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- Alonso, Fabiola, et al.
(författare)
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Influence of Virchow-Robin spaces on the electric field distribution in subthalamic nucleus deep brain stimulation
- 2021
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier. - 0303-8467 .- 1872-6968. ; 204
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Tidskriftsartikel (refereegranskat)abstract
- Patient MRI from DBS implantations in the subthalamic nucleus (STN) were reviewed and it was found that around 10% had Virchow-Robin spaces (VRS). Patient-specific models were developed to evaluate changes in the electric field (EF) around DBS leads. The patients (n = 7) were implanted bilaterally either with the standard voltage-controlled lead 3389 or with the directional current-controlled lead 6180. The EF distribution was evaluated by comparing simulations using patient-specific models with homogeneous models without VRS. The EF, depicted with an isocontour of 0.2 V/mm, showed a deformation in the presence of the VRS around the DBS lead. For patient-specific models, the radial extension of the EF isocontours was enlarged regardless of the operating mode or the DBS lead used. The location of the VRS in relation to the active contact and the stimulation amplitude, determined the changes in the shape and extension of the EF. It is concluded that it is important to take the patients? brain anatomy into account as the high conductivity in VRS will alter the electric field if close to the DBS lead. This can be a cause of unexpected side effects.
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| 2. |
- Alonso-Magdalena, Lucía, et al.
(författare)
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Prevalence and disease disability in immigrants with multiple sclerosis in Malmö, southern Sweden
- 2024
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier. - 0303-8467 .- 1872-6968. ; 240
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multiple sclerosis (MS) is the most common chronic demyelinating disease of the central nervous system and the major non-traumatic cause of permanent disability in young adults. Several migration studies have been performed over the years suggesting a pattern of higher disease disability in certain ethnic groups. To our knowledge, differences in disease progression in immigrants have not been studied in Sweden before. Thus, the aims of our study were to estimate the prevalence of multiple sclerosis among first-generation immigrants in the City of Malmö and to compare differences in disease severity with the native population.Methods: All persons with multiple sclerosis living in Malmö on prevalence day 31 Dec 2010 were included. Cases were classified according to the country of birth into Scandinavians, Western and non-Western.Results: The crude prevalence was 100/100,000 (95% CI, 80–124) among first-generation immigrants, 154/100,000 (95% CI, 137–173) among individuals with Scandinavian background, 123/100,000 (95% CI, 94–162) in the Western group and 76/100,000 (95% CI, 53–108) in the non-Western group. The mean Multiple Sclerosis Severity Score (MSSS) value among Scandinavians was 4.2 (SD 3.5), whereas the figures in the immigrant group were 4.6 (SD 3.3) and 5.2 (SD 3.7) among Westerns respectively non-Westerns, which differences were not statistically significant. When adjusting for gender, age at onset and initial disease course, the mean MSSS difference between the non-Western and the Scandinavian individuals was 1.7 (95% CI 0.18–3.3, p = 0.030). There were no differences on time to diagnosis or the time from diagnosis to treatment initiation between the three groups.Conclusions: We found a lower prevalence among Western and non-Western first-generation immigrants compared to the Scandinavian population and a more severe disease in non-Western immigrants than in Scandinavians.
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| 5. |
- Bobinski, Lukas, et al.
(författare)
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Complications following cranioplasty using autologous bone or polymethylmethacrylate-Retrospective experience from a single center
- 2013
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Ingår i: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print). - : Elsevier BV. - 0303-8467 .- 1872-6968. ; 115:9, s. 1788-1791
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Tidskriftsartikel (refereegranskat)abstract
- Objective: A decompressive hemicraniectomy is a potentially life-saving intervention following head trauma. Once performed patients are obliged to undergo a second procedure with cranioplasty. Two of the most commonly used materials are autologous bone and polymethylmethacrylate (PMMA). We have now evaluated complications following a cranioplasty using these materials. Materials and methods: During a 7-year period (2002-2008) 49 patients were operated with a decompressive craniectomy following head trauma. Patients received a cranioplasty consisting of autologous bone (30 patients, 61.2%) or PMMA (19 patients, 38.8%) and were followed at least 24 months. Patient data were collected retrospectively. Results: Twenty patients (20/49, 40.8%) experienced a complication that prompted a re-operation. There was a significantly higher rate of complications leading to a re-operation (53.3% vs. 21.1%, p = 0.03) and a shorter survival time of the cranioplasty (mean 48.1 +/- 7.8 vs. 79.5 +/- 9.0 months, p = 0.035) in patients with autologous bone compared to PMMA. Bone resorption and the presence of postoperative hematomas were significantly more common in patients with autologous bone. The material used for cranioplasty was the only variable that significantly correlated to the rate of complications. Conclusions: In our series we had a high percentage of patients needing re-operation due to complications following a cranioplasty. Though generally considered a straightforward procedure, complications and associated morbidity in patients undergoing cranioplasty should not be underestimated.
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| 8. |
- Corell, Alba, et al.
(författare)
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Spinal cord compression in relation to clinical symptoms in patients with spinal meningiomas.
