Thursday, August 30, 2012

Treatment of delayed Chiari malformation and syringomyelia after lumboperitoneal shunt placement: Ca

Analise F Peleggi, Thomas J Lovely

Surgical Neurology International 2012 3(1):101-101

Background: Delayed Chiari malformation with syringomyelia is an uncommon and sparsely reported complication after lumbar cisternal shunting. A number of treatments have been implemented with varying degrees of success. After review of these modalities, a treatment plan was devised and implemented. Case Description: A 15-year-old girl was diagnosed with idiopathic intracranial hypertension (pseudotumor cerebri) and had placement of a Medtronic Spetzler lumboperitoneal shunt. She did well for 10 years and then developed a 3-week history of headache, balance problems, and sensory loss. Workup demonstrated a new Chiari malformation and cervical syrinx. She underwent initial placement of a ventriculoperitoneal shunt, followed by ligation of the lumboperitoneal shunt. She then had a suboccipital decompression and duraplasty. Follow-up at 6 months showed relief of her symptoms and MRI demonstrated resolution of the Chiari malformation and syrinx. Conclusion: Delayed Chiari malformation and/or syringomyelia after lumbar shunting is best treated with placement of a ventricular device and ligation of the lumbar shunt. The Chiari malformation and/or syrinx should be surgically addressed for persistent symptoms or progression of the structural abnormality.





1 comment:

Wednesday, August 29, 2012

Acoustic neurinoma



Lucas Alverne F. Albuquerque
No comments:

Brachial plexus



Lucas Alverne F. Albuquerque
No comments:

T12-L1 spondylodiscitis



Lucas Alverne F. Albuquerque
No comments:

Vídeo aulas da USP

A USP lançou em maio um portal que já reúne 800 videoaulas, produzidas
por seus professores, nas áreas de Exatas, Humanas e Biológicas. Os
interessados podem assistir tanto a aulas isoladas como a disciplinas
inteiras, mas sem direito a qualquer tipo de certificado. O Portal
e-Aulas USP (www.eaulas.usp.br )foi inspirado em projetos semelhantes de universidades como Harvard, Princeton e





No comments:

Tuesday, August 28, 2012

"Time is brain" the Gifford factor - or: Why do some civilian gunshot wounds to the head do unexpect

David J Lin, Fred C Lam, Jeffrey J Siracuse, Ajith Thomas, Ekkehard M Kasper

Surgical Neurology International 2012 3(1):98-98

Background: Review of intracranial gunshot wounds (GSWs) undergoing emergent neurosurgical intervention despite a very low Glasgow Coma Scale (GCS) score on admission in order to identify predictors of good outcome, with correlates to recent literature. Methods: A retrospective review of select cases of GSWs presenting to our trauma center over the past 5 years with poor GCS requiring emergent neurosurgical intervention and a minimum of 1-year follow-up. Results: Out of a total of 17 patients who went to the operating room (OR) for GSW to the head during this period, 4 cases with a GCS < 5 on admission were identified. All cases required a hemicraniectomy to alleviate cerebral swelling. Two cases presented with a unilaterally blown pupil due to raised intracranial pressure. The remaining 2 cases had equal and reactive pupils. One patient with a GCS of 3 and a significant bilateral pattern of parenchymal bullet injury was initially assessed in moribund status but rallied and received a delayed hemicraniectomy on day 7. Three out of 4 patients are functionally independent at 1-year follow-up. The fourth patient who received a delayed decompression remains wheelchair dependent. Conclusion: Victims of GSWs can have good outcomes despite having a very poor admission GCS score and papillary abnormalities. Factors predicting good outcomes include the following: time from injury to surgical intervention of < 1 h; injury to noneloquent brain; and absence of injury to midbrain, brainstem, and major vessels.





No comments:

Sleep-disordered breathing in multiple sclerosis

Background:

The objectives of this cross-sectional study were to assess the prevalence and severity of sleep apnea in patients with multiple sclerosis (MS) referred for overnight polysomnography (PSG) and to explore the radiographic and clinical features that might signal risk for undiagnosed sleep apnea.

Methods:

Apnea-hypopnea (AHI) and central apnea indices (CAI) from laboratory-based PSG among 48 patients with MS were compared with those of group A, 84 sleep laboratory–referred patients without MS matched for age, gender, and body mass index; and group B, a separate group of 48 randomly selected, referred patients.

Results:

Mean AHI was higher among patients with MS than among control groups A or B (2-way analysis of variance and multiple linear regression, p = 0.0011 and 0.0118, respectively). Median and mean CAI were also increased among patients with MS in comparison to control groups (Wilcoxon signed rank and multiple linear regression, p = 0.0064 and 0.0027, respectively). Among MS patients with available data, those with evidence of brainstem involvement, compared with groups A and B, showed particularly robust differences in AHI (p = 0.0060 and 0.0016) and CAI (p = 0.0215 and <0.0001). In contrast, MS patients without brainstem involvement, compared with groups A and B, showed diminished differences in AHI, and CAI did not significantly differ among groups.

Conclusions:

These data suggest a predisposition for obstructive sleep apnea and accompanying central apneas among patients with MS, particularly among those with brainstem involvement.






No comments:

MRI abnormalities following febrile status epilepticus in children: The FEBSTAT study

Objective:

The FEBSTAT study is a prospective study that seeks to determine the acute and long-term consequences of febrile status epilepticus (FSE) in childhood.

Methods:

From 2003 to 2010, 199 children age 1 month to 5 years presenting with FSE (>30 minutes) were enrolled in FEBSTAT within 72 hours of the FSE episode. Of these, 191 had imaging with emphasis on the hippocampus. All MRIs were reviewed by 2 neuroradiologists blinded to clinical details. A group of 96 children with first simple FS who were imaged using a similar protocol served as controls.

Results:

A total of 22 (11.5%) children had definitely abnormal (n = 17) or equivocal (n = 5) increased T2 signal in the hippocampus following FSE compared with none in the control group (p < 0.0001). Developmental abnormalities of the hippocampus were more common in the FSE group (n = 20, 10.5%) than in controls (n = 2, 2.1%) (p = 0.0097) with hippocampal malrotation being the most common (15 cases and 2 controls). Extrahippocampal imaging abnormalities were present in 15.7% of the FSE group and 15.6% of the controls. However, extrahippocampal imaging abnormalities of the temporal lobe were more common in the FSE group (7.9%) than in controls (1.0%) (p = 0.015).

