Clinical Neurology and Neurosurgery最新文献

{"title":"Improvement in cranial nerve palsies following treatment of intracranial aneurysms with flow diverters: Institutional outcomes, systematic review and study-level meta-analysis","authors":"Nanthiya Sujijantarat ,&nbsp;Joseph P. Antonios ,&nbsp;Daniela Renedo ,&nbsp;Andrew B. Koo ,&nbsp;Joseph O. Haynes ,&nbsp;Bushra Fathima ,&nbsp;Jasmine W. Jiang ,&nbsp;Astrid C. Hengartner ,&nbsp;Apurv H. Shekhar ,&nbsp;Abdelaziz Amllay ,&nbsp;Kamil W. Nowicki ,&nbsp;Ryan M. Hebert ,&nbsp;Emily J. Gilmore ,&nbsp;Kevin N. Sheth ,&nbsp;Joseph T. King Jr ,&nbsp;Charles C. Matouk","doi":"10.1016/j.clineuro.2024.108555","DOIUrl":"10.1016/j.clineuro.2024.108555","url":null,"abstract":"<div><h3>Background</h3><div>Cranial nerve (CN) palsies are rare presenting symptoms of intracranial aneurysms. Our objectives were to report our institutional outcomes and study-level meta-analysis summarizing rates of improvement and identifying factors associated with recovery from CN symptoms after flow diversion.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of our institutional database for patients with intracranial aneurysms presenting with CN palsies who underwent treatment with flow diversion between 2015 and 2023. Systematic review of the literature was performed using Medline, EMBASE, Cochrane, as well as manual citation searches. Random effects meta-analysis was used.</div></div><div><h3>Results</h3><div>Thirteen of 136 studies were included in the meta-analysis and were combined with our institutional data. The pooled rate of improvement in any CN palsies following flow diversion was 71 % (95 %CI, 60 %-82 %, n=322). Patients presenting with CN II deficits were less likely to improve following treatment compared to other CN deficits (pooled OR [pOR] 0.32, 95 %CI, 0.16–0.63, n=224). The pooled rate of clinical improvement was 53 % in CNII deficits (95 %CI, 42 %-65 %, n=80) and 80 % in other CN deficits (95 %CI, 71 %-88 %, n=106). An increased rate of improvement was associated with acute intervention (pOR 9.12, 95 % CI, 2.26–36.73, n = 71) and radiographic aneurysm occlusion (pOR 5.29, 95 %CI, 1.66–16.90, n=118).</div></div><div><h3>Conclusions</h3><div>Flow diversion improves CN palsy outcomes in patients with symptomatic intracranial aneurysms. The lower rate of improvement in visual acuity compared to other CN deficits may point to a different mechanism of injury or potential recoverability in these patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108555"},"PeriodicalIF":1.8,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142359090","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}

{"title":"Development of a model to predict the risk of multi-drug resistant organism infections in ruptured intracranial aneurysms patients with hospital-acquired pneumonia in the neurological intensive care unit","authors":"Zhiyao Wang ,&nbsp;Yujia Huang ,&nbsp;Xiaoguang Liu ,&nbsp;Wenyan Cao ,&nbsp;Qiang Ma ,&nbsp;Yajie Qi ,&nbsp;Mengmeng Wang ,&nbsp;Xin Chen ,&nbsp;Jing Hang ,&nbsp;Luhang Tao ,&nbsp;Hailong Yu ,&nbsp;Yuping Li","doi":"10.1016/j.clineuro.2024.108568","DOIUrl":"10.1016/j.clineuro.2024.108568","url":null,"abstract":"<div><h3>Objective</h3><div>This study was developed to explore the incidence of multi-drug resistant organism (MDRO) infections among ruptured intracranial aneurysms(RIA) patient with hospital-acquired pneumonia(HAP) in the neurological intensive care unit (NICU), and to establish risk factors related to the development of these infections.</div></div><div><h3>Methods</h3><div>We collected clinical and laboratory data from 328 eligible patients from January 2018 to December 2022. Bacterial culture results were used to assess MDRO strain distributions, and risk factors related to MDRO infection incidence were identified through logistic regression analyses. These risk factors were further used to establish a predictive model for the incidence of MDRO infections, after which this model underwent internal validation.