Risk Of Neurological Deterioration Research Articles

Perioperative outcomes after minimally invasive and open surgery for treatment of spine metastases: a systematic review and meta-analysis.

This systematic review and meta-analysis compared minimally invasive surgery (MIS) to open surgery for treatment of spinal metastases with respect to perioperative outcomes. Few studies have systemically assessed the body of evidence on this topic. A systematic review of EMBASE and PubMed from database inception to December 2023 was performed to identify studies comparing MIS with open surgery for the treatment of spine metastases. Nine outcomes were collected: estimated blood loss (EBL), operative time, hospital length of stay (LOS), risk of revision, risk of neurological deterioration, likelihood of receiving postoperative radiation therapy, time to radiation therapy, time to chemotherapy, and treatment of pain measured through patient-reported visual analog scale (VAS) scores. Meta regression was used to estimate adjusted mean differences (aMDs) and adjusted odds ratios (aORs) for outcomes. Certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations approach. There were 34 eligible studies including 1656 patients with spinal metastases; 904 (54.6%) patients were treated with MIS and 752 (45.4%) were treated with open surgery. MIS was associated with significantly less blood loss (aMD -602 mL, 95% CI -1204 to -0.2 mL; I2 = 97%) with a moderate certainty of evidence. MIS was found to be noninferior with respect to operative time (aMD -2.6 minutes, 95% CI -53.3 to 48.1 minutes; I2 = 88%), risk of revision (aOR 0.9, 95% CI 0.8-1.1; I2 < 0.01), risk of neurological deterioration (aOR 0.9, 95% CI 0.8-1.0; I2 < 0.01), likelihood of postoperative radiation therapy (aOR 0.9, 95% CI 0.7-1.4; I2 < 0.01), and postoperative VAS score (aMD -0.6, 95% CI -1.5 to 0.4; I2 = 52%) with low certainty of evidence. MIS was associated with significantly shorter time to chemotherapy (MD -0.9 weeks, 95% CI -1.9 to -0.01 weeks; I2 = 22%), with very low certainty of evidence. Inferences for LOS and time to radiation were indeterminate; however, we found a trend toward earlier radiation therapy with MIS that was significant in the subgroup of patients treated with decompression and fusion. Treatment with MIS compared with open surgery was associated with reduced EBL, shorter time to chemotherapy, similar operative time, and similar reductions in postoperative pain. Limitations were largely due to heterogeneity across studies. Future research among subgroups is very likely to improve certainty in the comparative effect estimates.

It Looks Like a Spinal Cord Tumor but It Is Not.

Differentiating neoplastic from non-neoplastic spinal cord pathologies may be challenging due to overlapping clinical and radiological features. Spinal cord tumors, which comprise only 2-4% of central nervous system tumors, are rarer than non-tumoral myelopathies of inflammatory, vascular, or infectious origins. The risk of neurological deterioration and the high rate of false negatives or misdiagnoses associated with spinal cord biopsies require a cautious approach. Facing a spinal cord lesion, prioritizing more common non-surgical myelopathies in differential diagnoses is essential. A comprehensive radiological diagnostic approach is mandatory to identify spinal cord tumor mimics. The diagnostic process involves a multi-step approach: detecting lesions primarily using MRI techniques, precise localization of lesions, assessing lesion signal intensity characteristics, and searching for potentially associated anomalies at spinal cord and cerebral MRI. This review aims to delineate the radiological diagnostic approach for spinal cord lesions that may mimic tumors and briefly highlight the primary pathologies behind these lesions.

Neurologic Outcomes and Quality of Life in Children After Extracorporeal Membrane Oxygenation.

