Clinical Neurology and Neurosurgery最新文献

{"title":"Case report: Spontaneous improvement and treatment considerations in leukoencephalopathy with calcifications and cysts","authors":"","doi":"10.1016/j.clineuro.2024.108517","DOIUrl":"10.1016/j.clineuro.2024.108517","url":null,"abstract":"<div><p>We present the case of a patient with leukoencephalopathy with calcifications and cysts (LCC), who experienced progressive severe hemiparesis despite multiple neurosurgical interventions of a large contralateral cyst. Bevacizumab was proposed as an ultimate treatment option based on prior case reports. While awaiting reimbursement approval for bevacizumab, major improvement occurred in both clinical and radiological disease manifestations. The disease course of LCC is variable and unpredictable; neurosurgical treatment should be reserved for severe and progressive neurological deficits. Bevacizumab has been reported as a promising alternative treatment option. Importantly, in our case the observed clinical improvement would have been attributed to the effects of bevacizumab, if started when requested. Our case underscores the need for a natural history study for LCC and the necessity of validating treatment efficacy by systematic evaluation through appropriate clinical trials rather than relying on anecdotal evidence from published case reports.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0303846724004049/pdfft?md5=85173cfdcc180efb2213767b3b3fca02&pid=1-s2.0-S0303846724004049-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021249","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":"Mathematical modeling of meningioma volume change after radiation treatment","authors":"","doi":"10.1016/j.clineuro.2024.108513","DOIUrl":"10.1016/j.clineuro.2024.108513","url":null,"abstract":"<div><h3>Objective</h3><p>Meningiomas are the most common primary central nervous tumor and are often treated with radiation therapy. This study examines the long-term volumetric changes of intracranial meningiomas in response to radiation therapy. The objective is to analyze and model the volumetric changes following treatment.</p></div><div><h3>Methods</h3><p>Data from a retrospective single-institution database (2005–2015) were used, with inclusion criteria being patients with a diagnosis of meningiomas, along with additional inclusion criteria consisting of treatment with radiation, having at least three magnetic resonance imaging (MRI) scans with one or more before and after radiation treatment, and the patients following up for at least eighteen months. Exclusion criteria consisted of patients less than 18 years old, patients receiving surgery and/or adjuvant chemotherapy following radiation, and patients without any available details regarding radiation treatment parameters. Tumor volumes were measured via T1-weighted post-contrast MRI and calculated using the ABC/2 ellipsoidal approximation, a method allowing for the measurement of non-linear growth volume reduction.</p></div><div><h3>Results</h3><p>Of 48 meningioma patients considered, 10 % experienced post-radiation growth, while 75 % witnessed a ≥50 % decrease in volume over a follow-up period of 0.3–14.9 years. Median decay rate was 0.81, and within 1.17 years, 90 % achieved the predicted volume reduction. Predicted vs. actual volumes showed a mean difference of 0.009 ± 0.347 cc. Initial tumor volumes strongly correlated (Pearson’s R=0.98, R-squared=0.96) with final asymptotic volumes, which had a median of 1.50 cc, with interquartile range (IQR) = [0.39, 3.67].</p></div><div><h3>Conclusion</h3><p>90 % of patients achieved tumor-volume reduction at 1.17 years post-treatment, reaching a non-zero asymptote strongly correlated with initial tumor volume, and 75 % experienced at least a 50 % volume decrease. Individual volume changes for responsive meningiomas can be modeled and predicted using exponential decay curves.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040125","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":"Progression predictors of clinically isolated syndrome to multiple sclerosis: A prospective study in China","authors":"","doi":"10.1016/j.clineuro.2024.108514","DOIUrl":"10.1016/j.clineuro.2024.108514","url":null,"abstract":"<div><h3>Objectives</h3><p>Clinically isolated syndrome (CIS) is a preclinical phase of multiple sclerosis (MS). The progression rate of CIS to clinical definite MS (CDMS) varies significantly across different populations, and identifying predictors of progression is crucial for early diagnosis and treatment. We aimed to investigate predictors of progression from CIS to CDMS in a Chinese cohort.