Coiling of basilar tip aneurysms: results in 154 consecutive patients with emphasis on recurrent haemorrhage and re-treatment during mid- and long-term follow-up.
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PURPOSE: The purpose of this study is to report mid- and long-term clinical and angiographic results of coiling of basilar tip aneurysms. MATERIALS AND METHODS: Between January 1995 and August 2006, 154 basilar tip aneurysms were coiled. A total of 114 (74%) had ruptured and 40 (26%) were unruptured. There were 42 men and 112 women taking part in this study, with a mean age of 50.5 years (median, 50; range, 25-73 years). The mean aneurysm size was 11.1 mm (median, 10; range, 2-30 mm) and 71 (46%) were large or giant. Of 154 aneurysms, 40 (26%) were primarily coiled with a supporting device. RESULTS: Initial occlusion was (near) complete in 144 (94%) and incomplete in 10 (6%) aneurysms. The combined procedural mortality and morbidity was 3.8% (6 of 154, 95% CI 1.4-8.3%). The mean clinical follow-up of 144 surviving patients was 53 months (range, 3-144 months; 637 patient-years). The annual incidence rate for recurrent haemorrhage was 0.3% (2 in 637 patient years, 95% CI 0.04-1.1%). During angiographic follow-up of mean 34 months (range, 6-122 months) in 138 patients (96%), 27 basilar tip aneurysms (17.5%) re-opened over time and were additionally coiled. Of these, 11 repeatedly re-opened and were repeatedly coiled. An aneurysm size of median >10 mm was the only significant predictor for re-treatment at follow-up (OR 7.0, 95% CI 2.5-19.7). CONCLUSION: Coiling of basilar tip aneurysms is safe and effective in preventing recurrent haemorrhage. Follow-up angiography is mandatory to timely detection of re-opening, especially in large and giant aneurysms. (+info)
Nerve growth factor expression correlates with severity and outcome of traumatic brain injury in children.
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BACKGROUND: Secondary brain damage after traumatic brain injury (TBI) involves neuro-inflammatory mechanisms, mainly dependent on the intracerebral production of cytokines. In particular, interleukin 1beta (IL-1beta) is associated with neuronal damage, while interleukin 6 (IL-6) exerts a neuroprotective role due to its ability to modulate neurotrophins biosynthesis. However, the relationship between these cytokines and neurotrophins with the severity and outcome of TBI remains still controversial. AIMS: To determine whether the concentration of IL-1beta and IL-6 and neurotrophins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF)) in the cerebrospinal fluid (CSF) of children with TBI correlates with the severity of the injury and its neurologic outcome. METHODS: Prospective observational clinical study in a university hospital. CSF samples were collected from 27 children at 2h (Time T1) and 48 h (Time T2) after severe TBI, and from 21 matched controls. Severity of TBI was evaluated by GCS and neurologic outcome by GOS. CSF concentrations of cytokines and neurotrophins were measured by immunoenzymatic assays. RESULTS: Early NGF and IL-1beta concentrations (T1) correlated significantly with the severity of head injury, whereas no correlation was found for IL-6, BDNF, and GDNF. Furthermore, higher NGF and IL-6 and lower IL-1beta expression at T2 were associated with better neurologic outcomes. No significant association was found between BDNF or GDNF expression and neurologic outcome. CONCLUSIONS: NGF concentration in CSF is a useful marker of brain damage following severe TBI and its up-regulation, in the first 48 h after head injury together with lower IL-1beta expression, correlates with a favorable neurologic outcome. Clinical and prognostic information may also be obtained from IL-6 expression. (+info)
Intensive insulin therapy versus conventional glycemic control in patients with acute neurological injury: a prospective controlled trial.
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OBJECTIVE: To compare intensive insulin therapy to conventional glycemic control in patients with acute neurological injury evaluating neurological outcome and morbimortality. METHOD: Patients with two glycemias above 150 mg/dL 12 hours after admission were randomized to receive intensive insulin therapy (G1) or conventional treatment (G2). We evaluated a subgroup of patients with acute brain injury from July, 2004 to June, 2006. RESULTS: G1 patients (n=31) received 70.5 (45.1-87.5) units of insulin/day while G2 patients (n=19) received 2 (0.6-14.1) units/day (p<0.0001). The median glycemia was comparable in both groups (p=0.16). Hypoglycemia occurred in 2 patients (6.4%) in G1 and in 1 patient (5.8%) in G2 (p=1.0). Mortality in G1 was of 25.8% and of 35.2% in G2 (relative reduction of 27%). Neurological outcome was similar in both groups. CONCLUSION: A less strict intensive insulin therapy can reduce hypoglycemia and still maintain its benefits. (+info)
Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: a longitudinal study.