</div></div><div><h3>Results</h3><div>In this study cohort, 26.5 % of RIA patients with HAP developed MDRO infections (87/328). The most common MDRO pathogens in these patients included Multidrug-resistant Klebsiella pneumoniae (34.31 %) and Multidrug-resistant Acinetobacter baumannii (27.45 %). Six MDRO risk factors, namely, diabetes (P = 0.032), tracheotomy (P = 0.004), history of mechanical ventilation (P = 0.033), lower albumin levels (P &lt; 0.001), hydrocephalus (P &lt; 0.001) and Glasgow Coma Scale (GCS) score ≤8 (P = 0.032) were all independently correlated with MDRO infection incidence. The prediction model exhibited satisfactory discrimination (area under the curve [AUC], 0.842) and calibration (slope, 1.000), with a decision curve analysis further supporting the clinical utility of this model.</div></div><div><h3>Conclusions</h3><div>In summary, risk factors and bacterial distributions associated with MDRO infections among RIA patients with HAP in the NICU were herein assessed. The developed predictive model can aid clinicians to identify and screen high-risk patients for preventing MDRO infections.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108568"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314818","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}

{"title":"Early and long-term outcome of surgical versus conservative management for intracranial cerebral cavernous malformation: Meta-analysis of reconstructed time-to-event data","authors":"Gustavo da Fontoura Galvão ,&nbsp;Gabriel Verly ,&nbsp;Pablo Valença ,&nbsp;Flávio Sampaio Domingues ,&nbsp;Marcello Reis da Silva ,&nbsp;Jorge Marcondes","doi":"10.1016/j.clineuro.2024.108567","DOIUrl":"10.1016/j.clineuro.2024.108567","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral cavernous malformations (CCMs) present challenges in clinical management due to a lack of definitive evidence from clinical trials. Surgical intervention and observational management are commonly used, yet their efficacy and long-term outcomes remain controversial.</div></div><div><h3>Objective</h3><div>This meta-analysis evaluates the effectiveness of surgical intervention versus conservative management in patients with symptomatic CCMs over various time frames to determine optimal treatment strategies.</div></div><div><h3>Methods</h3><div>A systematic review and reconstructed time-to-event meta-analysis were conducted, following PRISMA guidelines. Data from selected studies comparing surgical intervention to conservative management for CCMs were analyzed using pooled patient data from Kaplan-Meier curves. New focal neurological deficit (FND) or intracranial hemorrhage (ICH) were the outcome metrics.</div></div><div><h3>Results</h3><div>Four eligible studies, comprising 290 patients, were included. Surgical intervention showed 43 events over a mean time to FND/ICH of 6.372 years (95 % CI: 3.536–8.005), while observational management had 48 events with a significantly longer mean time of 10.992 years (95 % CI: 6.070–8.005). No significant difference was found at 2 years (p = 0.910), but at 5 and 10 years, surgical intervention had more events and shorter mean times (p &lt; 0.0001). Sensitivity analysis for previously bleeding CCMs showed no significant difference in events (p = 0.131).</div></div><div><h3>Conclusion</h3><div>This meta-analysis suggests observational management may achieve favorable long-term outcomes for symptomatic CCMs. Despite ongoing controversies, the findings highlight the need for further research, particularly randomized controlled trials, to refine treatment strategies and optimize patient care.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108567"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323279","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}

