement in SAH patients and healthy volunteers using colour-coded transcranial Doppler (TCCD), with the secondary aim of describing prediction of angiographic vasospasm and mortality. METHODS: Sixty patients and 70 healthy controls were each examined in duplicate by alternating operators. A total of 939 measurements divided on 201 examination sets were conducted by four observers. The Bland-Altman limits of agreement (LoA) were calculated using a variance components analysis. Angiography was performed on clinical indication and survival recorded at 30 days. RESULTS: Differences between measurements increased with increasing average, and therefore, we analysed log-transformed values. Thus, LoA are given as ratios between measurements. There were no systematic intra- or interobserver differences (bias). The intraobserver LoA was 0.62-1.61 in patients and 0.67-1.50 in controls. However, they were 0.55-1.82 in patients with angiographic vasospasm, whereas in patients without, they were 0.66-1.52. The interobserver LoA was 0.55-1.81 in patients and 0.65-1.55 in controls, while in patients with and without angiographic vasospasm, they were 0.45-2.22 and 0.60-1.67, respectively. Flow velocity measurements day 6-10 were positively associated with 30 day mortality risk (P=0.02, logistic regression). CONCLUSIONS: TCCD measurement variability is wider in patient measurements than in controls. This discrepancy can largely be explained by a higher degree of error in patients with angiographic vasospasm. Despite the considerable measurement variability in TCCD, values are predictive of outcome in SAH.
Assuntos
Circulação Cerebrovascular/fisiologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Angiografia Digital , Angiografia Cerebral , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/fisiopatologia , Variações Dependentes do Observador , Estudos Prospectivos , Hemorragia Subaracnóidea/mortalidade , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/mortalidade , Adulto JovemRESUMO
Monitoring of intracranial pressure (ICP) has been used for decades in the fields of neurosurgery and neurology. There are multiple techniques: invasive as well as noninvasive. This paper aims to provide an overview of the advantages and disadvantages of the most common and well-known methods as well as assess whether noninvasive techniques (transcranial Doppler, tympanic membrane displacement, optic nerve sheath diameter, CT scan/MRI and fundoscopy) can be used as reliable alternatives to the invasive techniques (ventriculostomy and microtransducers). Ventriculostomy is considered the gold standard in terms of accurate measurement of pressure, although microtransducers generally are just as accurate. Both invasive techniques are associated with a minor risk of complications such as hemorrhage and infection. Furthermore, zero drift is a problem with selected microtransducers. The non-invasive techniques are without the invasive methods' risk of complication, but fail to measure ICP accurately enough to be used as routine alternatives to invasive measurement. We conclude that invasive measurement is currently the only option for accurate measurement of ICP.
RESUMO
Intraventricular hemorrhage (IVH) subsequent to intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) is associated with high mortality and morbidity. The use of fibrinolytic agents to treat this condition has previously been reported in small clinical trials with limited numbers of patients. Variability regarding inclusion criteria, method of administration and outcome have made it difficult to draw firm conclusions regarding the efficacy of antifibrinolytic therapy. Nine patients with CT-diagnosed IVH were treated with Alteplase intrathecally for 3 to 5 days according to the CT-verified clearance of IVH. After the treatment period, a repeat CT scan was performed to evaluate treatment effect.In this safety study, we achieved rapid removal of IVH compared to retrospective controls, without incidents of re-bleeding, with only 33% permanent shunt placements and a neurological outcome of GOS of 4-5 in 44% of the patients. Based on the above results, the treatment protocol was considered safe and highly effective. A prospective randomized national multicenter trial has been initiated in order to evaluate the efficacy of this novel method also in terms of outcome and shunt dependency.
