Clinical Neurology and Neurosurgery最新文献

Background/objectives: This study aims to assess the composite impact of frailty, malnutrition, and anemia on postoperative outcomes for elderly subdural hemorrhage (SDH) patients.

Methods: A retrospective cohort study was performed using the 2011-2023 NSQIP database. All patients > 65 years who underwent SDH evacuation were identified using CPT and ICD codes. The study population was divided based on RAI-rev frailty status, with frail patients being further subdivided based on anemia and Geriatric Nutritional Risk Index (GNRI) nutritional status. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of these health condition combinations with extended hospital length of stay (LOS), any 30-day adverse event (AE), non-routine discharge (NRD), and 30-day mortality.

Results: Of 3136 elderly SDH patients, 610 (19.5 %) were Frail Alone (F), 712 (22.7 %) were Frail + Anemic (FA), 464 (14.8 %) were Frail + Malnourished (FM), 1226 (39.1 %) were FA + Malnourished (FAM), and 124 (4.0 %) were Not Frail (NF). RAI-rev was a risk factor for extended LOS (aOR: 1.03, 95 % CI: 1.01-1.06), AEs (aOR: 1.04, 95 % CI: 1.02-1.06), and mortality (aOR: 1.05, 95 % CI: 1.03-1.08). GNRI was a predictor of decreased odds of extended LOS (aOR: 0.98, 95 % CI: 0.97-0.99) and NRD (aOR: 0.98, 95 % CI: 0.97-1.00), whereas anemia only predicted AEs (aOR: 1.58, 95 % CI: 1.27-1.96). On ROC analysis, adding anemia and GNRI to RAI-rev was associated with statistically significant (p = 0.034) but modest improvements in discrimination for 30-day adverse events.

Conclusion: Our findings suggest that adding anemia and GNRI to RAI-rev is associated with a modest incremental improvement in discrimination for 30-day adverse events in elderly SDH patients.

Background: Intracranial hemorrhage (ICH) is a serious potential complication of stroke mechanical thrombectomy (MT). We evaluated the predictors of symptomatic ICH (sICH) after MT for patients with acute ischemic stroke (AIS).

Methods: This retrospective study analyzed 170 consecutive patients with anterior circulation large vessel occlusion (LVO) undergoing MT. Outcomes were stratified as no hemorrhagic transformation (HT), asymptomatic ICH (aICH) and sICH. RAPID-processed perfusion parameters included ischemic core volume (rCBF<30 %), hypoperfusion volume (Tmax>6 s), mismatch volume, and hypoperfusion intensity ratio (HIR). Multivariable logistic regression with backward stepwise selection identified independent sICH predictors from ten candidate variables spanning clinical, laboratory, imaging and procedural domains.

Results: Among 170 patients, any ICH occurred in 67 (39.4 %), of whom 22 met sICH criteria. Platelet counts, balloon dilatation, ischemic core volume, Tmax> 6 s volume and HIR differed significantly across groups (all p < 0.05). Door-to-puncture time was longer for aICH group than no HT group (159.82 ± 64.05 vs. 131.99 ± 68.47; p < 0.05). Compared with the aICH group, the sICH group had lower platelet counts (141.82 ± 43.56 vs. 176.98 ± 72.36; p < 0.05), a larger ischemic core volume (77.50 ± 61.71 vs. 31.88 ± 34.87; p < 0.05) and higher HIR (0.64(0.45, 0.80) vs. 0.40(0.15, 0.57); p < 0.05). Multivariable analysis identified ischemic core volume (OR 3.62, 95 %CI 2.16-6.67, p < 0.001) and thrombocytopenia (OR 6.53, 95 %CI 2.03-25.41, p = 0.003) as independent sICH predictors. The integrated model achieved robust discrimination (AUC 0.874, accuracy 85.6 %).

Conclusions: Ischemic core volume and thrombocytopenia independently predict sICH following MT.

Introduction: Carotid web (CaW) is notably prevalent among young patients with cryptogenic stroke. Data investigating its occurrence in asymptomatic individuals remains scarce. We evaluated the prevalence of CaWs in a cohort of trauma patients.

Methods: Cross sectional retrospective analysis of consecutive patients who underwent thin-cut neck CT angiograms between October 2015 and August 2018 at a Level 1 Trauma Center. The scans were independently reviewed by two fellowship-trained vascular neurologists who were blinded to demographics and clinical information, and all CaW were reviewed by a fellowship-trained neurointerventionist.

Results: A total of 1157 CTAs in consecutive trauma patients were identified within the study period, and 998 were included. The median age was 39 years [IQR 27.0 - 55.0], 621 (61.3 %) were males, and 626 (62.7 %) were identified as Black or African Americans. 912 (91.4 %) patients had one CTA and 86 (8.6 %) patients had 2 or more CTAs available for review. 1320 (66.1 %) normal carotid bulbs were observed while 16 carotids were found to have a CaW (0.8 % of all carotids) in 15 patients (1.5 % of patients), in which 1 patient had bilateral webs. The lesion involved the postero-lateral carotid bulb wall in 46.7 % of cases, followed by posterior involvement in 33.3 %, postero-medial in 13.3 %, and anterior in 6.7 %. The mean web length was 2.6 ± 0.9 millimeters. Atherosclerotic lesions were otherwise identified in 484 carotid bulbs (24.2 % of all carotid arteries), affecting 394 patients (39.5 %) CONCLUSION: Incidental CaW were identified in 1.5 % of trauma patients undergoing CTA. Incidental CaW may be more common than previously recognized and underscore the need for further studies to determine its clinical relevance.