Conclusions:

This prospective study demonstrates that children with FSE are at risk for acute hippocampal injury and that a substantial number also have abnormalities in hippocampal development. Follow-up studies are in progress to determine the long-term outcomes in these children.






No comments:

Warfarin-Associated Intracerebral Hemorrhage Is Inadequately Treated at Community Emergency Departme

Background and Purpose—

The purpose of this study was to investigate time delays, adherence to guidelines, and their impact on outcomes in patients with warfarin-associated intracerebral hemorrhage transferred from community emergency departments to a comprehensive stroke center.

Methods—

We collected demographic, clinical, transfer time, treatment, and outcome data for patients transferred to our institution with warfarin-associated intracerebral hemorrhage from community emergency departments.

Results—

Among 928 patients with intracerebral hemorrhage, 56 (6%) with warfarin-associated intracerebral hemorrhage (median international normalized ratio, 2.55) were transferred to the comprehensive stroke center. Twenty patients received no acute reversal therapy before transfer, only 4 of whom had international normalized ratios ≤1.4 in the community emergency department. Median time of emergency department stay was 3.66 hours and median time to initiation of acute reversal therapy was 4.48 hours. Those who received ≥3 U of fresh–frozen plasma or recombinant activated Factor VIIa (11 patients) before transfer had lower repeat international normalized ratios and better discharge dispositions than those treated less aggressively.

Conclusions—

Treatment of warfarin-associated intracerebral hemorrhage in community emergency departments is often suboptimal and does not adhere to published guidelines. Treating coagulopathy aggressively before interhospital transfer may improve outcomes and warrants further investigation.






No comments:

Pharmacological Stabilization of Intracranial Aneurysms in Mice: A Feasibility Study [Original Contr

Background and Purpose—

An increasing number of unruptured intracranial aneurysms are being detected, partly due to the increased use of brain imaging techniques. Pharmacological stabilization of aneurysms for the prevention of aneurysmal rupture could potentially be an attractive alternative approach to clipping or coiling in patients with unruptured intracranial aneurysms. We have developed a mouse model of intracranial aneurysm that recapitulates key features of intracranial aneurysms. In this model, subarachnoid hemorrhage from aneurysmal rupture causes neurological symptoms that can be easily detected by a simple neurological examination. Using this model, we tested whether anti-inflammatory agents such as tetracycline derivatives, or a selective inhibitor of matrix metalloproteinases-2 and -9 (SB-3CT), can prevent the rupture of intracranial aneurysms.

Methods—

Aneurysms were induced by a combination of induced hypertension and a single injection of elastase into the cerebrospinal fluid in mice. Treatment with minocycline, doxycycline, or SB-3CT was started 6 days after aneurysm induction. Aneurysmal rupture was detected by neurological symptoms and confirmed by the presence of intracranial aneurysms with subarachnoid hemorrhage.

Results—

Minocycline and doxycycline significantly reduced rupture rates (vehicle versus doxycycline=80% versus 35%, P<0.05; vehicle versus minocycline=73% versus 24%, P<0.05) without affecting the overall incidence of aneurysms. However, SB-3CT did not affect the rupture rate (62% versus 55%, P=0.53).

Conclusions—

Our data established the feasibility of using a mouse model of intracranial aneurysm to test pharmacological stabilization of aneurysms. Tetracycline derivatives could be potentially effective in preventing aneurysmal rupture.






No comments:

Costs and Cost-Effectiveness of Carotid Stenting Versus Endarterectomy for Patients at Standard Surg

Background and Purpose—

The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) demonstrated similar rates of the primary composite end point between carotid artery stenting (CAS) and carotid endarterectomy (CEA), although the risk of stroke was higher with CAS, and the risk of myocardial infarction was higher with CEA. Given the large number of patients who are candidates for these procedures, an understanding of their relative cost and cost-effectiveness may have important implications for health care policy and treatment guidelines.

Methods—

We performed a formal economic evaluation alongside the CREST trial. Costs were estimated from all trial participants over the first year of follow-up using a combination of resource use data and hospital billing data. Patient-level health use scores were obtained using data from the SF-36. We then used a Markov disease-simulation model calibrated to the CREST results to project 10-year costs and quality-adjusted life expectancy for the 2 treatment groups.

Results—

Although initial procedural costs were $1025/patient higher with CAS, postprocedure costs and physician costs were lower such that total costs for the index hospitalization were similar for the CAS and CEA groups ($15 055 versus $14 816; mean difference, $239/patient; 95% CI for difference, –$297 to $775). Neither follow-up costs after discharge nor total 1-year costs differed significantly. For the CREST population, model-based projections over a 10-year time horizon demonstrated that CAS would result in a mean incremental cost of $524/patient and a reduction in quality-adjusted life expectancy of 0.008 years compared with CEA. Probabilistic sensitivity analysis demonstrated that CEA was economically attractive at an incremental cost-effectiveness threshold of $50 000/quality-adjusted life-year gained in 54% of samples, whereas CAS was economically attractive in 46%.

Conclusions—

Despite slightly lower in-trial costs and lower rates of stroke with CEA compared with CAS, projected 10-year outcomes from this controlled clinical trial demonstrate only trivial differences in overall healthcare costs and quality-adjusted life expectancy between the 2 strategies. If the CREST results can be replicated in clinical practice, these findings suggest that factors other than cost-effectiveness should be considered when deciding between treatment options for carotid artery stenosis in patients at standard risk for surgical complications.

Clinical Trial Registration—

URL: http://clinicaltrials.gov. Unique Identifier: NCT00004732.






No comments:

Systematic Review of Outcome After Ischemic Stroke Due to Anterior Circulation Occlusion Treated Wit

Background and Purpose—

The optimal approach to recanalization in acute ischemic stroke is unknown. We performed a literature review and meta-analysis comparing the relative efficacy of 6 reperfusion strategies: (1) 0.9 mg/kg intravenous tissue-type plasminogen activator; (2) intra-arterial chemical thrombolysis; (3) intra-arterial mechanical thrombolysis; (4) intra-arterial combined chemical/mechanical thrombolysis; (5) 0.6 mg/kg intravenous tissue-type plasminogen activator and intra-arterial thrombolysis; and (6) 0.9 mg/kg intravenous tissue-type plasminogen activator and intra-arterial thrombolysis.