Assuntos
Fibrinolíticos/uso terapêutico , Hematoma/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , Adulto , Idoso , Hemorragia Cerebral/complicações , Hemorragia Cerebral/tratamento farmacológico , Hemorragia Cerebral/cirurgia , Feminino , Escala de Coma de Glasgow , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/tratamento farmacológico , Hemorragia Subaracnóidea/cirurgia , Sucção/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study is to map and evaluate the available resources and the premises of traumatic head injury management in the Nordic countries, before the implementation of a Nordic adaption of the Brain Trauma Foundation guidelines for prehospital management. METHODS: The study is a synthesis of two cross-sectional surveys. Questionnaires were used to collect data on the annual number of acute head injury operations, the infrastructure, the level of education, the use of trauma protocols and the management of traumatic head injury at Nordic hospitals. RESULTS: The proportion of acute head injury operations performed outside a neurosurgical department was 0% in Denmark, 16% in Finland, 19% in Norway and 33% in Sweden. Eighty-four per cent of Nordic hospitals had written protocols for the assessment and treatment of trauma patients and 78% had regular training in trauma management; 67% had specific protocols for the treatment of traumatic head injury. Computed tomography (CT) was available in 93% of the hospitals, and 59% of the hospitals could link CT scans to the regional neurosurgical department. CONCLUSIONS: Most Nordic hospitals are well prepared to manage patients with acute traumatic head injury. A substantial proportion of the operations are performed at local and central hospitals without neurosurgical expertise, despite an efficient pre and interhospital transport system. The Nordic adaption of the Brain Trauma Foundation guidelines recommends that this practice is terminated.
Assuntos
Traumatismos Craniocerebrais/cirurgia , Serviços Médicos de Emergência/organização & administração , Hospitalização/estatística & dados numéricos , Protocolos Clínicos , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/epidemiologia , Finlândia/epidemiologia , Humanos , Países Escandinavos e Nórdicos/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricosRESUMO
Hypothermia is shown to be beneficial for the outcome after a transient global brain ischaemia through its neuroprotective effect. Whether this is also the case after focal ischaemia, such as following a severe traumatic brain injury (TBI), has been investigated in numerous studies, some of which have shown a tendency towards an improved outcome, whereas others have not been able to demonstrate any beneficial effect. A Cochrane report concluded that the majority of the trials that have already been published have been of low quality, with unclear allocation concealment. If only high-quality trials are considered, TBI patients treated with active cooling were more likely to die, a conclusion supported by a recent high-quality Canadian trial on children. Still, there is a belief that a modified protocol with a shorter time from the accident to the start of active cooling, longer cooling and rewarming time and better control of blood pressure and intracranial pressure would be beneficial for TBI patients. This belief has led to the instigation of new trials in adults and in children, including these types of protocol adjustments. The present review provides a short summary of our present knowledge of the use of active cooling in TBI patients, and presents some tentative explanations as to why active cooling has not been shown to be effective for outcome after TBI. We focus particularly on the compromised circulation of the penumbra zone, which may be further reduced by the stress caused by the difference in thermostat and body temperature and by the hypothermia-induced more frequent use of vasoconstrictors, and by the increased risk of contusional bleedings under hypothermia. We suggest that high fever should be reduced pharmacologically.
Assuntos
Lesões Encefálicas/terapia , Isquemia Encefálica/terapia , Protocolos Clínicos/normas , Hipotermia Induzida/métodos , Pressão Intracraniana , Adulto , Transtornos da Coagulação Sanguínea/etiologia , Isquemia Encefálica/etiologia , Criança , Pré-Escolar , Humanos , Hipotermia Induzida/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Estresse Fisiológico , Vasoconstritores/efeitos adversosRESUMO
BACKGROUND: Studies indicate a relationship between hospital caseload and health outcomes after both surgical and endovascular repair of intracranial aneurysms. PURPOSE: To evaluate outcomes after introduction of endovascular embolization for intracranial aneurysms in a low-volume regional university hospital. MATERIAL AND METHODS: Retrospective study of 243 consecutive patients treated for 284 intracranial aneurysms with endovascular embolization or surgical clipping from 2000 to 2006 at the University Hospital of North Norway. Postoperative complications were registered. The Glasgow Outcome Scale (GOS) was used for assessment of outcome. RESULTS: The mean annual number of procedures was 39 (microsurgery 23, embolization 16). Seventy-four percent of patients with ruptured aneurysms and all patients with unruptured aneurysms had a favorable outcome (GOS 4 or 5) at 1 year follow-up. Patients with subarachnoid hemorrhage were more likely to experience postoperative complications than patients treated for unruptured aneurysms (42% versus 8% of the patients, P<0.01). The immediate incomplete occlusion rate (Raymond II-III) in the initial embolization procedure was 29%. Ten endovascularly treated patients and one surgically treated patient required retreatments due to residual aneurysm or neck remnants. CONCLUSION: The present study indicates that acceptable outcome from aneurysm treatment, both endovascular and microsurgical, is possible in a low-volume institution.
