Clinical Neurology and Neurosurgery最新文献_第3页

Effects of anodal transcranial direct current stimulation on intracranial compliance in the subacute phase of stroke 阳极经颅直流电刺激对中风亚急性期颅内顺应性的影响。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-23 DOI: 10.1016/j.clineuro.2024.108597

Monalisa Resende Nascimento , Tiago Soares Bernardes , Kelly Cristina Sousa Santos , Gabrielly Fernanda Silva , Rodrigo Bazan , Luciane Aparecida Pascucci Sande de Souza , Gustavo José Luvizutto

Objectives

Transcranial direct current stimulation (tDCS) increases cerebral blood flow. This study evaluated the effects of anodal tDCS (A-tDCS) on intracranial compliance (ICC) in patients with subacute stroke using a non-invasive method.

Methods

This was a randomized, proof-of-concept, double-blind, pilot study. Patients with ischemic stroke of the middle cerebral artery (MCA) were divided into the following two groups: 1) A-tDCS in the motor cortex on the affected side for 30 min at 2 mA, and 2) sham tDCS in the motor cortex on the affected side. The primary outcomes were intracranial compliance (P2/P1 ratio and time-to-peak [TTP]) and ICC normalization after the intervention (P2/P1 ratio <1). Secondary outcomes were systolic and diastolic blood pressures, heart rate, and peripheral oxygen saturation.

Results

No significant differences were observed in the P2/P1 ratio (P = 0.509) and TTP (P = 0.480) between the groups. However, the A-tDCS group was significantly associated with a normal P2/P1 ratio after intervention (B = 2.583; standard error [SE]: 1.277; P = 0.043; corrected for age and stroke severity). No significant associations were observed between the groups and systolic blood pressure (F = 0.16; P = 0.902), diastolic blood pressure (F = 0.18; P = 0.892), heart rate (F = 0.11; P = 0.950), or peripheral oxygen saturation (F = 0.21; P = 0.750).

Conclusion

ICC morphology normalization was observed in the A-tDCS group. However, no differences were observed in the P2/P1 ratio, TTP, or hemodynamic variables between the groups. A sample size of 66 patients with ischemic stroke of the MCA can be estimated using the observed effect size and standard α = 5 % and β = 20 % for future trials. Furthermore, this will aid in conducting the necessary randomized trials targeting these populations.

目标：经颅直流电刺激（tDCS经颅直流电刺激（tDCS）可增加脑血流量。本研究采用无创方法评估了阳极 tDCS（A-tDCS）对亚急性中风患者颅内顺应性（ICC）的影响：这是一项随机、概念验证、双盲、试验性研究。大脑中动脉（MCA）缺血性中风患者被分为以下两组：1）在患侧运动皮层进行 30 分钟、2 毫安的 A-tDCS 治疗；2）在患侧运动皮层进行假 tDCS 治疗。主要结果是颅内顺应性（P2/P1 比值和峰值时间 [TTP]）和干预后 ICC 正常化（P2/P1 比值结果）：两组间的 P2/P1 比值（P = 0.509）和 TTP（P = 0.480）无明显差异。然而，A-tDCS 组与干预后正常的 P2/P1 比值有明显相关性（B = 2.583；标准误差 [SE]：1.277; P = 0.043；根据年龄和中风严重程度校正）。各组间未观察到收缩压（F = 0.16；P = 0.902）、舒张压（F = 0.18；P = 0.892）、心率（F = 0.11；P = 0.950）或外周血氧饱和度（F = 0.21；P = 0.750）的明显关联：结论：A-tDCS 组观察到 ICC 形态正常化。结论：A-tDCS 组观察到 ICC 形态正常化，但两组间的 P2/P1 比值、TTP 或血液动力学变量未见差异。根据观察到的效应大小和标准 α = 5 % 和 β = 20 %，可估算出 66 名 MCA 缺血性中风患者的样本量，供未来试验使用。此外，这将有助于针对这些人群开展必要的随机试验。

{"title":"Effects of anodal transcranial direct current stimulation on intracranial compliance in the subacute phase of stroke","authors":"Monalisa Resende Nascimento , Tiago Soares Bernardes , Kelly Cristina Sousa Santos , Gabrielly Fernanda Silva , Rodrigo Bazan , Luciane Aparecida Pascucci Sande de Souza , Gustavo José Luvizutto","doi":"10.1016/j.clineuro.2024.108597","DOIUrl":"10.1016/j.clineuro.2024.108597","url":null,"abstract":"<div><h3>Objectives</h3><div>Transcranial direct current stimulation (tDCS) increases cerebral blood flow. This study evaluated the effects of anodal tDCS (A-tDCS) on intracranial compliance (ICC) in patients with subacute stroke using a non-invasive method.</div></div><div><h3>Methods</h3><div>This was a randomized, proof-of-concept, double-blind, pilot study. Patients with ischemic stroke of the middle cerebral artery (MCA) were divided into the following two groups: 1) A-tDCS in the motor cortex on the affected side for 30 min at 2 mA, and 2) sham tDCS in the motor cortex on the affected side. The primary outcomes were intracranial compliance (P2/P1 ratio and time-to-peak [TTP]) and ICC normalization after the intervention (P2/P1 ratio <1). Secondary outcomes were systolic and diastolic blood pressures, heart rate, and peripheral oxygen saturation.</div></div><div><h3>Results</h3><div>No significant differences were observed in the P2/P1 ratio (P = 0.509) and TTP (P = 0.480) between the groups. However, the A-tDCS group was significantly associated with a normal P2/P1 ratio after intervention (B = 2.583; standard error [SE]: 1.277; P = 0.043; corrected for age and stroke severity). No significant associations were observed between the groups and systolic blood pressure (F = 0.16; P = 0.902), diastolic blood pressure (F = 0.18; P = 0.892), heart rate (F = 0.11; P = 0.950), or peripheral oxygen saturation (F = 0.21; P = 0.750).</div></div><div><h3>Conclusion</h3><div>ICC morphology normalization was observed in the A-tDCS group. However, no differences were observed in the P2/P1 ratio, TTP, or hemodynamic variables between the groups. A sample size of 66 patients with ischemic stroke of the MCA can be estimated using the observed effect size and standard α = 5 % and β = 20 % for future trials. Furthermore, this will aid in conducting the necessary randomized trials targeting these populations.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"247 ","pages":"Article 108597"},"PeriodicalIF":1.8,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Analysis of the impact of a rhinologist-assisted endoscopic approach on a single neurosurgeon’s outcomes in transsphenoidal resection of pituitary adenomas 分析鼻内镜辅助方法对一名神经外科医生经蝶窦切除垂体腺瘤手术效果的影响。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-23 DOI: 10.1016/j.clineuro.2024.108604

Arvind C. Mohan , Clare Grady , Samuel Malnik , Anil Patel , Paul Kubilis , Baker Chowdhury , Brian C. Lobo , Steven N. Roper

Objectives

Determine the improvements in outcomes of transsphenoidal pituitary adenoma resection following addition of a skull base rhinologist to the neurosurgical team.

