Search Results (54)

Background: Decompressive craniectomy (DC) is a life-saving procedure for severe traumatic brain injury (TBI); however, its long-term outcomes remain controversial. Cranioplasty traditionally performed to restore cranial integrity, has been increasingly recognized for its potential role in neurological recovery. This study aimed to investigate the impact of cranioplasty timing and status on long-term mortality and functional outcomes after DC for severe TBI. Methods: We retrospectively reviewed 151 patients who underwent DC between 2014 and 2018. Patients were categorized into three groups according to cranioplasty timing: early (<3 months), late (≥3 months), and no cranioplasty. Clinical and radiologic data, including the Rotterdam CT scores, were analyzed. The primary endpoints were 5-year mortality and 12-month functional outcome assessed by the Glasgow Outcome Scale (GOS). Univariate and multivariate logistic regression analyses identified independent predictors and receiver operating characteristic (ROC) curves with are under the curve (AUC) values evaluated model performance. Results: Of 151 eligible patients (mean age = 53.9 ± 17.4 years; 82.1% male), overall 5-year mortality was 76.8% (116/151). Mortality differed substantially by cranioplasty group: 64.5% in early cranioplasty, 70.8% in late cranioplasty, and 82.3% in patients who did not undergo cranioplasty. Unfavorable 12-month functional outcomes occurred in 45.2%, 79.2%, and 91.7% of these groups, respectively. In multivariate analysis, no cranioplasty independently predicted both higher 5-year mortality (OR = 2.78, 95% CI = 1.06–7.25, p = 0.038) and unfavorable functional outcome (OR = 3.09, 95% CI = 1.18–8.09, p = 0.022). Older age was also associated with increased mortality (p = 0.019). ROC analysis showed moderate discriminative performance for 5-year mortality (AUC = 0.71) and good discrimination for unfavorable functional outcome (AUC = 0.80). Conclusions: Absence of cranioplasty was associated with higher long-term mortality and poorer functional recovery following DC for severe TBI. Early cranioplasty may enhance cerebral restoration and rehabilitation potential, improving both survival and neurological outcomes. Full article

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) has persistently low survival rates. While advanced airway management (AAM) is crucial during cardiopulmonary resuscitation, optimal timing remains unclear. This study examined the association between early AAM and clinical outcomes in adult OHCA patients. Methods: This retrospective study analyzed Korean nationwide OHCA registry data (August 2019–December 2022). Adult patients with emergency medical service-treated OHCA of presumed medical origin receiving AAM were included. Early AAM was defined as airway placement within 5 min of CPR initiation. Time-dependent propensity score matching controlled for selection bias and time-related confounding. Structural equation modeling examined associations between AAM timing and other prehospital interventions. Primary outcome was survival to hospital discharge with good neurological recovery (cerebral performance category 1–2). Results: Among 51,869 patients receiving AAM, 27,591 received early AAM and 24,278 received delayed AAM. After propensity score matching, 12,014 patients were included per group with balanced characteristics. Early AAM was associated with higher prehospital return of spontaneous circulation (11.8% vs. 10.5%; adjusted RR 1.21, 95% CI 1.12–1.29) and favorable neurological recovery (5.8% vs. 5.1%; adjusted RR 1.12, 95% CI 1.01–1.23). AAM timing correlated with timing of other critical interventions, including rhythm analysis and epinephrine administration. Conclusions: Early AAM within 5 min of CPR initiation was associated with improved neurological outcomes and increased prehospital ROSC in OHCA. Airway timing may indicate overall resuscitation quality, emphasizing the importance of coordinated, timely prehospital interventions. Full article