Assuntos
Embolização Terapêutica/métodos , Embolização Terapêutica/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Noruega , Complicações Pós-Operatórias , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações , Resultado do Tratamento , Carga de Trabalho , Adulto JovemRESUMO
OBJECTIVE: To assess predictors for cognitive impairment one year after spontaneous subarachnoid hemorrhage (SAH). Evaluated predictors were the total amount of cisternal blood seen on computed tomography (CT) in the acute phase as measured by the Fisher grade, neurological grade at admission classified according to the Hunt and Hess scale, aneurysm site and patient's age, gender and education level. METHOD: 44 patients were operated by surgical clipping within 72 hours after CT verified aneurysmal SAH. After twelve months the remaining 42 patients were assessed by neuropsychological test, Beck Depression Inventory (BDI), the Glasgow Outcome Scale (GOS) and CT. Multiple regression analysis was conducted where predictor variables were independent factors and a global impairment index calculated for each patient was the dependent factor. RESULTS: The Fisher grade was the only independent predictor for neuropsychological impairment. Most patients had good neurological outcome as measured by the GOS and at the same time suffered from some degree of cognitive impairment at follow-up. Individual analysis of cognitive test scores showed mild to moderate dysfunction across multiple cognitive domains. Most frequent impairments were found in domains of memory, executive function and speed of information processing. Age below 50 years was associated with relatively better outcome. CONCLUSION: The severity of cognitive impairment one year post SAH is predicted by the volume of blood in the subarachnoid space as measured by the Fisher score.
Assuntos
Transtornos Cognitivos/diagnóstico , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Envelhecimento , Encéfalo/patologia , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Avaliação de Resultados em Cuidados de Saúde , Análise de Regressão , Caracteres Sexuais , Hemorragia Subaracnóidea/psicologiaRESUMO
OBJECTIVES: To study the prevalence of post-concussion symptoms (PCS) 5-7 years after mild head injury (MHI) and to investigate whether patients suffer from more symptoms than the normal population. METHODS: We conducted a 5- to 7-year follow-up of patients (n = 89) with MHI. Post-concussion symptoms were quantified with the Rivermead Post Concussion Symptoms Questionnaire (RPQ) and health-related quality of life (HRQL) was measured with the EuroQol-5D (EQ-5D). We also quantified subjective general health state with the EuroQol Visual Analogue Scale (EQ-VAS). An age- and sex-matched, but otherwise randomly chosen control group of 89 persons was recruited from the National Population Registry for a cross-sectional comparison. Twenty-eight patients (30%) and 27 (30%) controls responded. RESULTS: Patients reported significantly (P = 0.017) more PCS (median RPQ score 10, 95% CI 2-20) than controls (median 2, 95% CI 0-4). They also reported significantly (P = 0.008) lower HRQL (median EQ-5D score 0.866, 95% CI 0.796-1.000) than controls (1.000, 95% CI 1.000-1.000), but there was no difference between the groups in their subjective ratings of general health state. CONCLUSIONS: Patients reported significantly more PCS and lower HRQL 5 to 7 years after MHI than age- and sex-matched controls from the normal population.
