Clinical Neurology and Neurosurgery最新文献

{"title":"A nationwide provider survey of neuro-oncology tumor boards in a lower-middle-income country: Comparing centers with and without tumor boards","authors":"Roua Nasir ,&nbsp;Saad Akhtar Khan ,&nbsp;Mohad Kamran Abbasi ,&nbsp;Ahsan Amir Khan ,&nbsp;Mishal Zaman ,&nbsp;Alishba Mustafa ,&nbsp;Hana Habib ,&nbsp;Syeda Ayesha Hussain ,&nbsp;Naveed Zaman ,&nbsp;Saqib Kamran Bakhshi ,&nbsp;Saad Bin Anis ,&nbsp;Syed Ather Enam","doi":"10.1016/j.clineuro.2025.108728","DOIUrl":"10.1016/j.clineuro.2025.108728","url":null,"abstract":"<div><h3>Objectives</h3><div>To provide information about implementation, resources, practice patterns and prevalent perceptions regarding neuro-oncology tumor boards (NOTBs) in a lower middle income country.</div></div><div><h3>Methods</h3><div>A nationwide survey was designed to include licensed neurosurgeons involving data on practice, structure, and perceptions of NOTBs with non-probability sampling, a pre-validated proforma, data analysis using SPSS v27, and geospatial mapping using Quantum GIS.</div></div><div><h3>Results</h3><div>139 neurosurgeons were surveyed from 63 neurosurgical centers of a lower middle income country. 15/63 neurosurgical centers had dedicated NOTBs. Neurosurgeons from centers with NOTBs had better access to palliative care with radiation oncologists (70 %) and services (73 %) as compared to those without NOTBs (44 %, p = 0.012 and 44 %, p = 0.004). 76.3 % of neurosurgeons routinely prescribed postoperative CT scans with higher rate in centers without NOTBs (94 % vs. 80 %, p = 0.024). 57.6 % of neurosurgeons prescribed postoperative MRI scans within six weeks for intra-axial pathology, with higher rates in NOTB centers (63 % vs. 56 %, not significant). The perceived positive effects of NOTBs included improved patient outcomes (87.6 %), expedited centralized patient care (88.3 %), decreased referral times (74.4 %), increased uptake of adjuvant management (66.4 %), decreased mortality/morbidity (73.1 %), and significant treatment (78.5 %) and diagnostic plan changes (77.4 %) while perceived negative effects included the time-consuming nature (20.7 %), and suffering of patients due to wait associated with NOTBs (36 %). The perceived barriers included “lack of administrative support” (17.1 %), “limited resources” (15.2 %), and “lack of standardized protocols or guidelines” (13.8 %).</div></div><div><h3>Conclusion</h3><div>In this nationwide situational report from a lower middle income country, only a quarter of neurosurgical units had dedicated NOTBs. The centers with NOTBs were mostly education/training centers, and had better access/availability to palliative decision-making and care. The neurosurgeons from centers with NOTBs had lower rates of prescribing immediate postoperative CT scans while higher rates of prescribing MRI scans within 6 weeks for intra-axial pathology. Therefore, NOTBs can help advocate for judicious use of neuroimaging and increased uptake of adjuvant palliative treatment. While perceived effects were similar, the nature of perceived barriers was different for LMIC and HIC. Our study can aid policymakers, hospitals, and healthcare professionals, and can provide a roadmap for future in-depth studies with geospatial mapping of resources/services to fully elucidate the inequalities.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108728"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant multiple sclerosis and cervical myelopathy: A propensity-matched QOD analysis of patient-reported outcomes and return to work after cervical spine surgery","authors":"Joseph Tingen,&nbsp;Jainith Patel,&nbsp;Hiba Hamid,&nbsp;Helen Karimi,&nbsp;Ron I. Riesenburger,&nbsp;James Kryzanski","doi":"10.1016/j.clineuro.2025.108742","DOIUrl":"10.1016/j.clineuro.2025.108742","url":null,"abstract":"<div><h3>Objective</h3><div>The diagnosis of degenerative cervical myelopathy (CM) in multiple sclerosis (MS) patients is challenging due to overlapping symptomatology and radiological findings. Minimal literature reports patient reported outcomes measures (PROMs) for MS patients undergoing surgery for CM. Given the diagnostic difficulty, we aimed to determine if patients with MS have worse outcomes after elective cervical spine surgery.