Use of life support with extracorporeal membrane oxygenation (ECMO) is associated with brain injury. However, the consequences of these injuries on subsequent neurologic development and health-related quality of life (HRQoL) are poorly described in children. The aim of this preliminary study was to describe short- and long-term neurologic outcomes in survivors of ECMO, as well as their HRQoL. Retrospective identified cohort with contemporary evaluations. Necker Children's Hospital academic PICU. Forty survivors who underwent ECMO (October 2014 to January 2020) were included in follow-up assessments in May 2021. None. We first reviewed the outcomes of ECMO at the time of PICU discharge, which included a summary of neurology, radiology, and Pediatric Overall/Cerebral Performance Category (POPC/PCPC) scores. Then, in May 2021, we interviewed parents and patients to assess HRQoL (Pediatric Quality of Life Inventory [PedsQL]) and POPC/PCPC for children 3 years old or older, and Denver II test (DTII) for younger children. An evaluation of DTII in the youngest patients 1 year after ECMO decannulation was also added. Median age at ECMO was 1.4 years (interquartile range [IQR], 0.4-6 yr). Thirty-five children (88%) underwent a venoarterial ECMO. At PICU discharge, 15 of 40 patients (38%) had neurologic impairment. Assessment of HRQoL was carried out at median of 1.6 years (IQR, 0.7-3.3 yr) after PICU discharge. PedsQL scores were over 70 of 100 for all patients (healthy peers mean results: 80/100), and scores were like those published in patients suffering with chronic diseases. In May 2021, seven of 15 patients had a normal DTII, and 36 of 40 patients had a POPC/PCPC score less than or equal to 3. None of our patients presented severe disability at long term, and HRQoL evaluation was reassuring. Considering the risk of neurologic impairment after ECMO support, a systematic follow-up of these high-risk survivor patients would be advisable.

363 Treatment of Spinal Metastasis in the 21th Century

INTRODUCTION: Spinal metastases may present with different degrees of mechanical instability. The Spinal Instability Neoplastic Score (SINS) was developed to assess spinal neoplastic-related instability. Few have validated it clinically METHODS: A retrospective analysis of patients with a pathologic fracture due to a spinal metastasis between 01/2018-12/2020 was performed. We selected patients with a minimum follow-up of 12 months and analyzed them according to the SINS criteria. In the conservative-group group no spinal surgery was perfomed, in contrast the patients in the surgical-group underwent one or more surgeries, respectively. For both groups were the primary endpoint the progression of vertebral-body fracture following radiotherapy. RESULTS: In the conservative-group 332 Patients were identified. 30/283/19 Patients presented with low/moderate/high SINS, respectively. Fracture progression following radiotherapy was seen in 30%/30%/42% in cases with low/moderate/high SINS (P = 0.522), respectively. 17% of the progression cases in the moderate-group developed neurological deficits. In the interventional-group 35 patient were identified. 6/48/16 Patient presented with low/moderate/high SINS, respectively. Fracture-progression following radiotherapy was not seen in any case. In all cases we did not see any secondary alignment disorder or hints for an instability like loosening-hem. The overall survival was 59% in the conservative-group and 75% in the interventional-group. Analyzing the quality of life, we choose the walking-ability as a main-feature. 92% in the interventional-group are still able to walk, in contrast 86% in the conservative-group. CONCLUSIONS: SINS is an especially useful tool for assess stability of a pathologic fractures. Moderate or high SINS are associated with a remarkably high risk of fracture progression as well as risk for neurological deterioration. Furthermore, there are hints, that a corpectomy is not always necessary due to the secondary strengthening of the vertebral body by radio oncology.

Value of Repeat CT Brain in Mild Traumatic Brain Injury Patients with High Risk of Intracerebral Hemorrhage Progression.

192 patients with MTBI and ICH were treated between November 2019 to December 2020 at a single level II trauma center. The Glasgow Coma Scale (GCS) was used to classify MTBI, and initial head CT was performed according to the Canadian CT head rule. Patients with a higher risk of ICH progression, including the elderly (≥65 years old), patients on antiplatelets or anticoagulants, or patients with an initial head CT that revealed EDH, contusional bleeding, or SDH > 5 mm, and multiple ICH underwent a repeat head CT within 12 to 24 h later. Data regarding types of intervention, length of stay in the hospital, and outcome were collected. The risk of further neurological deterioration and readmission rates were compared between these two groups. All patients were followed up in the clinic after one month or contacted via phone if they did not return. 189 patients underwent scheduled repeated head CT, 18% had radiological intracranial bleed progression, and 82% had no changes. There were no statistically significant differences in terms of intervention rate, risk of neurological deterioration in the future, or readmission between them. Repeat head CT in mild TBI patients with no neurological deterioration is not recommended, even in patients with a higher risk of ICH progression.

