Management of intracranial hypertension(IH)has improved in the last decades driven by advancements in monitoring technologies and a deeper understanding of its pathophysiology.Although intracranial pressure(ICP)cathet...Management of intracranial hypertension(IH)has improved in the last decades driven by advancements in monitoring technologies and a deeper understanding of its pathophysiology.Although intracranial pressure(ICP)catheters are still recommended by current guidelines for monitoring patients at risk of IH,these methods are not without limitations.Challenges include procedural complications,availability of these devices in many healthcare settings and technical issues.In this context,management in the absence of ICP monitoring is common and now it can be augmented by intensivist-led point-of-care ultrasound,which includes tools such as transcranial doppler,optic nerve sheath measurement and brain ultrasound.These methods offer anatomic information that can sometimes withhold repeated head computed tomography(CT)scans,but they are also a window into ICP dynamics without the associated risks of invasive monitoring and are reasonable alternatives for guiding treatment,provided an integration between neurological examination,head CT anatomical findings and noninvasive monitors is considered.This manuscript synthesizes the evidence for using invasive ICP monitoring and methods for non-invasive monitoring,more focused on the role of ultrasound,given its wider availability.We also propose a practical approach of how to integrate this information at bedside to avoid both under and overtreatment,by embracing a clinical epidemiology paradigm to guide management decisions.展开更多
Background and Objective:Idiopathic intracranial hypertension(IIH)is a disorder of raised intracranial pressure(ICP)associated with overweight and obesity,with weight loss being the mainstay of management.Diet and lif...Background and Objective:Idiopathic intracranial hypertension(IIH)is a disorder of raised intracranial pressure(ICP)associated with overweight and obesity,with weight loss being the mainstay of management.Diet and lifestyle changes alone are often unsuccessful at achieving meaningful or sustained weight loss.Glucagon-like peptide-1 receptor agonists(GLP-1RA)are a class of medications developed for the treatment of diabetes but are also highly effective for weight reduction.The objective of this narrative review is to present the current evidence for GLP-1RAs in the management of IIH.Methods:Articles were searched for inclusion through OVID using the following terms:[papilledema OR intracranial hypertension OR idiopathic intracranial hypertension OR brain pseudotumor]and[glucagon like peptide 1 OR glucagon like peptide 1 receptor agonist OR semaglutide OR exendin 4 OR liraglutide OR tirzepatide].Titles and abstracts were screened manually for relevance.There were no exclusion criteria for time frame,language,population or article type,although conference abstracts were not included.An illustrative case of a patient with IIH treated with tirzepatide and semaglutide is also presented.Key Content and Findings:GLP-1RAs have demonstrated the potential for significantly greater weight loss in patients with IIH,with a reduced requirement for IIH medications and improved symptoms,compared to conventional weight management.Treatment with GLP-1RAs has also been shown to result in a rapid and persistent reduction in ICP in both rat and human studies.The side effects of GLP-1RAs are generally well-tolerated,with low rates of discontinuation in clinical trials.However,continuous treatment is likely required to avoid weight rebound and symptom recurrence after cessation.Conclusions:Despite highly promising preliminary evidence,further clinical trials are needed to determine the most effective GLP-1RA medications within this class,appropriate dosing regimens and treatment duration.展开更多
Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We dis...Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms,particularly in the anterior circulation.The article compares various imaging modalities,including computer tomography angiogram,magnetic resonance imaging/angiography,and digital subtraction angiogram,highlighting their strengths and limitations.We emphasize the im-portance of accurate differentiation to avoid unnecessary surgical interventions.The potential of emerging technologies,such as high-resolution vessel wall ima-ging and deep neural networks for automated detection,is explored as promising avenues for improving diagnostic accuracy.This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.展开更多
Intracranial aneurysms,characterized by focal arterial wall dilation,pose significant neurosurgical challenges due to their potential for rupture and hemorrhage,leading to severe clinical outcomes,including fatality.P...Intracranial aneurysms,characterized by focal arterial wall dilation,pose significant neurosurgical challenges due to their potential for rupture and hemorrhage,leading to severe clinical outcomes,including fatality.Patients often experience profound psychological and social impacts,such as depression,anxiety,and cognitive impairment,affecting their quality of life.Rapid progression and high mortality necessitate timely intervention.Advances in neurosurgical techniques,including microscopic surgery and neuroendoscopy,offer distinct advantages.Microscopic surgery provides precision and direct visualization,while neuroendoscopy ensures minimally invasive access and reduced tissue trauma.Integrating these methods optimizes treatment efficacy and clinical outcomes.AIM To evaluate the impact of combined microscopic and neuroendoscopic techniques on psychological,cognitive outcomes,and quality of life in patients with ruptured intracranial aneurysms.METHODS The study focused on 189 patients with intracranial aneurysm rupture and hemorrhage from January 2020 to May 2024 as the objects of observation and analysis.They were randomly divided into a control group(treated with simple microscope surgery,n=94)and an observation group(treated with microscope combined with neuroendoscopy,n=95).The treatment effects of the two groups were observed,mainly including depression and anxiety scale scores,cognitive function assessment results and quality of life assessment data.RESULTS Before treatment,the depression and anxiety scale scores,cognitive function assessment results and quality of life assessment data of the two groups of patients at different time points were compared,and there was no statistically significant difference(P>0.05).After microscope combined with neuroendoscopy treatment,the study revealed that the observation group surpassed the control group in alleviating depression and anxiety,accelerating cognitive function recovery,and enhancing quality of life,with these differences being statistically significant(P<0.05).CONCLUSION Surgical treatment combined with microscopy and neuroendoscopy has a significant positive effect on the mental health,cognitive function and overall quality of life of patients with intracranial aneurysm rupture and bleeding,can shorten the operation time and treatment time,and provides a new strategic reference for clinical treatment.展开更多
