Neurosurgery de Soda Virtual
https://itunes.apple.com/br/app/neurosurgery/id587505622?mt=8
https://itunes.apple.com/br/app/neurosurgery/id587505622?mt=8
Tuesday, February 25, 2014
Craniotomy App
Craniotomia de Soda Virtual
https://itunes.apple.com/br/app/craniotomia/id619836825?mt=8
https://itunes.apple.com/br/app/craniotomia/id619836825?mt=8
Antiepileptic drug nonadherence in children with epilepsy: Outcomes and potential intervention
Antiepileptic drug nonadherence in children with epilepsy: Outcomes and potential intervention
Neurology recent issues
Currently, no cure is available for many children with epilepsy, and the most frequently used treatment for seizures is antiepileptic drug (AED) therapy. Since 20% to 30% of children with epilepsy experience seizures that are not completely controlled with treatment,1 it is imperative that these children achieve and maintain adherence to prescribed treatment to have the best possible health outcomes. Studies have consistently shown that nonadherence is related to increased health care utilization.2 However, adherence rates in children with epilepsy, even within the first month of AED initiation, are not ideal.3 Modi et al.4 previously found that 58% of children with newly diagnosed epilepsy exhibited nonadherence over the first 6 months of AED therapy, and they identified 4 nonadherent trajectories: severe early, severe delayed, moderate, and mild, in addition to a near perfect trajectory.
Original Article: http://www.neurology.org/cgi/content/short/82/8/652?rss=1
Monday, February 24, 2014
Brain-training game improves vision and success of baseball players
Brain-training game improves vision and success of baseball players
Neurology News & Neuroscience News from Medical News Today
In baseball, vision can play a key role in a player's success. If they have trouble seeing the ball, chances are they could be out after three strikes. But new research from the University of California, Riverside, suggests that a brain-training video game could help to improve the vision of baseball players and, in turn, help them win more games.
Original Article: http://www.medicalnewstoday.com/articles/272983.php
Scientists discover brain region involved in social memory
Scientists discover brain region involved in social memory
Neurology News & Neuroscience News from Medical News Today
How does an animal recognize another of the same species? Researchers from the Columbia University Medical Center in New York say they have uncovered the brain region responsible for this process - known as social memory.
Original Article: http://www.medicalnewstoday.com/articles/273075.php
Stroke Rounds: Stents, Surgery Equal for Blocked Carotids (CME/CE)
Stroke Rounds: Stents, Surgery Equal for Blocked Carotids (CME/CE)
MedPage Today Neurology
(MedPage Today) -- For patients with symptomatic or asymptomatic carotid artery stenosis, stenting and endarterectomy appear to be equally effective for preventing ipsilateral stroke over the long term, a small, single-center trial suggested.
Original Article: http://www.medpagetoday.com/Cardiology/Strokes/44387
Insurance Status May Affect Transfer of Trauma Patients
Insurance Status May Affect Transfer of Trauma Patients
Medscape Today- Medscape
Insured patients are less likely to be moved to a trauma center and may be missing out on optimal care.
Medscape Medical News
Original Article: http://www.medscape.com/viewarticle/820915?src=rss
Neuroanatomy: Following subcortical development
Neuroanatomy: Following subcortical development
Nature Reviews Neuroscience - Issue - nature.com science feeds
Nature Reviews Neuroscience 15, 136 (2014). doi:10.1038/nrn3692
Author: Leonie Welberg
Structural MRI studies have provided insight into cerebral cortex development in humans, but little is known about the development of subcortical structures. This longitudinal study measured the shape and volume of cortical and subcortical regions in MRI scans of males and females obtained between the
Original Article: http://feeds.nature.com/~r/nrn/rss/current/~3/1d9ERuxpwrk/nrn3692
Sleep: A rude awakening
Sleep: A rude awakening
Nature Reviews Neuroscience - Issue - nature.com science feeds
Nature Reviews Neuroscience 15, 136 (2014). doi:10.1038/nrn3696
Author: Sian Lewis
A new study shows that responsiveness of the Caenorhabditis elegans ASH avoidance circuit to aversive stimuli is reduced during sleep and reveals that re-establishment of synchrony between interneurons in this circuit is crucial for rapid reversal to wakefulness.
