Thursday, March 6, 2014

Long-term, serial screening for intracranial aneurysms in individuals with a family history of aneurysmal subarachnoid haemorrhage: a cohort study

Long-term, serial screening for intracranial aneurysms in individuals with a family history of aneurysmal subarachnoid haemorrhage: a cohort study
ScienceDirect - The Lancet Neurology, Volume 10, Issue 2, Pages ...

Publication date:
Source:The Lancet Neurology
Author(s): A Stijntje E Bor , Gabriel J E Rinkel , Jeroen van Norden , Marieke J H Wermer




Original Article: http://rss.sciencedirect.com/action/redirectFile?&zone=main¤tActivity=feed&usageType=outward&url=http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSSEARCH&_method=citationSearch&_piikey=S1474442214700213&_version=1&md5=daf530f96c2bb6a068dc442965db55f2
No comments:

Saturday, March 1, 2014

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 - Most Popular Articles

imageObjectives: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
No comments:

Arterial Blood Pressure Management During Carotid Endarterectomy and Early Cognitive Dysfunction

Arterial Blood Pressure Management During Carotid Endarterectomy and Early Cognitive Dysfunction
Neurosurgery - Most Popular Articles

imageBACKGROUND: 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 deviation

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/03000/Arterial_Blood_Pressure_Management_During_Carotid.2.aspx
No comments:

Alzheimer's protein regulated by brain cell activity

Alzheimer's protein regulated by brain cell activity
Neurology News & Neuroscience News from Medical News Today

Increased brain cell activity boosts brain fluid levels of a protein linked to Alzheimer's disease, according to new research from scientists at Washington University School of Medicine in St. Louis.Tau protein is the main component of neurofibrillary tangles, one of the hallmarks of Alzheimer's disease.

Original Article: http://www.medicalnewstoday.com/releases/273246.php
No comments:

Subcortical Cystic Lesions within the Anterior Superior Temporal Gyrus: A Newly Recognized Characteristic Location for Dilated Perivascular Spaces

Subcortical Cystic Lesions within the Anterior Superior Temporal Gyrus: A Newly Recognized Characteristic Location for Dilated Perivascular Spaces
AJNR Blog

Fellows' Journal Club

February 2014

(2 of 3)

Fifteen patients with unusual dilated perivascular spaces in the subcortical white matter of the anterior superior temporal gyrus were presented. In one, pathology showed gliosis and innumerable perivascular spaces. Findings that suggest cysts in this location were perivascular spaces include: lack of symptoms, proximity to the subarachnoid space, adjacent blood vessels, and stability over time.

EIC signature

Summary

Cystic parenchymal lesions may pose an important diagnostic challenge, particularly when encountered in unexpected locations. Dilated perivascular spaces, which may mimic cystic neoplasms, are known to occur in the inferior basal ganglia and mesencephalothalamic regions; a focal preference within the subcortical white matter has not been reported. This series describes 15 cases of patients with cystic lesions within the subcortical white matter of the anterior superior temporal lobe, which followed a CSF signal; were located adjacent to a subarachnoid space; demonstrated variable surrounding signal change; and, in those that were followed up, showed stability. Pathology study results obtained in 1 patient demonstrated chronic gliosis surrounding innumerable dilated perivascular spaces. These findings suggest that dilated perivascular spaces may exhibit a regional preference for the subcortical white matter of the anterior superior temporal lobe. Other features—lack of clinical symptoms, proximity to the subarachnoid space, identification of an adjacent vessel, and stability with time—may help in confidently making the prospective diagnosis of a dilated perivascular space, thereby preventing unnecessary invasive management.

Full text

The post Subcortical Cystic Lesions within the Anterior Superior Temporal Gyrus: A Newly Recognized Characteristic Location for Dilated Perivascular Spaces appeared first on AJNR Blog.



Original Article: http://www.ajnrblog.org/2014/02/27/subcortical-cystic-lesions-within-anterior-superior-temporal-gyrus-newly-recognized-characteristic-location-dilated-perivascular-spaces/
No comments:
Subscribe to: Posts (Atom)