Validation of the NIH Toolbox-Cognition Battery against legacy neurocognitive measures in adults with cognitive impairments: An exploratory analysis.

The purpose of this exploratory study was to describe associations between NIH Toolbox-Cognition Battery subtests and legacy measures of neurocognitive function in two samples with neurological conditions (stroke and sickle cell disease (SCD)). This exploratory secondary analysis uses data from two studies that assessed cognition at one time point using the NIH Toolbox-Cognition Battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and subtests from the Delis-Kaplan Executive Functions System (DKEFS). People with stroke (n = 26) and SCD (n = 64) were included. Associations between the NIH Toolbox-Cognition Battery subtests and corresponding legacy measures were examined using linear correlations, Bland-Altman analysis, and Lin's Concordance Correlation Coefficient. Linear correlations and Lin's Concordance Correlation Coefficient were poor to strong in both samples on NIH Toolbox-CB subtests: Flanker Inhibitory Control and Attention (r = .35 to .48, Lin CCC = .27 to .37), Pattern Comparison Processing Speed (r = .40 to .65, Lin CCC = .37 to .62), Picture Sequence Memory (r = .19 to .55, Lin CCC = .18 to .48), Dimensional Change Card Sort (r = .39 to .77, Lin CCC = .38 to .63), Fluid Cognition Composite (r = .88 to .90, Lin CCC = .60 to .79), and Total Cognition Composite (r = .64 to .83, Lin CCC = .60 to .78). Bland-Altman analyses demonstrated wide limits of agreement across all subtests (-3.17 to 3.78). The NIH Toolbox-Cognition Battery subtests may behave similarly to legacy measures as an overall assessment of cognition across samples at risk for neurological impairment. Findings should be replicated across additional clinical samples.

Who gains from repeat radiosurgery for progressive previously treated brain metastases?—a case series

Background: Characterization of potential beneficiaries from repeat radiosurgery (RRS) for progressive previously treated brain metastases (PPT-BRM) has not received much attention, perhaps because many patients with BRM die following salvage radiosurgery. These individuals remain at risk for neurological deterioration when BRMs are left untreated.

Stem Cell Therapy for Neuroprotection in the Growth-Restricted Newborn.

Fetal growth restriction (FGR) occurs when a fetus is unable to grow normally due to inadequate nutrient and oxygen supply from the placenta. Children born with FGR are at high risk of lifelong adverse neurodevelopmental outcomes, such as cerebral palsy, behavioral issues, and learning and attention difficulties. Unfortunately, there is no treatment to protect the FGR newborn from these adverse neurological outcomes. Chronic inflammation and vascular disruption are prevalent in the brains of FGR neonates and therefore targeted treatments may be key to neuroprotection. Tissue repair and regeneration via stem cell therapies have emerged as a potential clinical intervention for FGR babies at risk for neurological impairment and long-term disability. This review discusses the advancement of research into stem cell therapy for treating neurological diseases and how this may be extended for use in the FGR newborn. Leading preclinical studies using stem cell therapies in FGR animal models will be highlighted and the near-term steps that need to be taken for the development of future clinical trials.