Original Article: http://feeds.nature.com/~r/nrn/rss/current/~3/EoRd9oVkToo/nrn3696
On the other hand: including left-handers in cognitive neuroscience and neurogenetics
On the other hand: including left-handers in cognitive neuroscience and neurogenetics
Nature Reviews Neuroscience - Issue - nature.com science feeds
Nature Reviews Neuroscience 15, 193 (2014). doi:10.1038/nrn3679
Authors: Roel M. Willems, Lise Van der Haegen, Simon E. Fisher & Clyde Francks
Left-handers are often excluded from study cohorts in neuroscience and neurogenetics in order to reduce variance in the data. However, recent investigations have shown that the inclusion or targeted recruitment of left-handers can be informative in studies on a range of topics, such as cerebral
Original Article: http://feeds.nature.com/~r/nrn/rss/current/~3/ElY-7OVPzoE/nrn3679
Parent Training Can Improve Kids' Behavior
Parent Training Can Improve Kids' Behavior
Scientific American: Mind and Brain
Original Article: http://www.scientificamerican.com/article/parent-training-can-improve-kids-behavior/
Percutaneous Stereotactic Radiofrequency Lesioning for Trigeminal Neuralgia: Determination of Minimum Clinically Important Difference in Pain Improvement for Patient-Reported Outcomes
Percutaneous Stereotactic Radiofrequency Lesioning for Trigeminal Neuralgia: Determination of Minimum Clinically Important Difference in Pain Improvement for Patient-Reported Outcomes
Neurosurgery - Current Issue
BACKGROUND: The Visual Analog Scale (VAS) and the Barrow Neurological Institute Pain Scale (BNI-PS) are 2 patient-reported outcome (PRO) tools frequently used to rate pain from trigeminal neuralgia (TN). Outcomes studies often use these patient-reported outcomes to assess treatment effectiveness, but it is unknown exactly what degree of change in the numerical scores constitutes the minimum clinically important difference (MCID). MCID remains uninvestigated for percutaneous stereotactic radiofrequency lesioning (RFL), a common surgical procedure for TN. OBJECTIVE: To determine MCID values for the VAS and BNI-PS in patients undergoing RFL. METHODS: Forty-three consecutive patients with TN who underwent RFL by a single surgeon were prospectively assessed with the VAS and BNI-PS preoperatively and 3 years postoperatively. Three anchors were used to assign each patient's outcome: satisfaction, willingness to have the surgery again, and Health Transition Index. We then used 3 well-established, anchor-based methods to calculate MCID: average change, minimum detectable change, and change difference. RESULTS: Patients experienced substantial improvement in both VAS (9.81 vs 3.35; P < .001) and BNI-PS (4.95 vs 2.44; P < .001) after RFL. The 3 MCID calculation methods generated a range of MCID values for each of the PROs (VAS, 4.13-8.20; BNI-PS, 1.03-3.30). The area under the receiver-operating characteristic curve was greater for BNI-PS compared with VAS for all 3 anchors, indicating that BNI-PS is probably better suited for calculating MCID. CONCLUSION: RFL-specific MCID is variable on the basis of the calculation technique. With the use of the minimum detectable change calculation method with the Health Transition Index anchor, the minimum clinically important difference is 4.49 for VAS and 1.16 for BNI-PS after RFL for TN. ABBREVIATIONS: AUC, area under the receiver-operating characteristic curve BNI-PS, Barrow Neurological Institute Pain Scale HTI, Health Transition Index MCID, minimum clinically important difference MDC, minimum detectable change PRO, patient-reported outcome RFL, percutaneous stereotactic radiofrequency lesioning TN, trigeminal neuralgia VAS, Visual Analog ScaleOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2014/03000/Percutaneous_Stereotactic_Radiofrequency_Lesioning.4.aspx
The Neurological Emergency Room and Prehospital Stroke Alert: The Whole Is Greater Than the Sum of Its Parts
The Neurological Emergency Room and Prehospital Stroke Alert: The Whole Is Greater Than the Sum of Its Parts
Neurosurgery - Current Issue
BACKGROUND: Emergency medical services (EMS) prenotification to hospitals regarding the arrival of patients who have had a stroke is recommended to facilitate the workup once the patient arrives. Most hospitals have the patient enter the emergency department (ED) before obtaining a head computed tomography (CT) scan. At Capital Health, prehospital stroke-alert patients are delivered directly to CT and met by a neurological emergency team. The goal of bypassing the ED is to reduce the time to treatment. OBJECTIVE: To evaluate (1) door-to-CT and door-to-needle time in patients with an acute stroke who arrive as prehospital stroke alerts and (2) the accuracy of EMS assessment. METHODS: A prospective database of all prehospital stroke alert patients was kept and data retrospectively reviewed for patients who were seen between July 2012 and July 2013. RESULTS: Between July 2012 and July 2013, 141 prehospital stroke alerts were called to our emergency department, and the patients were stable enough to bypass the ED and go directly to CT. EMS assessment of stroke was accurate 66% of the time, and the diagnosis was neurological 89% of the time. The average time between patient arrival and acquisition of CT imaging was 11.8 minutes. Twenty-six of the 141 patients (18%) received intravenous tissue plasminogen activator. The median time from arrival to intravenous tissue plasminogen activator bolus was 44 minutes. CONCLUSION: Trained EMS responders are able to correctly identify patients who are experiencing neurological/neurosurgical emergencies and deliver patients to our comprehensive stroke center in a timely fashion after prenotification. The prehospital stroke alert protocol bypasses the ED, allowing the patient to be met in CT by the neurological ED team, which has proven to decrease door-to-CT and door-to-needle times from our historical means. ABBREVIATIONS: ASLS, Advanced Stroke Life Support DTN, door-to-needle ED, emergency department EMS, emergency medical services EMT, emergency medical technician IV, intravenous MEND, Miami Emergency Neurological Deficit PHSA, prehospital stroke alert tPA, tissue plasminogen activatorOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2014/03000/The_Neurological_Emergency_Room_and_Prehospital.7.aspx