Assuntos
Concussão Encefálica/epidemiologia , Encefalopatias/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Estudos Transversais , Avaliação da Deficiência , Feminino , Seguimentos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estudos Prospectivos , Qualidade de Vida/psicologia , Distribuição por Sexo , Inquéritos e Questionários , Tempo , Fatores de TempoRESUMO
BACKGROUND: Selective dorsal rhizotomy (SDR) is an operation method that decreases the degree of spasticity with long-lasting beneficial effects for children with spastic diplegia. Children undergoing SDR are postoperatively in severe pain, a pain related to both the extensive surgical exposure with multilevel laminectomy and the nerve root manipulation. Various pain management strategies for children undergoing SDR have been published. The postoperative pain treatment is a vital part of the management. The aim of this study was to estimate the number of centers performing SDR, the frequency of SDR surgery and to investigate pain management of the different centers. METHODS: A questionnaire comprising 7 questions was sent by mail and/or e-mail to a total of 59 potential centers performing SDR, centers that have published material concerning SDR or centers that have been recommended. Forty-seven (80%) centers responded to the questionnaire; 11 of them do not presently perform SDR surgery, and the remaining 36 centers constitute the material of the present study. RESULTS: 23 of the 36 centers use Peacock's operation technique and 8 centers use Park's technique. Continuous intravenous infusion of opioids for postoperative pain treatment is used by 17 (47%) of the centers. Seven (19%) centers use the epidural (ED) approach for treating postoperative pain and 6 (17%) centers use intrathecal (IT) pain treatment. The duration of intravenous ED or IT pain relief ranged from 24 h up to 7 days. To evaluate pain relief, 25 (70%) centers used some form of pain scale. CONCLUSION: The most common operation techniques in use today are described by Peacock or by Park, with an estimated number of procedures of more than 487/year in 36 centers. The majority of the centers seem to have a satisfactory pain management strategy. These centers administer continuous infusions of opioids, with an intravenous, ED or IT approach, and incorporate the use of a pain assessment tool to evaluate pain relief.
Assuntos
Paralisia Cerebral/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Rizotomia , Raízes Nervosas Espinhais/cirurgia , Administração Oral , Adolescente , Analgesia Epidural/estatística & dados numéricos , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Infusões Intravenosas/estatística & dados numéricos , Injeções Espinhais/estatística & dados numéricos , Laminectomia , Masculino , Entorpecentes/administração & dosagem , Inquéritos e QuestionáriosRESUMO
BACKGROUND: This study investigates current management practice of children with MHI in Swedish hospitals to define present need for management guidelines for children. METHODS: A cross-sectional mail survey including 51 hospitals treating children with MHI outlines management routines concerning clinical and radiological examinations, in-hospital observation, discharge criteria and follow-up. RESULTS: Twenty-seven per cent of the hospitals have established written criteria for referral and management of children with MHI. Eighty-eight per cent use the Swedish Reaction Level Scale for assessing the level of consciousness. Eight per cent use the paediatric Glasgow Coma Scale. Routine computerised tomography is performed in 18% of the hospitals, 12% perform skull radiography and/or radiography of the cervical spine as routine. Eighty-four per cent have established criteria for early discharge without hospitalisation. CONCLUSION: The management of children with MHI varies in Swedish hospitals. There is a need for standardised protocols for detection of intracranial complications and guidelines for the management of MHI in children.
Assuntos
Traumatismos Craniocerebrais/terapia , Qualidade da Assistência à Saúde , Criança , Traumatismos Craniocerebrais/diagnóstico por imagem , Estudos Transversais , Serviço Hospitalar de Emergência , Pesquisas sobre Atenção à Saúde , Hospitalização , Humanos , Radiografia , Encaminhamento e Consulta , Suécia , Índices de Gravidade do TraumaRESUMO
BACKGROUND AND PURPOSE: Endovascular embolization is an increasingly common method to treat intracerebral arteriovenous malformations (AVM). To date, however, published data are rather scarce, especially with regard to true procedure-related complications and their causes. The purpose of our study was to evaluate treatment safety and correlate anatomic results with clinical outcome by using MR imaging, including diffusion-weighted (DWI) and perfusion imaging (PI). METHODS: We performed 50 endovascular procedures in 21 patients. Most AVMs were supratentorial, Spetzler-Martin grades II-IV. MR imaging was scheduled within 1 week before and 3 days after each treatment. MR imaging findings were correlated to digital subtraction angiography, procedure reports, and the clinical course. Outcome was graded according to the modified Rankin scale (mRS) 3-6 months after treatment. RESULTS: In this study, 104 MR imaging examinations were performed; mean interval between the endovascular procedure and posttreatment MR imaging was 28 hours. Nine adverse events occurred in 7 patients during 8 procedures (16%), one causing a permanent deficit. New lesions were noted on MR imaging after 22/50 procedures. Ischemic lesions in 22% of the procedures, frequently located perinidally. Most lesions were small, frequently asymptomatic, and reversible (18/23). Four hematomas were found. Subacute hemorrhages developed from a vasogenic edema on 2 occasions. New lesions, including hematomas, developed between treatments in 4 patients, mainly because of progressive occlusion of the nidus or draining veins. PI overestimated the AVM nidus on most occasions, and transient worsening of the PI pattern was noted in 2 patients. Treatment-related mortality and morbidity were 0% and 14.2%, respectively (mRS 1-2). CONCLUSIONS: Endovascular procedures are rather safe but are associated with more ischemic events and followed by less hemodynamic disturbances than previously understood. Adverse procedural events and new MR imaging lesions were generally asymptomatic and most often transient, if symptomatic. Most lesions would not have been verified without MR imaging. DWI and PI were most useful to detect and understand the cause of various complications. The most clinically important complications were caused by late venous occlusions.