Abstract WMP73: Surgical Timing In Infective Endocarditis Patients With Intracranial Hemorrhage -a Systematic Review And Meta-analysis

Background and Purpose: Cardiac surgery is indicated in more than half of patients with infective endocarditis (IE); however, it is performed in only 60% of the indicated cases. Majority of patients with surgical indications who were denied surgery due to certain reasons die within 30 days. Intracranial hemorrhage (ICH) is one of the main causes for denial of surgery despite the presence of surgical indications. We aimed to evaluate the impact of early surgery (within 30 days) in IE-patients with ICH on postoperative outcome and to elucidate the risk of 30-day mortality in patients for whom surgery was denied. Methods: Three libraries (MEDLINE, EMBASE and Cochrane Library) were assessed for studies evaluating the postoperative outcome in early vs. late surgery in IE-patients with preoperative ICH. The primary outcome was all-cause mortality, and the secondary outcome was neurological deterioration. Inverse variance method and random model were performed. Results: We identified 16 studies including 355 patients. Nine studies examined the impact of surgical timing (early vs. late) and were included in the meta-analyses. Only one study examined the fate of IE-patients with ICH who were treated conservatively despite of having an indication for cardiac surgery, showing higher mortality rates than those who were operated (11.8 % vs. 2.5 %). We found no significant association between early surgery, regardless of its definition, and a higher mortality (relative risk [RR]= 1.46; 95% confidence interval [CI]: 0.98-2.17). However, early surgery was associated with higher risk for neurological deterioration (RR= 1.97; 95% CI: 1.15-3.38). Conclusions: Cardiac surgery for IE within 30 days of ICH was not associated with higher mortality, but with increased rate of neurological deterioration. Thirty-day mortality in IE-patients with ICH for whom surgery was denied has not yet been sufficiently investigated. This patient group should be analysed in future studies in more detail.

Treatment Challenges in Acute Minor Ischemic Stroke.

Patients with acute ischemic stroke may present with minor neurologic deficits. Acute treatment decisions depend on the disability imposed by the symptoms along with radiographic features. The presence of disabling neurologic deficits warrants intravenous thrombolysis, but the indications for endovascular therapy are less defined. The degree of disability, presence of a large vessel occlusion with perfusion mismatch, and collateral circulation status may all be factors in selecting patients for endovascular treatment. Identification of patients who are at risk for neurologic deterioration is critical to preventing poor outcomes in this patient population.

SURG-14. Laser Ablation for Brain Metastases: Risk Factors for Neurologic Complication

IntroductionLaser interstitial thermal therapy (LITT) is a routinely used in treatment of recurrent brain metastases following SRS or open craniotomy. While considered safer than craniotomy, patients do experience neurologic decline following LITT. Identifying which patients are at risk for neurologic deterioration can help better advise patients on the most appropriate treatment options for their tumor.ObjectiveThe objective of the present study was to assess the frequency and identify risk factors for neurologic decline following LITT.MethodsData was gathered on patients who underwent LITT for ablation of metastatic brain tumors at our institution between 2014–2019. These cases were analyzed retrospectively and data was collected on patient demographics, tumor characteristics, procedural details, and post-operative complications and outcomes. Pre-operative neurologic function was compared to neurologic status at the 6–12 week post-op visit.Results16 patients underwent LITT of a total of 18 metastatic lesions during the study time period and were included in the analysis. 7/16 patients demonstrated reduced KPS or worse neurologic function at 6–12 week follow up. 4 patients (25%) demonstrated neurologic deficits that were attributable to the laser ablation procedure, and each of these 4 patients had lesions in eloquent areas. Comparatively, none of the other 12 patients analyzed had eloquent lesions (p = 0.002). The presence of a pre-op neurologic deficit was not predictive of worsening neurologic function following LITT (p = 0.35). Average lesion size in patients who experienced neurologic deficit was 5.69cm3 compared to 3.15cm3 in those that did not (p = 0.1).ConclusionOur complications rate is similar to other published case series (15–44%). LITT, while better tolerated than standard craniotomy, can lead to neurologic decline in patients with brain metastases regardless of lesion size or pre-operative functional status. Eloquence is a significant predictor of neurologic complications following laser ablation.