Technologies for Hacking the Brain
Technologies for Hacking the Brain
Scientific American: Mind and Brain
Original Article: http://www.scientificamerican.com/article/technologies-for-hacking-brain/
Saturday, February 22, 2014
Surprising differences revealed in brain activity of alcohol-dependent women
Surprising differences revealed in brain activity of alcohol-dependent women
Neurology News & Neuroscience News from Medical News Today
Original Article: http://www.medicalnewstoday.com/releases/272864.php
Arterial Blood Pressure Management During Carotid Endarterectomy and Early Cognitive Dysfunction
Arterial Blood Pressure Management During Carotid Endarterectomy and Early Cognitive Dysfunction
Neurosurgery - Current Issue
BACKGROUND: A common practice during cross-clamp of carotid endarterectomy (CEA) is to manage mean arterial pressure (MAP) above baseline to optimize the collateral cerebral blood flow and reduce the risk of ischemic stroke. OBJECTIVE: To determine whether MAP management ≥20% above baseline during cross-clamp is associated with lower risk of early cognitive dysfunction, a subtler form of neurological injury than stroke. METHODS: One hundred eighty-three patients undergoing CEA were enrolled in this ad hoc study. All patients had radial arterial catheters placed before the induction of general anesthesia. MAP was managed at the discretion of the anesthesiologist. All patients were evaluated with a battery of neuropsychometric tests preoperatively and 24 hours postoperatively. RESULTS: Overall, 28.4% of CEA patients exhibited early cognitive dysfunction (eCD). Significantly fewer patients with MAP ≥20% above baseline during cross-clamp exhibited eCD than those managed <20% above (11.6% vs 38.6%, P < .001). In a multivariate logistic regression model, MAP ≥20% above baseline during the cross-clamp period was associated with significantly lower risk of eCD (odds ratio [OR], 0.18 [0.07-0.40], P < .001), whereas diabetes mellitus (OR, 2.73 [1.14-6.61], P = .03) and each additional year of education (OR, 1.19 [1.06-1.34], P = .003) were associated with significantly higher risk of eCD. CONCLUSION: The observations of this study suggest that MAP management ≥20% above baseline during cross-clamp of the carotid artery may be associated with lower risk of eCD after CEA. More prospective work is necessary to determine whether MAP ≥20% above baseline during cross-clamp can improve the safety of this commonly performed procedure. ABBREVIATIONS: CABG, coronary artery bypass graft CEA, carotid endarterectomy eCD, early cognitive dysfunction EEG, electroencephalography MAP, mean arterial pressure MI, myocardial infarction OR, odds ratio PVD, peripheral vascular disease SD, standard deviationOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2014/03000/Arterial_Blood_Pressure_Management_During_Carotid.2.aspx
Perioperative Cardiac Complications and 30-Day Mortality in Patients Undergoing Intracranial Aneurysmal Surgery With Adenosine-Induced Flow Arrest: A Retrospective Comparative Study
Perioperative Cardiac Complications and 30-Day Mortality in Patients Undergoing Intracranial Aneurysmal Surgery With Adenosine-Induced Flow Arrest: A Retrospective Comparative Study
Neurosurgery - Current Issue
BACKGROUND: Adenosine-induced flow arrest is a technique used to assist in the surgical clipping of complex aneurysms. OBJECTIVE: To assess the safety associated with adenosine-assisted intracranial aneurysm surgery. METHODS: Medical records of all patients presenting between January 1, 2009, and December 31, 2012, for intracranial aneurysm surgery were analyzed. Patients were divided into 2 groups based on the intraoperative administration of adenosine: the nonadenosine group (n = 262) and the adenosine group (n = 64). The primary outcome compared between groups included a composite of 30-day mortality and incidences of perioperative cardiac complications (perioperative myocardial infarction or perioperative cardiac arrhythmias). RESULTS: The study groups were statistically similar except for a difference in the size and location of cerebral aneurysms and the incidence of coronary artery disease. The primary composite outcome occurred in 4.6% and 9.4% of patients in the nonadenosine and adenosine groups, respectively (P = .13). After adjustment for differences in the incidence of coronary artery disease between the 2 groups, the odds of the primary outcome were not significantly different between the groups (adjusted odds ratio = 2.12; 95% confidence interval, 0.76-5.93; P = .15). There were also no significant differences in the durations of hospital and intensive care unit stay between the study groups. CONCLUSION: Our results suggest that adenosine-assisted intracranial aneurysm surgery is not associated with an increase in perioperative cardiac complications or mortality in patients with low risk of coronary artery disease and may be considered a safe technique to assist clipping of complex aneurysms.Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/03000/Perioperative_Cardiac_Complications_and_30_Day.5.aspx
