Clinical Neurology and Neurosurgery最新文献

Introduction

Methods

Results

Conclusion

Objective

The Platelet-to-Lymphocyte Ratio (PLR) and Neutrophil-to-Lymphocyte Ratio (NLR) are established biomarkers that are associated with the severity, progression, and fatality of diseases. This study aimed to determine their predictive value for the occurrence of stress ulcers (SU) following surgery for acute cerebral hemorrhage.

Methods

Retrospective data from 210 patients with acute cerebral hemorrhage hospitalized between June 2020 and March 2023 were analyzed. Patients were categorized into two groups based on the occurrence of SU post-surgery: the SU group (42 patients) and the non-SU group (168 patients). Clinical characteristics of both groups were compared, and a multivariate logistic regression was conducted to identify independent risk factors for SU. The study evaluated the predictive value of NLR and PLR, individually and in combination, for predicting SU using Receiver Operating Characteristic (ROC) curves.

Results

We observed significant differences between the SU and non-SU groups in several parameters, including GCS score, absolute neutrophils, NLR, PLR, postoperative tracheotomy, and intracranial infection (P < 0.05). Our multivariate logistic regression analysis identified four independent risk factors for SU in patients undergoing surgery for acute cerebral hemorrhage: GCS score, NLR, PLR, and fasting blood glucose (P < 0.05). Furthermore, ROC analysis demonstrated that the combination of NLR and PLR exhibited the highest AUC, sensitivity, and specificity in predicting SU following surgery for acute cerebral hemorrhage (P < 0.001), with values of 0.864 (95 % CI: 0.776–0.953), 0.778 (95 % CI: 0.658–0.899), and 0.941 (95 % CI: 0.889–0.993) respectively.

Conclusion

This study highlighted the combined application of PLR and NLR as a significant predictor of SU in patients post-acute cerebral hemorrhage surgery.

Objective

The prevalence of chronic pain in Parkinson's disease (PD) in neurology practices ranges from 24 % to 83 %. To determine whether this prevalence is accurate across patients with PD, we leveraged data from electronic medical records in 80 inpatient and outpatient general practice settings.

Methods

We explored the prevalence of chronic pain in patients with PD relative to age and sex-matched controls in a large international database with electronic medical records from over 250 million patients (TriNetX Cambridge, MA, USA). We described demographics, co-morbid conditions and medication differences between patients with PD and without PD who have chronic pain.

Results

Extracted data included 4510 patients with PD and 4,214,982 age-matched control patients without Parkinson’s Disease. A chronic pain diagnosis was identified in 19.3 % of males and 22.8 % of females with PD. This differed significantly from age-matched patients without PD who had a significantly lower prevalence of chronic pain 3.78 % and 4.76 %. Significantly more PD patients (both male and females) had received tramadol, oxycodone, and neuropathic agents (p<0.001) than patients without PD. Females with PD more often received anti-depressants than males with PD (p<0.05), corresponding with a significantly higher prevalence of depression.

Conclusion

Chronic pain in patients with PD is five times as common as in age-matched controls in general practice settings. Patients with PD have a greater prevalence of comorbid conditions that affect development of chronic pain. Whether the pain or the PD is causative to those conditions remains to be elucidated.

Objective

Seizures can be triggered by a variety of endogenous or exogenous factors. We hypothesized that alterations in the gut microbiome may be a seizure precipitant and analyzed the composition and characteristics of the gut microbiome in epilepsy patients who experienced an abrupt seizure exacerbation without a clear seizure precipitant.

Methods

We prospectively enrolled 25 adult patients with epilepsy and collected fecal samples on the admission and after seizure recovery for next-generation sequencing analysis. We performed nonparametric paired t-test analysis to evaluate changes in the gut microbiota as seizures worsened and when it recovered and also estimated alpha and beta diversities in each category.