Assuntos
Embolização Terapêutica , Malformações Arteriovenosas Intracranianas/terapia , Imageamento por Ressonância Magnética , Adulto , Angioplastia/efeitos adversos , Angioplastia/métodos , Proteínas de Ligação a DNA , Imagem de Difusão por Ressonância Magnética , Dimetil Sulfóxido , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Embucrilato , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Polivinil , Adesivos Teciduais , Proteínas ViraisRESUMO
Protein S100B is today the most promising biomarker for cerebral injury. A welcomed area for the use of such a marker is in the early stages of head trauma and diagnosis of brain injury, in particular epidural haematomas. We report five consecutive cases of epidural haematoma where serum samples for S100B were drawn at admission. Three of the patients showed low levels of S100B (< or =0.2 microg/l). One patient with a large epidural haematoma with radiological signs of cerebral herniation displayed normal levels (0.14 microg/l) of S100B 3.5 h after the initial head trauma. Normal S100B levels in serum do not predict normal intracranial findings. S100B may be unreliable as a marker for epidural haematomas after closed head injury.
Assuntos
Traumatismos Cranianos Fechados/diagnóstico , Hematoma Epidural Craniano/sangue , Fatores de Crescimento Neural/sangue , Proteínas S100/sangue , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Feminino , Traumatismos Cranianos Fechados/sangue , Traumatismos Cranianos Fechados/complicações , Hematoma Epidural Craniano/etiologia , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Subunidade beta da Proteína Ligante de Cálcio S100RESUMO
OBJECTIVE: To assess the cognitive impairment and the association between neuropsychological measures and neuroimaging 1 year after aneurysmal subarachnoid hemorrhage (SAH). METHOD: Forty-two patients were examined clinically according to Glasgow Outcome Scale (GOS). Computed tomography (CT), single photon emission computed tomography (SPECT) and neuropsychological examination were performed. RESULTS: There were no association between GOS and cognitive impairment index based on the neuropsychological examination. CT showed no sign of cerebral ischemia in 17 (40%) and low attenuating areas indicating cerebral infarction(s) in 25 (60%) patients. A significant correlation (P = 0.01) was observed between the cognitive impairment index and the SPECT index (r = 0.6). SPECT measurement was the only independent predictor for cognitive impairment. CONCLUSION: GOS is a crude outcome measure and patients classified with good recoveries may have significant cognitive deficits. Neuropsychological examination is the preferred method for outcome evaluation as this method specifically addresses the disabilities affecting patients' everyday life.
Assuntos
Dano Encefálico Crônico/etiologia , Encéfalo/patologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Dano Encefálico Crônico/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/etiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Transtornos Cognitivos/diagnóstico , Feminino , Seguimentos , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos Testes , Hemorragia Subaracnóidea/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios XRESUMO
We have reviewed initial diagnostic features, treatment, and outcome in 29 patients with acute subarachnoid hemorrhage due to non-traumatic vertebrobasilar artery dissection diagnosed in our hospital between 1993 and 2003. The dissections occurred in the vertebral artery in 19 patients, the posterior inferior cerebellar artery (PICA) in two patients, the basilar artery in four patients, and in the vertebral artery extending into the PICA in four patients. A pseudoaneurysm was found in 20 patients. Clinical manifestations typically included sudden onset of moderate to severe headache, nuchal rigidity, and drowsiness. Fourteen patients were treated conservatively. Fifteen patients underwent endovascular treatment with either parent artery occlusion (13 patients) or aneurysmal coil occlusion with preservation of the parent artery (2 patients). Re-bleeding occurred within 12 days and before treatment in nine patients. Eight of these had a pseudoaneurysm. No patient bled after endovascular treatment. Poor grade and early re-bleeding were associated with less favorable outcome. Outcome at 6 months did not differ significantly between endovascular and conservative treatment. Altogether, good recovery was achieved for 16 patients, moderate disability was seen in one, severe disability in four, and eight patients (27%) died. The absence of bleeding subsequent to endovascular treatment in this study suggests that endovascular treatment may be a rational approach in these patients at high risk of re-bleeding, especially those with a pseudoaneurysm.
