Capillary Index Score in the Interventional Management of Stroke trials I and II.

BACKGROUND AND PURPOSE: The Capillary Index Score (CIS) is a simple angiography-based scale for assessing viable tissue in the ischemic territory. We retrospectively applied it to Interventional Management of Stroke (IMS) trials I and II to evaluate the predictive value for good outcomes. METHODS: CIS was calculated from pretreatment diagnostic cerebral angiograms blinded to outcome. IMS I and II diagnostic cerebral angiogram images of sufficient quality were reviewed and CIS calculated for treated subjects with internal carotid artery or M1 occlusion. CIS scoring (0-3) was dichotomized into favorable (f CIS; 2 or 3) and poor (p CIS; 0 or 1). Modified thrombolysis in cerebral infarction score 2b or 3 was considered good revascularization. CIS and modified thrombolysis in cerebral infarction scores were compared with good outcome, defined as modified Rankin Scale score≤2 at 90 days. RESULTS: Twenty-eight of 161 subjects met the inclusion criteria. Thirteen (46%) had f CIS. Good clinical outcome was significantly different between the 2 CIS groups (62% for f CIS versus 7% for p CIS; P=0.004). Good reperfusion correlated to good outcome (P=0.04). No significant differences in time to intravenous or intra-arterial treatment were identified between f CIS and p CIS groups (P>0.25). CONCLUSIONS: A f CIS was found in ≈50% of subjects and was a virtual prerequisite for good outcome in this study subgroup of IMS I and II. We call this the 50% barrier.

Aspergillus spinal epidural abscess: case presentation and review of the literature.

STUDY DESIGN: In this review, we present a case of Aspergillus spinal epidural abscess (ASEA) and review the literature. OBJECTIVES: To provide further insight on a rare condition. SETTING: A description of a patient with ASEA in a 58-year-old woman that was successfully treated with conservative management is presented. METHODS: Following case presentation, a literature search (MedLine and PubMed) and assessment of epidemiology, presentation, diagnosis, treatments, and outcomes is performed. RESULTS: Review of the literature finds 26 reported cases. The infection occurs in males with a higher frequency (66.7%). The thoracic and lumbar regions are more likely afflicted (96.1%). Common symptoms are backache, neurological deficits, and fever. Most frequent comorbidities were malignancy, diabetes mellitus, and immunodeficiency. Complications were numerous and often catastrophic. Treatment entailed a combination of antibiotics and surgery. Overall, ASEA patients did poorly: death in majority (52%), minimal recovery in 22%, and others did attain full recovery (26%). CONCLUSIONS: Generally, this infection has high morbidity and mortality. Early identification is important to a successful outcome. Appropriate management with antifungals is central and proves to be effective as seen in the reported case though surgical intervention is usually a necessity as the literature suggests. From an epidemiological and public health perspective, particularly with recent outbreaks, understanding the treatment of this rare CNS infection becomes even more imperative.

Erratum: Cervical spine epidural abscess: a single center analytical comparison to the literature.

[This corrects the article DOI: 10.1038/scsandc.2017.36.].

Cervical spine epidural abscess: a single center analytical comparison to the literature.

STUDY DESIGN: Retrospective review of patient charts. OBJECTIVES: Cervical spine epidural abscess (CSEA) is uncommon. In this study, characteristics of CSEA patients are described through an institutional analysis and literature review. SETTING: University-affiliated city hospital. METHODS: The electronic medical record was searched from 01/2001 to 01/2012. Data on presentation, comorbidities, diagnostic modalities, pathogens, treatments, and neurological recovery were collected. RESULTS: Sixteen patients were identified with a mean age of 57.9 years (33-83). Nine were females. Common symptoms were neck/back pain (62.5%), neurological deficits (62.5%), and fever (31.3%). Comorbidities included cardiovascular disease (56.3%), renal disease (37.5%), and diabetes mellitus (37.5%). Lower levels were more likely afflicted (C5-C7). Microorganisms were commonly Staphylococcus and Streptococcus (68.8%). Eight (50.0%) received surgery (anterior [87.5%] and posterior [12.5%] cervical fusion and corpectomy [37.5%]) plus antibiotics and 8 (50.0%) were treated with antibiotics only. Patients with less comorbidities were more likely to receive surgery; more comorbidities were was associated with a poor prognosis. Eight patients (50%) made had full neurological recovery, 2 (12.5%) with had minimal recovery, 2 deaths died, and the remaining (25%) 1 was were sent to a skilled facility and 1or lost to follow-up. CONCLUSIONS: Cervical SEA can be problematic. The vast majority do not present classically and treatment does vary. It occurs more frequently in the lower cervical levels. Though antibiotics alone may suffice, surgery is frequently employed and a multitude of techniques are at the utility of the spine surgeon. Cardiovascular comorbidities are associated with a poorer outcome. In order to improve prognosis, management considerations should include both patient factors and multidisciplinary efforts.