Results

A total of 19 patients (13 males) aged between 19 and 78 years (mean 45.2 years) were included in the study. The composition of the gut microbiota underwent a significant change following an abrupt seizure exacerbation. At the phylum level, the relative abundance of Fusobacteria and Synergistetes was decreased in the seizure recovery state compared to the acute seizure exacerbation. A similar trend was observed at the lower hierarchical levels, with a decrease in the relative abundance of Fusobacteria, Tissierellia, and Synergistia at the class level, and that of Synergistales, Tissierellales, and Fusobacteriales at the order level. At the family level, the relative abundance of Fusobacteriaceae and Staphylococcaceae was decreased, whereas that of Leuconostocaceae was increased. No statistical differences were observed in alpha and beta diversity between the pre- and post-acute seizure exacerbation periods.

Significance

Our study suggests that the changes in Fusobacteriaceae and Lecuonostocaceae may be associated with acute seizure exacerbation in epilepsy patients. Given that Fusobacteriaceae are associated with various systemic diseases due to their invasive properties and that Leuconostocaceae are known to produce GABA, our results may suggest a gut microbiome-based treatment option for epilepsy patients.

Background

Percutaneous balloon compression (PBC) is widely used to treat trigeminal neuralgia due to its significant efficacy and low treatment cost. However, there is considerable variation in postoperative pain recurrence among patients. Currently, the factors influencing pain recurrence after PBC are under discussion. This study aims to explore the impact of individual patient parameters and surgical parameters on postoperative pain recurrence following PBC. The goal is to provide clinicians with a reference for preoperative assessment of pain recurrence risk and to offer insights for effectively intervening in controllable influencing parameters.

Methods

A analysis was conducted on 114 patients who underwent PBC in the Department of Neurosurgery at Hebei General Hospital. Univariate Kaplan-Meier analysis and multivariate Cox regression analysis were performed on the general and surgical data of the patients to identify factors potentially associated with postoperative pain recurrence.

Results

The results of the multivariate Cox regression analysis showed that a history of hypertension, MRI indicating trigeminal nerve compression and a non-ideal pear-shaped balloon were statistically significant factors for pain recurrence after PBC. Additionally, the guidewire path during the procedure had a statistically significant impact on the rate of achieving a pear-shaped balloon (P<0.05).

Conclusion

A history of hypertension, MRI indicating trigeminal nerve compression and a non-ideal pear-shaped balloon shape are independent risk factors for pain recurrence after PBC. Additionally, to avoid pain recurrence due to an unfavorable balloon shape, it is recommended to use 3D-slicer for preoperative guidewire path simulation and 3D reconstruction of Meckel's cavity.

Background

Status Epilepticus (SE) is a neurological emergency with high mortality rate that often requires admission in Intensive Care Units (ICU). Several factors of worse outcome have been identified in prior studies. The aim of our study was to determine the mortality in ICU and in the ward in patients with SE admitted to an ICU and to identify risk factors of mortality.

Methods

Retrospective cohort study of patients admitted with SE treated in the ICU of a tertiary medical center between 2015 and 2020. The primary outcome measure was mortality in the ICU (ICU death) or in the ward after ICU discharge (post-ICU death).

Results

252 patients were included, with a mean age of 63 (±16) years and 127 males (50 %). 58 died in the ICU, 27 died in the ward. Overall mortality was associated with a higher burden of comorbidities (OR:1.28, p < 0.001), the use of vasopressors (OR: 5.65, p < 0.001) and a higher burden of ICU complications (OR: 1.32, p = 0.002). Mortality rate was higher in more severe SE episodes (nonconvulsive, acute symptomatic and refractoriness.

In-ICU mortality was associated with the use of vasopressors (OR: 7.92, p<0.001) and mechanical ventilation (OR: 3.13, p = 0.031), the length of in-ICU stay (OR: 0.91, p = 0.005) and a higher burden of ICU complications (OR: 1.37, p = 0.001). Compared to post-ICU deaths, ICU deaths also had higher Sequential Organ Failure Assessment (SOFA) score on ICU admission (p<0.001).