</p></div><div><h3>Methods</h3><p>A single-center cohort study was conducted with newly diagnosed patients with CIS in China between 2018 and 2021. All patients underwent a comprehensive clinical evaluation, including neurological examination, magnetic resonance imaging, and laboratory tests. Follow-up assessments were conducted at regular intervals to monitor disease progression. Progression to CDMS was defined according to the 2017 McDonald criteria. Age, sex, Expanded Disability Status Scale (EDSS) score, number of patients with magnetic resonance imaging gadolinium-enhancing (Gd+) lesions, T2 lesions and Gd+ lesions count, CSF cell count, CSF total protein, CSF and serum neurofilament light chain (NfL), progranulin (PGRN) and Th17-related cytokines (IL-6, IL-17, IL-21, IL-22, IL-23 and TGF-β) were measured for association with risk of progression to CDMS.</p></div><div><h3>Results</h3><p>A total of 96 CIS patients were recruited in the study. During the at least 24 months follow-up period, 57 (59.38 %) CIS patients progressed to CDMS, while 39 (40.62 %) patients without progression remained stable as CIS. Multivariate analysis revealed that younger age at onset (OR= 43.43, 95 % CI= 1.76–1071.68, p&lt;0.021), higher CSF elevated protein (OR=58.64, 95 % CI=2.72–1264.51, p=0.009), higher CSF NfL levels (OR= 97.00, 95 % CI= 4.68–2012.99, p=0.003) and higher CSF IL-23 levels (OR= 412.02, 95 % CI=6.56–25869.60, p=0.004) were associated with high risk of progression to CDMS.</p></div><div><h3>Conclusion</h3><p>Younger age at onset, elevated CSF NfL, IL-23 and protein levels might be progression predictors of CIS to CDMS in Chinese population.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142021248","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":"Reconstructive treatment using stent placement for type IIa+b lateral sinus dural arteriovenous fistulas complicated with sinus occlusion","authors":"","doi":"10.1016/j.clineuro.2024.108515","DOIUrl":"10.1016/j.clineuro.2024.108515","url":null,"abstract":"<div><h3>Background</h3><p>Cognard type IIa+b dural arteriovenous fistulas (DAVFs) in the lateral sinuses are often complicated with venous sinus obstruction and accompanied by clinical symptoms and a risk of hemorrhage. The purpose of this study was to assess venous sinus stenting as a viable alternative treatment in complex lateral sinus DAVFs and examine its efficacy and safety.</p></div><div><h3>Methods</h3><p>We retrospectively examined patients diagnosed with type IIa+b DAVF in the transverse or sigmoid sinus with associated venous sinus occlusion who were treated via stent placement between April 2017 and June 2019.</p></div><div><h3>Results</h3><p>Six patients were included in this study. Three patients had DAVFs in both the transverse and sigmoid sinuses, two in the transverse sinus and confluence of sinuses, and one in the transverse sinus. The most common symptoms were headache, dizziness, and limb weakness. At the last follow-up, three patients had significant improvement, and three were asymptomatic. Angiograms performed immediately after the surgery showed restoration of the anterograde venous drainage in all patients. According to the follow-up angiography results, two DAVFs were completely obliterated, and four remained as stable type I DAVFs. Most patients had satisfactory venous sinus drainage, except one who had in-stent stenosis.</p></div><div><h3>Conclusions</h3><p>Stent placement can restore sinus patency, improve clinical symptoms, and decrease intracranial hemorrhage risk. This approach may be an effective option for treating type IIa+b lateral DAVFs complicated by sinus occlusion.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040411","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":"Design of the “EAST” strategy in patients with asymptomatic intracranial atherosclerotic stenosis","authors":"","doi":"10.1016/j.clineuro.2024.108507","DOIUrl":"10.1016/j.clineuro.2024.108507","url":null,"abstract":"<div><h3>Introduction</h3><p>Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide and confers a high risk of stroke recurrence, despite aggressive medical therapy. Asymptomatic ICAS (aICAS) is a frequent finding on neuroimaging, and it’s an independent risk factor for future stroke. Alirocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9) and effectively lower low-density lipoprotein cholesterol levels. We hypothesize that extra alirocumab in addition to statin therapy (EAST) could stabilize intracranial plaques in patients with aICAS.