- 2021
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier BV. - 1872-6968 .- 0303-8467. ; 211
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Tidskriftsartikel (refereegranskat)abstract
- Spinal meningiomas are common primary tumors of the spinal canal and the resulting spinal cord compression (SCC) is intrinsically related to symptoms and outcome, but literature concerning this association is limited. We aimed to present data on both degree of SCC and tumor occupancy percentage in relation to neurological symptoms and outcome.Patients ≥18 years with a histological diagnosis of spinal canal meningioma treated between 2000 and 2017 were retrospectively evaluated for symptoms and neurological outcome in relation to SCC (i.e. compression of spinal cord at maximal tumor compression compared to maximum area above/below compression) and tumor occupancy percentage (percentage of dural sac area occupied by tumor at maximal tumor compression). Area segmentation of spinal cord, tumor and dural sac (as marker of spinal canal) was performed manually on magnetic resonance imaging (MRI) scans. The neurological deficit was assessed pre- and postoperatively according to the McCormick score. A logistic regression was made with a training set to identify the cut-off level for motor deficit.The cohort included 111 patients with a mean age of 62.5 years and 77.5% were female. The dominating symptoms preoperatively were sensory disturbance (91.0%), motor deficit (80.2%) and gait disturbance (67.6%). Postoperatively 53.2% of patients, also in some of those with severe deficit and high tumor occupancy, improved their neurological deficit and 43.2% were unchanged. Patients with intradural meningioma and assessable MRI scans were included to evaluate SCC (n=83). The mean extent of SCC was 50.6%. Exploration of tumor occupancy percentage identified a cut-off at 65% tumor occupancy to best discriminate between patients with or without motor deficit.Patients with an intradural tumor occupancy percentage of >65% are more likely to have a preoperative symptom and deficit, validating previous findings. Therefore, we suggest that even in asymptomatic, otherwise fit, patients with tumor occupancy approaching 65% should be considered for surgery since there is a high risk of developing deficit with even minimal growth. Concerning recovery, patients with tumor both high tumor occupancy and significantly impaired function tended to improve their functional level postoperatively.
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| 9. |
- El-Sherif, Ahmed M., et al.
(författare)
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Resource utilization in management of spontaneous intracerebral hemorrhage without systemic risk factors : Does early surgical decompression matter?
- 2023
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Ingår i: Clinical neurology and neurosurgery. - : Elsevier. - 0303-8467 .- 1872-6968. ; 231
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Forskningsöversikt (refereegranskat)abstract
- Background: Even though different subtypes of spontaneous ICH are frequently linked to a poor prognosis, their causes, pathological features, and prognoses vary. Atypical intracerebral hemorrhage is the subtype of spontaneous ICH that usually occurs due to an underlying localized vascular lesion. It is unrelated to systemic vascular risk factors, mostly affects children and young adults and is associated with a relatively good outcome. This fact should be considered when planning the evaluation and treatment. Investigating the cause of this subtype is fundamental to providing optimal management. However, if resources do not allow completing the investigations, the cause will be more difficult to discover. Treatment decisions will be made under stress to save the patient's life, especially with rapidly deteriorating patients. Methods: We described three cases of spontaneous ICH without systemic risk factors where the bleeding source could not be determined before surgery due to a lack of resources, preventing preoperative vascular investigation. Knowing that the atypical ICH has a distinct identity, regarding etiology and prognosis, encouraged the surgeons to resort to early surgical decompression as an alternative plan. We reviewed the literature searching for supporting evidence. Results: The results of treatment of the presented cases were satisfactory. The lack of reported similar cases was brought to light by a literature analysis that sought to provide backing for the proposed management strategy. In the end, we supplied two graphic organizers to help readers remember the different types and treatment of hemorrhagic stroke. Conclusion: There isn't enough evidence to show that there are other ways to treat atypical intracerebral haemorrhage when resources are limited. The presented cases highlight the importance of decisionmaking in resource-constrained situations when patient outcomes can be improved.
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| 10. |
- Eleftheriou, Andreas, et al.
(författare)
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Circadian rhythm in idiopathic normal pressure hydrocephalus
- 2018
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Ingår i: Clinical neurology and neurosurgery (Dutch-Flemish ed. Print). - : ELSEVIER SCIENCE BV. - 0303-8467 .- 1872-6968. ; 164, s. 72-74
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The pathogenesis of idiopathic normal pressure hydrocephalus (iNPH) takes place in structures close to the cerebral ventricular system. Suprachiasmatic nucleus (SCN), situated close to the third ventricle, is involved in circadian rhythm. Diurnal disturbances are well-known in demented patients. The cognitive decline in iNPH is potentially reversible after a shunt operation. Diurnal rhythm has never been studied in iNPH. We hypothesize that there is a disturbance of circadian rhythm in iNPH-patients and the aim was to study any changes of the diurnal rhythm (mesor and circadian period) as well as any changes of the diurnal amplitude and acrophase of the activity in iNPH-patients before and after a shunt operation. Patients and methods: Twenty consecutive iNPH-patients fulfilling the criteria of the American iNPH-guidelines, 9 males and 11 females, mean age 73 (49-81) years were included. The patients underwent a pre-operative clinical work-up including 10 m walk time (w10mt) steps (w10 ms), TUG-time (TUGt) and steps (TUGs) and for cognitive function an MMSE score was measured. In order to receive circadian rhythm data actigraphic recordings were performed using the SenseWear 2 (BodyMedia Inc Pittsburgh, PA, USA) actigraph. Cosinor analyses of accelerometry data were performed in "R" using non-linear regression with Levenburg-Marquardt estimation. Pre- and post-operative data regarding mesor, amplitude and circadian period were compared using Wilcoxon-Mann-Whitney test for paired data. Results: Twenty patients were evaluated before and three month post-operatively. Motor function (w10mt, w10 ms, TUGt, TUGs) was significantly improved while MMSE was not significantly changed. Actigraphic measurements (mesor, amplitude and circadian period) showed no significant changes after shunt operation. Conclusion: This is the first systematic study of circadian rhythm in iNPH-patients. We found no significant changes in circadian rhythm after shunt surgery. The conceptual idea of diurnal rhythm changes in hydrocephalus is still interesting from a theoretical standpoint and warrants further studies that could include a combination of better designed actigraphic studies in combination with neuroendocrine markers and imaging methods
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