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https://www.readbyqxmd.com/read/27884966/setting-up-a-neuroscience-stroke-and-rehabilitation-centre-in-brunei-darussalam-by-a-transcontinental-on-site-and-telemedical-cooperation
#1
U Meyding-Lamadé, B Bassa, E Craemer, C Jacobi, C Chan, W Hacke, B Kress
Due to the world-wide aging population, there is a need for specialist neurological knowledge, treatment and care. Stroke treatment is effective in reducing mortality and disability, but it is still not available in many areas of the world. We describe the set-up process of a specialized Neuroscience, Stroke and Rehabilitation Centre in Brunei Darussalam (BNSRC) in cooperation with a German hospital. This study details the setup of a stroke-, neurological intensive care- and neurorehabilitation unit, laboratories and a telemedical network to perform all evidence-based stroke treatments...
November 24, 2016: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/27884858/hemicraniectomy-versus-medical-treatment-with-large-mca-infarct-a-review-and-meta-analysis
#2
Paul Alexander, Diane Heels-Ansdell, Reed Siemieniuk, Neera Bhatnagar, Yaping Chang, Yutong Fei, Yuqing Zhang, Shelley McLeod, Kameshwar Prasad, Gordon Guyatt
OBJECTIVE: Large middle cerebral artery stroke (space-occupying middle-cerebral-artery (MCA) infarction (SO-MCAi)) results in a very high incidence of death and severe disability. Decompressive hemicraniectomy (DHC) for SO-MCAi results in large reductions in mortality; the level of function in the survivors, and implications, remain controversial. To address the controversy, we pooled available randomised controlled trials (RCTs) that examined the impact of DHC on survival and functional ability in patients with large SO-MCAi and cerebral oedema...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27879447/computed-tomographic-blend-sign-is-associated-with-computed-tomographic-angiography-spot-sign-and-predicts-secondary-neurological-deterioration-after-intracerebral-hemorrhage
#3
Peter B Sporns, Michael Schwake, Rene Schmidt, André Kemmling, Jens Minnerup, Wolfram Schwindt, Christian Cnyrim, Tarek Zoubi, Walter Heindel, Thomas Niederstadt, Uta Hanning
BACKGROUND AND PURPOSE: Significant early hematoma growth in patients with intracerebral hemorrhage is an independent predictor of poor functional outcome. Recently, the novel blend sign (BS) has been introduced as a new imaging sign for predicting hematoma growth in noncontrast computed tomography. Another parameter predicting increasing hematoma size is the well-established spot sign (SS) visible in computed tomographic angiography. We, therefore, aimed to clarify the association between established SS and novel BS and their values predicting a secondary neurological deterioration...
November 22, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27858578/severe-cerebral-edema-following-nivolumab-treatment-for-pediatric-glioblastoma-case-report
#4
Xiao Zhu, Michael M McDowell, William C Newman, Gary E Mason, Stephanie Greene, Mandeep S Tamber
Nivolumab is an immune checkpoint inhibitor (ICI) currently undergoing Phase III clinical trials for the treatment of glioblastoma. The authors present the case of a 10-year-old girl with glioblastoma treated with nivolumab under compassionate-use guidelines. After the first dose of nivolumab the patient developed hemiparesis, cerebral edema, and significant midline shift due to severe tumor necrosis. She was managed using intravenous dexamethasone and discharged on a dexamethasone taper. The patient's condition rapidly deteriorated after the second dose of nivolumab, demonstrating hemiplegia, seizures, and eventually unresponsiveness with a fixed and dilated left pupil...
November 18, 2016: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/27820620/endovascular-treatment-for-patients-with-acute-stroke-who-have-a-large-ischemic-core-and-large-mismatch-imaging-profile
#5
Leticia C Rebello, Mehdi Bouslama, Diogo C Haussen, Seena Dehkharghani, Jonathan A Grossberg, Samir Belagaje, Michael R Frankel, Raul G Nogueira
Importance: Endovascular therapy (ET) is typically not considered for patients with large baseline ischemic cores (irreversibly injured tissue). Computed tomographic perfusion (CTP) imaging may identify a subset of patients with large ischemic cores who remain at risk for significant infarct expansion and thus could still benefit from reperfusion to reduce their degree of disability. Objective: To compare the outcomes of patients with large baseline ischemic cores on CTP undergoing ET with the outcomes of matched controls who had medical care alone...