{"title":"Association between reduced left ventricular ejection fraction and functional outcomes in acute stroke: Systematic review and meta-analysis","authors":"Bruno Felipe Santos de Oliveira,&nbsp;Cárita Victória Carvalho de Santana,&nbsp;Rafaela Góes Bispo,&nbsp;Jamary Oliveira-Filho","doi":"10.1016/j.clineuro.2024.108566","DOIUrl":"10.1016/j.clineuro.2024.108566","url":null,"abstract":"<div><h3>Introduction</h3><div>Left ventricular ejection fraction (LVEF) is a measure of cardiac function and often reduced LVEF is indicative of cardiomyopathy/heart failure. The current study evaluated whether reduced LVEF is associated with poor outcomes and mortality in acute stroke.</div></div><div><h3>Methods</h3><div>Articles that compared poor outcomes (modified Rankin scale 3–6) or mortality in people with reduced LVEF compared to preserved LVEF in acute ischemic stroke were searched in the following databases: MEDLINE/PubMed, Embase, Scopus, Biomed central, and Cochrane Library. The last search was on March 17, 2024. The results obtained were pooled in meta-analyses.</div></div><div><h3>Results</h3><div>A total of 28933 participants were enrolled from 17 articles. Reduced left ventricular ejection fraction was independently associated with poor outcomes at 90 days (OR:2.38 CI95 % 1.52;3.71; I² = 71 %), the same was observed for death at 90 days (OR:3.15 CI 95 % 1.43; 6.96; I² = 60 %).</div></div><div><h3>Conclusion</h3><div>Reduced LVEF is associated with poor functional outcomes and death within 3 months after acute ischemic stroke compared to the setting in which LVEF is preserved.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108566"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323280","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}

{"title":"The surgical management of third ventricle region tumors","authors":"Chloe Verducci ,&nbsp;Dayna C. Sloane ,&nbsp;Rob Hand ,&nbsp;Shawn Choe ,&nbsp;Ignacio Jusue-Torres ,&nbsp;Rachyl M. Shanker ,&nbsp;Miri Kim ,&nbsp;Atul K. Mallik ,&nbsp;Anand V. Germanwala ,&nbsp;Douglas E. Anderson","doi":"10.1016/j.clineuro.2024.108564","DOIUrl":"10.1016/j.clineuro.2024.108564","url":null,"abstract":"<div><h3>Objectives</h3><div>The goal of this study was to characterize the largest known cohort of patients presenting with different tumor pathologies in the third ventricle region to better understand outcomes of surgical management.</div></div><div><h3>Methods</h3><div>All patients undergoing surgical intervention on tumors in or encroaching upon the third ventricle at Loyola University Medical Center between the years 1986–2021 were reviewed. Information recorded included presenting symptoms, pre- and post-operative interventions, tumor pathology, operative technique, extent of resection (EOR), and approach of operation. The primary clinical outcome was Karnofsky Performance Status (KPS) score.</div></div><div><h3>Results</h3><div>Ninety-seven patients underwent 123 operations. Forty-six (47.4 %) patients were female, and the median age at operation was 39 years. Eighty-seven (70.7 %) operations were open, and 36 (29.3 %) were endoscopic. Gross total resection (GTR) was achieved in 34.4 % of operations, near-total resection (NTR) in 31.5 %, subtotal resection in 25.0 %, and biopsy alone in 9.3 %. Median KPS increased pre- to postoperatively, regardless of surgical technique. Adjusting for preoperative KPS, age, and operation number, regression analysis demonstrated a trend that lesser EOR is associated with lower KPS at most recent follow-up (p=0.031 for NTR vs GTR, p=0.022 for biopsy vs GTR). There was no statistically significant association between the most recent KPS and either open or endoscopic surgical technique, with or without adjusting for the previously stated factors (p=0.26). There was no association between postoperative complication rates or age with either surgical technique.</div></div><div><h3>Conclusions</h3><div>Here, we characterize a large cohort of patients presenting for neurosurgical evaluation of tumors in the region of the third ventricle. Our results demonstrate a trend that a more aggressive resection may yield better KPS outcomes. Additionally, both open and endoscopic techniques lead to a similar improvement in clinical outcome and rates of complication. While ultimate surgical approach and technique is determined by individual tumor characteristics, patient health status, and surgeon expertise, ability to resect the tumor in its entirety should be taken into consideration.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108564"},"PeriodicalIF":1.8,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323281","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}