Abstract MP34: Retrospective Analysis on Predictive Factors and Timeline for Early Neurologic Decline and Symptomatic Intracranial Hemorrhage Following Administration of Intravenous Recombinant Tissue Plasminogen Activator for Ischemic Stroke

Introduction: Current guidelines recommend that patients given intravenous tPA (IV tPA) for acute ischemic stroke (AIS) receive comprehensive stroke care for 24 hours post-treatment to monitor key physiologic variables. 1,2,3 Early de-escalation of monitoring is likely feasible in a particular subset of patients, which may have implications in the post-COVID era. 4 In this study, we examined when patients with AIS are susceptible to early neurologic decline (END) and symptomatic intracranial hemorrhage (sICH) after IV tPA and whether those at low clinical risk of neurologic deterioration may be suitable for earlier transition to lower level of care. Methods: We performed a retrospective analysis of AIS receiving IV tPA based on AHA/ASA guidelines. We included those that presented within 4.5 hours of last seen well (LSW) without large vessel occlusion (LVO) or flow-limiting stenosis (FLS) on non-invasive angiographic imaging. Outcomes included END (≥4-point worsening of NIHSS at 24 hours) from any cause, parenchymal hemorrhage (PH1 or PH2), and/ or symptomatic intracranial hemorrhage (sICH; ≥4-point NIHSS worsening with presence of hemorrhage). Results: 1238 patients were included from 1/2013 - 6/2019. END and ICH occurred in 7.4% (91) and 9.4% (116), respectively. 63.7% of patients with END did not have ICH within 24 hours. In those with NIHSS &lt;12, 82% had END within 12 hours and most occurred within 5 hours. Predictive factors included older patients (72.6 ±16.1 vs 69.1 ±14.8, p=0.03), history of tobacco use (OR-2.1 [1.1-4.3], p = 0.04) and hyperlipidemia (OR-1.7 [1.1-2.8] p = 0.02). ICH occurred within 12 hours in 30% of patients, predictors included older age (74.6 ± 12.4 vs 68.8 ± 15.1, p ≤ 0.01), higher NIHSS (14.6 ± 7.3 vs 10.8 ± 7.9, p ≤ 0.01), and higher presentation serum glucose levels (155.1 ± 87.5 vs 140.4 ± 70.5, p = 0.04). Overall, only 2.7% (33) of patients developed sICH. There were no independent predictive factors for delayed ICH (≥ 12 hours). Conclusion: In our selected post-IV tPA patients, a relatively small proportion suffered sICH and END; most often within 12 hours of tPA administration. These findings may support earlier de-escalation of higher acuity monitoring for clinically stable post-IV tPA patients.

360 Prenatal tobacco smoke and risk of neurological impairment at age 10 among extremely preterm infants

To determine the association between prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm (<28 weeks gestation). The multicenter, prospective Extremely Low Gestational Age Newborn (ELGAN) Study enrolled newborns at birth between 2002-2004. Prenatal tobacco smoke included self-reported maternal (i.e., active) and passive smoking during pregnancy at study enrollment. Neurological impairment at 10 years of age included: epilepsy, cerebral palsy, and cognitive impairment. Poisson regression with generalized estimating equations was used to estimate adjusted risk ratios (aRRs), adjusted for mother’s age, race/ethnicity, education, insurance, multiple gestation, and infant’s sex; and separately, we adjusted for gestational age at delivery in sensitivity analysis, given its classification as an intermediate and not confounding variable. Secondarily, we assessed whether 1) the primary association varied by infant sex (male vs. female) given sexual epigenetic dimorphism in the placenta; and 2) postnatal inflammation in the child within 2 weeks after birth. Of 1,200 ELGAN study survivors, 886 were assessed at 10 years of age, of whom 14% (120/867) had been exposed to maternal tobacco use during pregnancy and 24% (210/863) to passive tobacco smoke. Compared to children who were not exposed prenatally to tobacco, children exposed to maternal tobacco use during pregnancy had a higher risk of epilepsy at 10 years of age (14% vs. 5%; aRR: 1.6, 95% CI: 1.6 to 1.7). This risk remained after adjustment for gestational age at delivery. Prenatal tobacco smoke exposure was not associated with cerebral palsy and cognitive impairment. Secondarily, the primary association held for female but not male infants; and tobacco smoke exposure did not influence the contribution of postnatal inflammation to impaired neurodevelopment. Among extremely preterm infants born <28 weeks, active maternal tobacco smoke during pregnancy increases the risk of epilepsy in the offspring at 10 years of life.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Neurosurgical Referral Patterns During the Coronavirus Disease 2019 Pandemic: A United Kingdom Experience