Intracranial aneurysm(IA)is a prevalent cerebrovascular disease associated with high mortality and disability rates upon rupture.The hemodynamics of IA,which are significantly influenced by geometric parameters,direct...Intracranial aneurysm(IA)is a prevalent cerebrovascular disease associated with high mortality and disability rates upon rupture.The hemodynamics of IA,which are significantly influenced by geometric parameters,directly impact its rupture.This study focuses on investigating the transient flow characteristics in saccular IA models fabricated using a water droplet-based method,specifically examining the influence of neck widths.Particle image velocimetry technique and numerical simulation were employed to investigate the dynamic evolution of flow structures within three IA models.The results reveal that neck width(W)has a substantial effect on flow characteristics in the neck region,subsequently impacting the deep flow inside the sac.Three distinct patterns were observed during flow evolution inside the sac:for W=2 mm,two vortices occur and then disappear with relatively low average flow velocity;for W=4 mm,enhanced effects of a high-speed jet result in periodic pulsatile flow velocity distribution while maintaining stable vortex core position;for W=6 mm,significant changes in flow velocity occur due to size expansion and intensity increase of vortices.These findings demonstrate that neck widths play a complex role in influencing transient flow characteristics within IAs.Overall,this research contributes to further understanding transient flow behaviors in IAs.展开更多
Non-traumatic headache is a common presentation in both emergency and outpatient settings,where timely identification of raised intracranial pressure(ICP)is crucial to prevent severe neurological complications.Convent...Non-traumatic headache is a common presentation in both emergency and outpatient settings,where timely identification of raised intracranial pressure(ICP)is crucial to prevent severe neurological complications.Conventional diagnostic methods such as computed tomography and lumbar puncture have important limitations,including invasiveness,delayed availability,and limited sensitivity in certain contexts.Point-of-care ultrasound measurement of the optic nerve sheath diameter(ONSD)has emerged as a rapid,non-invasive tool for detecting elevated ICP at the bedside.The technique is based on the anatomical continuity between the intracranial subarachnoid space and the optic nerve sheath,which expands in response to increased ICP.Evidence from multiple studies and meta-analyses indicates that ONSD measurements above 5.0-5.7 mm in adults strongly correlate with elevated ICP,showing pooled sensitivities and specificities approaching 90%.This modality enables immediate triage,guides urgency of neuroimaging,reduces unnecessary radiation exposure,and can be applied in outpatient and low-resource settings.Despite these advantages,ONSD assessment is subject to operator dependency,variability in threshold values,and reduced accuracy in patients with certain ocular or systemic conditions.Advances in artificial intelligence–assisted measurement,coupled with standardized training protocols,have the potential to improve reproducibility and broaden adoption.Overall,point-of-care ultrasound-based ONSD measurement represents a valuable adjunct in the early evaluation of patients with non-traumatic headache,facilitating faster diagnosis,better resource utilization,and improved patient outcomes.展开更多
The dorsal and ventral visual streams have been considered to play distinct roles in visual processing for action:the dorsal stream is assumed to support real-time actions,while the ventral stream facilitates memory-g...The dorsal and ventral visual streams have been considered to play distinct roles in visual processing for action:the dorsal stream is assumed to support real-time actions,while the ventral stream facilitates memory-guided actions.However,recent evidence suggests a more integrated function of these streams.We investigated the neural dynamics and functional connectivity between them during memory-guided actions using intracranial EEG.We tracked neural activity in the inferior parietal lobule in the dorsal stream,and the ventral temporal cortex in the ventral stream as well as the hippocampus during a delayed action task involving object identity and location memory.We found increased alpha power in both streams during the delay,indicating their role in maintaining spatial visual information.In addition,we recorded increased alpha power in the hippocampus during the delay,but only when both object identity and location needed to be remembered.We also recorded an increase in theta band phase synchronization between the inferior parietal lobule and ventral temporal cortex and between the inferior parietal lobule and hippocampus during the encoding and delay.Granger causality analysis indicated dynamic and frequency-specific directional interactions among the inferior parietal lobule,ventral temporal cortex,and hippocampus that varied across task phases.Our study provides unique electrophysiological evidence for close interactions between dorsal and ventral streams,supporting an integrated processing model in which both streams contribute to memory-guided actions.展开更多
Background: Lumboperitoneal (LP) shunts have been used to manage benign intracranial hypertension (BIH) for an extended period. While they may swiftly and effectively alleviate symptoms, their application is accompani...Background: Lumboperitoneal (LP) shunts have been used to manage benign intracranial hypertension (BIH) for an extended period. While they may swiftly and effectively alleviate symptoms, their application is accompanied by potential complications. Objectives: This research aimed to retrospectively analyze the difficulties and complications related to LP shunt implantation. Methods: We conducted a retrospective analysis of the records of 47 patients who had LP shunt placement for the treatment of BIH at our hospital throughout the research period. A thorough history and physical examination were conducted in every case. All patients were asked about age, gender, body mass index, neurological history, and oral contraceptive usage. Post-operative complications, clinical and ophthalmological follow-up occurred at 1, 3, and 6 months post-op. Results: Patients were mostly women (93.6%). The mean age of the patients was 35, and 80.9 percent had BMIs exceeding 25. Many female patients (40.9%) used oral contraceptives. Nearly all patients (93.6%) reported decreased vision, and 87.2% suffered headaches. The most common issue was shunt obstruction (51%), followed by low tension headaches (63.8%). The peritoneal side (10.6%) had higher shunt slippage than the thecal (2.1%). Superficial infections and radiculopathy affected 10.6% of patients, whereas CNS infections, arachnoiditis, and shunt failure affected just 2.1%. Five patients (10.6%) had Chiari malformation, and 60% had syringomyelia. Conclusion: Using LP shunts to treat BIH seems to be a method devoid of major risks despite the high revision rates. At the same time, more severe complications such as CNS infections, arachnoiditis, and shunt failure were less common.展开更多
Correction to:Neuroscience Bulletin https://doi.org/10.1007/s12264-025-01371-x In this article the affiliation"Department of Circuit Theory,Faculty of Electrical Engineering,Czech Technical University in Prague,M...Correction to:Neuroscience Bulletin https://doi.org/10.1007/s12264-025-01371-x In this article the affiliation"Department of Circuit Theory,Faculty of Electrical Engineering,Czech Technical University in Prague,Member of the Epilepsy Research Centre Prague-EpiReC Consortium,Prague,Czechia"should only be assigned to Radek Janca and Petr Jezdik.It is removed from the authors:Jiri Hammer,Michaela Kajsova,Adam Kalina,Petr Marusic,and Kamil Vlcek.展开更多