{"title":"Endovascular treatment for proximal middle cerebral artery occlusion due to underlying intracranial atherosclerotic disease: A retrospective single-center case series","authors":"Jonghoon Kim,&nbsp;Chul-Hoon Chang","doi":"10.1016/j.clineuro.2024.108558","DOIUrl":"10.1016/j.clineuro.2024.108558","url":null,"abstract":"<div><h3>Objective</h3><div>To compare treatment outcomes between patients who received a front-line stent-retriever thrombectomy (SRT) or first stenting without retrieval (FRESH) for treating proximal M1 occlusion due to underlying intracranial atherosclerotic disease (ICAD).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed consecutive acute ischemic stroke (AIS) patients with intracranial large vessel occlusion (LVO) in the anterior circulation who underwent endovascular treatment (EVT) between January 2017 and August 2021 at Yeungnam University Medical Center. LVO in the anterior circulation was classified according to etiology as follows: Embolic group and ICAD group. Occlusion of the proximal M1 due to ICAD were enrolled in this study. The ICAD group was divided into SRT and FRESH groups according to the treatment method.</div></div><div><h3>Results</h3><div>Among the 72 patients in the ICAD group, 55 patients had occlusion of the M1, and 27 had occlusion of the proximal M1 (27/55, 49.1 %). Among the 27 patients, 11 (40.7 %) underwent SRT and 16 (59.3 %) underwent FRESH. The puncture-to-recanalization time was significantly shorter in the FRESH group (28 min vs. 52 min, <em>p</em> = 0.023). Symptomatic ICH tended to occur more frequently in the SRT group than in the FRESH group (27.3 % vs. 0.0 %, <em>p</em>=0.056). There was a nonsignificant trend towards a good functional outcome in the FRESH group compared to the SRT group (81.3 % vs. 45.5 %, <em>p</em>=0.097).</div></div><div><h3>Conclusion</h3><div>In the FRESH group, the puncture-to-recanalization time was significantly shorter, symptomatic ICH tended to occur less frequently, and good functional outcomes were more common.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108558"},"PeriodicalIF":1.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319295","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}

{"title":"Lumbar puncture tap test in iNPH: Does extracting different volumes of CSF change the clinical response?","authors":"Evangelia Liouta,&nbsp;Christos Koutsarnakis,&nbsp;Eleytherios Neromyliotis,&nbsp;Lykourgos Anastasopoulos,&nbsp;Eirini Charalampopoulou,&nbsp;Loykas Kalpouzos,&nbsp;Alexandros Kossyvas,&nbsp;Aristotelis Kalyvas,&nbsp;Dimitrios Dimopoulos,&nbsp;Anastasia Mousiou,&nbsp;George Stranjalis","doi":"10.1016/j.clineuro.2024.108565","DOIUrl":"10.1016/j.clineuro.2024.108565","url":null,"abstract":"<div><h3>Introduction</h3><div>Although the Lumbar Tap Test (LTT) typically involves removing 30–50 ml of cerebrospinal fluid (CSF), the optimal amount for a valid test is unclear. This study investigates the relationship between the volume of CSF removed and the extent of gait improvement in idiopathic normal pressure hydrocephalus (iNPH).</div></div><div><h3>Methods</h3><div>Seventy-six iNPH patients with gait improvement after LTT were divided into two groups: high CSF volume (&gt; 40 ml) and low CSF volume (&lt; 40 ml). Spearman’s r correlations and non-parametric t-tests were used to analyze the relationship between CSF volume removed and gait improvement.</div></div><div><h3>Results</h3><div>Gait improvement after LTT showed a moderate positive correlation (r = 0.372, p &lt; 0.001) with CSF volume. Those in the high-volume group had significantly greater improvement (p &lt; 0.01). Improvement was also correlated with baseline gait parameters: pre-LTT gait speed (r = −4.14, p = 0.006), steps to complete a walking test (r = 0.440, p &lt; 0.001), and a 360° turn (r = 0.563, p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Larger CSF removal during LTT positively affects gait improvement in iNPH patients. Gait improvement is also greater in those with more severe initial gait impairments independently from the CSF volume extracted.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108565"},"PeriodicalIF":1.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314817","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}