Assuntos
Artéria Basilar , Cerebelo/irrigação sanguínea , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/terapia , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/terapia , Doença Aguda , Adulto , Idoso , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/etiologia , Resultado do Tratamento , Dissecação da Artéria Vertebral/complicaçõesRESUMO
Protein S100B has been shown to increase in serum and cerebrospinal fluid (CSF) in various neurological diseases. However, the levels of S100B in conjunction with cerebral herniation have not been studied and the significance of extracerebral S100B has become an important issue. We report on a multi-trauma patient in whom cerebral herniation occurred 2 days after admission. Following this, organ-harvesting procedures were performed for transplantation. We measured serial serum S100B during both the ongoing herniation and the following extracerebral surgery. We found that S100B levels seemed to peak immediately prior to cerebral herniation and then decreased shortly thereafter and concluded that the source of the measured serum S100B in this patient was of predominately cerebral origin. In conjunction with the organ harvesting procedure S100B levels increased, indicating that extracerebral sources of the protein also exist.
Assuntos
Morte Encefálica/sangue , Encefalocele/sangue , Proteínas S100/sangue , Acidentes de Trânsito , Adulto , Biomarcadores/sangue , Humanos , Masculino , Traumatismo Múltiplo/sangue , Fatores de Crescimento Neural , Subunidade beta da Proteína Ligante de Cálcio S100 , Coleta de Tecidos e ÓrgãosRESUMO
BACKGROUND: Epidemiological research on the incidence of traumatic head injuries relies on the correct definition and classification of the injury. OBJECTIVE: To address the use of diagnostic criteria and ICD-10 codes to define minor head injury in Swedish hospitals managing patients with head injury. METHODS: A questionnaire was mailed to all 76 Swedish hospitals managing head injuries. The hospitals were asked what diagnostic criteria they use to define minor head injury, and which ICD-10 codes they use to classify such injuries. RESULTS: 72 hospitals (95%) responded to the survey. The most common criterion was loss of consciousness (76%), followed by post-traumatic amnesia (38%). Almost half the hospitals used other signs and symptoms to define minor head injury. The ICD-10 code S.06 (intracranial injury) was used by 51 of the hospitals (91%). CONCLUSIONS: It is essential that there should be common definitions, classifications, and registration of minor head injuries. The wide variation in definition and classification found in this study emphasises the importance of improved implementation of the present guidelines.
Assuntos
Traumatismos Craniocerebrais/diagnóstico , Classificação Internacional de Doenças , Escala de Coma de Glasgow , Humanos , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: This study reports data on time consumption before aneurysm surgery and the results of treatment in northern Norway. MATERIAL AND METHODS: A total of 279 cases were identified and included in our analysis of time span from bleeding to arrival at our department. Fifty-one patients were treated conservatively, either because of bad clinical condition or because angiography revealed no aneurysm. The remaining 228 patients were operated and included in our analysis of outcome after early aneurysm surgery. RESULTS: Among all 279 patients with aneurysmal subarachnoid haemorrhage (SAH), median time from ictus to arrival at the university hospital was 1 (0-30) day. Forty-one per cent arrived at the day of bleeding and 86% within the first 3 days after bleeding. Among the 228 patients who underwent surgical aneurysm repair, median time from bleeding to operation was 2 (0-33) days. Early aneurysm surgery (< 72 h) was performed in 146 patients (64%). Fifty patients (22%) underwent intermediate surgery (days 4-10) and 32 patients (14%) were operated later (day 11 or later). A significant association was found between Hunt and Hess (HH) grade and Glasgow Outcome Scale (GOS) score (P < 0.001). CONCLUSIONS: Most patients suffering aneurysmal SAH in northern Norway undergo early aneurysm surgery and the outcome is comparable with that obtained in other Scandinavian centres. Initial Hunt and Hess grade is a major determinant for outcome in aneurysmal subarachnoid haemorrhage.