BACKGROUND The optic nerve sheath diameter(ONSD)measured by ultrasound has emerged as a significant noninvasive method for detecting elevated intracranial pressure(ICP),guiding timely interventions,and monitoring trea...BACKGROUND The optic nerve sheath diameter(ONSD)measured by ultrasound has emerged as a significant noninvasive method for detecting elevated intracranial pressure(ICP),guiding timely interventions,and monitoring treatment response.Previous studies have shown that the baseline ONSD at admission is a prognostic indicator of mortality in adult patients with cerebrovascular events,traumatic brain injury,hepatic encephalopathy,and acute stroke.However,pediatric data on the dynamic changes in ONSD remain limited.AIM To study the association between within-48 hours admission dynamic ONSD changes and mortality in children with clinically relevant elevated ICP.METHODS This single-institution prospective study was performed at a tertiary Children’s Hospital in Vietnam,between November 2023 and August 2024.The primary outcome was in-hospital mortality rate.ONSD data were measured at admission,24 hours,and 48 hours post-admission to pediatric intensive care unit(PICU).Linear mixed-effects models accounting for repeated measures within individuals were used to analyze the association between ONSD changes and in-hospital mortality.RESULTS A total of 69 PICU-admitted children with clinically relevant raised ICP were enrolled and included in the analysis.The median patient age was 6 years(interquartile range:1-12),and males accounted for 54%of all patients.The inhospital mortality rate in children with clinically relevant raised ICP was 23.2%.Traumatic brain injury,sepsisassociated encephalopathy,and septic shock were the main causes of death in this cohort.Linear mixed-effects analysis showed that dynamic variability in ONSD values upon PICU admission and during the first 48 hours later correlated significantly with increased mortality.Nonsurvivors had a 5.3%increase in the mean ONSD at 48 hours compared to baseline levels,while the survivors showed a 5.6%reduction in ONSD.CONCLUSION Serial ultrasound-based ONSD measurements within 48 hours of admission better predicted mortality than baseline data in critically ill children,offering a practical,noninvasive tool for early prognosis in elevated ICP.展开更多
BACKGROUND:Intracranial hemorrhage (ICH),a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO),is often related to poor outcomes.This study aimed to establish a predictive model for I...BACKGROUND:Intracranial hemorrhage (ICH),a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO),is often related to poor outcomes.This study aimed to establish a predictive model for ICH in adults receiving ECMO treatment.METHODS:Adults who received ECMO between January 2017 and June 2022 were the subjects of a single-center retrospective study.Patients under the age of 18 years old,with acute ICH before ECMO,with less than 24 h of ECMO support,and with incomplete data were excluded.ICH was diagnosed by a head computed tomography scan.The outcomes included the incidence of ICH,in-hosptial mortality and 28-day mortality.Multivariate logistic regression analysis was used to identify relevant risk factors of ICH,and a predictive model of ICH with a nomogram was constructed.RESULTS:Among the 227 patients included,22 developed ICH during ECMO.Patients with ICH had higher in-hospital mortality (90.9%vs.47.8%,P=0.001) and higher 28-day mortality (81.8%vs.47.3%,P=0.001) than patients with non-ICH.ICH was associated with decreased grey-white-matter ratio (GWR)(OR=0.894,95%CI:0.841–0.951,P<0.001),stroke history (OR=4.265,95%CI:1.052–17.291,P=0.042),fresh frozen plasma (FFP) transfusion (OR=1.208,95%CI:1.037–1.408,P=0.015)and minimum platelet (PLT) count during ECMO support (OR=0.977,95%CI:0.958–0.996,P=0.019).The area under the receiver operating characteristic curve of the ICH predictive model was 0.843 (95%CI:0.762–0.924,P<0.001).CONCLUSION:ECMO-treated patients with ICH had a higher risk of death.GWR,stroke history,FFP transfusion,and the minimum PLT count were independently associated with ICH,and the ICH predictive model showed that these parameters performed well as diagnostic tools.展开更多
Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracrani...Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracranial aneurysm rupture and hemorrhage and developed pulmonary embolism after clipping surgery,was selected as the research subject.Through multidisciplinary collaboration,standardized assessment and dynamic condition observation,various risks were identified early.Combined with the patient’s individual characteristics,a personalized nursing plan was formulated.During the treatment process,emphasis was placed on strengthening the patient’s airway management,closely monitoring various indicators,and preventing postoperative complications.Targeted nursing measures were adopted:reasonable airway humidification and effective lung care were used to gradually control the patient’s pulmonary infection;fluid balance management and individualized care were implemented to ensure the patient’s normal circulating blood volume,thereby optimizing cerebral perfusion and cerebral oxygenation.Since the patient had overlapping risk factors for bleeding and thromboembolic events,evidence-based nursing principles were followed for thromboembolism prevention,and anticoagulation strategies and nursing plans were dynamically adjusted to reduce the occurrence of postoperative complications.Results:The patient’s condition improved and was successfully discharged on the 22^(nd) day after surgery,and then transferred to a local rehabilitation hospital for further treatment.At the 1-month follow-up after discharge,the patient recovered well;at the 3-month follow-up after discharge,the patient had recovered and returned home.Conclusion:The results show that standardized assessment and condition observation,multidisciplinary collaboration,and personalized nursing plans can significantly reduce the occurrence of postoperative complications and improve the patient’s prognosis.This nursing experience provides a reference for the nursing of similar patients in the future.展开更多
Objective:To analyze the therapeutic effect and prognosis of frameless stereotactic soft channel intracranial hematoma evacuation for severe basal ganglia hemorrhage.Methods:Clinical data of 411 patients with severe b...Objective:To analyze the therapeutic effect and prognosis of frameless stereotactic soft channel intracranial hematoma evacuation for severe basal ganglia hemorrhage.Methods:Clinical data of 411 patients with severe basal ganglia hemorrhage admitted to the Neurological Intensive Care Unit of Linyi People’s Hospital from January 2020 to December 2021 were collected.According to the modified Rankin Scale(mRS)score at 180 days after onset,the patients were divided into the good prognosis group and the poor prognosis group.The therapeutic effect of frameless stereotactic soft channel intracranial hematoma evacuation on severe basal ganglia hemorrhage was explored,and the influencing factors of prognosis were analyzed.Results:Multivariate Logistic regression analysis showed that the admission Glasgow Coma Scale(GCS)score was an independent protective factor for the prognosis of patients with severe basal ganglia hemorrhage,while age,preoperative hematoma volume,random blood glucose level,and mechanical ventilation were independent risk factors.Conclusion:Frameless stereotactic soft channel intracranial hematoma evacuation has a good therapeutic effect on severe basal ganglia hemorrhage.However,it is necessary to screen the patients’basic information before surgery and provide medical care based on their specific conditions to promote their rapid recovery.展开更多