{"title":"Risk of spontaneous intracerebral hemorrhage associated with NOACs compared with aspirin and warfarin: A long-term single hospital follow-up study","authors":"Yu-Wen Cheng ,&nbsp;Cai-Sin Yao ,&nbsp;Yang-Yi Chen ,&nbsp;Ren-In Chang ,&nbsp;Ying-Chun Li ,&nbsp;Aij-Lie Kwan","doi":"10.1016/j.clineuro.2024.108561","DOIUrl":"10.1016/j.clineuro.2024.108561","url":null,"abstract":"<div><h3>Background</h3><div>Non-vitamin K antagonist oral anticoagulants (NOACs) are currently the mainstay treatment for preventing thrombosis-induced ischemic stroke in patients with atrial fibrillation (AF), deep vein thrombosis (DVT), or previous infarction. However, such management may potentially induce antithrombotic-associated intracranial hemorrhage, leading to significantly adverse clinical outcomes. To investigate the risk of spontaneous intracranial hemorrhage (sICH) in patients under therapeutic anticoagulation.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used a database established by Kaohsiung Veterans General Hospital to estimate the risk of first onset sICH in patients with AF, DVT or previous stroke who were 18 years old or older, and who had been on at least three months continuous long-term treatment with the oral anticoagulants aspirin, warfarin, or NOACs. In addition, we used propensity-score matching to minimize bias and Cox proportional hazards ratio to compare the risk of sICH among patients prescribed these anticoagulants.</div></div><div><h3>Results</h3><div>We analyzed the data of 546 patients (182 aspirin users, 182 warfarin users, and 182 NOAC users). 180 (20 taking aspirin, 74 warfarin, and 86 NOACs) developed new onset sICH before seven years. No new onset cases were found after 7 years. Importantly, those taking NOACs were found to be at a higher risk of early onset hemorrhage (47.80 %) compared to the groups taking aspirin (11.10 %) and warfarin (47.80 %) with a median time-to-occurrence being 2.50, 4.00, and 4.40 years, respectively.</div></div><div><h3>Conclusions</h3><div>Though NOACs prevented ischemic stroke, they were used with a higher risk of early onset spontaneous ICH at our large medical center.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108561"},"PeriodicalIF":1.8,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319293","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}

{"title":"Reevaluating the role of heparin during mechanical thrombectomy for acute ischemic stroke: Increased risks without functional benefit","authors":"Seyed Behnam Jazayeri ,&nbsp;Sherief Ghozy ,&nbsp;Ram Saha ,&nbsp;Aryan Gajjar ,&nbsp;Mohamed Elfil ,&nbsp;David F. Kallmes","doi":"10.1016/j.clineuro.2024.108560","DOIUrl":"10.1016/j.clineuro.2024.108560","url":null,"abstract":"<div><h3>Background</h3><div>Heparin may be administered during mechanical thrombectomy (MT) for acute ischemic stroke due to large vessel occlusions (AIS-LVO), with the aim of enhancing reperfusion and improving patient outcomes. The uncertain balance between risks and benefits of administering heparin during MT prompted us to perform this systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted in PubMed, Embase, and Scopus to find studies that report the safety or efficacy of administering heparin during MT for AIS-LVO. Meta-analysis was performed using the random effects model. In case of significant heterogeneity a subgroup analysis was performed.</div></div><div><h3>Results</h3><div>From 2398 screened records, we included 15 studies. Rate of favorable functional outcome (90 day modified Rankin Scale 0–2 (mRS 0–2)) was lower among patients who received heparin (OR, 0.88 [95 %CI 0.79–0.98]; p=.023). Risk of distal embolization was higher in patients who received heparin (OR, 1.25 [95 %CI 1.01–1.55]; p=.04). The subgroup analysis showed that patients who received intravenous thrombolysis (IVT) had higher risk of Symptomatic intracranial hemorrhage (sICH) (OR, 2.94 [95 %CI 1.30–6.63]; p=.009) and lower rate of mRS 0–2 (OR, 0.66 [95 %CI 0.50–0.87]; p=.004). Heparin use didn’t affect successful reperfusion rate (Thrombolysis in cerebral infarction ≥2B), mortality or any ICH risk.