Post-ICU mortality was associated with a higher burden of comorbidities (OR: 1.34, p<0.001), a higher burden of complications after ICU-discharge (OR: 1.33, p = 0.01), and more often refractory SE episode (OR: 2.63, p = 0.01). Compared to survivors, post-ICU deaths experienced mostly infectious and respiratory complications, after ICU-discharge.

Conclusion

Death was more frequent in more severe SE episodes: non convulsive semiology, acute etiology, and refractoriness. In-ICU, post-ICU and all-cause mortality in patients with SE admitted to an ICU are all associated with a higher burden of comorbidities, which are non-modifiable prognostic factors, but also with a higher burden of complications, some of which are preventable, such as respiratory infections.

Purpose

Methods

Results

Conclusion

Study Design

Double-center retrospective study.

Purpose

Utilization trends in interventional treatment for lumbar disc herniation (LDH) have not yet been examined. Furthermore, limited information is currently available on motor recovery with condoliase therapy. Therefore, the present study investigated utilization trends in treatment for LDH and the effects of condoliase therapy on muscle weakness.

Methods

This retrospective, double-center study involved patients with leg pain caused by LDH who received interventional treatment between September 2017 and August 2022. LDH patients were divided into two groups: an operative treatment group and condoliase therapy group. The period between September 2017 and August 2022 was divided into 5 equal parts and changes in the percentage of intervention treatment were examined. Motor recovery was also assessed in the two groups. Patients receiving condoliase therapy were divided into two groups: an effective group and non-effective group. Sex, age, the body mass index, duration of symptoms, herniation level, neurological and radiographic findings, a visual analog scale for leg pain, and the Oswestry disability index were examined in the two groups.

Results

Subjects included 226 males and 115 females with a mean age of 49.2 years, mean BMI of 22.8, and mean duration of symptoms of 5.0 months. The utilization of condoliase therapy for LDH surpassed surgery in the third year after its introduction. In the fourth year, condoliase therapy became the main treatment for LDH. Lower limb muscle strength improved in 76 % of cases receiving condoliase therapy.

Conclusions

Condoliase therapy has become an intermediate treatment before surgery in our institutions. Motor recovery in patients receiving condoliase therapy was not inferior to that after surgery; however, in cases with severe muscle weakness with manual muscle test ≤3, the improvement rate was approximately 60 %. These results will be useful for clinicians when providing informed consent and selecting condoliase therapy.

Background

Hemodynamic factors play an important role in the formation and rupture of intracranial aneurysms. Blood viscosity has been recognized as a potential factor influencing the hemodynamics of aneurysms. Computational fluid dynamics (CFD) is one of the main methods to study aneurysm hemodynamics. However, current CFD studies often set the viscosity to a standard value, neglecting the effect of individualized viscosity on hemodynamics. We investigate the impact of blood viscosity on hemodynamics in large intracranial aneurysm (IA) and assess the potential implications for aneurysm growth and rupture risk.

Methods

CFD simulations of 8 unruptured large internal carotid artery aneurysms were conducted using pulsatile inlet conditions. For each aneurysm, CFD simulations were performed at 5 different viscosity levels (0.004, 0.006, 0.008, 0.010, and 0.012 Pa·s). Differences in hemodynamic parameters across viscosity levels were compared using paired t-tests, and the correlation between viscosity and hemodynamic parameters was analyzed.

Results

Increasing blood viscosity leads to significant decrease in blood flow velocity within aneurysms. Time-averaged wall shear stress (WSS) showed significant positive correlation with viscosity, particularly at the aneurysm neck. Oscillatory shear index (OSI) showed general decreasing trend with increased viscosity, while it displayed an irregular pattern in a few cases.

Conclusions

Variations in viscosity markedly influence velocity, WSS, and OSI in aneurysms, suggesting a role in modulating aneurysm growth and rupture risk. Incorporating patient-specific viscosity values in CFD simulations is vital for accurate and reliable outcomes.