Design

All patients that underwent transsphenoidal resection of pituitary adenoma were identified. Demographic data, Otolaryngology (ENT) involvement, initial adenoma size, extent of resection, hormonal secretion status, visual field exam, post-operative DI, CSF leak, recurrence, need for nasoseptal flap (NSF), re-operation rate were all collected. A linear-regression model adjusteds for confounders.

Setting

A single academic institution

Participants

271 patients who underwent transsphenoidal surgery between 2015 and 2020.

Main Outcome Measures

The main outcome measures were Extent of Resection and Endocrinologic remission.

Results

Of the 271 patients identified, 228 (84 %) patients had macroadenomas, one-third of patients presented with bitemporal hemianopsia, and 27 % (72) were hormonally active. For these and demographics there were no statistically significant differences between the microscopic or endoscopic approach (EEA) groups. For patients with cavernous sinus invasion of >50 %, EEA was more likely to achieve gross total resection (GTR) (OR 2.6; p<0.001). For patients who had prior sellar surgery, EEA was 2.5x more likely to get a GTR (p=0.05). The EEA approach resulted in an extra hospital day (1–2 vs 2–3 p<0.05) and surgery lasted an additional hour (1.17 vs 2.5, p<0.05), but did not require fat grafts or lumbar drains on a routine basis.

Conclusions

While the operating time and LOS were longer, the EEA approach performed by two specialized co-surgeons demonstrates superior value for adenomas that have had a prior surgical attempt or with significant cavernous sinus invasion.

目标：确定颅底鼻科医生加入神经外科团队后，经蝶垂体腺瘤切除术的疗效有何改善：确定在神经外科团队中增加一名颅底鼻科医生后，经蝶垂体腺瘤切除术的疗效有何改善：设计：确定所有接受经蝶垂体腺瘤切除术的患者。人口统计学数据、耳鼻喉科（ENT）参与情况、腺瘤初始大小、切除范围、激素分泌状况、视野检查、术后DI、CSF漏、复发、鼻隔皮瓣（NSF）需求、再次手术率均被收集。采用线性回归模型对混杂因素进行调整：单一学术机构参与者：2015年至2020年期间接受经蝶手术的271名患者。主要结果指标主要结果指标为切除范围和内分泌学缓解：在已确定的271例患者中，228例（84%）患者患有大腺瘤，三分之一的患者伴有位颞侧半身不遂，27%（72例）患者激素分泌活跃。显微镜或内窥镜方法（EEA）组之间在这些方面和人口统计学上没有显著差异。对于海绵窦侵犯>50%的患者，EEA更有可能实现大体全切除（GTR）（OR 2.6; p结论：虽然手术时间和住院时间较长，但由两名专业的联合外科医生实施的 EEA 方法对于之前尝试过手术或有明显海绵窦侵犯的腺瘤具有更高的价值。

{"title":"Analysis of the impact of a rhinologist-assisted endoscopic approach on a single neurosurgeon’s outcomes in transsphenoidal resection of pituitary adenomas","authors":"Arvind C. Mohan , Clare Grady , Samuel Malnik , Anil Patel , Paul Kubilis , Baker Chowdhury , Brian C. Lobo , Steven N. Roper","doi":"10.1016/j.clineuro.2024.108604","DOIUrl":"10.1016/j.clineuro.2024.108604","url":null,"abstract":"<div><h3>Objectives</h3><div>Determine the improvements in outcomes of transsphenoidal pituitary adenoma resection following addition of a skull base rhinologist to the neurosurgical team.</div></div><div><h3>Design</h3><div>All patients that underwent transsphenoidal resection of pituitary adenoma were identified. Demographic data, Otolaryngology (ENT) involvement, initial adenoma size, extent of resection, hormonal secretion status, visual field exam, post-operative DI, CSF leak, recurrence, need for nasoseptal flap (NSF), re-operation rate were all collected. A linear-regression model adjusteds for confounders.</div></div><div><h3>Setting</h3><div>A single academic institution</div></div><div><h3>Participants</h3><div>271 patients who underwent transsphenoidal surgery between 2015 and 2020.</div><div>Main Outcome Measures</div><div>The main outcome measures were Extent of Resection and Endocrinologic remission.</div></div><div><h3>Results</h3><div>Of the 271 patients identified, 228 (84 %) patients had macroadenomas, one-third of patients presented with bitemporal hemianopsia, and 27 % (72) were hormonally active. For these and demographics there were no statistically significant differences between the microscopic or endoscopic approach (EEA) groups. For patients with cavernous sinus invasion of >50 %, EEA was more likely to achieve gross total resection (GTR) (OR 2.6; p<0.001). For patients who had prior sellar surgery, EEA was 2.5x more likely to get a GTR (p=0.05). The EEA approach resulted in an extra hospital day (1–2 vs 2–3 p<0.05) and surgery lasted an additional hour (1.17 vs 2.5, p<0.05), but did not require fat grafts or lumbar drains on a routine basis.</div></div><div><h3>Conclusions</h3><div>While the operating time and LOS were longer, the EEA approach performed by two specialized co-surgeons demonstrates superior value for adenomas that have had a prior surgical attempt or with significant cavernous sinus invasion.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"247 ","pages":"Article 108604"},"PeriodicalIF":1.8,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Letter to editor: The impact of tumor resection on survival and functional outcomes for patients with primary central nervous system lymphoma 致编辑的信肿瘤切除对原发性中枢神经系统淋巴瘤患者生存和功能预后的影响

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108608

Prajwal Ghimire , Francesco Marchi, Ali Elhag, Pranoy Das, Engelbert Mthunzi, Richard Gullan, Ranjeev Bhangoo, Keyoumars Ashkan, Francesco Vergani, José Pedro Lavrador

引用次数: 0

Prognostic factors of chronic subdural hematomas in two reference university teaching hospitals in the city of Yaounde 雅温得市两所大学教学医院慢性硬膜下血肿的预后因素。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108614

Nassourou Oumarou Haman , Orlane Ndome Toto , Indira Baboke , Dimitri Fogue , V.d.P. Djientcheu

Objectives

Despite the good prognosis of surgical treatment of chronic subdural hematomas, there are some early deaths, recurrences and post-operative complications. The objective of this study is to analyze the prognostic factors of chronic subdural hematomas in two reference university teaching hospitals in the city of Yaounde.