Background/Objectives: The association of scene time interval (STI) and field arrival to epinephrine administration time (FET) with outcomes in out-of-hospital cardiac arrest (OHCA) is unknown. The goal of this investigation is to assess the association of STI and FET with outcomes in OHCA. Methods: All adult OHCA cases with prehospital epinephrine administration in South Korea and Singapore were included. STI was divided into short and long stay based on the median value of each country. FET was categorized into early (<10 min) and late groups. We performed multivariable logistic regression for survival to discharge and good neurological recovery. Cases were grouped into short stay early epinephrine (SS-EE), short stay late epinephrine (SS-LE), long stay early epinephrine (LS-EE), and long stay late epinephrine (LS-LE) (reference). Interaction analysis with STI and FET for outcomes was conducted. Results: A total of 18,867 cases from South Korea and 4184 cases from Singapore were included. Adjusted odds ratio (AOR) for survival to discharge was 2.14 (95% CI: 1.18–2.25) in SS-EE, 1.15 (0.94–1.40) in SS-LE, and 1.82 (1.45–2.28) in LS-EE compared to LS-LE in South Korea with similar results for Singapore. SS-EE and LS-EE were also associated with good neurologic recovery. Interaction analysis showed that early epinephrine injection in short stay and long stay was associated with better outcomes. But short STI was not associated with better outcomes in early and late epinephrine groups. Conclusions: Early epinephrine administration was associated with higher survival to discharge irrespective of the scene time interval. Full article

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality, and outcomes may be influenced by underlying conditions such as cancer, hypertension (HTN), and diabetes mellitus (DM). This study aimed to evaluate whether HTN and DM modify the effects of post-resuscitation treatments—specifically targeted temperature management (TTM) and percutaneous coronary intervention (PCI)—on survival and neurological recovery in OHCA patients with a history of cancer. Methods: This retrospective cohort study analyzed data from the Korean national OHCA registry between January 2018 and December 2021. Adults aged ≥18 years with presumed cardiac-origin OHCA and a documented history of cancer—defined as any prior cancer diagnosis recorded in medical records regardless of remission status—were included. Multivariable logistic regression was used to examine associations between treatment and outcomes, and interaction effects were assessed using adjusted p-values to account for multiple testing. Results: Among the 124,916 EMS-assessed OHCA cases, 4115 patients met the inclusion criteria. TTM and PCI were both statistically associated with good neurological recovery (TTM: adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.12–2.55; p < 0.05; PCI: aOR, 11.35; 95% CI, 7.98–16.14; p < 0.05). In interaction analyses, the benefit of TTM and PCI for achieving good neurological recovery was attenuated in patients with diabetes mellitus (DM; TTM: aOR, 0.59; 95% CI, 0.23–1.49; PCI: aOR, 4.94; 95% CI, 2.69–9.06) and hypertension (HTN; TTM: aOR, 0.94; 95% CI, 0.49–1.82; PCI: aOR, 7.47; 95% CI, 4.48–12.44), with adjusted p-values < 0.05 for all interactions. Conclusions: In OHCA patients with a history of cancer, TTM and PCI are associated with improved survival and neurological outcomes. However, the presence of comorbidities such as HTN and DM may attenuate these benefits. These findings support the need for individualized post-resuscitation care strategies that account for comorbid conditions. Full article

Dopamine is a major catecholamine neurotransmitter that plays an essential role in the functioning of the human central nervous system. Imbalances in dopamine levels are associated with neurological disorders and depression. Thus, measuring the concentration of DA in human body fluids is significantly important. In this work, TEMPO-oxidized cellulose nanofibrils (TOCNFs) extracted from marram grass (Ammophilia arenaria), harvested in the central western part of Tunisia, were utilized to modify disposable screen-printed carbon electrodes (SPCEs) for the sensitive detection of dopamine in biological fluids. Differential pulse voltammetry (DPV) measurements displayed a sensitivity of 7.92 µA/µM and a detection limit of 10 nM. The disposable TOCNF-modified SPCE presents a charge transfer coefficient, α, comparable to that of a TOCNF/graphene/AgNP composite-modified GCE. Moreover, it exhibits good repeatability (RSD = 1.9%), good reproducibility (RSD = 2.3%), and appreciable storage stability (91% of its initial response after 3 weeks). The prepared disposable sensor showed satisfactory recovery of dopamine in human urine samples. Full article