Long-term Radiographic Results of Stent-Assisted Embolization of Cerebral Aneurysms
Long-term Radiographic Results of Stent-Assisted Embolization of Cerebral Aneurysms
Neurosurgery - Current Issue
BACKGROUND: Aneurysmal subarachnoid hemorrhage is a disabling disease. Endovascular coiling provides minimally invasive, effective, and safe treatment of both ruptured and unruptured intracranial aneurysms. Intracranial stents have improved the endovascular treatment of complex aneurysms, but the long-term durability of this treatment modality needs clarification. OBJECTIVE: To elucidate the long-term success of intracranial stent use in the treatment of aneurysms. METHODS: Four hundred ten patients were treated with stent-assisted endovascular management of 464 aneurysms. Treatment of 363 small aneurysms, 88 large aneurysms, and 13 giant aneurysms was analyzed with respect to both long-term anatomic results with digital subtraction angiography and magnetic resonance angiography over the follow-up period. RESULTS: The 6-month angiographic results of 387 aneurysm treatments revealed complete aneurysm occlusion in 282 (72.9%), residual aneurysm neck in 50 (12.9%), and residual aneurysm filling in 55 (14.2%). Long-term radiographic follow-up, performed in 262 patients (mean, 3.63 years), showed significant recurrence of only 3 aneurysms after 6-month follow-up imaging. Forty-eight aneurysms (11.9%) were considered radiographic failures during the follow-up period. CONCLUSION: The aneurysm recurrence rate after stent-assisted embolization in this series was similar to published data using only coil embolization for the period between treatment and the initial follow-up imaging. For aneurysms that do not initially recur, the presented data suggest improved durability in the subsequent long-term follow-up period. ABBREVIATIONS: DSA, digital subtraction angiography MRA, magnetic resonance angiographyOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2014/03000/Long_term_Radiographic_Results_of_Stent_Assisted.8.aspx
Implantation of Pipeline Flow-Diverting Stents Reduces Aneurysm Inflow Without Relevantly Affecting Static Intra-aneurysmal Pressure
Implantation of Pipeline Flow-Diverting Stents Reduces Aneurysm Inflow Without Relevantly Affecting Static Intra-aneurysmal Pressure
Neurosurgery - Current Issue
BACKGROUND: Flow-diverting stent (FDS) implantation is an endovascular treatment option for intracranial aneurysms. However, little is known about the hemodynamic effects. OBJECTIVE: To assess the effect of stent compression on FDS porosity, to evaluate the influence of single and overlapping implantation of FDS on intra-aneurysmal flow profiles, and to correlate stent porosity with changes in static mean intra-aneurysmal pressure. METHODS: Intra-aneurysmal time-density curves were recorded in a pulsatile in vitro flow model before and after implantation of FDSs (Pipeline Embolization Device; ev3) in 7 different types of aneurysm models. Reductions in the maximum contrast inflow and time to maximum intra-aneurysmal contrast were calculated. Micro--computed tomography was performed, and compression-related FDS porosity was measured. The influence of FDS placement on mean static intra-aneurysmal pressure was measured. RESULTS: FDS compression resulted in an almost linear reduction in stent porosity. Stent porosity (struts per 1 mm) correlated significantly with the reduction of aneurysm contrast inflow (R2 = 0.81, P < .001) and delay until maximum contrast (R2 = 0.34, P = .001). Circulating intra-aneurysmal high-velocity flow was terminated in all sidewall models after implantation of a single stent. Superimposition of 2 stents reduced maximum intra-aneurysmal contrast by 69.1 ± 3.1% (mean ± SD) in narrow-necked sidewall aneurysm models, whereas no substantial reduction in maximum intra-aneurysmal contrast was observed in wide-necked sidewall aneurysm models. Intra-aneurysmal mean static pressure did not correlate with FDS porosity or number of implanted stents. CONCLUSION: Implantation of FDS effectively reduces aneurysm inflow in a porosity-dependent way without relevantly affecting static mean intra-aneurysmal pressure. ABBREVIATIONS: FDS, flow-diverting stent MAP, mean arterial pressure PED, Pipeline Embolization DeviceOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2014/03000/Implantation_of_Pipeline_Flow_Diverting_Stents.12.aspx
Monkey controls limb movements of 'avatar' using its mind
Monkey controls limb movements of 'avatar' using its mind
Neurology News & Neuroscience News from Medical News Today
In the movie Avatar, humans operate the bodies of a human-hybrid species, called Na'vi, with their minds. Now, researchers from Harvard Medical School in Boston, MA, have carried out a similar technique in monkeys - using neural devices that allowed an alert monkey to control the mind of one that was temporarily paralyzed.
Original Article: http://www.medicalnewstoday.com/articles/272991.php
Brain scans of jazz musicians unveil language and music similarities
Brain scans of jazz musicians unveil language and music similarities
Neurology News & Neuroscience News from Medical News Today
Jazz fans will know that a defining characteristic of the genre - whose greats include Miles Davis, John Coltrane and Charles Mingus - are the spontaneous "musical conversations" that spark up when members of a jazz band improvise. This improvisation bears similarity to human speech, with the players often taking it in turns to trade lines that build up into a dialogue.