To investigate the histological,immunohistochemical,and molecular characteristics of sclerosing epithelioid fibrosarcoma(SEF),a rare intracranial lesion,we analyzed the clinical,pathological,and molecular features of ...To investigate the histological,immunohistochemical,and molecular characteristics of sclerosing epithelioid fibrosarcoma(SEF),a rare intracranial lesion,we analyzed the clinical,pathological,and molecular features of a group of cases involving both intracranial(case 1)and extracranial(cases 2,3,and 4)soft tissue tumors.These tumors were located in the bilateral parietal sinuses(one of four cases;25%),thoracic vertebrae(1 of 4 cases;25%),mediastinum(1 of 4 cases;25%),and parathyroid soft tissue(1 of 4 cases;25%).Microscopically,tumor cells were observed in both sparse and dense areas,arranged in sheets,cords,and a fusiform braided pattern,all within a dense sclerotic matrix.All four patients exhibited strong and diffuse positivity for MUC4.Cases 1 and 2 harbored an EWSR1–CREB3L1 fusion;case 3 had a CPSF6–ITPR2 fusion;and case 4 exhibited multiple fusion genes,including FUS–CREB3L2,KDM5A–ERC1,AKAP8L–BRD4,and ATF2–CHN1.Methylation analysis indicated that all cases clustered within the SEF spectrum.Copy number variation analysis revealed deletions in chromosomal arms 11p and 22q across all cases.The morphologies of intracranial and extracranial SEF were found to be similar.Although MUC4 serves as a reliable marker for diagnosing SEF,its molecular findings remain nonspecific.Methylation clustering and aneuploidy score assessment should be considered as additional tools to assist in diagnosis and prognostic monitoring.展开更多
Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study in-vestigated serum level of...Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study in-vestigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that resteno-sis occurred in 30% （3/10） of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% （2/17） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% （1/23） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically signiifcant （P 〉 0.05）. Experimental ifndings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervi-cal and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.展开更多
BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications.It is critical to make a rapid radiological evaluation of ruptured intracranial aneury...BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications.It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms(RIAs)to determine the appropriate surgical treatment.AIM To assess the reliability of computed tomography angiography(CTA)in assessing different features of ruptured intracranial aneurysm and its impact on patient management.METHODS The final cohort of this study consisted of 146 patients with RIAs(75 male and 71 female)who underwent cerebral CTA.Their age ranged from 25 to 80,and the mean age±SD was 57±8.95 years.Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment.Inter-observer agreement was measured using kappa statistics.Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms(K=0.95,P=0.001),aneurysm location(K=0.98,P=0.001),and(K=0.98,P=0.001),morphology(K=0.92,P=0.001)and margins(K=0.95,P=0.001).There was an excellent interobserver agreement for the measurement of aneurysm size(K=0.89,P=0.001),neck(K=0.85,P=0.001),and dome-to-neck ratio(K=0.98,P=0.001).There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis(K=0.82,P=0.001),calcification(K=1.0,P=0.001),bony landmark(K=0.89,P=0.001)and branch incorporation(K=0.91,P=0.001)as well as perianeurysmal findings including vasospasm(K=0.91,P=0.001),perianeurysmal cyst(K=1.0,P=0.001)and associated vascular lesions(K=0.83,P=0.001).Based on imaging features,87 patients were recommended to have endovascular treatment,while surgery was recommended in 59 patients.71.2%of the study population underwent the recommended therapy.CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.展开更多
Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging mo...Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging moda-lity for the diagnosis of RIAs,as it is considered to be a fast,economical,and less invasive method.In this letter,regarding an original study presented by Elmo-kadem et al,we present our insights and discuss how CTA can better assist in clinical decision-making for patients with RIAs complicated by SAH.展开更多
Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosi...Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosis for individuals and a great burden to society.The etiology and risk factors of ICAS in youth differ from those of older patients,thus resulting in a difference in the progression and prognosis of the disease.Even though the diagnosis of ICAS is lumen-based,it is sometimes difficult to identify in young patients based on imaging alone.Notably,novel vessel wall imaging techniques play an important role in determining the cause of stenosis and screening patients at high risk of recurrence.Moreover,pharmacologic regimens and risk factor control goals for ICAS in young adults are largely consistent with those in older patients.Thus,considering the poor prognosis,there is an urgent need for high-quality studies in the young ICAS population to analyze the high-quality observational data collected.展开更多
An epidural blood patch (EBP) is a procedure performed by injecting autologous blood into a patient’s epidural space, usually at the site of a suspected CSF leak. It is typically performed in patients with characteri...An epidural blood patch (EBP) is a procedure performed by injecting autologous blood into a patient’s epidural space, usually at the site of a suspected CSF leak. It is typically performed in patients with characteristic postural headaches due to low intracranial pressure. We report a case of a young female with an implanted Miethke Sensor Reservoir, which was used for continuous intracranial pressure (ICP) monitoring during a two-level epidural blood patch. ICP increased only with thoracic injection, suggesting thoracic EBP may have greater efficacy than lumbar EBP in treating SIH and PDPH when the site of CSF leak is unknown.展开更多
BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to th...BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.展开更多
文摘Management of intracranial hypertension(IH)has improved in the last decades driven by advancements in monitoring technologies and a deeper understanding of its pathophysiology.Although intracranial pressure(ICP)catheters are still recommended by current guidelines for monitoring patients at risk of IH,these methods are not without limitations.Challenges include procedural complications,availability of these devices in many healthcare settings and technical issues.In this context,management in the absence of ICP monitoring is common and now it can be augmented by intensivist-led point-of-care ultrasound,which includes tools such as transcranial doppler,optic nerve sheath measurement and brain ultrasound.These methods offer anatomic information that can sometimes withhold repeated head computed tomography(CT)scans,but they are also a window into ICP dynamics without the associated risks of invasive monitoring and are reasonable alternatives for guiding treatment,provided an integration between neurological examination,head CT anatomical findings and noninvasive monitors is considered.This manuscript synthesizes the evidence for using invasive ICP monitoring and methods for non-invasive monitoring,more focused on the role of ultrasound,given its wider availability.We also propose a practical approach of how to integrate this information at bedside to avoid both under and overtreatment,by embracing a clinical epidemiology paradigm to guide management decisions.