</div></div><div><h3>Conclusion</h3><div>Overall, our analysis indicates that administering heparin during MT for AIS-LVO correlates with worse clinical outcomes and increased distal embolization rates. Moreover, it is linked to a higher risk of sICH in patients who receive IVT. Consequently, the routine utilization of heparin during MT should be reconsidered.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108560"},"PeriodicalIF":1.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142318520","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}

{"title":"The Impact of Functionality and Psychological Outcome on Social Engagement 3-months after Intracerebral Hemorrhage","authors":"Benjamin Jadow ,&nbsp;Kara R. Melmed ,&nbsp;Aaron Lord ,&nbsp;Anlys Olivera ,&nbsp;Jennifer Frontera ,&nbsp;Benjamin Brush ,&nbsp;Koto Ishida ,&nbsp;Jose Torres ,&nbsp;Cen Zhang ,&nbsp;Leah Dickstein ,&nbsp;Ethan Kahn ,&nbsp;Ting Zhou ,&nbsp;Ariane Lewis","doi":"10.1016/j.clineuro.2024.108553","DOIUrl":"10.1016/j.clineuro.2024.108553","url":null,"abstract":"<div><h3>Background</h3><div>Although it is well-known that intracerebral hemorrhage (ICH) is associated with physical and psychological morbidity, there is scant data on factors influencing social engagement after ICH. Understanding the relationship between functionality, psychological outcome and social engagement post-bleed may facilitate identification of patients at high risk for social isolation after ICH.</div></div><div><h3>Methods</h3><div>Patients ≥18-years-old with non-traumatic ICH from January 2015-March 2023 were identified from the Neurological Emergencies Outcomes at NYU (NEON) registry. Data on discharge functionality were collected from the medical record. 3-months post-bleed, patients/their legally-authorized representatives (LARs) were contacted to complete Neuro-QoL social engagement, anxiety, depression, and sleep inventories. Patients were stratified by ability to participate in social roles and activities (good=T-score&gt;50, poor=T-score≤50) and satisfaction with social roles and activities (high=T-score&gt;50 and low=T-score≤50). Univariate comparisons were performed to evaluate the relationship between post-bleed social engagement and both functionality and psychological outcome using Pearson’s chi-square, Fisher’s Exact test, and Mann-Whitney U tests. Multivariate logistic regression was subsequently performed using variables that were significant on univariate analysis (p&lt;0.05).</div></div><div><h3>Results</h3><div>The social engagement inventories were completed for 55 patients with ICH; 29 (53 %) by the patient alone, 14 (25 %) by a LAR alone, and 12 (22 %) by both patient and LAR. 15 patients (27 %) had good ability to participate in social roles and activities and 10 patients (18 %) had high satisfaction with social roles and activities. Social engagement was associated with both functionality and psychological outcome on univariate analysis, but on multivariate analysis, it was only related to functionality; post-bleed ability to participate in social roles and activities was associated with discharge home, discharge GCS score, discharge mRS score, and discharge NIHSS score (p&lt;0.05) and post-bleed satisfaction with social roles and activities was related to discharge mRS score and discharge NIHSS score (p&lt;0.05).</div></div><div><h3>Conclusion</h3><div>In patients with nontraumatic ICH, social engagement post-bleed was related to discharge functionality, even when controlling for depression, anxiety, and sleep disturbance.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"246 ","pages":"Article 108553"},"PeriodicalIF":1.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314937","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}