Method

Three hundred and ten cases of chronic subdural hematomas were diagnosed on 3788 patients hospitalized in the neurosurgery departments of two reference university teaching hospitals in the city of Yaounde from January 1st, 2015 to December 31st, 2021 (7 years). The authors collected data from patients in whom surgical treatment was performed and assessed their prognosis with regard to the rate of early and late recurrence, mortality rate and postoperative complications and associated factors.

Results

Data from 284 patients were analyzed. The mortality rate was 6.7 % and the recurrence rate was 3.2 % in early postoperative period and 4.5 % after a follow-up of 3–24 months. Prognostic factors for death were age greater than or equal to 80 years (p value = 0.034) and presence of cortico-subcortical atrophy (p value = 0.003). The main recurrence factors were age greater than or equal to 70 years and compartmentalization of the hematoma.

Conclusion

Chronic subdural hematomas are generally of good prognosis when the Glasgow coma score on admission is good and adequate management is carried out as soon as possible. Advanced age, lesions such as cortico-subcortical atrophy and compartmentalization of the hematoma are all factors that predispose to recurrence or early mortality. Those groups of patients should therefore benefit from a closer follow-up in post-operative period.

目的：尽管慢性硬膜下血肿的手术治疗预后良好，但仍存在一些早期死亡、复发和术后并发症。本研究旨在分析雅温得市两所大学教学医院慢性硬膜下血肿的预后因素：方法：2015年1月1日至2021年12月31日（7年）期间，雅温得市两所大学教学医院神经外科的3788名住院患者中确诊了310例慢性硬膜下血肿。作者收集了接受手术治疗的患者数据，并根据早期和晚期复发率、死亡率、术后并发症及相关因素评估了患者的预后：分析了 284 名患者的数据。死亡率为 6.7%，术后早期复发率为 3.2%，随访 3-24 个月后复发率为 4.5%。死亡的预后因素是年龄大于或等于 80 岁（P 值 = 0.034）和存在皮质-皮质下萎缩（P 值 = 0.003）。主要的复发因素是年龄大于或等于 70 岁和血肿分隔：结论：慢性硬膜下血肿如果入院时格拉斯哥昏迷评分良好，并尽快进行适当处理，一般预后良好。高龄、皮质-皮质下萎缩和血肿分隔等病变都是导致血肿复发或早期死亡的因素。因此，这些患者群体应在术后接受更密切的随访。

{"title":"Prognostic factors of chronic subdural hematomas in two reference university teaching hospitals in the city of Yaounde","authors":"Nassourou Oumarou Haman , Orlane Ndome Toto , Indira Baboke , Dimitri Fogue , V.d.P. Djientcheu","doi":"10.1016/j.clineuro.2024.108614","DOIUrl":"10.1016/j.clineuro.2024.108614","url":null,"abstract":"<div><h3>Objectives</h3><div>Despite the good prognosis of surgical treatment of chronic subdural hematomas, there are some early deaths, recurrences and post-operative complications. The objective of this study is to analyze the prognostic factors of chronic subdural hematomas in two reference university teaching hospitals in the city of Yaounde.</div></div><div><h3>Method</h3><div>Three hundred and ten cases of chronic subdural hematomas were diagnosed on 3788 patients hospitalized in the neurosurgery departments of two reference university teaching hospitals in the city of Yaounde from January 1st, 2015 to December 31st, 2021 (7 years). The authors collected data from patients in whom surgical treatment was performed and assessed their prognosis with regard to the rate of early and late recurrence, mortality rate and postoperative complications and associated factors.</div></div><div><h3>Results</h3><div>Data from 284 patients were analyzed. The mortality rate was 6.7 % and the recurrence rate was 3.2 % in early postoperative period and 4.5 % after a follow-up of 3–24 months. Prognostic factors for death were age greater than or equal to 80 years (p value = 0.034) and presence of cortico-subcortical atrophy (p value = 0.003). The main recurrence factors were age greater than or equal to 70 years and compartmentalization of the hematoma.</div></div><div><h3>Conclusion</h3><div>Chronic subdural hematomas are generally of good prognosis when the Glasgow coma score on admission is good and adequate management is carried out as soon as possible. Advanced age, lesions such as cortico-subcortical atrophy and compartmentalization of the hematoma are all factors that predispose to recurrence or early mortality. Those groups of patients should therefore benefit from a closer follow-up in post-operative period.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"247 ","pages":"Article 108614"},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Development and validation of a nomogram for sleep disorders among stroke patients 中风患者睡眠障碍提名图的开发与验证。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108612

Yinyin Fan , Xueni Yang , Meng Sun , Xing Chen , Yanqing Li , Xiuqun Xu

Background

Precisely identifying high-risk sleep disorder patients and implementing suitable measures are important for decreasing the incidence of sleep disorders. In this study, a nomogram method was adopted to construct a tool to predict sleep disorders in stroke based on four factors: individual characteristics, treatment-related factors, psychological factors, and family-related factors.

Methods

A total of 450 stroke patients were continuously diagnosed at the Affiliated Hospital of Nantong University, and the data on participants were randomly distributed into a training set (n = 315) and a validation set (n = 135). Within the training set, using LASSO regression and random forest methods, five optimal predictors of sleep disorders were identified. Five optimal predictors were used to develop a model. The calibration, discrimination, generalization, and clinical applicability of the model were evaluated using calibration curves, receiver operating characteristic (ROC) curves, internal validation, and decision curve analysis (DCA).