November 7, 2016: JAMA Neurology
https://www.readbyqxmd.com/read/27733025/reduction-of-midline-shift-following-decompressive-hemicraniectomy-for-malignant-middle-cerebral-artery-infarction
#6
Sang-Beom Jeon, Sun U Kwon, Jung Cheol Park, Deok Hee Lee, Sung-Cheol Yun, Yeon-Jung Kim, Jae-Sung Ahn, Byung-Duk Kwun, Dong-Wha Kang, H Alex Choi, Kiwon Lee, Jong S Kim
BACKGROUND AND PURPOSE: Hemicraniectomy is a decompressive surgery used to remove a large bone flap to allow edematous brain tissue to bulge extracranially. However, early indicators of the decompressive effects of hemicraniectomy are unclear. We investigated whether reduction of midline shift following hemicraniectomy is associated with improved consciousness and survival in patients with malignant middle cerebral artery infarctions. METHODS: We studied 70 patients with malignant middle cerebral artery infarctions (MMI) who underwent hemicraniectomies...
September 2016: Journal of Stroke
https://www.readbyqxmd.com/read/27690654/stereotactic-laser-ablation-as-treatment-for-brain-metastases-that-recur-after-stereotactic-radiosurgery-a-multiinstitutional-experience
#7
Mir Amaan Ali, Kate T Carroll, Robert C Rennert, Thomas Hamelin, Leon Chang, Brian P Lemkuil, Mayur Sharma, Jill S Barnholtz-Sloan, Charlotte Myers, Gene H Barnett, Kris Smith, Alireza M Mohammadi, Andrew E Sloan, Clark C Chen
OBJECTIVE Therapeutic options for brain metastases (BMs) that recur after stereotactic radiosurgery (SRS) remain limited. METHODS The authors provide the collective experience of 4 institutions where treatment of BMs that recurred after SRS was performed with stereotactic laser ablation (SLA). RESULTS Twenty-six BMs (in 23 patients) that recurred after SRS were treated with SLA (2 patients each underwent 2 SLAs for separate lesions, and a third underwent 2 serial SLAs for discrete BMs). Histological findings in the BMs treated included the following: breast (n = 6); lung (n = 6); melanoma (n = 5); colon (n = 2); ovarian (n = 1); bladder (n = 1); esophageal (n = 1); and sarcoma (n = 1)...
October 2016: Neurosurgical Focus
https://www.readbyqxmd.com/read/27663488/association-between-prolonged-seizures-and-malignant-middle-cerebral-artery-infarction-in-children-with-acute-ischemic-stroke
#8
Andrea Andrade, Sandra Bigi, Suzanne Laughlin, Sujatha Parthasarathy, Adriane Sinclair, Peter Dirks, Ann Marie Pontigon, Mahendranath Moharir, Rand Askalan, Daune MacGregor, Gabrielle deVeber
BACKGROUND: Malignant middle cerebral artery infarct syndrome is a potentially fatal complication of stroke that is poorly understood in children. We studied the frequency, associated characteristics, and outcomes of this condition in children. METHODS: Children, aged two months to 18 years with acute middle cerebral artery infarct diagnosed at our center between January 2005 and December 2012 were studied. Associations with malignant middle cerebral artery infarct syndrome were sought, including age, seizures, neurological deficit severity (Pediatric National Institute of Health Stroke Severity Score), stroke etiology, fever, blood pressure, blood glucose, infarct location, infarct volume (modified pediatric Alberta Stroke Program Early Computed Tomography Score), and arterial occlusion...
August 27, 2016: Pediatric Neurology
https://www.readbyqxmd.com/read/27649670/size-of-bone-flap-and-bone-window-area-may-impact-the-outcome-of-decompressive-craniectomy-using-standard-bone-flap
#9
Y-S Wang, Y Wang, X-W Shi, J-D Zhang, Y-Y Ma
OBJECTIVE: To verify if the size of the bone flap and the bone window area may have an impact on the outcome of decompressive craniectomy. PATIENTS AND METHODS: From February 2012 to February 2014, 42 patients with acute intracranial hypertension were enrolled in this study. We conducted standard craniotomy and decompressive hemicraniectomy on all patients. The intracranial pressure was measured before the hemicraniectomy operation, at the time of bone flap removal, at the time of the incision of the dura mater and 24 hours after the operation...