Background and Clinical Significance: Fulminant pulmonary embolism (PE) leading to an out-of-hospital cardiac arrest (OHCA) is associated with a high mortality rate and cardiopulmonary resuscitation (CPR) frequently failing to achieve return of spontaneous circulation (ROSC). Extracorporeal CPR (eCPR) has emerged as a potential life-saving intervention. Case Presentation: A 66-year-old woman suffered an OHCA due to massive PE, presenting with pulseless electrical activity (PEA). After 90 min of pre- and in-hospital CPR without sustained ROSC, venoarterial extracorporeal membrane oxygenation (va-ECMO) was initiated as eCPR upon arrival at the hospital. Even after implantation of the va-ECMO, there was initially a pronounced acidosis (pH 6.9) with a high elevated lactate level (>30 mmol/L); these factors, together with the prolonged low-flow period, indicated a poor prognosis. Further diagnostic tests revealed intracranial hemorrhage (subdural hematoma), and systemic lysis was not possible. With persistent right heart failure, surgical thrombectomy was performed during hospitalization. Intensive multidisciplinary management finally led to successful therapy and weaning from mechanical ventilation, as well as to complete neurological recovery (CPC-Score 1-2). Conclusions: This case illustrates that eCPR can facilitate survival with good favorable neurological outcomes despite initially poor prognostic predictors. It underscores the importance of refining patient selection criteria and optimizing management strategies for eCPR in refractory cardiac arrest secondary to PE. Full article

Background/Objectives: Most survivors of out-of-hospital cardiac arrest (OHCA) may suffer from cognitive, mental difficulties, and fatigue, which negatively impact their quality of life, despite a good physical recovery. However, no definitive data are available on this topic, so this study aims to assess the feasibility and acceptability of a centralized, sub-regional screening system for OHCA survivors in Italy and the prevalence of these disorders. Methods: OHCA survivors discharged with good neurological outcomes (Cerebral Performance Category (CPC) ≤ 2 and modified Ranking Scale (mRS) ≤ 3) from hospitals in the “Lombardia CARe” registry will be evaluated by a clinical psychologist using the Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS), EQ-5D-5L for quality of life, and the Impact of Event Scale-Revised (IES-R) at pre-discharge or within 15 days and then at 1, 3, 6, and 12 months. Patients with clinical issues will be referred for psychological support or to a community rehabilitation program. Feasibility will be defined as a recruitment rate ≥ 80% and acceptability as a retention rate ≥ 50% over 12 months. Results: Based on historical data from the Lombardia CARe, an estimated 350 eligible survivors are expected, which will allow estimation of a prevalence ranging between 20% and 30% with 5% precision and 95% confidence. Conclusions: This study will be the first in Italy to evaluate the feasibility and acceptability of a centralized, sub-regional system for pre-/post-discharge evaluation of cognitive impairment, mental health, and quality of life in a large cohort of OHCA survivors, documenting the prevalence of these disorders. Full article

Background: Transforaminal spinal endoscopy is a minimally invasive technique used to treat several spinal conditions. Thanks to its minimally invasive approach, it offers numerous advantages over traditional open surgery, including reduced blood loss, faster post-operative hospital discharge, quicker recovery, and lower complications. This study aims to evaluate the efficacy and safety of transforaminal spinal endoscopy on a large cohort of patients. Methods: We conducted a retrospective study of 1000 patients who underwent transforaminal spinal endoscopy between January 2015 and December 2023. All patients were treated by a single surgeon in a single hospital. The patients presented with persistent symptoms of radicular pain, neurological deficits related to herniated discs, and foraminal stenosis. All patients underwent transforaminal spinal endoscopy using a transforaminal approach. Clinical outcomes were evaluated using the VAS (Visual Analogue Scale) for pain, the ODI (Oswestry Disability Index) for functional disability, and patient satisfaction. Perioperative complications were recorded and analyzed. Results: Reduction in Pain: The mean VAS score decreased significantly from 8.2 ± 1.3 pre-operatively to 2.1 ± 1.5 at 12 months post-operatively (p < 0.001). Functional Improvement: The mean ODI improved from 56% ± 12% pre-operatively to 18% ± 9% at 12 months post-operatively (p < 0.001) Patient Satisfaction: 92% of patients reported a high level of satisfaction with their treatment results. Complications: Perioperative complications were minimal, with an overall common complication rate of 4%. No major complications or functional impairments were observed. Conclusions: Transforaminal spinal endoscopy is associated with good clinical outcomes and a low complication rate in patients with spinal pathologies. This study supports the adoption of this technique as a first-line treatment for selected patients, offering a less invasive and equally effective option compared to traditional surgery. Full article