</p></div><div><h3>Methods and analysis</h3><p>In this prospective, randomized, open-label, blinded end-point study, we will use high-resolution vessel-wall magnetic resonance imaging (HR-vwMRI) to evaluate the efficacy and safety of alirocumab in patients with asymptomatic ICAS. Eighty patients with aICAS (50 %-99 %) caused by unstable plaques will be assigned to the arm of alirocumab plus statin therapy, or the arm of statin therapy in a 1:1 ratio. Patients will undergo HR-vwMRI at recruitment and after 6 months. The primary outcome is changes in plaque features evaluated by HR-vwMRI after 6 months’ treatment. This trial is being conducted at the first affiliated hospital of Nanjing medical university, China.</p></div><div><h3>Ethics and dissemination</h3><p>The study has been approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University. Written informed consents will be obtained from all participants. Study results will be published as peer-reviewed articles.</p></div><div><h3>Trial registration number</h3><p>ClinicalTrials.gov, Identifier: NCT06080256.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142048098","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 prominence of Oligoclonal Bands for clinical conversion in Radiologically isolated syndrome: 10-year follow-up study in Isfahan, Iran","authors":"","doi":"10.1016/j.clineuro.2024.108509","DOIUrl":"10.1016/j.clineuro.2024.108509","url":null,"abstract":"<div><h3>Background</h3><p>Since data is limited on radiologically isolated syndrome (RIS) subjects in certain regions like the Middle East, we aimed to further explore the replicability and generalizability of previously suggested predictors among a cohort of Iranian RIS subjects and report the long-term clinically definite MS (CDMS) conversion rate in this cohort.</p></div><div><h3>Methods</h3><p>We conducted a prospective 10-year cohort on our RIS participants, during which we collected the MRI, paraclinical, and demographic data of the subjects, and identified those who converted to CDMS.</p></div><div><h3>Results</h3><p>Out of 35 participants, 10 (28.5 %) developed CDMS during an average of 5.58 ± 3.08 years (range: 4 months to 10.33 years). OCB positivity was the only definitive predictor for conversion to CDMS in this cohort (P-value = 0.006), but other previously reported risk factors such as spinal cord lesions or age lacked statistical significance (P-values &gt; 0.05). We also reported the median survival time as 114 months, the proportion surviving after 14 months as 96.9 % ± 3.1 %, and the overall conversion rate as 0.05 cases per year.</p></div><div><h3>Conclusion</h3><p>Our results highlight OCB as an important predictive factor of clinical conversion in RIS. The prominence of OCB suggests a need for routine CSF analysis in RIS subjects and could guide clinicians in deciding which RIS subjects benefit from DMTs.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142012762","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":"Management of split cord malformation and tethered cord syndrome: Experience of a main referral center in Uzbekistan","authors":"","doi":"10.1016/j.clineuro.2024.108510","DOIUrl":"10.1016/j.clineuro.2024.108510","url":null,"abstract":"<div><h3>Background</h3><p>Split cord malformation and tethered cord syndrome are challenging pathologies in the pediatric population. During 2016–2022, 56 cases of split cord malformation (SCM) and tethered cord syndrome were treated at the Republican Specialized Scientific Medical Practical Center of Neurosurgery (RSSMPCN) of Uzbekistan. This article aims to provide a retrospective analysis of the clinical presentation, radiological findings, and surgical outcomes of patients with split cord malformation and tethered cord syndrome.