Neurosurgery Blog: September 2014

Tuesday, September 30, 2014

AAN Warns Against Opioids in Chronic Noncancer Pain (CME/CE)

MedPage Today Neurology

(MedPage Today) -- The neurology society says the drugs have no place in headache, back pain, or fibromyalgia.

Original Article: http://www.medpagetoday.com/PainManagement/PainManagement/47871

Lower IQ in Children Linked to Chemical in Water

Scientific American: Mind and Brain

Babies born to mothers with high levels of perchlorate during their first trimester are more likely to have lower IQs later in life, according to a new study

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/article/lower-iq-in-children-linked-to-chemical-in-water/

Monday, September 29, 2014

“Glass Brain” Offers Tours of the Space between Your Ears

"Glass Brain" Offers Tours of the Space between Your Ears

Scientific American: Mind and Brain

3-D visualizations combine EEG and MRI data to illustrate how brain signals propagate and could be used to study neural disorders

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/article/glass-brain-offers-tours-of-the-space-between-your-ears/

The brains of children with ADHD do not recognize angry expressions

Neurology News & Neuroscience News from Medical News Today

Inattention, hyperactivity, and impulsive behavior in children with ADHD can result in social problems and they tend to be excluded from peer activities.

Original Article: http://www.medicalnewstoday.com/releases/283071.php

Pearls & Oy-sters: Delayed traumatic intracerebral hemorrhage caused by cerebral venous sinus thrombosis

Neurology current issue

Cerebral venous sinus thrombosis is a possible etiology of delayed traumatic intracerebral hemorrhage.

Original Article: http://www.neurology.org/cgi/content/short/83/14/e135?rss=1

Challenges to ethics and professionalism facing the contemporary neurologist

Neurology current issue

Challenges to ethics and professionalism that can harm neurologists and their patients include the commercialization of medicine, poorly designed Medicare regulations, conflicts of interest, physician employment by hospitals, faulty measurement of medical quality care, electronic health records, electronic communications with patients, and the demotion of the role of physician beneficence. These threats can lead to inaccurate medical record-keeping, unnecessary medical care, a decline in the primacy of patients' interests, and damage to the sanctity of the patient–physician relationship. The increasing frequency of physician burnout can be attributed at least partially to unmitigated stresses on practicing physicians, particularly the growing time pressures for patient visits, the mounting daily requirements of documentation, and the increasing burden of time-consuming but unproductive tasks. Recommended correctives include reforming billing documentation regulations, improving electronic health records, designing proper quality indicators integrating physician wellness, and incorporating reasonable physician workflows in the design of accountable care organizations.

Original Article: http://www.neurology.org/cgi/content/short/83/14/1285?rss=1

A New Idea for Treating Alzheimer's

Scientific American: Mind and Brain

If it's good for the heart, it could also be good for the neurons, astrocytes and oligodendrocytes, cells that make up the main items on the brain's parts list.

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/blog/post/a-new-idea-for-treating-alzheimer-s/

Saturday, September 27, 2014

THOUGHTS FROM THE HOSPITAL

THOUGHTS FROM THE HOSPITAL de Júlio Pereira
https://itun.es/br/HImkX.l

Screening CT Angiography for Pediatric Blunt Cerebrovascular Injury with Emphasis on the Cervical “Seatbelt Sign”

Screening CT Angiography for Pediatric Blunt Cerebrovascular Injury with Emphasis on the Cervical "Seatbelt Sign"

AJNR Blog

Editor's Choice

September 2014

(3 of 3)

The authors investigated the significance of several clinical and imaging risk factors, most specifically the "cervical seatbelt sign," in the anterior neck in pediatric patients with suspected blunt cerebrovascular injury as seen by CTA. They found that this common indication for neck CTA was not associated with blunt cerebrovascular injury. With the exception of Glasgow Coma Scale score, no single risk factor was statistically significant in predicting vascular injury.

EIC signature

Abstract

BACKGROUND AND PURPOSE
There are no standard screening guidelines to evaluate blunt cerebrovascular injury in children. The purpose of this retrospective study was to understand the clinical and radiologic risk factors associated with pediatric blunt cerebrovascular injury on CTA of the neck with primary attention to the cervical "seatbelt sign."