Neurofilament light chain (NfL), an abundant cytoskeletal protein in neurons, has emerged as a promising serum biomarker that indicates non-specific neuronal damage secondary to various neurologic diseases, including multiple sclerosis (MS). Emerging evidence suggests that serum NfL levels correlate with future disability, brain atrophy, predict new disease activity, and decrease in response to various disease-modifying therapies. As research continues to validate NfL’s potential role in clinical practice, the need for a practical model to conceptualize and visualize its relevance to MS pathology becomes evident—not only for healthcare providers but also for patients. To address this, we propose the Neurofoundational Model (NFM), which likens a neuron to a home, with various parts of the home representing distinct regions of the central nervous system (CNS). In this model, the home (neuron) experiences scenarios such as a fire, an earthquake, and a slow flood, representing distinct MS disease states. A fire illustrates an MS relapse with good recovery, where serum NfL levels rise during the relapse and subsequently return near baseline. An earthquake represents an MS relapse with poor recovery, where NfL levels increase and remain elevated above baseline. Finally, a slow flood depicts MS in progressive stages, characterized by sustained and gradually increasing serum NfL levels without abrupt clinical changes. This approach offers a clear and relatable visualization for clinicians and patients alike, illustrating the dynamics of serum NfL levels during CNS damage caused by demyelination. By integrating this model into clinical practice, we aim to enhance understanding and communication regarding the role of NfL in MS pathology and its potential utility as a biomarker. Full article

Objective: Clinically, patients in a coma after cardiac arrest are given the prognosis of “neurological recovery” to minimize discrepancies in opinions and reduce judgment errors. This study aimed to analyze the background patterns of electroencephalogram (EEG) signals from such patients to identify the key indicators for assessing the prognosis after coma. Approach: Standard machine learning models were applied sequentially as feature selectors and filters. CatBoost demonstrated superior performance as a classification method compared to other approaches. In addition, Shapley additive explanation (SHAP) values were utilized to rank and analyze the importance of the features. Results: Our results indicated that the three different EEG features helped achieve a fivefold cross-validation receiver-operating characteristic (ROC) of 0.87. Our evaluation revealed that functional connectivity features contribute the most to classification at 70%. Among these, low-frequency long-distance functional connectivity (45%) was associated with a poor prognosis, whereas high-frequency short-distance functional connectivity (25%) was linked with a good prognosis. Burst suppression ratio is 20%, concentrated in the left frontal–temporal and right occipital–temporal regions at high thresholds (10/15 mV), demonstrating its strong discriminative power. Significance: Our research identifies key electroencephalographic (EEG) biomarkers, including low-frequency connectivity and burst suppression thresholds, to improve early and objective prognosis assessments. By integrating machine learning (ML) algorithms, such as Gradient Boosting Models and Support Vector Machines, with SHAP-based feature visualization, robust screening methods were applied to ensure the reliability of predictions. These findings provide a clinically actionable framework for advancing neurological prognosis and optimizing patient care. Full article