文摘Background and Objective:Idiopathic intracranial hypertension(IIH)is a disorder of raised intracranial pressure(ICP)associated with overweight and obesity,with weight loss being the mainstay of management.Diet and lifestyle changes alone are often unsuccessful at achieving meaningful or sustained weight loss.Glucagon-like peptide-1 receptor agonists(GLP-1RA)are a class of medications developed for the treatment of diabetes but are also highly effective for weight reduction.The objective of this narrative review is to present the current evidence for GLP-1RAs in the management of IIH.Methods:Articles were searched for inclusion through OVID using the following terms:[papilledema OR intracranial hypertension OR idiopathic intracranial hypertension OR brain pseudotumor]and[glucagon like peptide 1 OR glucagon like peptide 1 receptor agonist OR semaglutide OR exendin 4 OR liraglutide OR tirzepatide].Titles and abstracts were screened manually for relevance.There were no exclusion criteria for time frame,language,population or article type,although conference abstracts were not included.An illustrative case of a patient with IIH treated with tirzepatide and semaglutide is also presented.Key Content and Findings:GLP-1RAs have demonstrated the potential for significantly greater weight loss in patients with IIH,with a reduced requirement for IIH medications and improved symptoms,compared to conventional weight management.Treatment with GLP-1RAs has also been shown to result in a rapid and persistent reduction in ICP in both rat and human studies.The side effects of GLP-1RAs are generally well-tolerated,with low rates of discontinuation in clinical trials.However,continuous treatment is likely required to avoid weight rebound and symptom recurrence after cessation.Conclusions:Despite highly promising preliminary evidence,further clinical trials are needed to determine the most effective GLP-1RA medications within this class,appropriate dosing regimens and treatment duration.
文摘Despite advancements in neuroimaging,false positive diagnoses of intracranial aneurysms remain a significant concern.This article examines the causes,prevalence,and implications of such false-positive diagnoses.We discuss how conditions like arterial occlusion with vascular stump formation and infundibular widening can mimic aneurysms,particularly in the anterior circulation.The article compares various imaging modalities,including computer tomography angiogram,magnetic resonance imaging/angiography,and digital subtraction angiogram,highlighting their strengths and limitations.We emphasize the im-portance of accurate differentiation to avoid unnecessary surgical interventions.The potential of emerging technologies,such as high-resolution vessel wall ima-ging and deep neural networks for automated detection,is explored as promising avenues for improving diagnostic accuracy.This manuscript underscores the need for continued research and clinical vigilance in the diagnosis of intracranial aneurysms.
文摘Intracranial aneurysms,characterized by focal arterial wall dilation,pose significant neurosurgical challenges due to their potential for rupture and hemorrhage,leading to severe clinical outcomes,including fatality.Patients often experience profound psychological and social impacts,such as depression,anxiety,and cognitive impairment,affecting their quality of life.Rapid progression and high mortality necessitate timely intervention.Advances in neurosurgical techniques,including microscopic surgery and neuroendoscopy,offer distinct advantages.Microscopic surgery provides precision and direct visualization,while neuroendoscopy ensures minimally invasive access and reduced tissue trauma.Integrating these methods optimizes treatment efficacy and clinical outcomes.AIM To evaluate the impact of combined microscopic and neuroendoscopic techniques on psychological,cognitive outcomes,and quality of life in patients with ruptured intracranial aneurysms.METHODS The study focused on 189 patients with intracranial aneurysm rupture and hemorrhage from January 2020 to May 2024 as the objects of observation and analysis.They were randomly divided into a control group(treated with simple microscope surgery,n=94)and an observation group(treated with microscope combined with neuroendoscopy,n=95).The treatment effects of the two groups were observed,mainly including depression and anxiety scale scores,cognitive function assessment results and quality of life assessment data.RESULTS Before treatment,the depression and anxiety scale scores,cognitive function assessment results and quality of life assessment data of the two groups of patients at different time points were compared,and there was no statistically significant difference(P>0.05).After microscope combined with neuroendoscopy treatment,the study revealed that the observation group surpassed the control group in alleviating depression and anxiety,accelerating cognitive function recovery,and enhancing quality of life,with these differences being statistically significant(P<0.05).CONCLUSION Surgical treatment combined with microscopy and neuroendoscopy has a significant positive effect on the mental health,cognitive function and overall quality of life of patients with intracranial aneurysm rupture and bleeding,can shorten the operation time and treatment time,and provides a new strategic reference for clinical treatment.
基金supported by the National Natural Science Foundation of China(Grant Nos.12172017 and 11872083)Project of Beijing Municipal Education Commission(Grant Nos.KZ202210005006 and KZ202110005007).
文摘Intracranial aneurysm(IA)is a prevalent cerebrovascular disease associated with high mortality and disability rates upon rupture.The hemodynamics of IA,which are significantly influenced by geometric parameters,directly impact its rupture.This study focuses on investigating the transient flow characteristics in saccular IA models fabricated using a water droplet-based method,specifically examining the influence of neck widths.Particle image velocimetry technique and numerical simulation were employed to investigate the dynamic evolution of flow structures within three IA models.The results reveal that neck width(W)has a substantial effect on flow characteristics in the neck region,subsequently impacting the deep flow inside the sac.Three distinct patterns were observed during flow evolution inside the sac:for W=2 mm,two vortices occur and then disappear with relatively low average flow velocity;for W=4 mm,enhanced effects of a high-speed jet result in periodic pulsatile flow velocity distribution while maintaining stable vortex core position;for W=6 mm,significant changes in flow velocity occur due to size expansion and intensity increase of vortices.These findings demonstrate that neck widths play a complex role in influencing transient flow characteristics within IAs.Overall,this research contributes to further understanding transient flow behaviors in IAs.