Methods—

A literature search in Medline, Embase, and the Cochrane database identified case series, observational studies, and treatment arms of randomized trials of anterior circulation arterial occlusion treated with thrombolytic therapy. Included studies had ≥10 subjects, mean time to treatment <6 hours, and treatment specific reporting of disability, death, and intracerebral hemorrhage. Multivariable metaregression evaluated the effects of treatment group on outcome at the same time as accounting for differences in baseline covariates.

Results—

A total of 2986 abstracts were identified from which 54 studies (5019 subjects) were included. There were significant differences across groups in age (P=0.0008), baseline National Institutes of Health Stroke Scale (P=0.0002), and time to treatment initiation (P<0.0001). There were also differences in mean modified Rankin Scale (P<0.0001), mortality (P=0.0024), and symptomatic intracerebral hemorrhage (P=0.0305). Differences in modified Rankin Scale were not significant in the metaregression and likely attributable to differences in baseline covariates between studies.

Conclusions—

This study found no evidence that one reperfusion strategy is superior with respect to efficacy or safety, supporting clinical equipoise between reperfusion strategies. Intravenous tissue-type plasminogen activator remains the standard of care for acute ischemic stroke. Randomized clinical trials are necessary to determine the efficacy of alternative reperfusion strategies. Participation in such trials is strongly recommended.






No comments:

Elderly Patients Are at Higher Risk for Poor Outcomes After Intra-Arterial Therapy [Original Contrib

Background and Purpose—

Conflicting data exist regarding outcomes after intra-arterial therapy (IAT) in elderly stroke patients. We compare safety and clinical outcomes of multimodal IAT in elderly versus nonelderly patients and investigate differences in baseline health and disability as possible explanatory factors.

Methods—

Data from a prospectively collected institutional IAT database were analyzed comparing elderly (80 years or older) versus nonelderly patients. Baseline demographics, angiographic reperfusion (Thrombolysis in Cerebral Infarction scale score 2–3), rate of parenchymal hematoma type 2, and 90-day modified Rankin Scale scores were compared in univariate and multivariate analyses.

Results—

There were 49 elderly and 130 nonelderly patients treated between 2005 and 2010. Between the 2 cohorts, there was no significant difference in Thrombolysis in Cerebral Infarction 2 to 3 reperfusion (71% vs 75%; P=0.57), time to reperfusion (P=0.77), or rate of parenchymal hematoma type 2 (4% vs 7%; P=0.73) after IAT. However, elderly patients had significantly lower rates of good outcome (modified Rankin Scale score 0–2: 2% vs 33%; P<0.0001) and higher mortality (59% vs 24%; P<0.0001) at 90 days. Atrial fibrillation, coronary artery disease, hypertension, hyperlipidema, and baseline disability were significantly more common in elderly patients. Adjusting for baseline disability, stroke severity, and reperfusion, elderly patients were 29-times more likely to be dependent or dead at 90 days (odds ratio, 28.7; 95% confidence interval, 3.2–255.7; P=0.003).

Conclusions—

Despite comparable rates of reperfusion and significant hemorrhage, elderly patients had worse clinical outcomes after IAT, which may relate, in part, to worse baseline health and disability. The use of IAT in the elderly should be performed after a careful analysis of the potential risks and benefits.






No comments:

Intravenous Thrombolysis and Endovascular Therapy for Acute Ischemic Stroke With Internal Carotid Ar

Background and Purpose—

Strokes secondary to acute internal carotid artery (ICA) occlusion are associated with extremely poor prognosis. The best treatment approach to acute stroke in this setting is unknown. We sought to determine clinical outcomes in patients with acute ischemic stroke attributable to ICA occlusion treated with intravenous (IV) systemic thrombolysis or intra-arterial endovascular therapy.

Methods—

Using the PubMed database, we searched for studies that included patients with acute ischemic stroke attributable to ICA occlusion who received treatment with IV thrombolysis or intra-arterial endovascular interventions. Studies providing data on functional outcomes beyond 30 days and mortality and symptomatic intracerebral hemorrhage (sICH) rates were included in our analysis. We compared the proportions of patients with favorable functional outcomes, sICH, and mortality rates in the 2 treatment groups by calculating 2 and confidence intervals for odds ratios.

Results—

We identified 28 studies with 385 patients in the IV thrombolysis group and 584 in the endovascular group. Rates of favorable outcomes and sICH were significantly higher in the endovascular group than the IV thrombolysis-only group (33.6% vs 24.9%, P=0.004 and 11.1% vs 4.9%, P=0.001, respectively). No significant difference in mortality rate was found between the groups (27.3% in the IV thrombolysis group vs 32.0% in the endovascular group; P=0.12).

Conclusions—

According to our systematic review, endovascular treatment of acute ICA occlusion results in improved clinical outcomes. A higher rate of sICH after endovascular treatment does not result in increased overall mortality rate.






No comments:

Impact of Acute Ischemic Stroke Treatment in Patients

Background and Purpose—

Few studies have addressed outcomes among patients ≥80 years treated with acute stroke therapy. In this study, we outline in-hospital outcomes in (1) patients ≥80 years compared with their younger counterparts; and (2) those over >80 years receiving intra-arterial therapy (IAT) compared with those treated with intravenous recombinant tissue-type plasminogen activator (IV rtPA).

Methods—

Stroke centers within the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) prospectively collected data on all patients treated with IV rtPA or IAT from January 1, 2005, to December 31, 2010. IAT was defined as receiving any endovascular therapy; IAT was further divided into bridging therapy when the patient received both IAT and IV rtPA and endovascular therapy alone. In-hospital mortality was compared in (1) all patients aged ≥80 years versus younger counterparts; and (2) IAT, bridging therapy, and endovascular therapy alone versus IV rtPA only among those age ≥80 years using multivariable logistic regression. An age-stratified analysis was also performed.

Results—

A total of 3768 patients were included in the study; 3378 were treated with IV rtPA alone and 808 with IAT (383 with endovascular therapy alone and 425 with bridging therapy). Patients ≥80 years (n=1182) had a higher risk of in-hospital mortality compared with younger counterparts regardless of treatment modality (OR, 2.13; 95% CI, 1.60–2.84). When limited to those aged ≥80 years, IAT (OR, 0.95; 95% CI, 0.60–1.49), bridging therapy (OR, 0.82; 95% CI, 0.47–1.45), or endovascular therapy alone (OR, 1.15; 95% CI, 0.64–2.08) versus IV rtPA were not associated with increased in-hospital mortality.