Results

We found that the place of residence, average daily infusion time, the Hospital Anxiety and Depression Scale (HADS), the Type D Personality Scale-14 (DS14), and the Fatigue Severity Scale (FSS) were crucial factors associated with sleep disorders. The validation data showed an area under the curve (AUC) of 0.903 compared to 0.899 in the training set. There was an approach to the diagonal in the calibration curve of this model, and the results of DCA noted that it is clinically beneficial across a range of thresholds from 5 % to 99 %.

Conclusion

A model was developed to predict sleep disorders among stroke patients to help hospital staff evaluate the risk among patients and screen high-risk patients.

背景：准确识别高危睡眠障碍患者并采取适当措施对于降低睡眠障碍的发病率非常重要。本研究采用提名图法，从个体特征、治疗相关因素、心理因素和家庭相关因素四个方面构建脑卒中睡眠障碍预测工具：方法：南通大学附属医院连续诊断了450例脑卒中患者，并将参与者的数据随机分为训练集（n = 315）和验证集（n = 135）。在训练集中，利用 LASSO 回归和随机森林方法，确定了五个最佳睡眠障碍预测因子。五个最佳预测因子被用于建立一个模型。使用校准曲线、接收器操作特征曲线（ROC）、内部验证和决策曲线分析（DCA）对模型的校准性、区分度、概括性和临床适用性进行了评估：我们发现，居住地、平均每日输液时间、医院焦虑抑郁量表（HADS）、D型人格量表-14（DS14）和疲劳严重程度量表（FSS）是与睡眠障碍相关的关键因素。验证数据显示曲线下面积（AUC）为 0.903，而训练集为 0.899。该模型的校准曲线接近对角线，DCA结果表明，在5%至99%的阈值范围内，该模型对临床有益：结论：建立了一个预测脑卒中患者睡眠障碍的模型，可帮助医院工作人员评估患者的风险并筛查高危患者。

{"title":"Development and validation of a nomogram for sleep disorders among stroke patients","authors":"Yinyin Fan , Xueni Yang , Meng Sun , Xing Chen , Yanqing Li , Xiuqun Xu","doi":"10.1016/j.clineuro.2024.108612","DOIUrl":"10.1016/j.clineuro.2024.108612","url":null,"abstract":"<div><h3>Background</h3><div>Precisely identifying high-risk sleep disorder patients and implementing suitable measures are important for decreasing the incidence of sleep disorders. In this study, a nomogram method was adopted to construct a tool to predict sleep disorders in stroke based on four factors: individual characteristics, treatment-related factors, psychological factors, and family-related factors.</div></div><div><h3>Methods</h3><div>A total of 450 stroke patients were continuously diagnosed at the Affiliated Hospital of Nantong University, and the data on participants were randomly distributed into a training set (n = 315) and a validation set (n = 135). Within the training set, using LASSO regression and random forest methods, five optimal predictors of sleep disorders were identified. Five optimal predictors were used to develop a model. The calibration, discrimination, generalization, and clinical applicability of the model were evaluated using calibration curves, receiver operating characteristic (ROC) curves, internal validation, and decision curve analysis (DCA).</div></div><div><h3>Results</h3><div>We found that the place of residence, average daily infusion time, the Hospital Anxiety and Depression Scale (HADS), the Type D Personality Scale-14 (DS14), and the Fatigue Severity Scale (FSS) were crucial factors associated with sleep disorders. The validation data showed an area under the curve (AUC) of 0.903 compared to 0.899 in the training set. There was an approach to the diagonal in the calibration curve of this model, and the results of DCA noted that it is clinically beneficial across a range of thresholds from 5 % to 99 %.</div></div><div><h3>Conclusion</h3><div>A model was developed to predict sleep disorders among stroke patients to help hospital staff evaluate the risk among patients and screen high-risk patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108612"},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical and radiographic outcomes after subduro-peritoneal shunt insertion in adults 成人腹膜下分流术后的临床和影像学结果。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108613

Tarik Alp Sargut , Emmanouil Verigos , David Wasilewski , Anton Früh , Ahmad Almahozi , Joan Alsolivany , Kiarash Ferdowssian , Simon Bayerl , Peter Vajkoczy , Judith Roesler

Background

Subdural collections consist amongst others of cerebrospinal, inflammatory, haemorrhagic or infective fluid. While these accumulations can be treated with conservative or surgical measures, such as burr hole evacuation or craniotomy, clinicians may resort to implantation of a subduro-peritoneal shunt, due to their high recurrence rates. While this treatment option is widely used in the pediatric population, its efficacy and safety in adults is scarcely reported.

Methods

This project is a retrospective case series of 25 adult patients, who underwent subduro-peritoneal shunt (SDPS) implantation between December 2008 and June 2021. The indications included symptomatic subdural collections following trauma, tumor resection or bone flap reimplantation. In general, adjustable valves were used. All patients received a pre- and postoperative computed tomography (CT) scan. We evaluated patients’ postoperative clinical outcomes as well as radiographic criteria, including midline shift, frontal horn width and collection volume. Additionally, we analyzed shunt-related complications.

Results

Impaired consciousness was the commonest presenting symptom. We report a significant reduction in volume and width of the subdural collection after SDP shunt implantation. Furthermore, the midline shift decreased significantly. While 60 % (N=15) of the patients improved clinically, only 12 % (N=3) deteriorated. Complications comprised infection in 12 % (N=3) of patients and valve dysfunction in 1 patient.

Conclusions

Our study shows that SDPS in adults is an effective treatment to eliminate or reduce subdural collections, that improves clinical outcomes in the majority of patients. Hence, it should be utilised more widely in this patient population. However, further studies are necessary to validate the treatment and identify eligible patients.