文摘Non-traumatic headache is a common presentation in both emergency and outpatient settings,where timely identification of raised intracranial pressure(ICP)is crucial to prevent severe neurological complications.Conventional diagnostic methods such as computed tomography and lumbar puncture have important limitations,including invasiveness,delayed availability,and limited sensitivity in certain contexts.Point-of-care ultrasound measurement of the optic nerve sheath diameter(ONSD)has emerged as a rapid,non-invasive tool for detecting elevated ICP at the bedside.The technique is based on the anatomical continuity between the intracranial subarachnoid space and the optic nerve sheath,which expands in response to increased ICP.Evidence from multiple studies and meta-analyses indicates that ONSD measurements above 5.0-5.7 mm in adults strongly correlate with elevated ICP,showing pooled sensitivities and specificities approaching 90%.This modality enables immediate triage,guides urgency of neuroimaging,reduces unnecessary radiation exposure,and can be applied in outpatient and low-resource settings.Despite these advantages,ONSD assessment is subject to operator dependency,variability in threshold values,and reduced accuracy in patients with certain ocular or systemic conditions.Advances in artificial intelligence–assisted measurement,coupled with standardized training protocols,have the potential to improve reproducibility and broaden adoption.Overall,point-of-care ultrasound-based ONSD measurement represents a valuable adjunct in the early evaluation of patients with non-traumatic headache,facilitating faster diagnosis,better resource utilization,and improved patient outcomes.
基金supported by European Union–Next Generation EU(LX22NPO5107(MEYS))the Czech Science Foundation(20-21339S)+2 种基金the Grant Agency of Charles University(GAUK 248122 and 272221)ERDF-Project Brain Dynamics(CZ.02.01.01/00/22_008/0004643)the Ministry of Health of the Czech Republic Project NU21J-08-00081.
文摘The dorsal and ventral visual streams have been considered to play distinct roles in visual processing for action:the dorsal stream is assumed to support real-time actions,while the ventral stream facilitates memory-guided actions.However,recent evidence suggests a more integrated function of these streams.We investigated the neural dynamics and functional connectivity between them during memory-guided actions using intracranial EEG.We tracked neural activity in the inferior parietal lobule in the dorsal stream,and the ventral temporal cortex in the ventral stream as well as the hippocampus during a delayed action task involving object identity and location memory.We found increased alpha power in both streams during the delay,indicating their role in maintaining spatial visual information.In addition,we recorded increased alpha power in the hippocampus during the delay,but only when both object identity and location needed to be remembered.We also recorded an increase in theta band phase synchronization between the inferior parietal lobule and ventral temporal cortex and between the inferior parietal lobule and hippocampus during the encoding and delay.Granger causality analysis indicated dynamic and frequency-specific directional interactions among the inferior parietal lobule,ventral temporal cortex,and hippocampus that varied across task phases.Our study provides unique electrophysiological evidence for close interactions between dorsal and ventral streams,supporting an integrated processing model in which both streams contribute to memory-guided actions.
文摘Background: Lumboperitoneal (LP) shunts have been used to manage benign intracranial hypertension (BIH) for an extended period. While they may swiftly and effectively alleviate symptoms, their application is accompanied by potential complications. Objectives: This research aimed to retrospectively analyze the difficulties and complications related to LP shunt implantation. Methods: We conducted a retrospective analysis of the records of 47 patients who had LP shunt placement for the treatment of BIH at our hospital throughout the research period. A thorough history and physical examination were conducted in every case. All patients were asked about age, gender, body mass index, neurological history, and oral contraceptive usage. Post-operative complications, clinical and ophthalmological follow-up occurred at 1, 3, and 6 months post-op. Results: Patients were mostly women (93.6%). The mean age of the patients was 35, and 80.9 percent had BMIs exceeding 25. Many female patients (40.9%) used oral contraceptives. Nearly all patients (93.6%) reported decreased vision, and 87.2% suffered headaches. The most common issue was shunt obstruction (51%), followed by low tension headaches (63.8%). The peritoneal side (10.6%) had higher shunt slippage than the thecal (2.1%). Superficial infections and radiculopathy affected 10.6% of patients, whereas CNS infections, arachnoiditis, and shunt failure affected just 2.1%. Five patients (10.6%) had Chiari malformation, and 60% had syringomyelia. Conclusion: Using LP shunts to treat BIH seems to be a method devoid of major risks despite the high revision rates. At the same time, more severe complications such as CNS infections, arachnoiditis, and shunt failure were less common.
文摘Correction to:Neuroscience Bulletin https://doi.org/10.1007/s12264-025-01371-x In this article the affiliation"Department of Circuit Theory,Faculty of Electrical Engineering,Czech Technical University in Prague,Member of the Epilepsy Research Centre Prague-EpiReC Consortium,Prague,Czechia"should only be assigned to Radek Janca and Petr Jezdik.It is removed from the authors:Jiri Hammer,Michaela Kajsova,Adam Kalina,Petr Marusic,and Kamil Vlcek.