Conclusions—

IAT does not appear to increase the risk of in-hospital mortality among those aged >80 years compared with IV thrombolysis alone.






No comments:

Jugular Veins in Transient Global Amnesia: Innocent Bystanders [Original Contributions; Clinical Sci

Background and Purpose—

Transient global amnesia (TGA) has been associated with an increased prevalence of internal jugular valve insufficiency and many patients report Valsalva-associated maneuvers before TGA onset. These findings have led to the assumption of hemodynamic alterations in intracranial veins inducing focal hippocampal ischemia. We investigated this hypothesis in patients with TGA and control subjects.

Methods—

Seventy-five patients with TGA and 75 age- and sex-matched healthy subjects were enrolled into a cross-sectional study. Extracranial and transcranial high-resolution venous echo-color-Doppler sonography was performed blindly in all patients and control subjects. Blood flow direction and velocities were recorded at the internal jugular veins, basal veins of Rosenthal, and vein of Galen, both at rest and during Valsalva-associated maneuvers.

Results—

Mean age of patients with TGA was 60.3±8.0 years (median, 60 years; range, 44–78 years); 44 (59%) were female (female/male ratio: 1.42). Internal jugular valve insufficiency (left, right, or bilateral) was found to be more frequent in patients with TGA than in control subjects: 53 (70.7%) versus 22 (29.3%; P<0.05). Blood flow velocities in the deep cerebral veins of patients with TGA did not differ from control subjects both at rest and during Valsalva-associated maneuvers. Intracranial venous reflux was neither observed in patients with TGA nor in control subjects despite unilateral or bilateral internal jugular valve insufficiency during prolonged and maximal Valsalva-associated maneuvers.

Conclusions—

This study, although confirming the association between TGA and internal jugular valve insufficiency, challenges the hypothesis that cerebral venous congestion plays a significant role in the pathogenesis of TGA.






No comments:

Risk Score for Intracranial Hemorrhage in Patients With Acute Ischemic Stroke Treated With Intraveno

Background and Purpose—

There are few validated models for prediction of risk of symptomatic intracranial hemorrhage (sICH) after intravenous tissue-type plasminogen activator treatment for ischemic stroke. We used data from Get With The Guidelines–Stroke (GWTG-Stroke) to derive and validate a prediction tool for determining sICH risk.

Methods—

The population consisted of 10 242 patients from 988 hospitals who received intravenous tissue-type plasminogen activator within 3 hours of symptom onset from January 2009 to June 2010. This sample was randomly divided into derivation (70%) and validation (30%) cohorts. Multivariable logistic regression identified predictors of intravenous tissue-type plasminogen activator-related sICH in the derivation sample; model β coefficients were used to assign point scores for prediction.

Results—

sICH within 36 hours was noted in 496 patients (4.8%). Multivariable adjusted independent predictors of sICH were increasing age (17 points), higher baseline National Institutes of Health Stroke Scale (42 points), higher systolic blood pressure (21 points), higher blood glucose (8 points), Asian race (9 points), and male sex (4 points). The C-statistic was 0.71 in the derivation sample and 0.70 in the independent internal validation sample. Plots of observed versus predicted sICH showed good model calibration in the derivation and validation cohorts. The model was externally validated in National Institute of Neurological Disorders and Stroke trial patients with a C-statistic of 0.68.

Conclusions—

The GWTG-Stroke sICH risk "GRASPS" score provides clinicians with a validated method to determine the risk of sICH in patients treated with intravenous tissue-type plasminogen activator within 3 hours of stroke symptom onset.






No comments:

Genetic Variation Within the Interleukin-1 Gene Cluster and Ischemic Stroke [Original Contributions;

Background and Purpose—

Evidence is emerging that inflammation plays a key role in the pathophysiology of ischemic stroke (IS). The aim of this study was to investigate whether genetic variation in the interleukin-1α, interleukin-1β, and interleukin-1 receptor antagonist genes (IL1A, IL1B, and IL1RN) is associated with IS and/or any etiologic subtype of IS.

Methods—

Twelve tagSNPs were analyzed in the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS), which comprises 844 patients with IS and 668 control subjects. IS subtypes were defined according to the Trial of Org 10172 in Acute Stroke Treatment criteria in SAHLSIS. The Lund Stroke Register and the Malmö Diet and Cancer study were used as a replication sample for overall IS (in total 3145 patients and 1793 control subjects).

Results—

The single nucleotide polymorphism rs380092 in IL1RN showed an association with overall IS in SAHLSIS (OR, 1.21; 95% CI, 1.02–1.43; P=0.03), which was replicated in the Lund Stroke Register and the Malmö Diet and Cancer study sample. An association was also detected in all samples combined (OR, 1.12; 95% CI, 1.04–1.21; P=0.03). Three single nucleotide polymorphisms in IL1RN (including rs380092) were nominally associated with the subtype of cryptogenic stroke in SAHLSIS, but the statistical significance did not remain after correction for multiple testing. Furthermore, increased plasma levels of interleukin-1 receptor antagonist were observed in the subtype of cryptogenic stroke compared with controls.

Conclusion—

This comprehensive study, based on a tagSNP approach and replication, presents support for the role of IL1RN in overall IS.






No comments:

Monday, August 27, 2012

Spine gunshot



Lucas Alverne F. Albuquerque
No comments:

Hemorrhagic stroke



Lucas Alverne F. Albuquerque
No comments:

MCA aneurysm



Lucas Alverne F. Albuquerque
No comments:

Instagram: MCA aneurysm



No comments:

Instagram Apps Neurosurgery Blog



No comments:

Instagram: Lombar Artrodesis



No comments:

Saturday, August 25, 2012

Depression Linked with Hyperconnected Brain Areas

Like an overwhelmed traffic cop, the depressed brain may transmit signals among regions in a dysfunctional way. Recent brain-imaging studies suggest that areas of the brain involved in mood, concentration and conscious thought are hyperconnected, which scientists believe could lead to the problems with focus, anxiety and memory frequently seen in depression.

[More]

Add to digg Add to StumbleUpon Add to Reddit Add to Facebook Add to del.icio.us Email this Article





No comments:

Guide the Future of Neurology–Become a Mentor!