MATERIALS AND METHODS
Radiology reports from 2002 to 2012 were queried for the examination "CTA neck." The electronic medical record was reviewed for mechanism of injury, Glasgow Coma Scale score, and physical examination findings. Radiology reports from adjunct radiographic studies were reviewed. CTA neck examinations with reported blunt cerebrovascular injury were reviewed to confirm imaging findings. Patients with penetrating injury or those without a history of trauma were excluded.

RESULTS
Four hundred sixty-three patients underwent CTA of the neck; 137 had blunt trauma. Forty-two of 85 patients involved in a motor vehicle collision had a cervical seatbelt sign; none had blunt cerebrovascular injury. Nine vessels (4 vertebral arteries, 4 ICAs, 1 common carotid artery) in 8 patients ultimately were diagnosed with various grades (I–IV) of blunt cerebrovascular injury, representing 5.8% (8/137) of the population screened for blunt neck trauma. The mean Glasgow Coma Scale score was significantly lower (P = .02) in the blunt cerebrovascular injury group versus the non-blunt cerebrovascular injury group. Although not statistically significant, patients with blunt cerebrovascular injury had a higher tendency to have additional traumatic injuries, primarily basilar skull fractures (P = .05) and intracranial hemorrhage (P = .13).

CONCLUSIONS
A common indication for neck CTA, the cervical seatbelt sign, was not associated with blunt cerebrovascular injury. With the exception of Glasgow Coma Scale score, no single risk factor was statistically significant in predicting vascular injury in this series.

Full text

The post Screening CT Angiography for Pediatric Blunt Cerebrovascular Injury with Emphasis on the Cervical "Seatbelt Sign" appeared first on AJNR Blog.

Original Article: http://www.ajnrblog.org/2014/09/27/screening-ct-angiography-pediatric-blunt-cerebrovascular-injury-emphasis-cervical-seatbelt-sign/

Friday, September 26, 2014

Addressing neurologic needs in sub-Saharan Africa: An opportunity for multisociety cooperation

Neurology current issue

Approximately 26,000,000 people live in sub-Saharan African (SSA) nations where there are no neurologists. A total of 270,000,000 live in nations where there are fewer than 5 neurologists per country.¹ There are neurologic societies in fewer than 50% of SSA countries.² The WHO recommends a ratio of 1 neurologist:100,000 people. In those SSA nations where there are neurologists, the ratio is up to 175 times that recommended by the WHO.¹

Original Article: http://www.neurology.org/cgi/content/short/83/13/1207?rss=1

New Watchman Data Put Spotlight on Ischemic Stroke in AF

Medscape NeurologyHeadlines

New, longer-term data from PREVAIL, plus a new meta-analysis, highlight the ischemic-stroke risk in AF patients treated with this novel device. Hemorrhagic strokes went in the opposite direction.
Heartwire

Original Article: http://www.medscape.com/viewarticle/832150?src=rss

Stroke Rounds: Managing ICH

MedPage Today Neurology

(MedPage Today) -- A statin onboard may be a life-saver for intracerebral hemorrhage patients.

Original Article: http://www.medpagetoday.com/Cardiology/Strokes/47785

Does Marijuana Harm the Brain?

Scientific American: Mind and Brain

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/article/does-marijuana-harm-the-brain/

Deep brain stimulation as OCD treatment: new guideline

Neurology News & Neuroscience News from Medical News Today

A research team has produced a systematic review of the evidence for deep brain stimulation to treat OCD and a guideline for its clinical use.

Original Article: http://www.medicalnewstoday.com/articles/282899.php

The History of Neurosurgical Treatment of Sports Concussion

Neurosurgery - Most Popular Articles

Concussion has a long and interesting history spanning at least the 5 millennia of written medical record and closely mirrors the development of surgery and neurosurgery. Not surprisingly, much of the past and present experimental head injury and concussion work has been performed within neurosurgically driven laboratories or by several surgically oriented neurologists. This historical review chronicles the key aspects of neurosurgical involvement in sports concussion as related to the diagnosis, treatment, mitigation, and prevention of injury using the example of American football. In addition, we briefly trace the developments that led to our current understanding of the biomechanical and neurophysiological basis of concussion. ABBREVIATIONS: AFCA, American Football Coaches Association CTE, chronic traumatic encephalopathy EEG, electroencephalography LOC, loss of consciousness RTP, return to play

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/10001/The_History_of_Neurosurgical_Treatment_of_Sports.2.aspx

Biomarkers for neurology: Guides and lines

Neurology current issue

Although clinical judgment and experience remain at the center of patient evaluation and management, they have limitations, especially in the context of preclinical disease processes.¹ In this regard, valuable additions to the physician's toolkit are biomarkers, that is, measurable substances or characteristics that closely track or reflect the disease in question.