</div></div><div><h3>Methods</h3><div>126 patients who underwent surgery for CM were retrospectively obtained from the Quality Outcomes Database (QOD). 63 MS patients were age and gender matched to 63 without MS. Postoperative PROMs including Visual Analogue Scale for neck/arm pain (VAS), Neck Disability Index (NDI), and satisfaction were compared at 3 and 12 months. Postoperative complications and return to work were studied as secondary outcomes.</div></div><div><h3>Results</h3><div>The average age of both cohorts was 57.9 years, and 63.5 % were female. Baseline functional status and symptomatology were similar, although fewer MS patients could independently ambulate (p = .014). The operative time and length of stay were similar. MS patients had a greater average ASA grade (p = 0.018), however there were no significant differences in VAS, NDI, or satisfaction. MS patients had a higher 3-month readmission rate (p = .044), however returned to work at a similar rate greater than 70 %.</div></div><div><h3>Conclusion</h3><div>PROMs do not significantly differ for CM patients with concomitant MS. Patients with MS had a higher 3-month complication rate, although readmissions were largely unrelated to the procedure. Thus, despite the diagnostic challenge of CM in MS patients, the surgical outcomes are comparable to those without MS.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108742"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior reversible encephalopathy syndrome as a multiple sclerosis relapse mimic during interferon therapy","authors":"Mariana Dias da Costa ,&nbsp;Miguel Leal Rato ,&nbsp;João Ferreira ,&nbsp;João de Sá ,&nbsp;Mónica Santos","doi":"10.1016/j.clineuro.2024.108666","DOIUrl":"10.1016/j.clineuro.2024.108666","url":null,"abstract":"<div><div>Posterior reversible encephalopathy syndrome is a rare syndrome involving the subcortical cerebral white matter. We describe the case of a 63-year-old male patient with relapsing remitting multiple sclerosis under interferon beta therapy and acute onset of atypical unilateral posterior reversible encephalopathy syndrome mimicking a relapse. This case highlights the importance of clinical suspicion for multiple sclerosis mimics, namely in older patients, which may need disease modifying treatment suspension and directed treatment in order to achieve better clinical prognosis.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108666"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142790977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parasellar region meningiomas with optic canal (OC) invasion: Correlation between the degree of decompression of the OC and the improvement of visual acuity","authors":"Bianca Maria Baldassarre ,&nbsp;Alessandro Pesaresi ,&nbsp;Giuseppe Di Perna ,&nbsp;Enrico Lo Bue ,&nbsp;Raffaele De Marco ,&nbsp;Irene Portonero ,&nbsp;Alice Antico ,&nbsp;Federica Penner ,&nbsp;Fabio Cofano ,&nbsp;Diego Garbossa ,&nbsp;Michele Maria Rosario Lanotte ,&nbsp;Francesco Zenga","doi":"10.1016/j.clineuro.2024.108672","DOIUrl":"10.1016/j.clineuro.2024.108672","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the correlation between the degrees of circumferential decompression of the optic canal (OC) and the improvement of visual acuity in patients with parasellar meningiomas (PMs) with optic canal invasion.</div></div><div><h3>Methods</h3><div>This is a monocentric retrospective study conducted at author’s institution. The visual acuity was evaluated preoperative and at 3-months after surgery with Snellen acuity test. The degree of decompression of the OC was calculated through postoperative multiplanar CT-scan reconstructions in coronal plane at intraorbital opening (IOO), intracranial opening (ICO) and middle point between them (MP). OC was then divided in two segments (anterior and posterior).</div></div><div><h3>Results</h3><div>29 consecutive patients were identified. Improvement of visual acuity was observed in 18 patients (62 %). Mean decompression achieved at ICO, MP and IOO was 226.2°± 43.6° (range: 68.7°-297.1°), 217.5°± 37.2° (range: 75.3°-268.7°) and 204.6°± 41.2° (range: 67.3°-252.6°) respectively. A decompression &gt; 90° of the anterior segment of the OC, a decompression &gt; 180° of the posterior segment and a full-length decompression &gt; 90° were associated visual acuity improvement at univariate analysis (p = 0.010, p = 0.002 and p &lt; 0.001, respectively). A decompression &gt; 180° of the posterior segment and a full-length decompression &gt; 90° of the OC maintained statistical significance at multivariate analysis (p = 0.030 and p = 0.035, respectively).