September 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/27637622/surgical-management-of-aneurysmal-hematomas-prognostic-factors-and-outcome
#10
P Meneghelli, F Cozzi, A Hasanbelliu, F Locatelli, Alberto Pasqualin
From 1991 until 2013, 304 patients with intracranial hematomas from aneurysmal rupture were managed surgically in our department, constituting 17 % of all patients with aneurysmal rupture. Of them, 242 patents presented with isolated intracerebral hematomas (in 69 cases associated with significant intraventricular hemorrhage), 50 patients presented with combined intracerebral and subdural hematomas (in 11 cases associated with significant intraventricular hemorrhage), and 12 presented with an isolated subdural hematoma...
2016: Acta Neurochirurgica. Supplement
https://www.readbyqxmd.com/read/27591100/volume-of-brain-herniation-in-ischemic-stroke-patients-following-decompressive-craniectomy
#11
Kirsten E Stoner, Kingsley O Abode-Iyamah, Nicole M Grosland, Matthew A Howard
BACKGROUND: Decompressive craniectomy procedures are performed in patients with malignant intracranial hypertension. A bone flap is removed to relieve pressure. Later a second operation is performed to reconstruct the skull after brain swelling has resolved. This surgical treatment would be improved if it were possible to perform a single operation that decompressed the brain acutely while eliminating the need for a second operation. In order to design a device and procedure that achieves this objective it is essential to understand how the brain swells following a craniectomy procedure...
August 30, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27523587/early-urgent-cranioplasty-for-symptomatic-hygroma-report-of-two-cases
#12
James G Malcolm, Brandon A Miller, Jonathan A Grossberg, Gustavo Pradilla, Faiz U Ahmad
Following craniectomy, hygromas are relatively common. While many cases resolve spontaneously, some patients develop neurologic deficits. Management of symptomatic hygromas often involves shunting or drainage. We present two patients who three weeks after decompressive hemicraniectomy developed declining neurologic status secondary to enlarging hygroma. Failing conservative management, both were treated with urgent cranioplasty and returned to neurologic baseline. Early cranioplasty may be safe and effective for symptomatic collections...
August 11, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27512937/subdural-hematoma-associated-with-labor-epidural-analgesia-a-case-series
#13
Grace Lim, Jamie M Zorn, Yuanxu J Dong, Joseph S DeRenzo, Jonathan H Waters
OBJECTIVE: This report aimed to describe the characteristics and impact of subdural hematoma (SDH) after labor epidural analgesia. CASE REPORTS: Eleven obstetric patients had SDHs associated with the use of labor epidural analgesia over 7 years at a tertiary care hospital. Ten of 11 patients had signs consistent with postdural puncture headache before the diagnosis of SDH. Five patients (45%) had a recognized unintentional dural puncture, 1 (9%) had a combined spinal-epidural with a 24-gauge needle, and 5 (45%) had no recognized dural puncture...
September 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/27495258/utilization-of-long-term-care-after-decompressive-hemicraniectomy-for-severe-stroke-among-older-patients
#14
Corey R Fehnel, Yoojin Lee, Linda C Wendell, Bradford B Thompson, N Stevenson Potter, Vincent Mor
BACKGROUND: While clinical trial data support decompressive hemicraniectomy (DHC) as improving survival among patients with severe ischemic stroke, quality of life outcomes among older persons remain controversial. AIMS: To aid decision-making and understand practice variation, we measured long-term outcomes and patterns of regional variation for a nationwide cohort of ischemic stroke patients after DHC. METHODS: Medicare fee-for-service ischemic stroke cases over age 65 during the year 2008 were used to create a cohort followed for 2 years (2009-2010) after stroke and DHC procedure...
August 5, 2016: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/27488978/extended-use-of-hypothermia-in-elderly-patients-with-malignant-cerebral-edema-as-an-alternative-to-hemicraniectomy
#15
Han-Yeong Jeong, Jun-Young Chang, Kyu Sun Yum, Jeong-Ho Hong, Jin-Heon Jeong, Min-Ju Yeo, Hee-Joon Bae, Moon-Ku Han, Kiwon Lee
BACKGROUND AND PURPOSE: The use of decompressive hemicraniectomy (DHC) for the treatment of malignant cerebral edema can decrease mortality rates. However, this benefit is not sufficient to justify its use in elderly patients. We investigated the effects of therapeutic hypothermia (TH) on safety, feasibility, and functional outcomes in elderly patients with malignant middle cerebral artery (MCA) infarcts. METHODS: Elderly patients 60 years of age and older with infarcts affecting more than two-thirds of the MCA territory were included...