文摘BACKGROUND The optic nerve sheath diameter(ONSD)measured by ultrasound has emerged as a significant noninvasive method for detecting elevated intracranial pressure(ICP),guiding timely interventions,and monitoring treatment response.Previous studies have shown that the baseline ONSD at admission is a prognostic indicator of mortality in adult patients with cerebrovascular events,traumatic brain injury,hepatic encephalopathy,and acute stroke.However,pediatric data on the dynamic changes in ONSD remain limited.AIM To study the association between within-48 hours admission dynamic ONSD changes and mortality in children with clinically relevant elevated ICP.METHODS This single-institution prospective study was performed at a tertiary Children’s Hospital in Vietnam,between November 2023 and August 2024.The primary outcome was in-hospital mortality rate.ONSD data were measured at admission,24 hours,and 48 hours post-admission to pediatric intensive care unit(PICU).Linear mixed-effects models accounting for repeated measures within individuals were used to analyze the association between ONSD changes and in-hospital mortality.RESULTS A total of 69 PICU-admitted children with clinically relevant raised ICP were enrolled and included in the analysis.The median patient age was 6 years(interquartile range:1-12),and males accounted for 54%of all patients.The inhospital mortality rate in children with clinically relevant raised ICP was 23.2%.Traumatic brain injury,sepsisassociated encephalopathy,and septic shock were the main causes of death in this cohort.Linear mixed-effects analysis showed that dynamic variability in ONSD values upon PICU admission and during the first 48 hours later correlated significantly with increased mortality.Nonsurvivors had a 5.3%increase in the mean ONSD at 48 hours compared to baseline levels,while the survivors showed a 5.6%reduction in ONSD.CONCLUSION Serial ultrasound-based ONSD measurements within 48 hours of admission better predicted mortality than baseline data in critically ill children,offering a practical,noninvasive tool for early prognosis in elevated ICP.
基金supported by the National Natural Science Foundation of China (82072159)。
文摘BACKGROUND:Intracranial hemorrhage (ICH),a severe complication among adults receiving extracorporeal membrane oxygenation (ECMO),is often related to poor outcomes.This study aimed to establish a predictive model for ICH in adults receiving ECMO treatment.METHODS:Adults who received ECMO between January 2017 and June 2022 were the subjects of a single-center retrospective study.Patients under the age of 18 years old,with acute ICH before ECMO,with less than 24 h of ECMO support,and with incomplete data were excluded.ICH was diagnosed by a head computed tomography scan.The outcomes included the incidence of ICH,in-hosptial mortality and 28-day mortality.Multivariate logistic regression analysis was used to identify relevant risk factors of ICH,and a predictive model of ICH with a nomogram was constructed.RESULTS:Among the 227 patients included,22 developed ICH during ECMO.Patients with ICH had higher in-hospital mortality (90.9%vs.47.8%,P=0.001) and higher 28-day mortality (81.8%vs.47.3%,P=0.001) than patients with non-ICH.ICH was associated with decreased grey-white-matter ratio (GWR)(OR=0.894,95%CI:0.841–0.951,P<0.001),stroke history (OR=4.265,95%CI:1.052–17.291,P=0.042),fresh frozen plasma (FFP) transfusion (OR=1.208,95%CI:1.037–1.408,P=0.015)and minimum platelet (PLT) count during ECMO support (OR=0.977,95%CI:0.958–0.996,P=0.019).The area under the receiver operating characteristic curve of the ICH predictive model was 0.843 (95%CI:0.762–0.924,P<0.001).CONCLUSION:ECMO-treated patients with ICH had a higher risk of death.GWR,stroke history,FFP transfusion,and the minimum PLT count were independently associated with ICH,and the ICH predictive model showed that these parameters performed well as diagnostic tools.
文摘Objective:To summarize the nursing experience of a patient with intracranial aneurysm rupture and hemorrhage who developed pulmonary embolism after clipping surgery.Methods:A patient in our hospital,who had intracranial aneurysm rupture and hemorrhage and developed pulmonary embolism after clipping surgery,was selected as the research subject.Through multidisciplinary collaboration,standardized assessment and dynamic condition observation,various risks were identified early.Combined with the patient’s individual characteristics,a personalized nursing plan was formulated.During the treatment process,emphasis was placed on strengthening the patient’s airway management,closely monitoring various indicators,and preventing postoperative complications.Targeted nursing measures were adopted:reasonable airway humidification and effective lung care were used to gradually control the patient’s pulmonary infection;fluid balance management and individualized care were implemented to ensure the patient’s normal circulating blood volume,thereby optimizing cerebral perfusion and cerebral oxygenation.Since the patient had overlapping risk factors for bleeding and thromboembolic events,evidence-based nursing principles were followed for thromboembolism prevention,and anticoagulation strategies and nursing plans were dynamically adjusted to reduce the occurrence of postoperative complications.Results:The patient’s condition improved and was successfully discharged on the 22^(nd) day after surgery,and then transferred to a local rehabilitation hospital for further treatment.At the 1-month follow-up after discharge,the patient recovered well;at the 3-month follow-up after discharge,the patient had recovered and returned home.Conclusion:The results show that standardized assessment and condition observation,multidisciplinary collaboration,and personalized nursing plans can significantly reduce the occurrence of postoperative complications and improve the patient’s prognosis.This nursing experience provides a reference for the nursing of similar patients in the future.
基金Shandong Provincial Medical and Health Science and Technology Development Program,Clinical Study on Modified Stereotactic Soft Channel Intracranial Hematoma Evacuation for Severe Basal Ganglia Hemorrhage(Project No.:202203071107)。
文摘Objective:To analyze the therapeutic effect and prognosis of frameless stereotactic soft channel intracranial hematoma evacuation for severe basal ganglia hemorrhage.Methods:Clinical data of 411 patients with severe basal ganglia hemorrhage admitted to the Neurological Intensive Care Unit of Linyi People’s Hospital from January 2020 to December 2021 were collected.According to the modified Rankin Scale(mRS)score at 180 days after onset,the patients were divided into the good prognosis group and the poor prognosis group.The therapeutic effect of frameless stereotactic soft channel intracranial hematoma evacuation on severe basal ganglia hemorrhage was explored,and the influencing factors of prognosis were analyzed.Results:Multivariate Logistic regression analysis showed that the admission Glasgow Coma Scale(GCS)score was an independent protective factor for the prognosis of patients with severe basal ganglia hemorrhage,while age,preoperative hematoma volume,random blood glucose level,and mechanical ventilation were independent risk factors.Conclusion:Frameless stereotactic soft channel intracranial hematoma evacuation has a good therapeutic effect on severe basal ganglia hemorrhage.However,it is necessary to screen the patients’basic information before surgery and provide medical care based on their specific conditions to promote their rapid recovery.