BackgroundCoronavirus disease 2019 (COVID-19) is a severe respiratory viral illness that has spread rapidly across the world. However, the United Kingdom has been particularly affected. Evidence has suggested that stroke, cardiac, and spinal presentations decreased during the pandemic as the public avoided seeking care. The effect on neurosurgical presentations and referrals during COVID-19 is unclear. Our aim, therefore, was to describe the referral patterns to a high-volume neurosurgical department in the United Kingdom during the COVID-19 pandemic.MethodsElectronic referrals were identified from the referrals database from January 1, 2020 to May 31, 2020, inclusive, with January used as the baseline. The demographic data and referral diagnoses were captured on Excel (Microsoft, Redmond, Washington, USA). Statistical analyses were performed using SPSS, version 22 (IBM Corp., Armonk, New York, USA). Differences between referral volumes were evaluated using χ2 goodness-of-fit tests.ResultsA total of 2293 electronic referrals had been received during the study period. The median age was 63 years. Overall, the referrals had decreased significantly in volume during the study period [χ2(4) = 60.95; P < 0.001]. We have described the patterns in the daily referrals as the pandemic progressed. The reduction in the volume of referrals for degenerative spine cases and traumatic brain injuries was statistically significant (P < 0.001).ConclusionsThe referrals for degenerative spine and traumatic brain injuries decreased significantly during the pandemic, which can be explained by the lower vehicular traffic and patient avoidance of healthcare services, respectively. The risk of neurological deterioration and increased morbidity and mortality, as a consequence, is of concern, and neurosurgeons worldwide should consider the optimal strategies to mitigate these risks as the pandemic eases.

Reduction in Cerebrospinal Fluid Volume as an Early Quantitative Biomarker of Cerebral Edema After Ischemic Stroke.

Background and Purpose- Cerebral edema (CED) develops in the hours to days after stroke; the resulting increase in brain volume may lead to midline shift (MLS) and neurological deterioration. The time course and implications of edema formation are not well characterized across the spectrum of stroke. We analyzed displacement of cerebrospinal fluid (ΔCSF) as a dynamic quantitative imaging biomarker of edema formation. Methods- We selected subjects enrolled in a stroke cohort study who presented within 6 hours of onset and had baseline and ≥1 follow-up brain computed tomography scans available. We applied a neural network-based algorithm to quantify hemispheric CSF volume at each imaging time point and modeled CSF trajectory over time (using a piecewise linear mixed-effects model). We evaluated ΔCSF within the first 24 hours as an early biomarker of CED (defined as developing MLS on computed tomography beyond 24 hours) and poor outcome (modified Rankin Scale score, 3-6). Results- We had serial imaging in 738 subjects with stroke, of whom 91 (13%) developed CED with MLS. Age did not differ (69 versus 70 years), but baseline National Institutes of Health Stroke Scale was higher (16 versus 7) and baseline CSF volume lower (132 versus 161 mL, both P<0.001) in those with CED. ΔCSF was faster in those developing MLS, with the majority seen by 24 hours (36% versus 11% or 2.4 versus 0.8 mL/h; P<0.0001). Risk of CED almost doubled for every 10% ΔCSF within 24 hours (odds ratio, 1.76 [95% CI, 1.46-2.14]), adjusting for age, glucose, and National Institutes of Health Stroke Scale. Risk of neurological deterioration (1.6-point increase in National Institutes of Health Stroke Scale at 24 hours) and poor outcome (adjusted odds ratio, 1.34 [95% CI, 1.15-1.56]) was also greater for every 10% increase in ΔCSF. Conclusions- CSF volumetrics provides quantitative evaluation of early edema formation. ΔCSF from baseline to 24-hour computed tomography is a promising early biomarker for the development of MLS and worse neurological outcome.