September 2016: Journal of Stroke
https://www.readbyqxmd.com/read/27468660/decompressive-craniectomy-for-ischemic-stroke-effect-of-hemorrhagic-transformation-on-outcome
#16
Hosam Al-Jehani, Kevin Petrecca, Phillipe Martel, David Sinclair, Denis Sirhan
BACKGROUND: Decompressive hemicraniectomy (DhC) is a life-saving surgical procedure being increasingly employed for malignant middle cerebral artery strokes. We examined the incidence of hemorrhagic transformation following DhC. METHODS: We retrospectively reviewed the charts and radiological images of patients who underwent DhC for malignant middle cerebral artery strokes. We classified the hemorrhagic events and assessed the short-term 30-day outcome associated with these events...
September 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27443695/timing-of-symptomatic-infarct-swelling-following-intravenous-thrombolysis-in-acute-middle-cerebral-artery-infarction-a-case-control-study
#17
Ting-Chun Lin, Jiann-Der Lee, Ya-Hui Lin, Rey-Yue Yuan, Hsu-Huei Weng, Ying-Chih Huang, Meng Lee, Chih-Ying Wu, Huan-Lin Hsu, Chia-Yu Hsu, Tsong-Hai Lee, Shan-Jin Liu, Yeu-Jhy Chang, Chien-Hung Chang, Tsung-I Peng, Chia-Wei Liou, Ku-Chou Chang, Yi-Ting Pan, Yen-Chu Huang
BACKGROUND: The risk of symptomatic infarct swelling has been reported to be higher in patients treated with recombinant tissue plasminogen activator (rt-PA). The aim of this study was to evaluate the timing of symptomatic infarct swelling after rt-PA treatment. METHODS: We retrospectively analyzed 14 868 patients with acute ischemic stroke from a stroke registry databank. We recruited patients with massive middle cerebral artery (MCA) infarction and symptomatic infarct swelling and excluded those with parenchymal or symptomatic hemorrhage...
July 21, 2016: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/27406817/patient-age-and-the-outcomes-after-decompressive-hemicraniectomy-for-stroke-a-nationwide-inpatient-sample-analysis
#18
Hormuzdiyar H Dasenbrock, Faith C Robertson, M Ali Aziz-Sultan, Donovan Guittieres, Rose Du, Ian F Dunn, William B Gormley
BACKGROUND: Decompressive hemicraniectomy (DHC) for space-occupying cerebral infarction in older adults remains controversial, and there are limited nationwide data evaluating the outcomes after craniectomy for stroke by patient age. METHODS: Patients who underwent DHC for ischemic stroke were extracted from the Nationwide Inpatient Sample (2002-2011). Multivariable logistic regression examined in-hospital mortality and a poor outcome (death, tracheostomy and gastrostomy, or discharge to institutional care)...
December 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27402215/abusive-head-trauma-an-epidemiological-and-cost-analysis
#19
Scott Boop, Mary Axente, Blakely Weatherford, Paul Klimo
OBJECTIVE Research on pediatric abusive head trauma (AHT) has largely focused on clinical presentation and management. The authors sought to review a single-institution experience from a public health perspective to gain a better understanding of the local population affected, determine overall incidence and seasonal trends, and provide details on the initial hospitalization, including extent of injuries, neurosurgical interventions, and hospital charges. METHODS All cases of AHT involving patients who presented to Le Bonheur Children's Hospital (LBCH) from 2009 through 2014 were identified...
July 12, 2016: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/27379413/decompressive-hemicraniectomy-in-malignant-middle-cerebral-artery-infarction-the-real-world-beyond-studies
#20
Hans-Werner Pledl, Carolin Hoyer, Juliane Rausch, Anne D Ebert, Marcel Seiz, Mirko Arp, Michael G Hennerici, Angelika Alonso
BACKGROUND: Decompressive hemicraniectomy (DHC) is life-saving in patients with malignant middle cerebral artery infarction (MMI), but outcome, perspectives and complications after DHC in daily practice are largely unknown. METHODS: From 2008 until 2014, we extracted patient's characteristics as well as complications from our database for patients with MMI who underwent DHC. Additionally, we analysed medical records from the different rehabilitation steps. RESULTS: We identified 48 consecutive patients (mean 57 years, 21 male, 41...
2016: European Neurology
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