The Academy's Neurology Career Center is working to bring experienced members together with members who seek guidance on their career path.





No comments:

Symptomatic Cerebral Vasospasm Following Resection of a Medulloblastoma in a Child

Abstract
Background  
Vasospasm may occur following intracranial tumor resection but is uncommon following resection of tumors in the posterior fossa.
Methods  
Case report.
Results  
Here, we report an unusual pediatric case of symptomatic cerebral vasospasm following resection of a posterior fossa medulloblastoma in a 10-year-old child. CT angiogram and serial Transcranial Doppler (TCD) studies confirmed the presence of vasospasm and response to hemodynamic augmentation therapy, resulting in favorable outcome.
Conclusion  
This case illustrates an unusual complication of posterior fossa tumor resection, and the potential utility of TCD studies in the detection and management of vasospasm in pediatric neurocritical care.

  • Content Type Journal Article
  • Category Practical Pearl
  • Pages 1-5
  • DOI 10.1007/s12028-012-9769-y
  • Authors
    • Vamshi K. Rao, Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, No. 51, 225 E. Chicago Ave., Chicago, IL 60611, USA
    • Abilash Haridas, Department of Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
    • Thanh T. Nguyen, Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, No. 51, 225 E. Chicago Ave., Chicago, IL 60611, USA
    • Rishi Lulla, Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
    • Mark S. Wainwright, Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, No. 51, 225 E. Chicago Ave., Chicago, IL 60611, USA
    • Joshua L. Goldstein, Division of Neurology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, No. 51, 225 E. Chicago Ave., Chicago, IL 60611, USA





No comments:

Microsurgical clipping of an unruptured lenticulostriate aneurysm

Publication year: 2012
Source:Journal of Clinical Neuroscience
M. Yashar S. Kalani, Nikolay L. Martirosyan, Peter Nakaji, Robert F. Spetzler
Aneurysms of the lenticulostriate artery have been associated with hypertension, vasculopathy, tumors, and arteriovenous malformations. Although several cases of microsurgical treatment of ruptured lenticulostriate artery aneurysms have been reported, to our knowledge there is no published case of microsurgical treatment of an unruptured lenticulostriate artery aneurysm. We report a 66-year-old woman with a history of moyamoya disease, previously treated with a right-sided middle cerebral artery-to-superficial temporal artery bypass who presented with an unruptured aneurysm of a lenticulostriate artery. We report successful microsurgical treatment of this rare lesion and discuss the rationale for our treatment strategy.






No comments:

Efficacy of extracranial–intracranial revascularization for non-moyamoya steno-occlusive cerebrovasc

Publication year: 2012
Source:Journal of Clinical Neuroscience
Yuxiang Gu, Wei Ni, Hanqiang Jiang, Gang Ning, Bin Xu, Yanlong Tian, Feng Xu, Yujun Liao, Donglei Song, Ying Mao
Although there is uncertainty about whether extracranial–intracranial arterial bypass is useful for the treatment of steno-occlusive cerebrovascular disease in general, there is some argument for its continued use in particular patients. In the present study, we evaluated the efficacy of superficial temporal artery–middle cerebral artery (STA–MCA) anastomosis combined with encephalo-duro-myo-synangiosis (EDMS) in the treatment of non-moyamoya steno-occlusive cerebrovascular disease by retrospectively reviewing clinical and radiological data from 66 patients treated between January 2006 and April 2011. Forty-six double STA–MCA anastomoses and 20 single anastomoses were completed, and all remained patent in the perioperative phase, as confirmed by CT angiography. Postoperative CT perfusion imaging demonstrated immediate improvement in perfusion in the revascularized hemisphere. On discharge, 50 of the 66 patients (75.8%) had an improved National Institutes of Health Stroke Scale (NIHSS) score relative to preoperative values. After at least 6months of follow-up, 54 (88.5%) patients had improved NIHSS scores relative to discharge values. CT perfusion imaging showed significant improvement compared to post-operative images. Follow-up digital subtraction angiography confirmed that 95 of 96 (99%) anastomoses remained patent. There was no significant difference between the single and double bypasses in terms of either clinical or hemodynamic outcomes on the revascularized side. STA–MCA combined with EDMS was effective for the treatment of non-moyamoya steno-occlusive cerebrovascular disease with hemodynamic impairment. Hemodynamic evaluation before and after surgery may help identify patients in need of a bypass and may be useful for predicting outcome.






No comments:

Clinical complications in patients with severe cervical spinal trauma: a ten-year prospective study



Clinical complications in patients with severe cervical spinal trauma: a ten-year prospective study
ARQUIVOS DE NEURO-PSIQUIATRIA | AUGUST 25, 2012
http://pulse.me/s/cCk9u
OBJECTIVE: To determine the complications due to severe acrescentar sigla após o nome (CST). METHODS: Between 1997 and 2006, ... Read more

--
Sent via Pulse/
No comments:

Friday, August 24, 2012

Tarlov cyst



Lucas Alverne F. Albuquerque
No comments:

High grade glioma



Lucas Alverne F. Albuquerque
No comments:

Temporal arachnoid cyst



Lucas Alverne F. Albuquerque
No comments:

T6 fracture



Lucas Alverne F. Albuquerque
No comments:

Giant orbital meningioma



Lucas Alverne F. Albuquerque
No comments:

Instagram cervical disc herniation


No comments:

Thursday, August 23, 2012

Management dilemma in penetrating head injuries in comatose patients: Scenario in underdeveloped cou

Abrar Ahad Wani, Altaf Umar Ramzan, Tanveer Iqbal Dar, Nayil K Malik, Abdul Quyoom Khan, Mohd Afzal Wani, Shafeeq Alam, Furqan A Nizami

