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Pakistan Journal of Medical Sciences 2024To explore the effects of clinical nursing pathway (CNP) on the postoperative satisfaction and quality of life (QOL) of patients with subarachnoid hemorrhage (SAH).
OBJECTIVE
To explore the effects of clinical nursing pathway (CNP) on the postoperative satisfaction and quality of life (QOL) of patients with subarachnoid hemorrhage (SAH).
METHODS
This is a retrospective study. Eighty patients with SAH admitted to Baoding No.1 Central Hospital from June 2021 to January 2023 were prospectively divided into a observation group and a control group by random numbers. The control group was given routine nursing, and the observation group was additional given CNP. The prognosis, cognitive function, QOL, self-care ability, nursing satisfaction and the incidence of complications were compared between the two groups.
RESULTS
After CNP nursing, the GCS and MMSE scores in the observation group were higher than those in the control group 14 days, one month and six months after the operation; and the difference was statistically significant (p< 0.05). Six months after the operation, the SS-QOL and Ability of daily living (ADL) scores in both groups were significantly improved compared with those before the intervention; and the improvement in the observation group was significantly better than that in the control group; and the difference was statistically significant(p<0.05). The nursing satisfaction score in the observation group was significantly higher than in the control group. The total incidence of complications in the observation group was lower than that in the control group.
CONCLUSIONS
The CNP intervention in perioperative period of SAH patients has remarkable clinical effect, can improve the pertinence and efficiency of nursing, promote patients to recover as soon as possible, significantly improve the QOL of patients,and is worthy of clinical popularization.
PubMed: 38544986
DOI: 10.12669/pjms.40.4.7800 -
Journal of Clinical Medicine Mar 2024In patients with Chiari 1.5 malformation (CM1.5), a more aggressive disease course and an increased association with craniovertebral junction (CVJ) anomalies has been...
In patients with Chiari 1.5 malformation (CM1.5), a more aggressive disease course and an increased association with craniovertebral junction (CVJ) anomalies has been suggested. The best management of this subgroup of patients is not clearly defined, also due to the lack of specific series elucidating this anomaly's peculiar characteristics. We evaluated a series of 33 patients (25 females, 8 males; mean age at surgery: 13 years) fulfilling the criteria for Chiari 1.5 diagnosis who underwent posterior fossa decompression and duraplasty (PFDD) between 2006 and 2021. Headache was present in all children, five presented central apnea, five had dysphagia, and three had rhinolalia. Syringomyelia was present in 19 (58%) children. Twenty patients (61%) showed various CVJ anomalies, but only one child presented instability requiring arthrodesis. The mean tonsil displacement below the foramen magnum was 19.9 mm (range: 12-30), without significant correlation with the severity of symptoms. Syringomyelia recurred or was unchanged in three patients, and one needed C1-C2 fixation. The headache disappeared in 28 children (84%). Arachnoid opening and tonsil coagulation or resection was necessary for 19 children (58%). In our pediatric CM series, the need for tonsil resection or coagulation was higher in CM1.5 children due to a more severe crowding.
PubMed: 38541933
DOI: 10.3390/jcm13061708 -
Veterinary Sciences Mar 2024This retrospective study aimed to report the surgical treatment and outcomes of laminectomies followed by durotomy and the application of a non-synthetic collagen matrix...
This retrospective study aimed to report the surgical treatment and outcomes of laminectomies followed by durotomy and the application of a non-synthetic collagen matrix dura substitute (Durepair) in ten dogs with a spinal subarachnoid diverticulum (SAD). The medical records of these ten client-owned dogs with SAD diagnosed by magnetic resonance imaging (MRI) were reviewed. All patients had chronic and progressive deficits. At presentation, common neurological signs were proprioceptive ataxia, ambulatory spastic paraparesis or tetraparesis, and faecal incontinence. Dorsal thoracolumbar laminectomy was performed in eight dogs; one dog underwent cervical dorsolateral laminectomy, and one patient had thoracic hemilaminectomy. Laminectomies were followed by durotomy, allowing the dissection of the pia-arachnoid adhesions. A rectangular patch of a non-synthetic dura substitute was applied as an onlay graft over the durotomy site before routine closure. Proprioceptive ataxia, paraparesis, and tetraparesis improved in all patients. Faecal incontinence in one patient resolved postoperatively. Laminectomy, durotomy, and the application of a non-synthetic dura substitute was a safe procedure facilitating postoperative improvement over a long-term follow-up period (from 9 to 40 months).
PubMed: 38535862
DOI: 10.3390/vetsci11030128 -
Journal of Neurosurgery. Case Lessons Mar 2024Spinal arachnoiditis can result from various factors, including spinal subarachnoid hemorrhage (sSAH). In this paper, the authors describe a case of intradural...