Background and Clinical Significance: Neurological complications in extension-type-III supracondylar humeral fractures (SCHFs) in children represent 11% of cases. An extension-type-III SCHF with posterolateral displacement of the distal fragment is commonly associated with damage to the median nerve and the anterior interosseous nerve (AIN). Neurological complications are often unnoticed, and their immediate postoperative diagnosis is difficult, particularly in young children. Neurapraxia, the most common complication, usually undergoes spontaneous nerve recovery. Case Presentation: We report a case of a 7-year-old patient with postoperative median nerve palsy after an SCHF (Gartland type III) who was referred to our unit from another hospital due to a lack of spontaneous recovery. In addition, motor and sensory functions were absent. As ultrasound (US) indicated nerve kinking at the fracture site, an exploration was performed. The nerve was trapped within the fracture and the callus. It was surgically extracted, and intraoperative examination with US indicated that resecting the kinked nerve, freeing the two stumps, and attempting a primary end-to-end suture represented the best course of action. We present this case with a 5-year follow-up surgery, which showed a good clinical outcome. Conclusions: This case is noteworthy because of its diagnostic and therapeutic pathways, and it is complemented by surgical and ultrasound images that can assist other surgeons in similar circumstances. Full article

Background: The time lapse between the acute event and the beginning of rehabilitation seems to play a significant role in determining the effectiveness of rehabilitation together with the severity of neurological deficits and impairments of motor and cognitive functions. The present study aims to further explore the prognostic role of cognitive and motor functions, concerning the different times of the beginning of neurorehabilitation. Methods: A secondary examination was conducted by applying a cluster analysis on the data of 386 stroke patients in the subacute phase who were enrolled in the Cognitive and Recovery of Motor Functions (CogniReMo) study. Results: The Barthel Index at the admission predicts clinical outcome: if BI was 0, it was on average 28.7 ± 24.1 at discharge. For patients with Barthel Index <15 at discharge, the discriminant was unaltered executive functions having an average output of 61.3 instead of 45.5. In the range of BI at admission between 16 and 45, the discriminant variable was to have an NIHSS ≤ 5 to obtain a high outcome (BI = 75.4 instead of BI = 61.9). Subjects with a BI at admission >45 were the best responders to rehabilitation, with a mean BI at discharge of 85 if they have alteration in spatial attention, and 95.3 if they have no deficits in spatial attention. Also, for inpatients hospitalized in a period ranging from the 20th to the 37th day after stroke, spatial attention was a discriminant variable to have a poor outcome (BI = 34.3) vs. a good one (BI = 76.7). Conclusions: The algorithm identified a hierarchical decision tree that might assume a significant role for clinicians in defining an appropriate rehabilitation pathway, depending on the time of rehabilitation beginning and the severity of motor and cognitive deficits. Full article

Background: Cannabidiol (CBD) is a highly lipophilic compound with potential therapeutic applications in neurological disorders. However, its poor aqueous solubility and bioavailability, coupled with instability in physiological conditions, significantly limit its clinical use. Objectives: This study aimed to develop and characterize nanovesicles incorporating Tween 20 to enhance CBD encapsulation, stability, and the performance across the blood–brain barrier (BBB). Methods: Nanovesicles were prepared via thin-film hydration followed by sonication and optimized for size, polydispersity index, and zeta potential. Stability studies were conducted under physiological conditions and during storage at 4 °C. In vitro release studies employed the dialysis bag method, while permeability across the BBB was assessed using PAMPA-BBB and the hCMEC/D3-BBB cell line, characterized for brain endothelial phenotype and largely employed as a model of human blood–brain barrier (BBB) function. Cytotoxicity was evaluated via MTT and LDH assays. Results: The quantification of CBD was carried out by HPLC-DAD and HPLC-MS/MS. Nanovesicles with Tween 20 (VS-CBD) exhibited smaller size (65.27 ± 1.27 nm vs. 90.7 ± 0.2), lower polydispersity (0.230 ± 0.005 vs. 0.295 ± 0.003), and higher stability compared to conventional liposomes (L-CBD). VS-CBD achieved high encapsulation efficiency (96.80 ± 0.96%) and recovery (99.89 ± 0.52%). Release studies showed sustained CBD release with Higuchi model fitting (R² = 0.9901). Both PAMPA-BBB and hCMEC/D3-BBB cell lines demonstrated an improved controlled permeability of the formulation compared to free CBD. Cytotoxicity tests confirmed the good biocompatibility of VS-CBD formulations. The addition of Tween 20 to nanovesicles enhanced CBD encapsulation, stability, and controlled release. Conclusions: These nanovesicles represent a promising strategy to improve CBD delivery to the brain, offering sustained therapeutic effects and reduced dosing frequency, potentially benefiting the treatment of neurological disorders. Full article