Surgical Neurology International 2012 3(1):89-89

Background: The optimal management of patients with minimal injury to brain has been a matter of controversy and this is especially intensified when the patient has a poor neurological status. This is important in the regions where neurosurgical services are limited and patient turnover is disproportionate to the available resources. We aimed to determine the effectiveness of aggressive management in coma patients after penetrating missile injuries of the brain. Methods: All the patients of gunshots or blast injuries were included if they had a Glasgow Coma Scale score of less than 8 after initial resuscitation and had no other injury that could explain their poor neurological status. The indication for emergency surgery was evidence of a mass lesion causing a significant mass effect; otherwise, debridement was done in a delayed fashion. The patients who were not operated were those with irreversible shock or having small intracranial pellets with no significant scalp wounds. The patients who had a Glasgow outcome score of 1, 2, or 3 were classified as having an unfavorable outcome (UO) and those with scores 4 and 5 were classified as having a favorable outcome (FO). Results: We operated 13 patients and the rest 13 were managed conservatively. The characteristics of the patients having a favorable outcome were young age (OR = 28, P = 0 .031), normal hemodynamic status (OR = 18, P = 0.08), presence of pupillary reaction (OR = 9.7, P = 0.1), and injury restricted to one hemisphere only (OR = 15, P = 0.07). All of the patients who were in shock after resuscitation died while 25% of the patients with a normal hemodynamic status had a favorable outcome. Conclusions: In developing countries with limited resources, the patients who are in a comatose condition after sustaining penetrating missile injuries should not be managed aggressively if associated with bihemispheric damage, irreversible shock, or bilateral dilated nonreacting pupils. This is especially important in the event of receiving numerous patients with the same kind of injuries.





No comments:

The treatment of chronic incisional pain and headache after retromastoid craniectomy

Thomas J Lovely

Surgical Neurology International 2012 3(1):92-92

Background: A seldom emphasized complication of retromastoid craniectomy is chronic postcraniectomy incisional pain or headache. Although hypotheses have been proposed to explain this problem, there have been few attempts to treat patients in a delayed fashion. The results of postoperative treatments for chronic postretromastoid craniectomy pain and their rationales are discussed in a preliminary number of patients. Methods: Eight patients with chronic postretromastoid craniectomy pain who did not have placement of a cranioplasty at their initial operation underwent placement of a methylmethacrylate cranioplasty as a separate procedure. Three additional patients who did have a cranioplasty, but who had chronic pain underwent selective blocking of the ipsilateral second cervical nerve. If blocks resulted in relief of pain they then underwent a dorsal rhizotomy or ganglionectomy. Results: Two of the eight patients undergoing a cranioplasty had excellent results and one partial improvement while five failed at last follow-up. The three patients with a cranioplasty representing four symptomatic sides underwent a dorsal rhizotomy or ganglionectomy after a positive selective cervical nerve blocking. All four operations resulted in excellent relief with one side failing 3 months postop after a motor vehicle accident. Conclusion: Chronic headache or incisional pain after retromastoid craniectomy remains a significant complication of the operation. The patients presented here support the contention that multiple etiologies may play a role. Pain caused by scalp to dura adhesions can be treated effectively with a simple cranioplasty while occipital nerve injury can be identified using selective second cervical nerve blocking, and long-term relief obtained with a dorsal rhizotomy or ganglionectomy.





No comments:

Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus n

Julio Leonardo Barbosa Pereira, Gerival Vieira, Lucas Alverne Freitas de Albuquerque, George de Albuquerque Cavalcanti Mendes, Ludmila Rezende Salles, André Felipe Ferreira de Souza, Marcos Dellaretti, Atos Alves de Sousa

Surgical Neurology International 2012 3(1):94-94

Background: The craniotomy performed with minimal hair removal and closure with intradermal suture alone is an option in neurosurgical procedures, which can help faster psychological recovery of the patient, as it allows a better cosmetic result. This study is aimed at evaluating if such method is safe and effective, compared with continuous skin sutures with 2-0 nylon. Methods: We analyzed the sutures in 117 patients undergoing craniotomies for cerebral aneurysm clipping. In the case group (n = 49), closure of the scalp was performed only with intradermal absorbable sutures using wire Monocryl&#894; 2-0. In the control group (n = 68), closure was performed with continuous suture using 2-0 nylon. Results: The case group was composed of 49 patients in whom just intradermal suture was performed. One (2.2%) patient developed wound infection and was given proper medical treatment. No cases of dehiscence or cerebrospinal fluid leaks were observed. The control group was composed of 68 patients in whom the skin was closed with 2-0 nylon continuous suture. Three (5.3%) patients developed wound infection and were given proper medical treatment. There were no cases of wound dehiscence. The overall infection rate in the control group was 4%. There was no statistically significant difference in the number of wound infections between the two groups (P = 0.73). Conclusion: The closure with intradermal suture alone in craniotomies is as safe as the traditional skin closure with nylon sutures, besides eliminating the need for suture removal and providing a cosmetic advantage.





No comments:

Even A Few Years Of Music Training Benefits The Brain

Music has a remarkable ability to affect and manipulate how we feel. Simply listening to songs we like stimulates the brain's reward system , creating feelings of pleasure and comfort. But music goes beyond our hearts to our minds, shaping how we think. Scientific evidence suggests that even a little music training when we're young can shape how brains develop, improving the ability to differentiate sounds and speech.

With education funding constantly on the rocks and tough economic times tightening many parents' budgets, students often end up with only a few years of music education. Studies to date have focused on neurological benefits of sustained music training, and found many upsides. For example, researchers have found that musicians are better able to process foreign languages because of their ability to hear differences in pitch , and have incredible abilities to detect speech in noise . But what about the kids who only get sparse musical tutelage? Does picking up an instrument for a few years have any benefits?

[More]

Add to digg Add to StumbleUpon Add to Reddit Add to Facebook Add to del.icio.us Email this Article





No comments:

Mapping Brain Activity In Patients With Brain Lesions

The frontal lobes are the largest part of the human brain, and thought to be the part that expanded most during human evolution. Damage to the frontal lobes - which are located just behind and above the eyes - can result in profound impairments in higher-level reasoning and decision making...





No comments:

A Headache-Specific Multidisciplinary Treatment Program

This study evaluated a newly developed integrated headache-specific outpatient and inpatient multidisciplinary treatment program for chronic headache.
Headache





No comments:

Musical Training During Childhood Shapes Brains As Adults

A new Northwestern University study shows that a little music training in childhood has a great benefit in improving brain functions in adulthood when it comes to listening and the complex processing of sound. The study entitled "A Little Goes a Long Way: How the Adult Brain is Shaped by Musical Training in Childhood" will be featured in the August 22 issue of the Journal of Neuroscience...





No comments:

Schizophrenia Signs Can Be Reversed With Training

Researchers studying an animal model of schizophrenia have discovered that the animals can behave normal as adults if they underwent cognitive training in adolescence. The study is published in Neuron. André Fenton of New York University said: "The brain can be loaded with all sorts of problems. What this work shows is that experience can overcome those disabilities...