BACKGROUND
Spinal arachnoiditis can result from various factors, including spinal subarachnoid hemorrhage (sSAH). In this paper, the authors describe a case of intradural extramedullary cavernoma with an initial presentation of subarachnoid hemorrhage leading to multilevel spinal arachnoiditis to discuss the pathophysiology and optimal treatment strategy.
OBSERVATIONS
Spinal intradural extramedullary cavernoma manifesting with sSAH is a rare clinical presentation; therefore, there is no clear strategy for the management of sSAH. Spinal arachnoiditis is a result of chronic inflammation of the pia arachnoid layer due to hematomyelia. No effective treatment that interrupts this inflammatory cascade and would also prevent the development of spinal arachnoiditis has been described to date.
LESSONS
Lumbar drainage could aid in sSAH management, relieve spinal cord compression, and restore the normal spinal cerebrospinal fluid circulation gradient. It could help to clear the blood degradation products rapidly and prevent early inflammatory arachnoiditis development. Mini-invasive intrathecal endoscopic adhesiolysis appears to be a reasonable approach for reducing the risk of aggravating spinal arachnoiditis with a mechanical-surgical stimulus. Whether a conservative approach should be applied in these patients with mild myelopathy symptoms is still debatable.
PubMed: 38531082
DOI: 10.3171/CASE2417 -
Radiology Case Reports May 2024Arachnoid cysts, fluid-filled lesions within the central nervous system, pose diagnostic challenges. This study examines a unique case of a quadrigeminal arachnoid cyst...
Arachnoid cysts, fluid-filled lesions within the central nervous system, pose diagnostic challenges. This study examines a unique case of a quadrigeminal arachnoid cyst in a 13-year-old girl, emphasizing accurate identification and treatment. The patient's symptoms of blurred vision and headaches led to the discovery of papilledema and imaging revealing a sizable cyst causing obstructive hydrocephalus. Urgent surgical intervention involved suboccipital craniectomy and infratentorial-supracerebellar cyst drainage, resulting in favorable postoperative outcomes. Further analysis of anatomical variations, age-related factors, and etiological debates deepens understanding. Diagnostic advancements, notably MRI, are crucial for noninvasive characterization. This case offers nuanced insights into managing arachnoid cysts, highlighting the success of tailored surgical strategies. Recognizing clinical subtleties, utilizing diagnostic innovations, and customizing surgical techniques are essential for navigating complexities. This study underscores the importance of a comprehensive approach in addressing the challenges of arachnoid cysts within the central nervous system.
PubMed: 38523695
DOI: 10.1016/j.radcr.2024.02.048 -
Annals of Indian Academy of Neurology 2024Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between the arachnoid membrane and the dura mater. Atorvastatin is of...
Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between the arachnoid membrane and the dura mater. Atorvastatin is of increasing clinical interest for CSDH. We performed a meta-analysis of published randomized controlled trials (RCTs) and used objective data as the primary outcomes to provide an evidence-based analysis of the efficacy of atorvastatin for CSDH treatment. Databases of MEDLINE (via PubMed), EMBASE, the Cochrane Library, Scopus, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure (CNKI), Cqvip database (CQVIP), and Wanfang database were systematically searched for RCTs reporting the use of atorvastatin for CSDH treatment. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were used as summary statistics. I-square () test was performed to assess the impact of study heterogeneity on the results of the meta-analysis. Nine relevant RCTs with 611 patients were identified for inclusion in this meta-analysis. Compared to controls, atorvastatin treatment had a significantly higher effectiveness (OR: 7.41, 95% CI: 3.32-16.52, < 0.00001, = 0%), lower hematoma volume (SMD: -0.46. 95% CI: -0.71 to -0.20, = 0.0005, = 0%), higher activities of daily living-Barthel Index (ADL-BI) (SMD: 2.07, 95% CI: 1.06-3.09, < 0.0001, = 92%), and smaller Chinese stroke scale (CSS) (SMD: -1.10, 95% CI: -1.72 to -0.48, = 0.0005, = 57%). In view of these findings, we conclude that the outcomes of experimental group are superior to the control group with respect to effectiveness, hematoma volume, ADL-BI, and CSS based on nine RCTs with 611 patients. Atorvastatin is beneficial to CSDH patients without surgery.
PubMed: 38495243
DOI: 10.4103/aian.aian_818_23 -
World Neurosurgery May 2024Chiari malformation is characterized by inferior displacement of the cerebellar tonsils through the foramen magnum, frequently resulting in strain related headaches, and...