Original Article: http://www.neurology.org/cgi/content/short/83/13/1130?rss=1

Emergent Treatment of Athletes With Brain Injury

Neurosurgery - Most Popular Articles

The focus of this article is the early recognition and emergent treatment of severe or catastrophic traumatic brain injury. The pathophysiology and management of mild traumatic brain injury are reviewed extensively in other sections. Classification of head injuries can be based on anatomic location (epidural, subdural, intraparenchymal), mechanism of injury (coup, contrecoup, linear, rotational), distribution (focal or diffuse), and clinical presentation. Severe head injuries include epidural hematoma, subdural hematoma, intracerebral contusion/hemorrhage, traumatic subarachnoid hemorrhage, diffuse axonal injury, and malignant brain edema syndrome, either alone or in combinations. Protective equipment, regulations, and athletic training have improved dramatically as a result of the recognition of potentially devastating neurological injuries from competitive play. Physicians and other healthcare professionals have become integral members of organized sport and must advocate for the players' best interest. Once a neurological injury has been identified on field, it is imperative that prompt management and prevention of secondary injury occur. The goal of this article is to help provide a clear plan of action that is well thought out and rehearsed and that will lead to improved outcomes for the players, particularly those with severe or catastrophic brain injury. ABBREVIATIONS: BTF, Brain Trauma Foundation CBF, cerebral blood flow ECP, emergency care plan GCS, Glasgow Coma Scale ICP, intracranial pressure TBI, traumatic brain injury

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/10001/Emergent_Treatment_of_Athletes_With_Brain_Injury.9.aspx

Limbs of a completely paralyzed rat controlled: project NEUWalk closer to clinical trials

Neurology News & Neuroscience News from Medical News Today

EPFL scientists have discovered how to control the limbs of a completely paralyzed rat in real time to help it walk again. Their results are published in Science Translational Medicine.

Original Article: http://www.medicalnewstoday.com/releases/283009.php

Multitasking with media devices linked to brain changes

Neurology News & Neuroscience News from Medical News Today

Simultaneous use of cellphones, laptops and other media devices may change brain structure, according to an MRI study that found gray matter differences in media multitaskers.

Original Article: http://www.medicalnewstoday.com/articles/283059.php

Tuesday, September 23, 2014

World Alzheimer Report 2014: the key points

Neurology News & Neuroscience News from Medical News Today

As September is World Alzheimer's Month, we look at the core messages on dementia and risk reduction presented in Alzheimer's Disease International's 2014 report.

Original Article: http://www.medicalnewstoday.com/articles/282759.php

Acute Care Clinical Indicators Associated With Discharge Outcomes in Children With Severe Traumatic Brain Injury*

Critical Care Medicine - Most Popular Articles

Objective: The effect of the 2003 severe pediatric traumatic brain injury (TBI) guidelines on outcomes has not been examined. We aimed to develop a set of acute care guideline–influenced clinical indicators of adherence and tested the relationship between these indicators during the first 72 hours after hospital admission and discharge outcomes. Design: Retrospective multicenter cohort study. Setting: Five regional pediatric trauma centers affiliated with academic medical centers. Patients: Children under 18 years with severe traumatic brain injury (admission Glasgow Coma Scale score ≤ 8, International Classification of Diseases, 9th Edition, diagnosis codes of 800.0–801.9, 803.0–804.9, 850.0–854.1, 959.01, 950.1–950.3, 995.55, maximum head abbreviated Injury Severity Score ≥ 3) who received tracheal intubation for at least 48 hours in the ICU between 2007 and 2011 were examined. Interventions: None. Measurements and Main Results: Total percent adherence to the clinical indicators across all treatment locations (prehospital, emergency department, operating room, and ICU) during the first 72 hours after admission to study center were determined. Main outcomes were discharge survival and Glasgow Outcome Scale score. Total adherence rate across all locations and all centers ranged from 68% to 78%. Clinical indicators of adherence were associated with survival (adjusted hazard ratios, 0.94; 95% CI, 0.91–0.96). Three indicators were associated with survival: absence of prehospital hypoxia (adjusted hazard ratios, 0.20; 95% CI, 0.08–0.46), early ICU start of nutrition (adjusted hazard ratios, 0.06; 95% CI, 0.01–0.26), and ICU PaCO2 more than 30 mm Hg in the absence of radiographic or clinical signs of cerebral herniation (adjusted hazard ratios, 0.22; 95% CI, 0.06–0.8). Clinical indicators of adherence were associated with favorable Glasgow Outcome Scale among survivors (adjusted hazard ratios, 0.99; 95% CI, 0.98–0.99). Three indicators were associated with favorable discharge Glasgow Outcome Scale: all operating room cerebral perfusion pressure more than 40 mm Hg (adjusted relative risk, 0.61; 95% CI, 0.58–0.64), all ICU cerebral perfusion pressure more than 40 mm Hg (adjusted relative risk, 0.73; 95% CI, 0.63–0.84), and no surgery (any type; adjusted relative risk, 0.68; 95% CI, 0.53– 0.86). Conclusions: Acute care clinical indicators of adherence to the Pediatric Guidelines were associated with significantly higher discharge survival and improved discharge Glasgow Outcome Scale. Some indicators were protective, regardless of treatment location, suggesting the need for an interdisciplinary approach to the care of children with severe traumatic brain injury.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/10000/Acute_Care_Clinical_Indicators_Associated_With.14.aspx