背景：硬膜下积液主要包括脑脊液、炎性积液、出血性积液或感染性积液。虽然这些积液可通过保守或手术措施治疗，如钻孔抽液或开颅手术，但由于其复发率较高，临床医生可能会采用植入腹膜下分流术。虽然这种治疗方法在儿科人群中广泛使用，但其在成人中的疗效和安全性却鲜有报道：该项目是一项回顾性病例系列研究，共收集了 25 例在 2008 年 12 月至 2021 年 6 月间接受腹膜下分流术（SDPS）的成人患者。适应症包括外伤、肿瘤切除术或骨瓣再植术后出现的无症状硬膜下积液。一般情况下，均使用可调节瓣膜。所有患者都接受了术前和术后计算机断层扫描（CT）。我们评估了患者的术后临床疗效以及放射学标准，包括中线移位、额角宽度和收集体积。此外，我们还分析了与分流相关的并发症：结果：意识障碍是最常见的症状。我们报告称，SDP 分流术后硬膜下积液的体积和宽度明显缩小。此外，中线移位也明显减少。60%（15 人）的患者临床症状有所改善，只有 12%（3 人）的患者病情恶化。并发症包括12%的患者（3例）出现感染，1例患者出现瓣膜功能障碍：我们的研究表明，成人 SDPS 是消除或减少硬膜下积液的有效治疗方法，能改善大多数患者的临床疗效。因此，应该在这一患者群体中更广泛地使用。不过，还需要进一步的研究来验证这种治疗方法，并确定符合条件的患者。

{"title":"Clinical and radiographic outcomes after subduro-peritoneal shunt insertion in adults","authors":"Tarik Alp Sargut , Emmanouil Verigos , David Wasilewski , Anton Früh , Ahmad Almahozi , Joan Alsolivany , Kiarash Ferdowssian , Simon Bayerl , Peter Vajkoczy , Judith Roesler","doi":"10.1016/j.clineuro.2024.108613","DOIUrl":"10.1016/j.clineuro.2024.108613","url":null,"abstract":"<div><h3>Background</h3><div>Subdural collections consist amongst others of cerebrospinal, inflammatory, haemorrhagic or infective fluid. While these accumulations can be treated with conservative or surgical measures, such as burr hole evacuation or craniotomy, clinicians may resort to implantation of a subduro-peritoneal shunt, due to their high recurrence rates. While this treatment option is widely used in the pediatric population, its efficacy and safety in adults is scarcely reported.</div></div><div><h3>Methods</h3><div>This project is a retrospective case series of 25 adult patients, who underwent subduro-peritoneal shunt (SDPS) implantation between December 2008 and June 2021. The indications included symptomatic subdural collections following trauma, tumor resection or bone flap reimplantation. In general, adjustable valves were used. All patients received a pre- and postoperative computed tomography (CT) scan. We evaluated patients’ postoperative clinical outcomes as well as radiographic criteria, including midline shift, frontal horn width and collection volume. Additionally, we analyzed shunt-related complications.</div></div><div><h3>Results</h3><div>Impaired consciousness was the commonest presenting symptom. We report a significant reduction in volume and width of the subdural collection after SDP shunt implantation. Furthermore, the midline shift decreased significantly. While 60 % (N=15) of the patients improved clinically, only 12 % (N=3) deteriorated. Complications comprised infection in 12 % (N=3) of patients and valve dysfunction in 1 patient.</div></div><div><h3>Conclusions</h3><div>Our study shows that SDPS in adults is an effective treatment to eliminate or reduce subdural collections, that improves clinical outcomes in the majority of patients. Hence, it should be utilised more widely in this patient population. However, further studies are necessary to validate the treatment and identify eligible patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"247 ","pages":"Article 108613"},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Real world experience with cladribine tablets in the management of relapsing multiple sclerosis in Qatar 卡塔尔使用克拉利宾片治疗复发性多发性硬化症的实际经验

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108615

Beatriz Garcia Cañibano , Lina Okar , Yahya Zakarya Baniamer , Dirk Deleu

Objectives

To study the 30-month safety and effectiveness of Cladribine tablets (CladT) in relapsing multiple sclerosis (RMS) months in a real-world setting.

Methods

Retrospective single-centre observational study in Qatar (January 2018–Feb 2023). Clinical and MRI data, lymphocyte counts and adverse events (AE) were recorded for patients with RMS who received at least one course of CladT.

Results

Forty-six patients were included (mean follow-up 22 months); 34 (74 %) were female, 22 (48 %) were disease-modifying therapy (DMT) naïve, 16 (35 %) had switched from platform DMT and 8 (17 %) from high efficacy (HE) DMD. Mean age was 26.7±7.2 y, mean disease duration was 7.2±6.0 y. Common reasons for treatment with CladT were MS activity (91 %), pregnancy planning (17 %), AE (20 %), compliance (9 %). 44/46 ( 96 %) received the year 2 course of CladT. Annualised relapse rate (ARR) fell from 1.02 (baseline) to 0.1, 0, 0.1, 0.1 and 0.1 for years 1–5 post-treatment, respectively; 87.5–100 % were free of relapses at these times, vs. 21 % at baseline. There were no relapses in year 2; 78 %, 100 %, 84 %, 80 % and 100 %, respectively, were free of GD+ MRI lesions at years 1–5, vs. 31 % at baseline. Most clinical AE were mild (1 moderate, no severe AE); 12 contracted Covid-19 (no hospitalisations). Grade 3 lymphopenia occurred in 5 patients.

Conclusions

CladT appeared to be effective and safe in our retrospective study, irrespective of prior treatments, consistent with other real world data that support the early use of CladT in the management of RRMS.

目的在真实世界环境中研究克拉利宾片（CladT）治疗复发性多发性硬化症（RMS）30 个月的安全性和有效性。方法在卡塔尔进行的单中心回顾性观察研究（2018 年 1 月至 2023 年 2 月）。结果纳入了46例患者（平均随访22个月）；34例（74%）为女性，22例（48%）为疾病修饰疗法（DMT）新患者，16例（35%）从平台DMT转入，8例（17%）从高效（HE）DMD转入。平均年龄为（26.7±7.2）岁，平均病程为（7.2±6.0）年。使用CladT治疗的常见原因是多发性硬化症活动（91%）、怀孕计划（17%）、AE（20%）、依从性（9%）。44/46（96%）人接受了第二年的CladT治疗。治疗后第 1-5 年的年复发率（ARR）分别从 1.02（基线）降至 0.1、0、0.1、0.1 和 0.1；87.5%-100% 的患者在这些时间内没有复发，而基线为 21%。第 2 年无复发；第 1-5 年分别有 78%、100%、84%、80% 和 100% 的患者无 GD+ MRI 病灶，基线时为 31%。大多数临床AE为轻度（1例中度，无重度AE）；12例感染Covid-19（无住院治疗）。结论在我们的回顾性研究中，无论之前是否接受过治疗，CladT似乎都是有效和安全的，这与其他支持早期使用CladT治疗RRMS的实际数据一致。