No comments:

Meta-analysis of fMRI studies of timing in Attention Deficit Hyperactivity Disorder (ADHD)

Publication year: 2012
Source:Neuroscience & Biobehavioral Reviews
Heledd Hart, Joaquim Radua, David Mataix-Cols, Katya Rubia
Attention-Deficit Hyperactivity Disorder (ADHD) is associated with deficits in timing functions with, however, inconclusive findings on the underlying neurofunctional deficits. We therefore conducted a meta-analysis of 11 functional magnetic resonance imaging (fMRI) studies of timing in ADHD, comprising 150 patients and 145 healthy controls. Peak coordinates were extracted from significant case-control activation differences as well as demographic, clinical, and methodological variables. In addition, meta-regression analyses were used to explore medication effects. The most consistent deficits in ADHD patients relative to controls were reduced activation in typical areas of timing such as left inferior prefrontal cortex (IFC)/insula, cerebellum, and left inferior parietal lobe. The findings of left fronto-parieto-cerebellar deficits during timing functions contrast with well documented right fronto-striatal dysfunctions for inhibitory and attention functions, suggesting cognitive domain-specific neurofunctional deficits in ADHD. The meta-regression analysis showed that right dorsolateral prefrontal cortex (DLPFC) activation was reduced in medication-naïve patients but normal in long-term stimulant medicated patients relative to controls, suggesting potential normalization effects on the function of this prefrontal region with long-term psychostimulant treatment.

Highlights

► Timing functions are impaired in Attention Deficit Hyperactivity Disorder (ADHD) ► A meta-analysis was conducted of functional imaging studies of timing in ADHD ► ADHD patients show consistent inferior frontal, cerebellar and parietal dysfunction ► Long-term stimulant medication was associated with normal frontal activation.





No comments:

Wednesday, August 22, 2012

Instagram App Traumatic Brain Injury



No comments:

Tuesday, August 21, 2012

Instagram: lumbar puncture




No comments:

Confira Traumatismo Crânio-Encefálico (TCE)

Traumatismo Crânio-Encefálico (TCE)

Confira este app na App Store:

Cover Art

Traumatismo Crânio-Encefálico (TCE)

Fuze.cc

Categoria: Medicina

Atualizado: 19/06/2012
9 avaliações



Aplicativos iOS
Observe que você não foi adicionado a nenhuma lista de e-mail.
Direitos autorais © 2012 Apple Inc. Todos os direitos reservados

No comments:

Protocol Management of Severe Traumatic Brain Injury in Intensive Care Units: A Systematic Review

Abstract  
To examine clinical trials and observational studies that compared use of management protocols (MPs) versus usual care for adult intensive care unit (ICU) patients with acute severe traumatic brain injury (TBI) on 6-month neurologic outcome (Glasgow Outcome Scale, GOS) and mortality, major electronic databases were searched from 1950 to April 18, 2011. Abstracts from major international meetings were searched to identify gray literature. A total of 6,151 articles were identified; 488 were reviewed in full and 13 studies were included. Data on patient and MP characteristics, outcomes and methodological quality were extracted. All 13 included studies were observational. A random effects model showed that use of MPs was associated with a favorable neurologic outcome (GOS 4 or 5) at 6 months (odds ratio [OR] and 95 % confidence interval [CI] 3.84 (2.47–5.96)) but not 12 months (OR, 95 % CI 0.87 (0.56–1.36)). Use of MPs was associated with reduced mortality at hospital discharge and 6 months (OR and 95 % CI 0.72 (0.45–1.14) and 0.33 (0.13–0.82) respectively), but not 12 months (OR, 95 % CI 0.79 (0.5–1.24)). Sources of heterogeneity included variation in study design, methodological quality, MP design, MP neurophysiologic endpoints, and type of ICU. MPs for severe TBI were associated with reductions in death and improved neurologic outcome. Although no definitive conclusions about the efficacy of MPs for severe TBI can be drawn from our study, these results should encourage the conduct of randomized controlled trials to more rigorously examine the efficacy of MPs for severe TBI.

  • Content Type Journal Article
  • Category Review Article
  • Pages 1-12
  • DOI 10.1007/s12028-012-9748-3
  • Authors
    • Shane W. English, Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada
    • Alexis F. Turgeon, Department of Anesthesia (Critical Care), L'Enfant-Jésus, Québec City, QC, Canada
    • Elliott Owen, Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada
    • Steve Doucette, Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
    • Giuseppe Pagliarello, Department of Surgery (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada
    • Lauralyn McIntyre, Department of Medicine (Critical Care), The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, ON, Canada





No comments:

Endovascular treatment of infectious intracranial aneurysms

Abstract  
Infectious intracranial aneurysms (IIA) are rare but a considerable source of morbidity and mortality as a result of rupture. Most patients with these lesions have considerable medical comorbidities, making endovascular approaches a crucial modality in their treatment armamentarium. Contributing our own case, we performed a comprehensive review of the literature to illustrate overall results and outcomes for patients with IIA treated with endovascular approaches. Incorporating our own case, we found 65 patients harboring 72 IIA across 31 reports. Fifty-one were treated via parent artery occlusion (71 %), 17 via direct aneurysm embolization (24 %), two via stent-coiling (3 %), and two with stent monotherapy (3 %). Twenty-nine IIAs were treated with n‐butylcyanoacrylate (NBCA) (40 %), 25 with coils (35 %), seven with Onyx or ethylene vinyl alcohol (10 %), five with detachable balloons (7 %), four with stents (6 %), and one with autologous clot (1 %). One case of incomplete aneurysm occlusion and two cases of recanalization were reported. Six symptomatic periprocedural ischemic events were reported (9 %), with only three resulting in permanent sequelae (5 %). No infectious complications were reported. Incorporating the natural history of the disease, 28 patients were neurologically intact (43 %), while seven had died at the time of follow-up (11 %). Endovascular treatment of ruptured, symptomatic, or enlarging IIA is an excellent treatment modality with high occlusion rates and low procedure-related complication rates. Distal IIA are more often treated with parent artery occlusion, in our hands, preferentially with Onyx, while proximal lesions may be treated with direct stent-coiling or even flow-diverting stent monotherapy.