After mild traumatic brain injury, specialized MRI technique helps clinicians predict outcomes

Neurology News & Neuroscience News from Medical News Today

Diffusion Tensor Imaging (DTI), a specialized magnetic resonance imaging (MRI) technique that detects microstructural changes in brain tissue, can help physicians better predict the likelihood for...

Original Article: http://www.medicalnewstoday.com/releases/282721.php

Transcranial Magnetic Stimulation for Chronic Pain

Neurosurgery Clinics of North America

Current data suggest that transcranial magnetic stimulation (TMS) has the potential to be an effective and complimentary treatment modality for patients with chronic neuropathic pain syndromes. The success of TMS for pain relief depends on the parameters of the stimulation delivered, the location of neural target, and duration of treatment. TMS can be used to excite or inhibit underlying neural tissue that depends on long-term potentiation and long-term depression, respectively. Long-term randomized controlled studies are warranted to establish the efficacy of repetitive TMS in patients with various chronic pain syndromes.

Original Article: http://www.neurosurgery.theclinics.com/article/S1042-3680(14)00080-1/abstract?rss=yes

In-Hospital Statins Linked to Better Outcome in ICH

Medscape NeurologyHeadlines

A new study shows lower mortality rate and better discharge status in patients with intracerebral hemorrhage who received a statin in hospital vs those who didn't, or stayed on the statin they were already taking.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/832126?src=rss

Saturday, September 20, 2014

Seizure outcomes following radiosurgery for cerebral arteriovenous malformations

Journal of Neurosurgery: Neurosurgical FOCUS: Table of Contents

Neurosurgical Focus, Volume 37, Issue 3, Page E17, September 2014.
Object Seizures are a common presentation of cerebral arteriovenous malformations (AVMs). The authors evaluated the efficacy of stereotactic radiosurgery (SRS) for the management of seizures associated with AVMs and identified factors influencing seizure outcomes following SRS for AVMs. Methods A systematic literature review was performed using PubMed. Studies selected for review were published in English, included at least 5 patients with both cerebral AVMs and presenting seizures treated with SRS, and provided post-SRS outcome data regarding obliteration of AVMs and/or seizures. Demographic, radiosurgical, radiological, and seizure outcome data were extracted and analyzed. All seizure outcomes were categorized as follows: 1) seizure free, 2) seizure improvement, 3) seizure unchanged, and 4) seizure worsened. Systematic statistical analysis was conducted to assess the effect of post-SRS AVM obliteration on seizure outcome. Results Nineteen case series with a total of 3971 AVM patients were included for analysis. Of these, 28% of patients presented with seizures, and data for 997 patients with available seizure outcome data who met the inclusion criteria were evaluated. Of these, 437 (43.8%) patients achieved seizure-free status after SRS, and 530 (68.7%) of 771 patients with available data achieved seizure control (seizure freedom or seizure improvement) following SRS. Factors associated with improved seizure outcomes following SRS for AVMs were analyzed in 9 studies. Seizure-free status was achieved in 82% and 41.0% of patients with complete and incomplete AVM obliteration, respectively. Complete AVM obliteration offered superior seizure-free rates compared with incomplete AVM obliteration (OR 6.13; 95% CI 2.16–17.44; p = 0.0007). Conclusions Stereotactic radiosurgery offers favorable seizure outcomes for AVM patients presenting with seizures. Improved seizure control is significantly more likely with complete AVM obliteration.