Original Article: http://www.medicalnewstoday.com/articles/273060.php
Wednesday, February 19, 2014
Hot Topics: Alzheimer's Treatment Advances
Hot Topics: Alzheimer's Treatment Advances
MedPage Today Neurology
Original Article: http://www.medpagetoday.com/Geriatrics/AlzheimersDisease/44341
Emerging Subspecialties in Neurology: Palliative care
Emerging Subspecialties in Neurology: Palliative care
Neurology recent issues
As we work to find cures for so many devastating neurologic injuries and diseases, our patients suffer tremendously on a daily basis. Individuals with conditions including stroke, multiple sclerosis, Parkinson disease (PD), muscular dystrophies, amyotrophic lateral sclerosis (ALS), and nervous system malignancies share a host of physical, emotional, and existential symptoms that can be difficult to treat. In addition, patients and their families face the realities of loss of function, loss of ability to communicate, and lifespans limited by the neurologic diagnosis or complications related to it (e.g., dysphagia, immobility, infection). We may not always be able to reverse damage to the nervous system, but we can optimize quality of life for our patients by providing expertise in communicating difficult news, in pain and symptom management, and in advance planning and end-of-life care.
Original Article: http://www.neurology.org/cgi/content/short/82/7/640?rss=1
DBS reduced hemichorea associated with a developmental venous anomaly and microbleeding in STN
DBS reduced hemichorea associated with a developmental venous anomaly and microbleeding in STN
Neurology current issue
Developmental venous anomaly (DVA) is the most common vascular malformation and is usually asymptomatic. Movement disorders associated with DVA have rarely been reported, except a case of hemichorea and hemiballism caused by DVA in the contralateral putamen associated with hyperglycemia.1 The abnormal movements in that case nearly resolved after treatment with insulin and risperidone. We report a case of DVA who presented with hemichorea without metabolic derangement but microbleeding surrounding the DVA in the contralateral subthalamic nucleus (STN) area. The lesion was unresectable and deep brain stimulation (DBS) of globus pallidus interna (GPi) helped control the pharmacologically refractory symptoms.
Original Article: http://www.neurology.org/cgi/content/short/82/7/636?rss=1
Stroke Rounds: USPSTF Says Carotid Screening Overused
Stroke Rounds: USPSTF Says Carotid Screening Overused
MedPage Today Neurology
(MedPage Today) -- The U.S. Preventive Services Task Force (USPSTF) has reaffirmed its recommendation against screening asymptomatic adults in the general population for carotid artery stenosis, draft guidance showed.
Original Article: http://www.medpagetoday.com/Cardiology/Strokes/44344
Balloons in Endovascular Neurosurgery: History and Current Applications
Balloons in Endovascular Neurosurgery: History and Current Applications
Neurosurgery - Most Popular Articles
The use of balloons in the field of neurosurgery is currently an essential part of our clinical practice. The field has evolved over the last 40 years since Serbinenko used balloons to test the feasibility of occluding cervical vessels for intracranial pathologies. Since that time, indications have expanded to include sacrificing cervical and intracranial vessels with detachable balloons, supporting the coil mass in wide-necked aneurysms (balloon remodeling technique), and performing intracranial and cervical angioplasty for atherosclerotic disease, as well as an adjunct to treat arteriovenous malformations. With the rapid expansion of endovascular technologies, it appears that the indications and uses for balloons will continue to expand. In this article, we review the history of balloons, the initial applications, the types of balloons available, and the current applications available for endovascular neurosurgeons. ABBREVIATIONS: BRT, balloon remodeling technique BTO, balloon test occlusion CAS, carotid artery stenting CCF, carotid cavernous fistulas CEA, carotid endarterectomy CPD, cerebral protection device DMSO, dimethyl sulfoxide FDA, Food and Drug Administration ICA, internal carotid artery MCA, middle cerebral artery PTA, percutaneous transluminal angioplasty SAMMPRIS, Stenting vs Aggressive Medical Management for the Prevention of Recurrent Stroke TBA, transluminal balloon angioplastyOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2014/02001/Balloons_in_Endovascular_Neurosurgery___History.19.aspx
Intracranial carotid artery atherosclerosis associated with increased stroke risk
Intracranial carotid artery atherosclerosis associated with increased stroke risk
Neurology News & Neuroscience News from Medical News Today
Original Article: http://www.medicalnewstoday.com/releases/272758.php
Current Advances in Childhood Absence Epilepsy
Current Advances in Childhood Absence Epilepsy
Pediatric Neurology
Abstract: Background: Childhood absence epilepsy is an age-dependent, idiopathic, generalized epilepsy with a characteristic seizure appearance. The disorder is likely to be multifactorial, resulting from interactions between genetic and acquired factors, but the debate is still open. We review recent studies on different aspects of childhood absence epilepsy and also to describe new concepts.Methods: Data for this review were identified using Medline and PubMed survey to locate studies dealing with childhood absence epilepsy. Searches included articles published between 1924 and 2013.Results: The diagnosis comprises predominant and associated seizure types associated with other clinical and electroencephalographic characteristics. Many studies have challenged the prevailing concepts, particularly with respect to the pathophysiological mechanisms underlying the electroencephalographic seizure discharges. Childhood absence epilepsy fits the definition of system epilepsy as a condition resulting from the persisting susceptibility of the thalamocortical system as a whole to generate seizures. This syndrome, if properly defined using strict diagnostic criteria, has a good prognosis. In some cases, it may affect multiple cognitive functions determining risk for academic and functional difficulties; the detection of children at risk allows tailored interventions. Childhood absence epilepsy is usually treated with ethosuximide, valproate, lamotrigine, or levetiracetam, but the most efficacious and tolerable initial empirical treatment has not been well defined.Conclusions: We review recent studies and new concepts on the electroclinical features and pathophysiological findings of childhood absence epilepsy in order to highlight areas of consensus as well as areas of uncertainty that indicate directions for future research.