</div></div><div><h3>Conclusion</h3><div>Anterior segment decompression &gt; 90° and posterior segment decompression &gt; 180° were associated with improvement of visual acuity at 3 months after surgery. A full-length decompression of the optic canal &gt; 90° showed better visual outcome, while a full-length decompression &gt; 180° did not seem to be related to significative improvements in visual acuity.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108672"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and clinical outcomes of percutaneous treatments for trigeminal neuralgia secondary to multiple sclerosis","authors":"Mathieu Lozouet ,&nbsp;Elisabeth Garrido ,&nbsp;Bertrand Bourre ,&nbsp;Lou Grangeon ,&nbsp;Laurent Iasci ,&nbsp;Stephane Derrey","doi":"10.1016/j.clineuro.2024.108695","DOIUrl":"10.1016/j.clineuro.2024.108695","url":null,"abstract":"<div><h3>Background</h3><div>People with Multiple Sclerosis (MS) have a 20-fold higher risk of developing trigeminal neuralgia compared to the general population. Treating trigeminal neuralgia in these patients is particularly challenging due to reduced tolerance and increased side effects from medications. When no neurovascular conflict exist, percutaneous treatments are usually the first option after drug therapy. According to the literature, treatment outcomes for MS-associated trigeminal neuralgia show higher relapse rates and lower rates of sustained pain relief compared to primary trigeminal neuralgia, often necessitating multiple procedures.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients who underwent percutaneous procedures for trigeminal neuralgia between 2010 and 2021 at Rouen University Hospital. The patients were divided into two groups based on the presence or absence of multiple sclerosis. The primary endpoint was the postoperative Barrow Neurological Institute (BNI) pain score, categorized as favourable (I-III) or unfavourable (IV-V) at 3 months postoperatively and at the last date of follow-up.</div></div><div><h3>Results</h3><div>Patients with multiple sclerosis were younger, had fewer comorbidities, and experienced more bilateral trigeminal pain compared to those without multiple sclerosis. BNI score evaluations at 3 months and at the last follow-up did not differ significantly between the two groups, with 81 % and 77 % of patients, showing favourable outcomes. However, the recurrence of pain after percutaneous procedures was significantly higher in patients with multiple sclerosis (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Percutaneous rhizotomies achieve satisfactory clinical outcomes in patients with MS, despite a higher incidence of recurrences and subsequent percutaneous procedures compared to the general population.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108695"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural evolution of idiopathic carpal tunnel syndrome with respect to wrist and hand anthropometry","authors":"Erdi Imre","doi":"10.1016/j.clineuro.2025.108739","DOIUrl":"10.1016/j.clineuro.2025.108739","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108739"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive impairment after hemorrhagic stroke is less common in patients with elevated body mass index and private insurance","authors":"Hamza Ahmed ,&nbsp;Saami Zakaria ,&nbsp;Kara R. Melmed ,&nbsp;Benjamin Brush ,&nbsp;Aaron Lord ,&nbsp;Lindsey Gurin ,&nbsp;Jennifer Frontera ,&nbsp;Koto Ishida ,&nbsp;Jose Torres ,&nbsp;Cen Zhang ,&nbsp;Leah Dickstein ,&nbsp;Ethan Kahn ,&nbsp;Ting Zhou ,&nbsp;Ariane Lewis","doi":"10.1016/j.clineuro.2025.108772","DOIUrl":"10.1016/j.clineuro.2025.108772","url":null,"abstract":"<div><h3>Background</h3><div>Hemorrhagic stroke survivors may have cognitive impairment. We sought to identify preadmission and admission factors associated with cognitive impairment after hemorrhagic stroke.</div></div><div><h3>Design</h3><div>Patients with nontraumatic intracerebral or subarachnoid hemorrhage (ICH or SAH) were assessed 3-months post-bleed using the Quality of Life in Neurological Disorders (Neuro-QoL) Cognitive Function short form. Univariate and multivariate analysis were used to evaluate the relationship between poor cognition (Neuro-QoL t-score ≤50) and preadmission and admission factors.