{"title":"Real world experience with cladribine tablets in the management of relapsing multiple sclerosis in Qatar","authors":"Beatriz Garcia Cañibano , Lina Okar , Yahya Zakarya Baniamer , Dirk Deleu","doi":"10.1016/j.clineuro.2024.108615","DOIUrl":"10.1016/j.clineuro.2024.108615","url":null,"abstract":"<div><h3>Objectives</h3><div>To study the 30-month safety and effectiveness of Cladribine tablets (CladT) in relapsing multiple sclerosis (RMS) months in a real-world setting.</div></div><div><h3>Methods</h3><div>Retrospective single-centre observational study in Qatar (January 2018–Feb 2023). Clinical and MRI data, lymphocyte counts and adverse events (AE) were recorded for patients with RMS who received at least one course of CladT.</div></div><div><h3>Results</h3><div>Forty-six patients were included (mean follow-up 22 months); 34 (74 %) were female, 22 (48 %) were disease-modifying therapy (DMT) naïve, 16 (35 %) had switched from platform DMT and 8 (17 %) from high efficacy (HE) DMD. Mean age was 26.7±7.2 y, mean disease duration was 7.2±6.0 y. Common reasons for treatment with CladT were MS activity (91 %), pregnancy planning (17 %), AE (20 %), compliance (9 %). 44/46 ( 96 %) received the year 2 course of CladT. Annualised relapse rate (ARR) fell from 1.02 (baseline) to 0.1, 0, 0.1, 0.1 and 0.1 for years 1–5 post-treatment, respectively; 87.5–100 % were free of relapses at these times, vs. 21 % at baseline. There were no relapses in year 2; 78 %, 100 %, 84 %, 80 % and 100 %, respectively, were free of GD+ MRI lesions at years 1–5, vs. 31 % at baseline. Most clinical AE were mild (1 moderate, no severe AE); 12 contracted Covid-19 (no hospitalisations). Grade 3 lymphopenia occurred in 5 patients.</div></div><div><h3>Conclusions</h3><div>CladT appeared to be effective and safe in our retrospective study, irrespective of prior treatments, consistent with other real world data that support the early use of CladT in the management of RRMS.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"247 ","pages":"Article 108615"},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Association of serum glucose/potassium index levels with poor long-term prognosis in patients with Aneurysmal Subarachnoid Hemorrhage 动脉瘤性蛛网膜下腔出血患者血清葡萄糖/钾指数水平与长期预后不良的关系。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108609

Claudia Cruzalegui-Bazán , Arturo Durán-Pecho , David Botello-Gonzales , José Luis Acha-Sánchez , Miguel Cabanillas-Lazo

Introduction

The glucose/potassium index (GPI) has been reported as a predictor biomarker of in-hospital complications in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Objectives

To determine the association between GPI and functional outcome at 3 to 6 months after discharge in patients diagnosed with aSAH in a Peruvian referral hospital during 2018 - 2021.

Materials and Methods

We conducted a retrospective cohort observational study with a secondary database in patients with aSAH during 2018-2021 in a Peruvian referral hospital. We evaluated the relationship between GPI values and motor functionality from 3 to 6 months post-discharge, using a Poisson family generalized linear model with Log link function and robust variance according to categorization of good and poor outcome. We considered a value of p<0.05 as statistically significant. We used restricted cubic splines with five nodes to evaluate the linear correlation between the 2 main variables.

Results

212 patients were included in the analysis. 21.1% and 19.3% had poor outcome at 3 and 6 months after discharge, respectively. Multivariate analysis showed that GPI was not associated with poor outcome at 3 (RR=0.999; 95%CI=0.979-1.018) or 6 months after discharge (RR=0.979; 95%CI=0.979-1.020). On the other hand, Splines plots showed no correlation between GPI and modified Rankin.

Conclusions

Despite the usefulness of GPI to prognosticate in-hospital complications, its association with functional outcome is inconclusive.

简介据报道，葡萄糖/钾指数（GPI）是动脉瘤性蛛网膜下腔出血（aSAH）患者院内并发症的预测生物标志物：目的：确定2018-2021年期间在秘鲁一家转诊医院确诊的动脉瘤性蛛网膜下腔出血患者出院后3-6个月GPI与功能预后之间的关联：我们利用二级数据库对秘鲁一家转诊医院 2018-2021 年期间的 aSAH 患者进行了一项回顾性队列观察研究。我们评估了 GPI 值与出院后 3 米至 6 个月的运动功能之间的关系，根据良好和不良结果的分类，使用了具有对数链接函数和稳健方差的泊松族广义线性模型。结果：212 名患者被纳入分析。在出院后 3 个月和 6 个月，分别有 21.1% 和 19.3% 的患者预后不佳。多变量分析显示，GPI 与出院后 3 个月（RR=0.999；95 %CI=0.979-1.018）或 6 个月（RR=0.979；95 %CI=0.979-1.020）的不良预后无关。另一方面，Splines 图显示 GPI 与修改后的 Rankin 之间没有相关性：结论：尽管 GPI 对预后院内并发症很有用，但其与功能预后的关系尚无定论。