Original Article: http://thejns.org/doi/abs/10.3171/2014.6.FOCUS1454?ai=rw&mi=3ba5z2&af=R

Júlio Pereira

www.weneuro.com

www.linkedin.com/in/juliommais

lattes.cnpq.br/7687651239699170

Consultório (11)3141-9550/3141-9553

Narcissists Self-Involved Enough to Recognize Their Narcissism

Scientific American: Mind and Brain

The simple question "To what extent do you agree with this statement: I am a narcissist" is about as good at identifying narcissists as a 40-question clinical assessment. Erika Beras...

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/podcast/episode/narcissists-self-involved-enough-to-recognize-their-narcissism/

Júlio Pereira

www.weneuro.com

www.linkedin.com/in/juliommais

lattes.cnpq.br/7687651239699170

Consultório (11)3141-9550/3141-9553

[Review] The role of iron in brain ageing and neurodegenerative disorders

The Lancet Neurology

In the CNS, iron in several proteins is involved in many important processes such as oxygen transportation, oxidative phosphorylation, myelin production, and the synthesis and metabolism of neurotransmitters. Abnormal iron homoeostasis can induce cellular damage through hydroxyl radical production, which can cause the oxidation and modification of lipids, proteins, carbohydrates, and DNA. During ageing, different iron complexes accumulate in brain regions associated with motor and cognitive impairment.

Original Article: http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70117-6/abstract?rss=yes

Júlio Pereira

www.weneuro.com

www.linkedin.com/in/juliommais

lattes.cnpq.br/7687651239699170

Consultório (11)3141-9550/3141-9553

Economic Evaluation of Decompressive Craniectomy Versus Barbiturate Coma for Refractory Intracranial Hypertension Following Traumatic Brain Injury*

Critical Care Medicine - Current Issue

Objectives: Decompressive craniectomy and barbiturate coma are often used as second-tier strategies when intracranial hypertension following severe traumatic brain injury is refractory to first-line treatments. Uncertainty surrounds the decision to choose either treatment option. We investigated which strategy is more economically attractive in this context. Design: We performed a cost-utility analysis. A Markov Monte Carlo microsimulation model with a life-long time horizon was created to compare quality-adjusted survival and cost of the two treatment strategies, from the perspective of healthcare payer. Model parameters were estimated from the literature. Two-dimensional simulation was used to incorporate parameter uncertainty into the model. Value of information analysis was conducted to identify major drivers of decision uncertainty and focus future research. Setting: Trauma centers in the United States. Subjects: Base case was a population of patients (mean age = 25 yr) who developed refractory intracranial hypertension following traumatic brain injury. Interventions: We compared two treatment strategies: decompressive craniectomy and barbiturate coma. Measurements and Main Results: Decompressive craniectomy was associated with an average gain of 1.5 quality-adjusted life years relative to barbiturate coma, with an incremental cost-effectiveness ratio of $9,565/quality-adjusted life year gained. Decompressive craniectomy resulted in a greater quality-adjusted life expectancy 86% of the time and was more cost-effective than barbiturate coma in 78% of cases if our willingness-to-pay threshold is $50,000/quality-adjusted life year and 82% of cases at a threshold of $100,000/quality-adjusted life year. At older age, decompressive craniectomy continued to increase survival but at higher cost (incremental cost-effectiveness ratio = $197,906/quality-adjusted life year at mean age = 85 yr). Conclusions: Based on available evidence, decompressive craniectomy for the treatment of refractory intracranial hypertension following traumatic brain injury provides better value in terms of costs and health gains than barbiturate coma. However, decompressive craniectomy might be less economically attractive for older patients. Further research, particularly on natural history of severe traumatic brain injury patients, is needed to make more informed treatment decisions.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/10000/Economic_Evaluation_of_Decompressive_Craniectomy.11.aspx

Júlio Pereira

www.weneuro.com

www.linkedin.com/in/juliommais

lattes.cnpq.br/7687651239699170

Consultório (11)3141-9550/3141-9553