BACKGROUND
Chiari malformation is characterized by inferior displacement of the cerebellar tonsils through the foramen magnum, frequently resulting in strain related headaches, and motor/sensory dysfunction. Chiari decompression technique varies significantly, possibly contributing to frequent revisions. We reviewed revision Chiari decompressions at our institution to determine the primary indications for revision and outcomes after revision.
METHODS
We retrospectively reviewed patients who underwent revision of Chiari decompression at our institution from 2005 to 2020. Demographics, indications for revision surgery, operative techniques, imaging findings, and preoperative/postoperative symptoms were collected. χ test was performed to determine statistical significance using a P < 0.05. Independent predictors of operative outcomes were identified.
RESULTS
A total of 46 patients (91% females, mean age 38.8 years) were included for analysis. The median time to revision surgery was 69.1 months (range 0-364 months) with headache (n = 37, 80%) being the most commonly recurring symptom. Large craniectomy (n = 28, 61%) was the most frequent indication for revision surgery. Thirty-two (70%) patients underwent cranioplasty, 20 (43%) required duraplasty, 15 (33%) required arachnoid dissection, and 15 (33%) required tonsillar reduction during revision surgery. Postrevision follow-up (at 8.9 ± 5.2 months average, range 1-18 months), revealed an average reduction in all Chiari-related symptoms relative to symptoms before the revision.
CONCLUSIONS
The most common indication for revision Chiari decompression was a large craniectomy resulting in cerebellar ptosis. We found that tonsillar reduction paired with modest craniectomy achieved near-complete resolution of symptoms with minimal complications. For patients with recurrent or persistent sequelae of Chiari malformation after decompression, revision may reduce symptom severity.
Topics: Humans; Arnold-Chiari Malformation; Female; Male; Reoperation; Adult; Decompression, Surgical; Retrospective Studies; Middle Aged; Treatment Outcome; Young Adult; Cohort Studies; Decompressive Craniectomy; Postoperative Complications
PubMed: 38490446
DOI: 10.1016/j.wneu.2024.03.026 -
Der Nervenarzt Jun 2024
Topics: Humans; Arachnoid Cysts; Alzheimer Disease; Diagnosis, Differential; Magnetic Resonance Imaging; Female; Male; Aged
PubMed: 38483549
DOI: 10.1007/s00115-024-01638-0 -
Journal of Veterinary Internal Medicine 2024Intervertebral disc herniation is widely recognized as the most common cause of myelopathy in dogs older than 2 years; however, the prevalence of various causes of...
BACKGROUND
Intervertebral disc herniation is widely recognized as the most common cause of myelopathy in dogs older than 2 years; however, the prevalence of various causes of myelopathy in younger dogs has not been reported.
HYPOTHESIS/OBJECTIVES
To describe the prevalence, clinical presentation, and etiology of myelopathy in dogs aged 18 months or less. Secondarily, to investigate which clinical features were associated with each of the most common etiologies.
ANIMALS
Two hundred twenty-four dogs aged 18 months or less with myelopathy were included in the study.
METHODS
Retrospective review of clinical records from 4 referral institutions. Multivariable logistic regression analyses assessed which clinical features were associated with each diagnosis.
RESULTS
French bulldogs (n = 51, 22.8%), pugs (n = 18, 8.0%), crossbreeds (n = 12, 5.4%), and English bulldogs (n = 11, 4.9%) were the most frequently affected breeds. Overall, 31 diagnoses were reached. The 5 most frequent diagnoses were vertebral malformation (VM; n = 42, 18.8%), spinal arachnoid diverticulum (SAD; n = 28, 12.5%), traumatic fracture of the vertebral column (n = 22, 9.8%), atlantoaxial instability (n = 18, 8.0%), and osseous-associated cervical spondylomyelopathy (n = 17, 7.6%). Intervertebral disc extrusion (IVDE) accounted for 4.5% of cases (n = 10). A final diagnosis of VM was associated with younger, screw-tailed, and pug breeds with chronic signs of T3-L3 myelopathy. SAD was associated with screw-tailed and pug breeds with nonpainful clinical signs. Intervertebral disc extrusion was associated with older, screw-tailed, and pug breeds with shorter duration of clinical signs.
CONCLUSIONS AND CLINICAL IMPORTANCE
Prioritization of differential diagnoses for dogs presenting with signs of myelopathy when aged 18 months or less should differ to those for older dogs, with IVDE not the most common cause in the former.
Topics: Animals; Dogs; Dog Diseases; Retrospective Studies; Spinal Cord Diseases; Male; Female; Prevalence; Intervertebral Disc Displacement
PubMed: 38483074
DOI: 10.1111/jvim.17045