{"title":"Association of serum glucose/potassium index levels with poor long-term prognosis in patients with Aneurysmal Subarachnoid Hemorrhage","authors":"Claudia Cruzalegui-Bazán , Arturo Durán-Pecho , David Botello-Gonzales , José Luis Acha-Sánchez , Miguel Cabanillas-Lazo","doi":"10.1016/j.clineuro.2024.108609","DOIUrl":"10.1016/j.clineuro.2024.108609","url":null,"abstract":"<div><h3>Introduction</h3><div>The glucose/potassium index (GPI) has been reported as a predictor biomarker of in-hospital complications in patients with aneurysmal subarachnoid hemorrhage (aSAH).</div></div><div><h3>Objectives</h3><div>To determine the association between GPI and functional outcome at 3 to 6 months after discharge in patients diagnosed with aSAH in a Peruvian referral hospital during 2018 - 2021.</div></div><div><h3>Materials and Methods</h3><div>We conducted a retrospective cohort observational study with a secondary database in patients with aSAH during 2018-2021 in a Peruvian referral hospital. We evaluated the relationship between GPI values and motor functionality from 3 to 6 months post-discharge, using a Poisson family generalized linear model with Log link function and robust variance according to categorization of good and poor outcome. We considered a value of p<0.05 as statistically significant. We used restricted cubic splines with five nodes to evaluate the linear correlation between the 2 main variables.</div></div><div><h3>Results</h3><div>212 patients were included in the analysis. 21.1% and 19.3% had poor outcome at 3 and 6 months after discharge, respectively. Multivariate analysis showed that GPI was not associated with poor outcome at 3 (RR=0.999; 95%CI=0.979-1.018) or 6 months after discharge (RR=0.979; 95%CI=0.979-1.020). On the other hand, Splines plots showed no correlation between GPI and modified Rankin.</div></div><div><h3>Conclusions</h3><div>Despite the usefulness of GPI to prognosticate in-hospital complications, its association with functional outcome is inconclusive.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"247 ","pages":"Article 108609"},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Endovascular Thrombectomy after 24 Hours for Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion: A Systematic Review and Meta-Analysis of Outcomes 大血管闭塞导致急性缺血性卒中患者 24 小时后进行血管内血栓切除术：结果的系统回顾和荟萃分析。

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108610

Muhammad Shakir , Hammad Atif Irshad , Bilal Ahmed Lodhi , Zuhaib Ali , Fizza Zubair , Muhammad Umar Mahar , Illiyun Banani , Amna Wajahat , Inamullah Khan , Farhan Siddiq , Adnan I. Qureshi

Objective

To evaluate the role of endovascular thrombectomy in patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion in the very late window (>24 hours).

Methods

A systematic review was conducted according to PRISMA guidelines using PubMed, CINAHL, Scopus, and Google Scholar databases till 2024. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). Outcomes were analyzed with a single-arm meta-analysis (Sidik-Jonkman model) and a double-arm meta-analysis (Mantel-Haenszel model) to compare EVT within and after 24 hours, reporting pooled risk ratios. Analysis was performed using STATA version 18.0 and Review Manager version 5.4.1, with p<0.05 considered significant.

Results

This review included 35 studies with 15,086 patients. The frequency of symptomatic intracerebral hemorrhage (sICH) in patients treated with EVT after 24 hours was 4.74% (CI: 3.20%-6.58%), with a risk ratio (RR) of 0.85 (CI: 0.44-1.64) compared to EVT patients treated within 24 hours. The pooled percentage for functional independence (90 day mRS 0-2) was 35.73% (CI- 27.26%, 44.64%) with an overall pooled risk ratio of 0.85 (CI: 0.34, 2.09). The frequency of the 90-day mortality rate was 22.30% (CI: 16.12%, 29.09%), with an overall pooled risk ratio of 1.80(CI: 0.73, 1.61). The overall frequency of intracerebral hemorrhage (ICH) was 12.23% (CI: 5.47-20.86) following EVT after 24 hours.

Conclusion

Patients treated with EVT after 24 hours have comparable safety and effectiveness to those treated within 24 hours. The outcomes suggest that EVT after 24 hours is a viable treatment option, offering similar benefits to earlier intervention.

目的评估血管内血栓切除术（EVT）在因大血管闭塞导致的急性缺血性卒中（AIS）晚期（>24 小时）患者中的作用：根据 PRISMA 指南，使用 PubMed、CINAHL、Scopus 和 Google Scholar 数据库（截至 2024 年）进行了一项系统性综述。采用纽卡斯尔-渥太华量表（NOS）进行质量评估。结果分析采用单臂荟萃分析（Sidik-Jonkman模型）和双臂荟萃分析（Mantel-Haenszel模型），比较24小时内和24小时后的EVT，并报告汇总风险比。分析使用 STATA 18.0 版和 Review Manager 5.4.1 版进行，并使用 pResults：本综述纳入了 35 项研究，共 15,086 名患者。与24小时内接受EVT治疗的患者相比，24小时后接受EVT治疗的患者出现症状性脑出血（sICH）的比例为4.78%（95% CI：3.20%-6.58%），风险比（RR）为0.85（95% CI：0.44-1.64）。功能独立（90 天 mRS 0-2）的汇总百分比为 35.73 %（95 % CI- 27.26 %，44.64 %），风险比为 0.85（95 % CI：0.34，2.09）。90天死亡率为22.30%（95% CI：16.12%，29.09%），风险比为1.08（95% CI：0.73，1.61）。24小时后接受EVT治疗的脑出血（ICH）总比例为12.23%（95% CI：5.47-20.86）：结论：24小时后接受EVT治疗的患者与24小时内接受治疗的患者具有相似的安全性和有效性。结果表明，24 小时后进行 EVT 是一种可行的治疗方案，与早期干预具有相似的益处。