Original Article: http://www.pedneur.com/article/S0887-8994(13)00649-8/abstract?rss=yes
Two Decades of Mortality Trends Among Patients With Severe Sepsis: A Comparative Meta-Analysis*
Two Decades of Mortality Trends Among Patients With Severe Sepsis: A Comparative Meta-Analysis*
Critical Care Medicine - Current Issue
Objectives:Trends in severe sepsis mortality derived from administrative data may be biased by changing International Classification of Diseases, 9th Revision, Clinical Modification, coding practices. We sought to determine temporal trends in severe sepsis mortality using clinical trial data that does not rely on International Classification of Diseases, 9th Revision, Clinical Modifications coding and compare mortality trends in trial data with those observed from administrative data. Design:We searched MEDLINE for multicenter randomized trials that enrolled patients with severe sepsis from 1991 to 2009. We calculated standardized mortality ratios for each trial from observed 28-day mortality of usual care participants and predicted mortality from severity-of-illness scores. To compare mortality trends from clinical trials to administrative data, we identified adult severe sepsis hospitalizations in the Nationwide Inpatient Sample, 1993–2009, using two previously validated algorithms. Setting:In-patient. Patients:Patients with severe sepsis or septic shock. Interventions:None. Measurements and Main Results:Of 3,244 potentially eligible articles, we included 36 multicenter severe sepsis trials, with a total of 14,418 participants in a usual care arm. Participants with severe sepsis receiving usual care had a 28-day mortality of 33.2%. Observed mortality decreased 3.0% annually (95% CI, 0.8%–5.0%; p = 0.009), decreasing from 46.9% (standardized mortality ratio 0.94; 95% CI, 0.86–1.03) during years 1991–1995 to 29% (standardized mortality ratio 0.53; 95% CI, 0.50–0.57) during years 2006–2009 (3.0% annual change). Trends in hospital mortality among patients with severe sepsis identified from administrative data (Angus definition, 4.7% annual change; 95% CI, 4.1%–5.3%; p = 0.69 and Martin definition, 3.5% annual change; 95% CI, 3.0%–4.1%; p = 0.97) were similar to trends identified from clinical trials. Conclusion:Since 1991, patients with severe sepsis enrolled in usual care arms of multicenter randomized trials have experienced decreasing mortality. The mortality trends identified in clinical trial participants appear similar to those identified using administrative data and support the use of administrative data to monitor mortality trends in patients with severe sepsis.Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/03000/Two_Decades_of_Mortality_Trends_Among_Patients.16.aspx
Cornell Assessment of Pediatric Delirium: A Valid, Rapid, Observational Tool for Screening Delirium in the PICU*
Cornell Assessment of Pediatric Delirium: A Valid, Rapid, Observational Tool for Screening Delirium in the PICU*
Critical Care Medicine - Current Issue
Objective:To determine validity and reliability of the Cornell Assessment of Pediatric Delirium, a rapid observational screening tool. Design:Double-blinded assessments were performed with the Cornell Assessment of Pediatric Delirium completed by nursing staff in the PICU. These ratings were compared with an assessment by consultation liaison child psychiatrist using the Diagnostic and Statistical Manual IV criteria as the "gold standard" for diagnosis of delirium. An initial series of duplicate Cornell Assessment of Pediatric Delirium assessments were performed in blinded fashion to assess interrater reliability. Nurses recorded the time required to complete the Cornell Assessment of Pediatric Delirium screen. Setting:Twenty-bed general PICU in a major urban academic medical center over a 10-week period, March–May 2012. Patients:One hundred eleven patients stratified over ages ranging from 0 to 21 years and across developmental levels. Intervention:Two hundred forty-eight paired assessments completed. Measurements and Main Results:The Cornell Assessment of Pediatric Delirium had an overall sensitivity of 94.1% (95% CI, 83.8–98.8%) and specificity of 79.2% (95% CI, 73.5–84.9%). Overall Cronbach's α of 0.90 was observed, with a range of 0.87–0.90 for each of the eight items, indicating good internal consistency. A scoring cut point of 9 demonstrated good interrater reliability of the Cornell Assessment of Pediatric Delirium when comparing results of the screen between nurses (overall κ = 0.94; item range κ = 0.68–0.78). In patients without significant developmental delay, sensitivity was 92.0% (95% CI, 85.7–98.3%) and specificity was 86.5% (95% CI, 75.4–97.6%). In developmentally delayed children, the Cornell Assessment of Pediatric Delirium showed decreased specificity of 51.2% (95% CI, 24.7–77.8%) but sensitivity remained high at 96.2% (95% CI, 86.5–100%). The Cornell Assessment of Pediatric Delirium takes less than 2 minutes to complete. Conclusions:With an overall prevalence rate of 20.6% in our study population, delirium is a common problem in pediatric critical care. The Cornell Assessment of Pediatric Delirium is a valid, rapid, observational nursing screen that is urgently needed for the detection of delirium in PICU settings.Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/03000/Cornell_Assessment_of_Pediatric_Delirium__A_Valid,.20.aspx