Evolution of Different Bacterial Mningoencephalitis: Series of Case Presentations and Literature Review

Abstract Bacterial meningitis is one of the most important medical emergencies, a life-threatening condition that leads to death in all the cases in untreated patients. In infants and young children, especially under 5 years old, the most encountered and severe forms are caused by Streptococcus pneumoniae, Neisseria meningitidis and Hemophilus influenzae type b. The risk of neurological impairment after an acute episode of bacterial meningitis is relatively high. Worldwide, prevention through vaccination decreased dramatically incidence and mortality related to these disease. In Romania vaccination for Neisseria meningitides is optional available for just 6 months, vaccination for Streptococcus pneumoniae by one year, and for Haemophylus influenzae type B is available over 10 years. We present evolution of a series of three cases with different bacterial meningoencephalitis with severe evolution and prolonged hospitalization. All these cases were reported in unvaccinated children for germs that cause meningitis.

Continuous EEG monitoring after brain tumor surgery

BackgroundProlonged seizures generate cerebral hypoxia and increased intracranial pressure, resulting in an increased risk of neurological deterioration, increased long-term morbidity, and shorter survival. Seizures should be recognized early and treated promptly.The aim of the study was to investigate the occurrence of postoperative seizures in patients undergoing craniotomy for primary brain tumors and to determine if non-convulsive seizures could explain some of the postoperative neurological deterioration that may occur after surgery.MethodsA single-center prospective study of 100 patients with suspected glioma. Participants were studied with EEG and video recording for at least 24 h after surgery.ResultsSeven patients (7%) displayed seizure activity on EEG recording within 24 h after surgery and another two patients (2%) developed late seizures. One of the patients with early seizures also developed late seizures. In five patients (5%), there were non-convulsive seizures. Four of these patients had a combination of clinically overt and non-convulsive seizures and in one patient, all seizures were non-convulsive. The non-convulsive seizures accounted for the majority of total seizure time in those patients. Non-convulsive seizures could not explain six cases of unexpected postoperative neurological deterioration. Postoperative ischemic lesions were more common in patients with early postoperative seizures.ConclusionsEarly seizures, including non-convulsive, occurred in 7% of our patients. Within this group, non-convulsive seizure activity had longer durations than clinically overt seizures, but only 1% of patients had exclusively non-convulsive seizures. Seizures were not associated with unexpected neurological deterioration.

Predictive factors of neurologic deterioration in patients with spontaneous cerebellar hemorrhage: a retrospective analysis

BackgroundCerebellar hemorrhage is a potentially life-threatening condition and neurologic deterioration during hospitalization could lead to severe disability and poor outcome. Finds out the factors influencing neurologic deterioration during hospitalization is essential for clinical decision-making.MethodsOne hundred fifty-five consecutive patients who suffered a first spontaneous cerebellar hemorrhage (SCH) were evaluated in this 10-year retrospective study. This study aimed to identify potential clinical, radiological and clinical scales risk factors for neurologic deterioration during hospitalization and outcome at discharge.ResultsNeurologic deterioration during hospitalization developed in 17.4% (27/155) of the patient cohort. Obliteration of basal cistern (p≦0.001) and hydrocephalus (p≦0.001) on initial brain computed tomography (CT), median Glasgow Coma Scale (GCS) score at presentation (p≦0.001) and median intracerebral hemorrhage (ICH) score (P≦0.001) on admission were significant factors associated with neurologic deterioration. Stepwise logistic regression analysis showed that patients with obliteration of basal cistern on initial brain CT scan had an odds ratio (OR) of 9.17 (p = 0.002; 95% confidence interval (CI): 0.026 to 0.455) adjusted risk of neurologic deterioration compared with those without obliteration of basal cistern. An increase of 1 point in the ICH score on admission would increase the neurologic deterioration rate by 83.2% (p = 0.010; 95% CI: 1.153 to 2.912). The ROC curves showed that the AUC for ICH score on presentation was 0.719 (p = 0.000; 95% CI: 0.613–0.826) and the cutoff value was 2.5 (sensitivity 80.5% and specificity 73.7%).ConclusionPatients had obliteration of basal cistern on initial brain CT and ICH score greater or equal to 3 at admission implies a greater danger of neurologic deterioration during hospitalization. Cautious clinical assessments and repeated brain images study are mandatory for those high-risk patients to prevent neurologic deterioration during hospitalization.