{"title":"Endovascular Thrombectomy after 24 Hours for Patients with Acute Ischemic Stroke Due to Large Vessel Occlusion: A Systematic Review and Meta-Analysis of Outcomes","authors":"Muhammad Shakir , Hammad Atif Irshad , Bilal Ahmed Lodhi , Zuhaib Ali , Fizza Zubair , Muhammad Umar Mahar , Illiyun Banani , Amna Wajahat , Inamullah Khan , Farhan Siddiq , Adnan I. Qureshi","doi":"10.1016/j.clineuro.2024.108610","DOIUrl":"10.1016/j.clineuro.2024.108610","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the role of endovascular thrombectomy in patients presenting with acute ischemic stroke (AIS) due to large vessel occlusion in the very late window (>24hours).</div></div><div><h3>Methods</h3><div>A systematic review was conducted according to PRISMA guidelines using PubMed, CINAHL, Scopus, and Google Scholar databases till 2024. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). Outcomes were analyzed with a single-arm meta-analysis (Sidik-Jonkman model) and a double-arm meta-analysis (Mantel-Haenszel model) to compare EVT within and after 24hours, reporting pooled risk ratios. Analysis was performed using STATA version 18.0 and Review Manager version 5.4.1, with p<0.05 considered significant.</div></div><div><h3>Results</h3><div>This review included 35 studies with 15,086 patients. The frequency of symptomatic intracerebral hemorrhage (sICH) in patients treated with EVT after 24hours was 4.74% (CI: 3.20%-6.58%), with a risk ratio (RR) of 0.85 (CI: 0.44-1.64) compared to EVT patients treated within 24hours. The pooled percentage for functional independence (90 day mRS 0-2) was 35.73% (CI- 27.26%, 44.64%) with an overall pooled risk ratio of 0.85 (CI: 0.34, 2.09). The frequency of the 90-day mortality rate was 22.30% (CI: 16.12%, 29.09%), with an overall pooled risk ratio of 1.80(CI: 0.73, 1.61). The overall frequency of intracerebral hemorrhage (ICH) was 12.23% (CI: 5.47-20.86) following EVT after 24hours.</div></div><div><h3>Conclusion</h3><div>Patients treated with EVT after 24hours have comparable safety and effectiveness to those treated within 24hours. The outcomes suggest that EVT after 24hours is a viable treatment option, offering similar benefits to earlier intervention.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"247 ","pages":"Article 108610"},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is the hemoglobin, albumin, lymphocyte, and platelet (HALP) score a novel biomarker for predicting mortality in patients with middle cerebral artery infarctions undergoing mechanical thrombectomy? 血红蛋白、白蛋白、淋巴细胞和血小板（HALP）评分是预测接受机械血栓切除术的大脑中动脉梗塞患者死亡率的新型生物标志物吗？

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery

Pub Date : 2024-10-22 DOI: 10.1016/j.clineuro.2024.108598

Deniz Kamaci Sener , Cemile Haki , Suleyman Bekircavusoglu , Suat Kamisli , Kaya Sarac

Background

The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, easily calculated parameter, indicating systemic inflammation and nutritional status

Introduction

In this study, we used the HALP score in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT) to predict 90-day mortality.

Method

122 patients with AIS who underwent either MT or MT and tissue plasminogen activator (tPA) for middle cerebral artery (MCA) M1 occlusion. The HALP score was calculated, demographic data, modified Rankin Scale (mRS) score, and mortality status in retrospectively reviewed. The effectiveness of the HALP score in predicting mortality within 90 days was assessed using the receiver operating characteristic ( ROC) curves. The optimal cutoff value for HALP was 13.10.

Results

A HALP score <13.10 increased the risk of death within 90 days and was associated with a higher incidence of large artery thrombosis. Cardioembolism and hyperlipidemia were more common in patients with high (>13) HALP scores. In addition to the HALP score, the length of hospital stay, 24-h National Institutes of Health Stroke Scale score (NIHSS), number of days of intubation, acute physiologic assessment and chronic health evaluation (APACHE) II score, and symptom-to-groin time were statistically significant risk factors for mortality within 90 days.

Discussion

The HALP score is an easily calculated, inexpensive, and noninvasive parameter that can be used to predict mortality in patients with MCA M1 occlusion undergoing reperfusion therapy. Low HALP scores indicate a poor prognosis. Thus, there is a relationship between the HALP score and survival.

背景血红蛋白、白蛋白、淋巴细胞和血小板（HALP）评分是一种易于计算的参数，可显示全身炎症和营养状况。方法122例急性缺血性脑卒中（AIS）患者因大脑中动脉（MCA）M1闭塞接受了MT或MT和组织浆细胞酶原激活剂（tPA）治疗。研究人员计算了HALP评分，并对人口统计学数据、改良Rankin量表（mRS）评分和死亡状况进行了回顾性分析。使用接收者操作特征曲线（ROC）评估了 HALP 评分在预测 90 天内死亡率方面的有效性。HALP 的最佳临界值为 13.10。结果 HALP 评分为 13.10 会增加 90 天内死亡的风险，并与较高的大动脉血栓形成发生率相关。心肌栓塞和高脂血症在 HALP 分数较高（>13）的患者中更为常见。除 HALP 评分外，住院时间、24 小时美国国立卫生研究院卒中量表评分（NIHSS）、插管天数、急性生理评估和慢性健康评估（APACHE）II 评分以及症状到胃肠道时间也是 90 天内死亡率的显著危险因素。低 HALP 评分表明预后较差。因此，HALP 评分与存活率之间存在一定的关系。

{"title":"Is the hemoglobin, albumin, lymphocyte, and platelet (HALP) score a novel biomarker for predicting mortality in patients with middle cerebral artery infarctions undergoing mechanical thrombectomy?","authors":"Deniz Kamaci Sener , Cemile Haki , Suleyman Bekircavusoglu , Suat Kamisli , Kaya Sarac","doi":"10.1016/j.clineuro.2024.108598","DOIUrl":"10.1016/j.clineuro.2024.108598","url":null,"abstract":"<div><h3>Background</h3><div>The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, easily calculated parameter, indicating systemic inflammation and nutritional status</div></div><div><h3>Introduction</h3><div>In this study, we used the HALP score in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT) to predict 90-day mortality.</div></div><div><h3>Method</h3><div>122 patients with AIS who underwent either MT or MT and tissue plasminogen activator (tPA) for middle cerebral artery (MCA) M1 occlusion. The HALP score was calculated, demographic data, modified Rankin Scale (mRS) score, and mortality status in retrospectively reviewed. The effectiveness of the HALP score in predicting mortality within 90 days was assessed using the receiver operating characteristic ( ROC) curves. The optimal cutoff value for HALP was 13.10.</div></div><div><h3>Results</h3><div>A HALP score <13.10 increased the risk of death within 90 days and was associated with a higher incidence of large artery thrombosis. Cardioembolism and hyperlipidemia were more common in patients with high (>13) HALP scores. In addition to the HALP score, the length of hospital stay, 24-h National Institutes of Health Stroke Scale score (NIHSS), number of days of intubation, acute physiologic assessment and chronic health evaluation (APACHE) II score, and symptom-to-groin time were statistically significant risk factors for mortality within 90 days.</div></div><div><h3>Discussion</h3><div>The HALP score is an easily calculated, inexpensive, and noninvasive parameter that can be used to predict mortality in patients with MCA M1 occlusion undergoing reperfusion therapy. Low HALP scores indicate a poor prognosis. Thus, there is a relationship between the HALP score and survival.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"247 ","pages":"Article 108598"},"PeriodicalIF":1.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0