  • Content Type Journal Article
  • Category Review
  • Pages 1-9
  • DOI 10.1007/s10143-012-0414-1
  • Authors
    • Bradley A. Gross, Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
    • Ajit S. Puri, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA





No comments:

Results of microsurgical treatment of paraclinoid carotid aneurysms

Abstract  
The term "paraclinoid aneurysms", has been used for aneurysms of the internal carotid artery (ICA) between the cavernous sinus and the posterior communicating artery. Due to their complex anatomical relationship at the skull base and because they are frequently large/giant, their surgical treatment remains a challenge. Ninety-five patients harboring 106 paraclinoid aneurysms underwent surgery (1990–2010). Age, 11–72 years old. Sex, 74:21 female/male. Follow-up; 1–192 months (mean = 51.7 months). Eighty-six patients had single and 9 had multiple paraclinoid aneurysms. Sixty-six were ophthalmic, 14 were in the ICA superior wall, 13 in the inferior, 10 in the medial, and 3 in the ICA lateral wall. Eleven were giant, 29 were large, and 66 were small. Sixty-three patients had ruptured and 32 had unruptured aneurysms. Two patients with bilateral aneurysms had bilateral approaches, totaling 97 procedures. A total of 98.2 % of aneurysms were clipped (complete exclusion in 93.8 %). ICA occlusion occurred in 10 (5.6 %). There was no patient rebleeding during the follow-up period. A good outcome was achieved in 76.8 %, with better results for unruptured aneurysms, worse results for patients with vasospasm, and with no difference according to size. Thirty-six (37.9 %) patients had transient/permanent postoperative neurological deficits (25.4 % ruptured vs. 62.5 % unruptured aneurysms). The most frequent deficits were visual impairment and third cranial nerve palsies. Operative mortality was 11.6 %, all in patients presenting with ruptured aneurysms. Despite relatively high morbidity/mortality, especially for patients with ruptured aneurysms, microsurgical treatment of paraclinoid aneurysm has high efficacy, with better outcome for unruptured aneurysms and worse outcome for patients with vasospasm.

  • Content Type Journal Article
  • Category Original Article
  • Pages 1-17
  • DOI 10.1007/s10143-012-0415-0
  • Authors
    • Benedicto Oscar Colli, Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
    • Carlos Gilberto Carlotti Jr, Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
    • João Alberto Assirati Jr, Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
    • Daniel Giansanti Abud, Department of Internal Medicine, Division of Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
    • Marcelo Campos Moraes Amato, Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
    • Roberto Alexandre Dezena, Division of Neurosurgery, Department of Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil





No comments:

Adult neurology training during child neurology residency

As it is currently configured, completion of child neurology residency requires performance of 12 months of training in adult neurology. Exploration of whether or not this duration of training in adult neurology is appropriate for what child neurology is today must take into account the initial reasons for this requirement and the goals of adult neurology training during child neurology residency.






No comments:

Can Obesity Be Treated With Deep Brain Stimulation? Researchers Say Yes

A review article in the August issue of Neurosurgery, the official journal of the Congress of Neurological Surgeons, suggests that scientific advances in understanding the "addiction circuitry" of the brain could effectively treat obesity using deep brain stimulation (DBS)...





No comments:

What I Learned from Hallucinogens

This week's New Yorker (issue dated August 27) features an excerpt from Dr. Sacks's new book, Hallucinations. At newyorker.com, Dr. Sacks talks about his psychedelic days in an audio interview. Finally, Dr. Sacks talks about how psychedelic drugs helped him understand his patients better (video will be posted at newyorker.com later this week, but you can see it nowon our YouTube channel).We are really excited about this book, and we hope that you, faithful Sacks fans, will help us spread the word about Hallucinations. Do you have any friends who would like to hear about the book? Click on the link above to forward this month's free newsletter to them. We'll be sending you sneak previews of the book in September and October. And if you or your friends are more into Facebook or Twitter, we have that covered, too.author at work

As some of you asked after our last newsletter, how come the famously computer-illiterate Dr. Sacks has all this social media???  That would be us, the Sacks Office (a.k.a. Kate and Hailey). He gives us the info, and we translate it into computerese. Sometimes we tweet things he says at the office, sometimes he writes out notes for us. It's true: he won't touch a computer. He's always been a seriously fast two-fingered typist with his IBM Selectric (that's a typewriter, for those of you under 40). But these days, he's gone back to the tried and true method of fountain pen and yellow paper. More on this next month.





No comments:

Sunday, August 19, 2012


Put patients to work during their wait time
I talk with lot of


Put patients to work during their wait time
I talk with lot of physicians about the need to improve the quality of communications between physicians and patients. Regular followers of my work will know that I am an advocate for the adoption of patient-centered communication skills by the physician and provider community.Physicians with whom I talk seldom disagree as to the need for better physician-patient communications. They know that physician communication skills top the list of patient complaints about their physicians, i.e., my doctor doesn't listen," "my doctor ignores me," and so on. Rather, they simply dismiss the subject out of hand as being impractical due to a "lack of time" on the part of most physicians.Continue reading ... Follow KevinMD.com on Facebook, Twitter, Google+, and LinkedIn.

No comments:

Working Throughout the Night: Beyond ‘sleepiness’ - impairments to critical decision making

Publication year: 2012
Source:Neuroscience & Biobehavioral Reviews
Jim Horne
By the end of the first night on a 12h night-shift, wakefulness may have lasted upto 24h since the previous sleep. Although most work situations requiring critical decisions are foreseen and effectively resolved by well trained staff, such wakefulness can produce impairments in dealing with unexpected challenging situations involving uncertainty, change, distractions and capacity to evaluate risks. Also compromised can be the ability to engage in and keep abreast of protracted negotiations undertaken throughout the night. These effects, which are not just 'sleepiness', seem due to deteriorations with 'supervisory executive functions' of the prefrontal cortex; a region that appears particularly vulnerable to prolonged wakefulness. Recent research findings are presented to support this case, and some evidence-based recommendations made about practical countermeasures.

Highlights

► Wakefulness can last up to 24h by the end on the first night of a 12h night-shift ► This causes impairments to critical decisions during unexpected, changing challenges ► And the ability to engage in and keep abreast of protracted key negotiations ► These effects are with 'supervisory executive functions' of the prefrontal cortex ► Recent findings relevant to 24h wakefulness are reviewed, with countermeasures





No comments:
Subscribe to: Posts (Atom)