</p></div><div><h3>Methods</h3><p>The retrospective study was conducted for 56 pediatric patients with split cord malformation and tethered cord syndrome during the abovementioned six-year period. All patients underwent MR imaging with computed tomography, followed by surgery with intraoperative neurophysiological monitoring. Each patient underwent follow-up examinations at 3 and 6 months postoperatively and yearly thereafter.</p></div><div><h3>Results</h3><p>The mean patient age was 5.7 years (10 months to 15 years), and the male-to-female ratio was 1:2.2. Encouragingly, 44 (78.6 %) of the 56 patients showed improved neurological status postoperatively. Even in the cases where spur resection procedures were performed, there was partial neurological improvement, demonstrating the overall positive outcomes of the surgeries. Importantly, none of the 56 patients had neurological deteriorations in the postoperative period</p></div><div><h3>Conclusions</h3><p>Split cord malformation is a rare but challenging pathology of childhood. The presentation is primarily characterized by movement, sensory or bowel disorders, and back and leg pain. This underscores the importance of early recognition and intervention when neurological symptoms are evident. Surgical intervention, as demonstrated in our study, is both appropriate and efficient in improving the neurological status of the patients.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141997813","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":"Implications of surgical infection on surgical and hospital outcomes after spine surgery: A NSQIP study of 410,930 patients","authors":"","doi":"10.1016/j.clineuro.2024.108505","DOIUrl":"10.1016/j.clineuro.2024.108505","url":null,"abstract":"<div><h3>Study design</h3><p>Retrospective cohort study.</p></div><div><h3>Objectives</h3><p>Surgical infections are unfortunately a fairly common occurrence in spine surgery, with rates reported as high as 16 %. However, there is a relative paucity of studies that look to understand how surgical infections may impact outcome variables. The aim of this study was to assess the impact of surgical infection on other perioperative complications, extended hospital length of stay (LOS), discharge disposition, and unplanned readmission following spine surgery.</p></div><div><h3>Methods</h3><p>A retrospective cohort study was performed using the 2016–2022 ACS NSQIP database. Adults receiving spine surgery for trauma, degenerative disease, and tumors were identified using CPT and ICD-9/10 codes. Patients were divided into two cohorts: surgical infection (superficial surgical site infection, deep surgical site infection, organ space surgical site infection, or wound dehiscence) and no surgical infection (those who did not experience any infection). Patient demographics, comorbidities, intraoperative variables, postoperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analysis was utilized to identify predictors of AEs, extended hospital length of stay, non-routine discharge, and unplanned readmission.</p></div><div><h3>Results</h3><p>In our cohort of 410,930 patients, 7854 (2.2 %) were found to have experienced a surgical infection. Regarding preoperative variables, a greater proportion of the surgical infection cohort was a female (<em><u>p &lt; 0.001</u></em>) and had a higher mean BMI (<em><u>p &lt; 0.001</u></em>), greater frailty and ASA scores (<em><u>p &lt; 0.001</u></em>), and higher rates of all presenting comorbidities included in the study. Rates of AEs (<em><u>p &lt; 0.001</u></em>), unplanned readmission (<em><u>p &lt; 0.001</u></em>), reoperation (<em><u>p &lt; 0.001</u></em>), non-home discharge (<em><u>p &lt; 0.001</u></em>), and 30-day mortality were all greater in the surgical infection group when compared to the group without surgical infection. On multivariate analysis, surgical infection was found to be an independent predictor of experiencing postoperative complications [a<em>OR: 6.15, 95 % CI: (5.72, 6.60), <u>p &lt; 0.001</u></em>], prolonged LOS [<em>2.71, 95 % CI: (2.54, 2.89), <u>p &lt; 0.001</u></em>], non-routine discharge [a<em>OR: 1.74, 95 % CI: (1.61, 1.88), <u>p &lt; 0.001</u></em>], and unplanned readmission [a<em>OR: 22.57, 95 % CI: (21.06, 24.19), <u>p &lt; 0.001</u></em>].</p></div><div><h3>Conclusions</h3><p>Our study found that surgical infection increases the risk of complications, extended LOS, non-routine discharge, and unplanned readmission. Such findings warrant further studies that aim to validate these results and identify risk factors for surgical infections.