What is the importance of the spinal canal encroachment in the management of thoracolumbar burst fracture without neurological deficit?

Introduction: The relevant features in the treatment of thoracolumbar fractures vary in the literature. The classical surgical indications of burst fractures are loss of vertebral body height, kyphosis, neurological deficit and canal encroachment. Recent papers have attributed less importance to canal impingement as a surgical indicator in intact patients, irrespectively of the degree of encroachment. The several thoracolumbar fracture classifications have prompted efforts to guide the surgical indications. We analyzed the relevance attributed to the canal encroachment by thoracolumbar fracture classifications in the management of burst fractures without neurological deficit. Objective: To evaluate the relevance attributed by the thoracolumbar fractures classifications to the canal encroachment in the management of burst fractures without posterior ligamentous complex disruptions or neurological deficits. Methods: A literature search was performed by tracking the related articles of thoracolumbar fractures classifications from Vaccaro’s to Holdsworth’s study. We analyzed the role of canal impingement in the management of burst fractures without posterior ligament complex injury or neurological deficits in each classification. Results: Seven classifications were included. Holdsworth considered the burst fractures as stable, irrespectively of the amount of canal impingement or neurological deficit. Denis considered that the burst fracture carried a neurological instability criterion, therefore, in these cases he suggested surgical treatment because of the riskof new neurological damage. McAffee postulated that there is no reliable predictor to correlate the severity of canal encroachment with the risk of neurological damage. Ferguson and Allen discussed the possibility of anterior decompression, stabilization and anterior fusion of the spine in certain cases of burst fractures. The classifications of McCormack, Karaikovic and Gaines, Magerl and Vaccaro did not include canal encroachment in their considerations. Conclusion: The thoracolumbar fractures classifications did not directly consider the severity of canal encroachment in the treatment decision making of burst fractures without neurological damage. It is not possible to predict which patients will deteriorate if not operated. It remains unclear what is the risk of neurological deterioration in a SCE greater than 50%.

The relationship between infant iron status and risk of neurological impairment

Background Iron deficiency (ID) is a commonly found nutritional disorder and a persistent problem, especially in Indonesia. Iron deficiency during the critical period in childhood brain development is estimated to cause irreversible damage that hinders infant development.Objective To determine the relationship between infant iron status and neurological development.Methods We conducted a cross-sectional study at the Growth and Development Outpatient Clinic, Prof. Dr. R. D. Kandou Hospital, Manado, from March to May 2015. By consecutive sampling, we obtained 44 healthy infants aged 7 to 10 months who fulfilled the inclusion criteria. Infants with a history of perinatal complications, such as head trauma, hypoglycemia, respiratory distress syndrome, infection, or malaria were excluded Subjects’ serum hemoglobin and ferritin were examined for iron status. Infants’ risk of neurological impairment was assessed by the Bayley Infant Neurodevelopmental Screener (BINS). Results were analyzed by descriptive analysis for the characteristics and Spearman’s rank correlation coefficient analysis for the relationship between iron status and neurological development.Results From 14 infants with ID, 8 infants had a high risk of developmental impairment. Of the 30 non-ID subjects, 4 infants had a high risk of developmental impairment. Of the 30 non-ID infants, 16 infants had a low risk of impaired development, while 2 infants with ID had low risk of developmental impairment. Spearman’s rho revealed that infant iron deficiency was significantly associated with high risk of neurological impairment. (r=-0.547; P&lt;0.0001).Conclusion Lower serum ferritin levels (iron deficiency) is significantly associated with greater risk of impaired neurological development in infants aged 7-10 months.