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Neurosurgery. 2000 Nov;47(5):1098-104; discussion 1104-5.
Neurological grades of patients with poor-grade subarachnoid hemorrhage improve after short-term pretreatment.
Suzuki M, Otawara Y, Doi M, Ogasawara K, Ogawa A.
Department of Neurosurgery, Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Japan.
OBJECTIVE: Short-term pretreatment of patients with subarachnoid hemorrhage, but without hematomas causing mass effect, who presented in poor neurological condition at admission was evaluated as a protocol for the selection of candidates for radical surgery. METHODS: One hundred-three patients were pretreated for 12 hours with control of blood pressure and intracranial pressure, using diuretic agents and/or ventricular drainage. RESULTS: Neurological improvement was observed for 32 of 47 patients in Grade IV at admission and 23 of 56 patients in Grade V (P < 0.01). Hydrocephalus requiring drainage was more common (P < 0.05) and the interval between onset and admission was shorter (P < 0.01) for the improved group. Clipping surgery was performed for all patients in Grade III or better and for patients in Grade IV who were less than 75 years of age and without systemic complications, i.e., 38 of 47 patients in Grade IV and 16 of 56 patients in Grade V at admission. Good outcomes (defined as moderately disabled or better on the Glasgow Outcome Scale) were achieved by 34 of 38 patients in Grade IV and 10 of 16 patients in Grade V (P < 0.01). The proportion of patients in Grade IV after pretreatment was lower for Grade IV (2 of 38 patients) than for Grade V (9 of 16 patients) (P < 0.00001). However, none of the 49 patients who underwent nonsurgical treatment achieved good outcomes. CONCLUSION: Our protocol may be beneficial for the selection of candidates for radical surgery among patients with subarachnoid hemorrhage but without hematomas who are in poor neurological condition at admission and for the improvement of postoperative outcomes.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11063102&dopt=Abstract hemorrhage
Neurosurgery. 2000 Nov;47(5):1117-22; discussion 1123.
Transcranial brainstem stab injuries: a retrospective analysis of 17 patients.
Nathoo N, Boodhoo H, Nadvi SS, Naidoo SR, Gouws E.
Department of Neurosurgery, Wentworth Hospital, School of Clinical Sciences, University of Natal, Durban, South Africa. nathowh.und.ac.za
OBJECTIVE: Transcranial stab injuries remain a frequent cause of emergent neurosurgical admissions to neurosurgical units in South Africa. Brainstem stabs are an uncommon, yet often fatal, form of brain injury. METHODS: A retrospective audit of 597 patients with transcranial stab injuries admitted to our unit over a 12-year period (January 1987 to December 1998) identified 17 patients (2.85%) with brainstem stab injuries. The computed tomographic scans of all patients were analyzed, and a detailed autopsy examination of the skull and its contents was performed in all patients who died. Stepwise linear regression analysis was used to formulate a predictive model of outcome for the entire series of 597 patients. RESULTS: The majority of the patients were males (16 patients), and the study group had a mean age of 28.65 +/- 9.59 years and a mean Glasgow Coma Scale score of 8.59 +/- 2.76. Knives (82%) were the most common instruments of penetration. Cerebral angiography identified 3 patients with vascular abnormalities, and autopsy revealed an additional 4 patients with vascular injury. Emergency ventriculostomy was performed in 10 patients for obstructive hydrocephalus. Four of the 17 patients survived (76.5% mortality). Factors significantly predictive of outcome in patients with transcranial stab injuries were the Glasgow Coma Scale score (F = 43.7), the occurrence of intraventricular hemorrhage (F = 22.8), the type of associated lesion (intracranial bleed, vascular abnormality, or brain abscess) (F = 5.9), and the number of operations (F = 3.2). CONCLUSION: The Glasgow Coma Scale score is the most significant predictor of outcome in low-velocity transcranial stab injuries. Brainstem stab injuries have a great propensity for vascular damage. Survivors are incapacitated by severe, fixed neurological deficits.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11063104&dopt=Abstract hemorrhage
Am J Obstet Gynecol. 2002 Nov;187(5):1213-6.
Maternal death at an inner-city hospital, 1949-2000.
Ho EM, Brown J, Graves W, Lindsay MK.
Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Ga, USA.