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035405","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":"Transcranial doppler ultrasound for the diagnosis of large vessel occlusion in patients with acute ischemic stroke: A systematic review","authors":"","doi":"10.1016/j.clineuro.2024.108506","DOIUrl":"10.1016/j.clineuro.2024.108506","url":null,"abstract":"<div><h3>Introduction</h3><p>Transcranial Doppler (TCD) ultrasound may enhance the swift diagnosis of large vessel occlusion (LVO) in patients with a clinical suspicion of acute ischemic stroke (AIS). This is a comprehensive review of the literature on the use and performance of TCD ultrasound in diagnosing AIS caused by LVO.</p></div><div><h3>Patients and methods</h3><p>We conducted a systematic search in PubMed and Google scholar to identify studies reporting data on TCD biomarkers for LVO diagnosis and management of AIS. The main outcomes of interest were the identified TCD-derived biomarkers performances (specificity, sensitivity, predictive values) for LVO diagnosis.</p></div><div><h3>Results</h3><p>A total of 170 studies were screened, of which 7 (4.1 %) studies with a total of 2260 patients (mean age: 65.3 +/- 4.5 years, 1114 (49.3 %) females) were included in this review. Most of the studies were prospective (n=5, 71.4 %), all of the studies had an overall low risk of bias. In 6 studies (85.7 %), TCD was used at the time of hospital admission, on triage field in one study in the context of a confirmed AIS. A total of six TCD based biomarkers were described in the included articles, with high accuracies for LVO diagnosis (ranging from 85.9 % to 99.2 %). Pulsatility Index had the highest reported performances in terms of Accuracy for LVO diagnosis (ranging from 96 % to 99.2 %). Authors reported suboptimal temporal windows for data acquisition in 13–19.7 % of patients.</p></div><div><h3>Conclusion</h3><p>TCD is as a promising non-invasive and cost-effective tool for LVO diagnosis, presenting opportunities to enhance stroke management.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0303846724003937/pdfft?md5=d081fe9d5c86962f4c4f1491074be2f5&pid=1-s2.0-S0303846724003937-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141919220","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":"A systematic review and meta-analysis on glycemic control in traumatic brain injury","authors":"","doi":"10.1016/j.clineuro.2024.108504","DOIUrl":"10.1016/j.clineuro.2024.108504","url":null,"abstract":"<div><h3>Background</h3><p>Hyperglycemia is associated with adverse outcomes in patent with traumatic brain injury. There is convincing evidence of the deleterious effects of early systemic hyperglycemia on neurological outcomes and guides management toward intensive glycemic control. The purpose of this systematic review and meta analysis is to evaluate and summarize the level of evidence on the role of glycemic control in traumatic brain injury.</p></div><div><h3>Methods</h3><p>A systematic review and meta-analysis were performed following PRISMA guidelines. This review involved studies conducted in humans covering glycemic control in traumatic brain injury. A systematic literature search was performed in PubMed, Embase, EBSCO Host, Scopus, ScienceDirect, Medline, and LILACS from database inception to October 2020. The risk of bias was evaluated with the GRADE quality Scale.</p></div><div><h3>Results</h3><p>The results of this meta-analysis that involved 1236 patients included in 10 studies suggest that intensive glycemic control did not show significant differences in mortality compared with conservative management (RR 0.99 [95 % CI 0.81–1.21] p = 0.92). Intensive glycemic control reduced the risk of unfavorable clinical outcomes compared to standard management (RR 0.87 [95 % CI 0.78–0.96] p = 0.007) and increased favorable clinical outcomes compared to standard neurocritical care (RR 1.19 [95 % CI 1.02–138] p = 0.003).</p></div><div><h3>Conclusions</h3><p>The possible effect of glycemic control could be associated with silent hypoglycemic episodes during intensive care. Further studies evaluating the impact of glycemic control in traumatic brain injury are necessary.</p></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141979464","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}