Objectives: To assess the outcomes in aggressively treated patients with aneurysmal intracerebral hematoma (ICH) and signs of brain herniation, and to investigate possible predictive factors.
Methods: This retrospective study included 43 patients with aneurysmal ICH who presented to the Emergency Department with brain herniation and received aggressive surgical treatment between 2008 and 2016. Emergency surgical clipping, hematoma removal, and external decompression were combined as an aggressive surgical treatment. Outcomes were assessed using in-hospital survival and the Glasgow Outcome Scale at a 6-month follow-up.
Results: All the patients were World Federation of Neurological Societies grade V on presentation. The mean hematoma volume was 59.1 ± 16.5 mL. The in-hospital mortality rate was 48.8%. At the 6-month follow-up, favorable outcomes were achieved in 7 patients (16.3%). Significant factors related to death included bilateral mydriasis, lower initial Glasgow Coma Scale (GCS) score, larger hematoma volume, and no recovery of pupil reactivity after surgery. Bilateral restoration of pupil reactivity and higher initial GCS score were associated with 6-month favorable outcomes. Patients with an intrasylvian hematoma were more likely than those with an intraparenchymal hematoma to achieve a favorable outcome (62.5% vs. 5.7%; P = 0.001).
Conclusions: Our data indicate that the protocol of aggressive surgical treatment in patients with a herniated aneurysmal ICH might be warranted. Despite mydriasis, favorable outcomes might be achieved in some patients. However, careful individual patient-centered decision making is essential, particularly when bilateral pupil dilation persists.
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http://dx.doi.org/10.1016/j.wneu.2018.03.011 | DOI Listing |
Cureus
November 2024
Department of Neurosurgery, Radboud University Medical Center, Nijmegen, NLD.
Patients with complex diseases are mostly treated in a multidisciplinary setting. The impact of multidisciplinary care cannot be emphasized enough as it has the potential to significantly increase survival and, in some cases, help avoid a risky treatment approach. The aim of this case illustration is to emphasize the importance of multidisciplinary treatment and learn from the different approaches that can be made while treating such patients.
View Article and Find Full Text PDFBMJ Neurol Open
December 2024
Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Introduction: Ischaemic stroke, primarily caused by thromboembolic events, typically arises as a consequence of underlying vascular or cardiac pathology. Non-thrombotic embolic strokes, although rare, are increasingly seen in interventional and intravascular procedures. Oxygen-ozone therapy (OOT) is one of the popular treatments for lumbar disc herniation, providing pain relief.
View Article and Find Full Text PDFNeurohospitalist
December 2024
Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
Deterioration of a patient's state of consciousness is among the most concerning signs encountered in clinical practice. The evaluation of this finding carries a broad initial differential diagnosis and must account for any relevant medical history. We describe the case of a 41-year-old male with known retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) who presented with progressive mental status decline and acute onset intractable headache.
View Article and Find Full Text PDFChin J Integr Med
December 2024
Department of Spine, The Third Affiliated Hospital of Zhejiang Chinese Medicine University, Hangzhou, 310053, China.
Objective: To elucidate how spinal manipulative therapy (SMT) exerts its analgesic effects through regulating brain function in lumbar disc herniation (LDH) patients by utilizing resting-state functional magnetic resonance imaging (rs-fMRI).
Methods: From September 2021 to September 2023, we enrolled LDH patients (LDH group, n=31) and age- and sex-matched healthy controls (HCs, n=28). LDH group underwent rs-fMRI at 2 distinct time points (TPs): prior to the initiation of SMT (TP1) and subsequent to the completion of the SMT sessions (TP2).
Curr Probl Diagn Radiol
December 2024
Department of Radiology, George Washington University Hospital, 900 23rd St NW, Washington, DC 20037, USA. Electronic address:
Arachnoid granulations have been known for centuries yet remain incompletely understood. While traditionally associated with cerebrospinal fluid transport, the precise mechanism remains uncertain. This manuscript reviews the literature on the anatomy, histology, and imaging findings of arachnoid granulations and their mimickers and anomalous variations.
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