OBJECTIVE: The purpose of this study was to determine the rates and causes of maternal deaths at an inner-city hospital from 1949 through 2000. STUDY DEATH: Death summaries, autopsy reports, and previously collected data were reviewed for maternal deaths from January 1949 through December 2000. The chi(2) and Fisher exact tests were used to test the relationship between time and classification of death. RESULTS: There were 290 maternal deaths and 314,436 live births, for a hospital-specific maternal mortality rate of 92.2 per 100,000. The percentage of deaths that were related directly to pregnancy decreased, and the percentage of deaths that were unrelated to pregnancy increased (P <.001). This is attributable to a decrease in deaths from obstetric infections and hemorrhage and an increase in deaths from nonobstetric infections and homicide. CONCLUSION: The major causes of maternal death in our hospital have changed. A better understanding of these causes may lead to more effective prevention efforts.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12439506&dopt=Abstract hemorrhage
Stroke. 2000 Nov;31(11):2558-62.
Prediction of functional outcome and in-hospital mortality after admission with oral anticoagulant-related intracerebral hemorrhage.
Berwaerts J, Dijkhuizen RS, Robb OJ, Webster J.
Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen, UK. j.berwaertbdn.ac.uk
BACKGROUND AND PURPOSE: Early survival of patients with intracerebral hemorrhage in general is known to be most strongly dependent on the Glasgow Coma Scale score on admission. The aim of this study was to examine the factors determining functional outcome and in-hospital mortality of patients admitted with an intracerebral hemorrhage related to oral anticoagulant (OAC) use. METHODS: Correlation studies and multiple logistic regression analyses were performed on data from a retrospective series of 42 patients admitted with OAC-related intracerebral hemorrhages over a 6-year period to a tertiary care center in the north of Scotland. RESULTS: The functional outcome after an OAC-related intracerebral hemorrhage was dependent on maximum diameter of hematoma on CT scan (R:=-0.72, P:<0. 001) and international normalized ratio (INR) (R:=-0.35, P:=0.024). Hematoma diameter and INR were not themselves strongly correlated (R:=0.31, P:=0.099). In-hospital mortality can be predicted by the Glasgow Coma Scale score alone (R:(2)=0.36, overall predictive accuracy 68%) but more accurately by a logistic regression model including hematoma diameter and CT signs of cerebrovascular disease (R:(2)=0.70, predictive accuracy 83%). CONCLUSIONS: Neither functional outcome nor in-hospital mortality appears to be strongly dependent on INR measured on admission. CT scan, however, provides essential information and allows accurate predictions about the short-term outcome of OAC-related intracerebral hemorrhages.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11062275&dopt=Abstract hemorrhage
Neurosurgery. 2000 Nov;47(5):1138-45; discussion 1145-6.
Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging: stereotactic brain biopsy.
Moriarty TM, Quinones-Hinojosa A, Larson PS, Alexander E 3rd, Gleason PL, Schwartz RB, Jolesz FA, Black PM.
Department of Neurological Surgery, University of Louisville School of Medicine, Kentucky 40202, USA. tmoriartiky.com
OBJECTIVE: To assess the application accuracy of intraoperative magnetic resonance imaging for frameless stereotactic surgery, and to evaluate the performance of intraoperative magnetic resonance imaging for the brain biopsy, a standard stereotactic procedure. METHODS: A series of spatial coordinate and phantom experiments were performed to analyze the application accuracy of the system. A prospective analysis of 68 consecutive patients undergoing stereotactic brain biopsy was then performed. RESULTS: The spatial coordinate experiments revealed a mean overall error in acquisition of 0.2 mm. The phantom experiments demonstrated a 1:1 correlation between the magnetic resonance image of a stereotactically guided probe and its relationship to a target and the actual relationship of the probe and target. Sixty-eight brain biopsies were successfully performed in all intracranial compartments except the sella. The radiographic abnormality was localized successfully in all patients (100%). Sixty-six (97.1%) of the biopsies yielded diagnostic tissue. Two biopsies (2.9%) were complicated by intraparenchymal hemorrhage. One expanding temporal lobe hemorrhage was evacuated by immediate craniotomy in the magnet with no postoperative sequelae. A deep hemorrhage from a lymphoma was managed conservatively with interval resolution of symptoms. There were no infections. There was no perioperative mortality. CONCLUSION: Intraoperative magnetic resonance imaging allows excellent target localization, provides true real-time imaging to account for anatomic changes during surgery, and permits intraoperative confirmation that the biopsy needle has reached the targeted lesion. Immediate postoperative imaging in the operating room allows assessment of adverse events and the potential for immediate management of hemorrhagic complications.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11063107&dopt=Abstract hemorrhage
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