基金supported by grants from the National Natural Science Foundation of China(No.82273082)Chongqing Technical Innovation and Application Development Key Project(No.cstc2021jscx-cylhX0005)。
文摘To investigate the histological,immunohistochemical,and molecular characteristics of sclerosing epithelioid fibrosarcoma(SEF),a rare intracranial lesion,we analyzed the clinical,pathological,and molecular features of a group of cases involving both intracranial(case 1)and extracranial(cases 2,3,and 4)soft tissue tumors.These tumors were located in the bilateral parietal sinuses(one of four cases;25%),thoracic vertebrae(1 of 4 cases;25%),mediastinum(1 of 4 cases;25%),and parathyroid soft tissue(1 of 4 cases;25%).Microscopically,tumor cells were observed in both sparse and dense areas,arranged in sheets,cords,and a fusiform braided pattern,all within a dense sclerotic matrix.All four patients exhibited strong and diffuse positivity for MUC4.Cases 1 and 2 harbored an EWSR1–CREB3L1 fusion;case 3 had a CPSF6–ITPR2 fusion;and case 4 exhibited multiple fusion genes,including FUS–CREB3L2,KDM5A–ERC1,AKAP8L–BRD4,and ATF2–CHN1.Methylation analysis indicated that all cases clustered within the SEF spectrum.Copy number variation analysis revealed deletions in chromosomal arms 11p and 22q across all cases.The morphologies of intracranial and extracranial SEF were found to be similar.Although MUC4 serves as a reliable marker for diagnosing SEF,its molecular findings remain nonspecific.Methylation clustering and aneuploidy score assessment should be considered as additional tools to assist in diagnosis and prognostic monitoring.
基金supported by the Fund for Distinguished Young Doctors from Fujian Provincial Health Department,No.2011-1-7
文摘Cervical and intracranial angioplasty and stenting is an effective and safe method of reducing the risk of ischemic stroke, but it may be affected by in-stent restenosis. The present study in-vestigated serum level of matrix metalloproteinase 9 as a predictor of restenosis after 40 patients underwent cervical and/or intracranial angioplasty and stenting. Results showed that resteno-sis occurred in 30% （3/10） of patients when the serum level of matrix metalloproteinase 9 at 3 days after surgery was 2.5 times higher than preoperative level. No restenosis occurred when the serum level of matrix metalloproteinase 9 at 3 days after surgery was not 2.5 times higher than preoperative level. Restenosis occurred in 12% （2/17） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for more than 30 days after surgery, but only occurred in 4% （1/23） of patients when the serum level of matrix metalloproteinase 9 was higher than preoperative level for less than 30 days after surgery. However, the differences observed were not statistically signiifcant （P 〉 0.05）. Experimental ifndings indicate that when the serum level of matrix metalloproteinase 9 is 2.5 times higher than preoperative level at 3 days after cervi-cal and intracranial angioplasty and stenting, it may serve as a predictor of in-stent restenosis.
文摘BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications.It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms(RIAs)to determine the appropriate surgical treatment.AIM To assess the reliability of computed tomography angiography(CTA)in assessing different features of ruptured intracranial aneurysm and its impact on patient management.METHODS The final cohort of this study consisted of 146 patients with RIAs(75 male and 71 female)who underwent cerebral CTA.Their age ranged from 25 to 80,and the mean age±SD was 57±8.95 years.Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment.Inter-observer agreement was measured using kappa statistics.Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms(K=0.95,P=0.001),aneurysm location(K=0.98,P=0.001),and(K=0.98,P=0.001),morphology(K=0.92,P=0.001)and margins(K=0.95,P=0.001).There was an excellent interobserver agreement for the measurement of aneurysm size(K=0.89,P=0.001),neck(K=0.85,P=0.001),and dome-to-neck ratio(K=0.98,P=0.001).There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis(K=0.82,P=0.001),calcification(K=1.0,P=0.001),bony landmark(K=0.89,P=0.001)and branch incorporation(K=0.91,P=0.001)as well as perianeurysmal findings including vasospasm(K=0.91,P=0.001),perianeurysmal cyst(K=1.0,P=0.001)and associated vascular lesions(K=0.83,P=0.001).Based on imaging features,87 patients were recommended to have endovascular treatment,while surgery was recommended in 59 patients.71.2%of the study population underwent the recommended therapy.CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.
基金Supported by Natural Science Foundation Project of Chongqing,No.CSTB2024NSCQ-MSX1265.
文摘Ruptured intracranial aneurysms(RIAs)are a leading cause of subarachnoid haemorrhage(SAH)and are associated with a poor prognosis and high mortality rate.Computed tomography angiography(CTA)is the preferred imaging moda-lity for the diagnosis of RIAs,as it is considered to be a fast,economical,and less invasive method.In this letter,regarding an original study presented by Elmo-kadem et al,we present our insights and discuss how CTA can better assist in clinical decision-making for patients with RIAs complicated by SAH.
基金supported by the National Natural Science Foundation of China(82071468,82271507).
文摘Intracranial artery stenosis(ICAS)in youth is an under-explored condition.ICAS is one of the leading causes of stroke in young people worldwide and confers a higher risk of stroke recurrence,leading to a poor prognosis for individuals and a great burden to society.The etiology and risk factors of ICAS in youth differ from those of older patients,thus resulting in a difference in the progression and prognosis of the disease.Even though the diagnosis of ICAS is lumen-based,it is sometimes difficult to identify in young patients based on imaging alone.Notably,novel vessel wall imaging techniques play an important role in determining the cause of stenosis and screening patients at high risk of recurrence.Moreover,pharmacologic regimens and risk factor control goals for ICAS in young adults are largely consistent with those in older patients.Thus,considering the poor prognosis,there is an urgent need for high-quality studies in the young ICAS population to analyze the high-quality observational data collected.
文摘An epidural blood patch (EBP) is a procedure performed by injecting autologous blood into a patient’s epidural space, usually at the site of a suspected CSF leak. It is typically performed in patients with characteristic postural headaches due to low intracranial pressure. We report a case of a young female with an implanted Miethke Sensor Reservoir, which was used for continuous intracranial pressure (ICP) monitoring during a two-level epidural blood patch. ICP increased only with thoracic injection, suggesting thoracic EBP may have greater efficacy than lumbar EBP in treating SIH and PDPH when the site of CSF leak is unknown.
文摘BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.