</div></div><div><h3>Results</h3><div>Of 101 patients (62 ICH and 39 SAH), 51 (50 %) had poor cognition 3-months post-bleed. On univariate analysis, poor cognition was associated with (p &lt; 0.05): age [66.0 years (52.0–77.0) vs. 54.5 years (40.8–66.3)]; private insurance (37.3 % vs. 74.0 %); BMI &gt; 30 (13.7 % vs. 34.0 %); and admission mRS score &gt; 0 (41.2 % vs. 14.0 %), NIHSS score [8.0 (2.0–17.0) vs. 0.5 (0.0–4.0)], and APACHE II score [16.0 (11.0–19.0) vs. 9.0 (6.0–14.3)]. On multivariate analysis, poor cognition was associated with mRS score &gt; 0 [OR 4.97 (1.30–19.0), p = 0.019], NIHSS score [OR 1.14 (1.02–1.28), p = 0.026], private insurance [OR 0.21 (0.06–0.76), p = 0.017] and BMI &gt; 30 [OR 0.13 (0.03–0.56), p = 0.006].</div></div><div><h3>Conclusions</h3><div>Cognitive impairment after hemorrhagic stroke is less common in patients with BMI &gt; 30 and private insurance. Heightened surveillance for non-obese patients without private insurance is suggested. Additional investigation into the relationship between cognition and both BMI and insurance type is needed.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108772"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The stent-screw assisted internal fixation (SAIF) technique: A treatment option for OF5, the three-column unstable osteoporotic vertebral fractures – A case series","authors":"Christian Commodaro ,&nbsp;Lukasz Strulak ,&nbsp;Ivan Cabrilo ,&nbsp;Marco Pileggi ,&nbsp;Maurizio Isalberti ,&nbsp;Joshua A. Hirsch ,&nbsp;Andrea Cardia ,&nbsp;Alessandro Cianfoni","doi":"10.1016/j.clineuro.2025.108757","DOIUrl":"10.1016/j.clineuro.2025.108757","url":null,"abstract":"<div><h3>Purpose</h3><div>The OF5 type of vertebral osteoporotic fracture (AO Spine-DGOU classification) represents a three-column lesion and as such is considered as highly unstable. These lesions, however, tend to affect elderly, frail patients, in whom invasive management options are limited. The stent-screw-assisted internal fixation (SAIF) technique has previously been reported as a minimally invasive treatment for osteoporotic and neoplastic vertebral fractures. Here, we sought to assess the safety and efficacy of the SAIF technique in a retrospective series of patients with thoracic OF5-fractures.</div></div><div><h3>Methods</h3><div>Retrospective identification, in a prospectively maintained database, of patients with OF5-fractures treated with SAIF. Intra- and post-operative complications were reported. Clinical outcome using NRS pain scale and Patient’s Global Impression of Change (PGIC) and radiological outcome, with local kyphotic angle (LKA) and VB height (VBH) correction were analyzed.</div></div><div><h3>Results</h3><div>N = 22 consecutive patients were identified. All fractures were located in the thoracic spine. No intra-procedural complications occurred, although hospitalization-related complications did occur in 2 patients (9 %). There was a statistically significant pain reduction on follow-up. VBH restoration range was 0–12 mm (mean 5.5 mm). The mean postoperative LKA correction was 7.5°, which was maintained at last follow-up.</div></div><div><h3>Conclusion</h3><div>The SAIF technique appears to be a viable alternative in the management of OF5-fractures. Although it does not address all elements of OF5 instability, it appears that the stabilisation of the anterior and middle vertebral columns, coupled with the stabilising effect of the ribcage in the hypomobile thoracic spine, are biomechanically sufficient to treat OF5-fractures in this section of the spine.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108757"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143180750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed postoperative impedance issues in patients treated with deep brain stimulation: A single-center retrospective study","authors":"Drew Sturgill ,&nbsp;Dana Dolce ,&nbsp;Eric L. Hargreaves ,&nbsp;John Kilgallon ,&nbsp;Syed A. Sarwar ,&nbsp;Deborah Caputo ,&nbsp;Rocco J. DiPaola ,&nbsp;Sean Munier ,&nbsp;Shabbar Danish","doi":"10.1016/j.clineuro.2024.108702","DOIUrl":"10.1016/j.clineuro.2024.108702","url":null,"abstract":"<div><h3>Background</h3><div>In rare circumstances, an implanted deep brain stimulation device will develop impedance issues across its contacts. Even more rare is the resultant inability to program a patient effectively, or that the patients’ prior programming settings become unusable.