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Diffusion tensor imaging (DTI) has been proposed as a sensitive biomarker of traumatic white matter injury, which could potentially serve as a tool for prognostic assessment and for studying microstructural changes during recovery from traumatic brain injury (TBI). However, there is a lack of longitudinal studies on TBI that follow DTI changes over time and correlate findings with long-term clinical outcome. We performed a prospective longitudinal study of 30 adult patients admitted for subacute rehabilitation following severe traumatic brain injury. DTI and conventional MRI were acquired at mean 8 weeks (5-11 weeks), and repeated in 23 of the patients at mean 12 months (9-15 months) post-trauma. Using a region-of-interest-based approach, DTI parameters were compared to those of healthy matched controls, scanned during the same time period and rescanned with a similar interval as that of patients. At the initial scan, fractional anisotropy was reduced in all the investigated white matter regions in patients compared to controls (P +info)
Predictive value of scoring system in severe pediatric head injury.
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OBJECTIVES: To determine the threshold values of Pediatric Index of Mortality 2 (PIM 2) score, Pediatric Trauma Score (PTS), and Glasgow Coma Scale (GCS) score for mortality in children after severe head injury and to evaluate changes in outcomes of children after severe head injury on discharge and after 6 months. MATERIAL AND METHODS: All children with severe head injury admitted to the Pediatric Intensive Care Unit of Kaunas University of Medicine Hospital, Lithuania, from January 2004 to June 2006 were prospectively included in the study. The severity of head injury was categorized according to the GCS score < or =8. As initial assessment tools, the PTS, postresuscitation GCS, and PIM 2 scores were calculated for each patient. Outcome was assessed according to Glasgow Outcome Scale on discharge and after 6 months. RESULTS: The study population consisted of 59 children with severe head injury. The group consisted of 37 (62.7%) boys and 22 (37.3%) girls; the mean age was 10.6+/-6.02. The mean GCS, PTS, and PIM 2 scores were 5.9+/-1.8, 4.8+/-2.7, and 14.0+/-19.5, respectively. In terms of overall outcome, 46 (78.0%) patients survived and 13 (22.0%) died. All three scales appeared to be significant predictors of death. Threshold values for which potential mortality in children after severe head injury increased were 10.75 for PIM 2, 3 for PTS and 5 for GCS. PIM 2 score provided the best discrimination between survivors and nonsurvivors. CONCLUSIONS: The threshold values for mortality in children after severe head trauma were PIM 2> or =10.75%, PTS< or =3 and GCS< or =5, and these values were significant risk factors of death in severely head injured children. The changes in outcome for survivals on discharge and after 6 months were statistically significant. (+info)
237 ACoA aneurysms clipped or embolized. Outcomes measurement using the De Santis-CESE assessment tool.
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AIM: The aim of this retrospective study was to demonstrate the difference in patient outcomes after treatment for bleeding endocranial aneurysms when evaluated with methods based on different assessment criteria. METHODS: The outcome of 237 patients, 141 of which were operated on for anterior communicating artery aneurysm and 96 embolized, was assessed by a new method developed by De Santis. The patients operated on were assessed by the Glasgow Outcome Scale (GOS) and Rank Disability Scale (RDS) and the results of the latter were compared with the new method, the De Santis-CESE (Clinical Emotional Social Evaluation) method, which consists of a clinical evaluation and a numeric scoring system based on seven standard points. Comparison between the three methods showed significantly different outcomes. Patients who underwent surgical operation showed changes in character and behaviour, whereas the others showed cognitive, emotional and sexual habit changes. CONCLUSION: Compared with the GOS and RDS instruments, the CESE method showed significant differences in patient outcome assessment, particularly regarding best outcomes. These differences may be due to the greater sensitivity of the CESE method over the other two scales. Furthermore, surgical patients seemed to achieve a better outcome than endovascular patients. The authors intend to conduct a prospective study to test the results obtained in this retrospective study. (+info)
Outcomes and costs of blunt trauma in England and Wales.
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Pattern of cerebellar perfusion on single photon emission computed tomography in subcortical hematoma: a clinical and computed tomography correlation.
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BACKGROUND: There is paucity of studies evaluating the role of asymmetry index (AI) on single photon emission computed tomography (SPECT) studies in patients with intracerebral hemorrhage (ICH). AIM: To evaluate cerebellar perfusion in ICH employing SPECT study and correlate with clinical and CT scan findings. SETTING AND DESIGN: Tertiary care teaching hospital. MATERIALS AND METHODS: A total of 29 patients with ICH were subjected to neurological examination including Glasgow Coma Scale (GCS) and Canadian Neurological Stroke Scale (CNS). Clinical features of raised intracranial pressure and herniation were noted. On CT scan, ICH location, volume, ventricular extension and midline (ML) shift were noted. On SPECT, cerebral and cerebellar perfusion was measured semiquantitatively and AI calculated. Outcome was defined at 3 months into poor and good. RESULTS: Fourteen patients had putaminal and 15 thalamic hemorrhages. Their mean age was 59 years. The mean GCS score was 10 and CNS score 2.8. Hematoma was large in five, medium in 16 and small in eight patients. ML shift was present in 15 and hematoma extended to ventricule in 16 patients. On SPECT, cerebellar AI significantly related to ML shift but not with size of hematoma. AI was low in patients with ML shift. Outcome was related to GCS score, ML shift, size of hematoma and cerebellar AI. CONCLUSION: In acute stage of ICH, cerebellar AI is lower in patients with more severe stroke having ML shift. (+info)