Monitoring of Spinal Cord Perfusion Pressure in Acute Spinal Cord Injury: Initial Findings of the Injured Spinal Cord Pressure Evaluation Study*
Monitoring of Spinal Cord Perfusion Pressure in Acute Spinal Cord Injury: Initial Findings of the Injured Spinal Cord Pressure Evaluation Study*
Critical Care Medicine - Current Issue
Objectives:To develop a technique for continuously monitoring intraspinal pressure at the injury site (intraspinal pressure) after traumatic spinal cord injury. Design:A pressure probe was placed subdurally at the injury site in 18 patients who had isolated severe traumatic spinal cord injury (American Spinal Injuries Association grades A–C). Intraspinal pressure monitoring started within 72 hours of the injury and continued for up to a week. In four patients, additional probes were inserted to simultaneously monitor subdural pressure below the injury and extradural pressure. Blood pressure was recorded from a radial artery catheter kept at the same horizontal level as the injured segment of the spinal cord. We determined the effect of various maneuvers on spinal cord perfusion pressure and spinal cord function and assessed using a limb motor score and motor-evoked potentials. Setting:Neurosurgery and neuro-ICU covering a 3 million population in London. Subjects:Patients with severe traumatic spinal cord injury. Control subjects without spinal cord injury (to monitor spinal cerebrospinal fluid signal and motor evoked potentials). Interventions:Insertion of subdural spinal pressure probe. Measurements and Main Results:There were no procedure-related complications. Intraspinal pressure at the injury site was higher than subdural pressure below the injury or extradural pressure. Average intraspinal pressure from the 18 patients with traumatic spinal cord injury was significantly higher than average intraspinal pressure from 12 subjects without traumatic spinal cord injury. Change in arterial Pco2, change in sevoflurane dose, and mannitol administration had no significant effect on intraspinal pressure or spinal cord perfusion pressure. Increase in inotrope dose significantly increased spinal cord perfusion pressure. Bony realignment and laminectomy did not effectively lower intraspinal pressure. Laminectomy was potentially detrimental by exposing the swollen spinal cord to compression forces applied to the skin. By intervening to increase spinal cord perfusion pressure, we could increase the amplitude of motor-evoked potentials recorded from below or just above the injury level in nine of nine patients with traumatic spinal cord injury. In two of two patients with American Spinal Injuries Association grade C traumatic spinal cord injury, higher spinal cord perfusion pressure correlated with increased limb motor score. Conclusions:Our findings provide proof-of-principle that subdural intraspinal pressure at the injury site can be measured safely after traumatic spinal cord injury.Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/03000/Monitoring_of_Spinal_Cord_Perfusion_Pressure_in.19.aspx
Monday, February 17, 2014
Stress can make the brain more susceptible to mental illness
Stress can make the brain more susceptible to mental illness
Neurology News & Neuroscience News from Medical News Today
Original Article: http://www.medicalnewstoday.com/articles/272703.php
From music to medicine
From music to medicine
Neurology News & Neuroscience News from Medical News Today
Original Article: http://www.medicalnewstoday.com/releases/272673.php
Sunday, February 16, 2014
Check out Grays Anatomy Student Edition for iPad
Check out this application on the App Store:
 | Grays Anatomy Student Edition for iPadArchibald Industries Category: Medical Updated: 15 Nov 2011 |
| iOS Applications |
| Please note that you have not been added to any email lists. Copyright © 2014 Apple Inc. All rights reserved |
Júlio Leonardo B. Pereira
Linkedin: http://www.linkedin.com/in/juliommais
Site: www.neurocirurgiabr.com
Saturday, February 15, 2014
Clinical Reasoning: An unusual cause of transverse myelitis?
Clinical Reasoning: An unusual cause of transverse myelitis?
Neurology current issue
A 71-year-old woman presented with a 1-week history of progressive weakness involving her lower extremities, leading to an inability to walk. She also noticed diminished sensation in her lower extremities. She did not complain of bowel or bladder dysfunction. She did not have any neurologic symptoms in her upper extremities. She experienced an upper respiratory tract infection 5 days prior to the start of these symptoms and was treated with antibiotics. There was no history of headache, impaired cognition, or speech impairment.