</div></div><div><h3>Objective</h3><div>In this study we investigate this occurrence across the device manufacturers implanted, and whether this could be resolved.</div></div><div><h3>Methods</h3><div>The authors performed a retrospective review of all patients managed with DBS at HMH-Jersey Shore University Medical Center from October 2021 to January 2024.</div></div><div><h3>Results</h3><div>A total of 155 DBS patients were identified; thirty four patients with the Abbott system and 121 with the Medtronic system. Upon follow-up, 16 independent impedance issues were identified from 12 patients. Two patients (1.7 %) from the Medtronic group and 10 patients (29.4 %) from the Abbott group (p &lt; .01). Falls were the most common significant event noted and occurred prior to 5 impedance issues (31.3 %). When falls were controlled for, 9 patients (11 impedance issues) were identified. All of these patients were from the Abbott group (p &lt; 0.01). Revision surgery occurred in 7 (63.6 %) of these cases after an average of 1.05 years following primary implantation. Surgical replacement of the internal pulse generator (IPG) (n = 3), IPG and extension wires (n = 2), or IPG and lead revision (n = 1) resolved impedance in 6 cases.</div></div><div><h3>Conclusion</h3><div>Patients with the Abbott St. Jude DBS Systems have significantly higher rates of impedance issues requiring reoperation when compared to those implanted with the Medtronic Systems.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108702"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical risk factors for mortality in low severity acute epidural hematoma","authors":"Nikith Erukulla ,&nbsp;Kaho Adachi ,&nbsp;Haarisudhan Sureshkumar ,&nbsp;Mishaal Hukamdad ,&nbsp;Sam H. Jiang ,&nbsp;Ryan G. Chiu ,&nbsp;Ankit I. Mehta","doi":"10.1016/j.clineuro.2025.108764","DOIUrl":"10.1016/j.clineuro.2025.108764","url":null,"abstract":"<div><h3>Background</h3><div>Epidural hematomas (EDH) pose life-threatening risks with considerable morbidity and mortality if left untreated. The prognosis for patients with low-severity acute EDH managed conservatively is variable, with limited understanding of risk factors. This study aims to identify clinical risk factors for mortality in low-severity acute epidural hematoma patients managed conservatively, helping clinicians recognize cases where deviation from conservative management may be necessary.</div></div><div><h3>Methods</h3><div>The National Trauma Data Bank was queried from 2017 to 2019 for all patients with EDH with a Glasgow Coma Scale score greater than or equal to 13 who were non-surgically treated. A multivariable logistic regression (MLR) was performed to identify risk factors associated with mortality in this patient group (Alpha=0.05).</div></div><div><h3>Results</h3><div>The MLR included 12,634 patients who survived and 245 patients who died during their hospital stay. Older age (OR=1.056, 95 % CI: 1.047–1.065), congestive heart failure (OR=1.708, 95 % CI: 1.079–2.705), chronic renal failure (OR=2.727, CI: 1.577–4.713), anticoagulant therapy (OR=1.428, 95 % CI: 1.019–2.001), and cirrhosis (OR=3.027, 95 % CI: 1.436–6.380)) were associated with increased odds of mortality.</div></div><div><h3>Conclusion</h3><div>Among patients that present with a low-severity acute EDH who were treated non-surgically, this study indicates that risk factors for mortality include older age, congestive heart failure, chronic renal failure, anticoagulant therapy, and cirrhosis. Our findings highlight comorbidities that significantly increase mortality risk, underscoring the need for increased vigilance and consideration of surgical intervention in patients meeting these criteria, even when conservative management is initially pursued. Further research is warranted to determine how to mitigate the mortality risk in these patients.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"249 ","pages":"Article 108764"},"PeriodicalIF":1.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}