Background: Intracranial AVMs are a highly heterogeneous group of lesions that, while not very common, can pose significant risks. The therapeutic management of AVMs is complicated by ambiguous guidelines, particularly regarding which Spetzler–Martin grades should dictate specific treatment options. This study analyzed the clinical presentations and treatment approaches of 128 brain AVM cases managed between 2014 and 2022 at the National Institute of Neurology and Neurovascular Diseases in Bucharest, Romania. Methods: A retrospective analysis was conducted on patient demographics, clinical symptoms, Spetzler–Martin categorization, nidus localization, therapeutic management, and outcomes. Statistical analysis was performed using Python 3.10. Results: In our cohort of patients, the median age was 45 years, with a slight male predominance (67 males, 61 females). At admission, 51.5% presented with elevated blood pressure. The majority of patients had a Spetzler–Martin score of 2 (37.5%), followed by scores of 3 (31.3%) and 1 (20.3%). Treatment strategies included microsurgical resection in 32% of cases, conservative management in 31.2%, Gamma Knife radiosurgery in 22.6%, and endovascular embolization in 13.3%. Notably, open surgery was predominantly chosen for Grade II AVMs. The functional outcomes were favorable, with 69.5% achieving a good recovery score on the Glasgow Outcome Scale. Only four in-hospital deaths occurred, all in patients who underwent open surgery, and no deaths were recorded during the two-year follow-up. Conclusions: AVMs within the same Spetzler–Martin grade display considerable complexity, necessitating personalized treatment strategies. Our findings highlight the limitations of open surgery for Grade I cases but affirm its effectiveness for Grade II AVMs. Full article

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) offers cardiorespiratory support to patients experiencing cardiac arrest. However, this technology is not yet considered a standard treatment, and the evidence on eCPR criteria and its association with survival and good neurological outcomes remains scarce. Therefore, we aimed to investigate the overall mortality and risk factors for mortality. Moreover, we provide a comparison of demographic, clinical, and laboratory characteristics of patients, including neurological outcomes and adverse events during support. Methods: This retrospective analysis included in-hospital and out-of-hospital cardiac arrest patients who received eCPR and were admitted between January 2008 and June 2022 at a tertiary and trauma one-level university hospital in Austria. Results: In total, 90 patients fulfilled inclusion criteria, 41 (46%) patients survived until intensive care unit discharge, and 39 (43%) survived until hospital discharge. The most common cause of cardiac arrest was myocardial infarction (42, 47%), and non-shockable initial rhythm was reported in 50 patients (56%). Of 33 survivors with documented outcomes, 30 had a good recovery as measured with Cerebral Performance Category score, 2 suffered severe disability, and 1 remained in a persistent vegetative state. Finally, multivariate analysis identified asystole as initial rhythm (HR 2.88, p = 0.049), prolonged CPR (HR 1.02, p = 0.043), and CPR on the weekend (HR 2.57, p = 0.032) as factors with a higher risk of mortality. Conclusions: eCPR-related decision-making could be additionally supported by the comprehension of the reported risk factors for mortality and severe disability. Further studies are needed to elucidate the impact of peri-arrest variables on outcomes, aiming to improve patient selection. Full article