Original Article: http://www.neurology.org/cgi/content/short/82/6/e46?rss=1
Advances and Surgical Considerations in the Treatment of Moyamoya Disease
Advances and Surgical Considerations in the Treatment of Moyamoya Disease
Neurosurgery - Most Popular Articles
Moyamoya is a rare disorder that involves steno-occlusive arterial changes of the anterior circulation, along with proliferative development of basal arterial collaterals. It is either idiopathic (called moyamoya disease) or the result of a specific underlying condition such as atherosclerosis, radiation therapy, or sickle cell disease (called moyamoya syndrome or phenomenon). In recent years, numerous insights into and advances in the understanding, evaluation, and management of moyamoya patients have occurred. This article briefly reviews the spectrum of moyamoya conditions and then provides a synopsis of numerous recent investigations that shed light on various aspects of the disease, including its clinical characteristics, natural history, underlying pathology, imaging, surgical techniques, and long-term patient outcome. ABBREVIATIONS: CBF, cerebral blood flow EDAS, encephaloduroarteriosynangiosis MCA, middle cerebral artery MMD, moyamoya disease STA, superficial temporal artery TIA, transient ischemic attackOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2014/02001/Advances_and_Surgical_Considerations_in_the.14.aspx
Endovascular Advances for Extracranial Carotid Stenosis
Endovascular Advances for Extracranial Carotid Stenosis
Neurosurgery - Most Popular Articles
Carotid artery stenting has become a viable alternative to carotid endarterectomy in the management of carotid stenosis. Over the past 20 years, many trials have attempted to compare both treatment modalities and establish the indications for each one, depending on clinical and anatomic features presented by patients. Concurrently, carotid stenting techniques and devices have evolved and made endovascular management of carotid stenosis safe and effective. Among the most important innovations are devices for distal and proximal embolic protection and new stent designs. This paper reviews these advances in the endovascular management of carotid artery stenosis within the context of the historical background. ABBREVIATIONS: ACAS, Asymptomatic Carotid Atherosclerosis Study ACST, Asymptomatic Carotid Surgery Trial CAS, carotid artery angioplasty and stenting CAVATAS, Carotid and Vertebral Transluminal Angioplasty Study CCA, common carotid artery CEA, carotid endarterectomy CREST, Carotid Revascularization Endarterectomy vs Stenting Trial ECA, external carotid artery ECST, European Carotid Surgery Trial EVA-3S, Endarterectomy vs Stenting in Patients with Symptomatic Severe Carotid Stenosis ICA, internal carotid artery ICSS, International Carotid Stenting Study IVUS, intravascular ultrasound MI, myocardial infarction NASCET, North American Symptomatic Carotid Endarterectomy Trial SAPPHIRE, Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy SPACE, Stent supported Percutaneous Angioplasty of the Carotid artery vs EndarterectomyOriginal Article: http://journals.lww.com/neurosurgery/Fulltext/2014/02001/Endovascular_Advances_for_Extracranial_Carotid.12.aspx
Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial.
Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial.
Unbound MEDLINE | Lancet journal articles
- Morrison AP, Turkington D, Pyle M, et al.
- Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. [JOURNAL ARTICLE]
- Lancet 2014 Feb 5.
Antipsychotic drugs are usually the first line of treatment for schizophrenia; however, many patients refuse or discontinue their pharmacological treatment. We aimed to establish whether cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs.We did a single-blind randomised controlled trial at two UK centres between Feb 15, 2010, and May 30, 2013. Participants aged 16-65 years with schizophrenia spectrum disorders, who had chosen not to take antipsychotic drugs for psychosis, were randomly assigned (1:1), by a computerised system with permuted block sizes of four or six, to receive cognitive therapy plus treatment as usual, or treatment as usual alone. Randomisation was stratified by study site. Outcome assessors were masked to group allocation. Our primary outcome was total score on the positive and negative syndrome scale (PANSS), which we assessed at baseline, and at months 3, 6, 9, 12, 15, and 18. Analysis was by intention to treat, with an ANCOVA model adjusted for site, age, sex, and baseline symptoms. This study is registered as an International Standard Randomised Controlled Trial, number 29607432.74 individuals were randomly assigned to receive either cognitive therapy plus treatment as usual (n=37), or treatment as usual alone (n=37). Mean PANSS total scores were consistently lower in the cognitive therapy group than in the treatment as usual group, with an estimated between-group effect size of -6·52 (95% CI -10·79 to -2·25; p=0·003). We recorded eight serious adverse events: two in patients in the cognitive therapy group (one attempted overdose and one patient presenting risk to others, both after therapy), and six in those in the treatment as usual group (two deaths, both of which were deemed unrelated to trial participation or mental health; three compulsory admissions to hospital for treatment under the mental health act; and one attempted overdose).Cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs. Evidence-based treatments should be available to these individuals. A larger, definitive trial is needed.National Institute for Health Research.
Original Article: http://www.unboundmedicine.com/medline/citation/24508320/Cognitive_therapy_for_people_with_schizophrenia_spectrum_disorders_not_taking_antipsychotic_drugs:_a_single_blind_randomised_controlled_trial_
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