Prognostic values of optic nerve sheath diameter for comatose patients with acute stroke:An observational study

BACKGROUND Optic nerve sheath diameter(ONSD)measurement is one of the non-invasive methods recommended for increased intracranial pressure(ICP)monitoring.AIM This study aimed to evaluate the roles of optic nerve sheath diameter(ONSD)and ONSD/eyeball transverse diameter(ETD)ratio in predicting prognosis of death in comatose patients with acute stroke during their hospitalization.METHODS A total of 67 comatose patients with acute stroke were retrospectively recruited.The ONSD and ETD were measured by cranial computed tomography(CT)scan.All patients underwent cranial CT scan within 24 h after coma onset.Patients were divided into death group and survival group according to their survival status at discharge.The differences of the ONSD and ONSD/ETD ratio between the two groups and their prognostic values were compared.RESULTS The ONSD and ONSD/ETD ratio were 6.07±0.72 mm and 0.27±0.03 in the comatose patients,respectively.The ONSD was significantly greater in the death group than that in the survival group(6.32±0.67 mm vs 5.65±0.62 mm,t=4.078,P<0.0001).The ONSD/ETD ratio was significantly higher in the death group than that in the survival group(0.28±0.03 vs 0.25±0.02,t=4.625,P<0.0001).The area under the receiver operating characteristic curve was 0.760(95%CI:0.637-0.882,P<0.0001)for the ONSD and 0.808(95%CI:0.696-0.920,P<0.0001)for the ONSD/ETD ratio.CONCLUSION The mortality increased in comatose patients with acute stroke when the ONSD was>5.7 mm or the ONSD/ETD ratio was>0.25.Both indexes could be used as prognostic tools for comatose patients with acute stroke.The ONSD/ETD ratio was more stable than the ONSD alone,which would be preferred in clinical practice.

Chinese expert consensus on the management of aneurysmal subarachnoid hemorrhage-related hydrocephalus

Aneurysmal subarachnoid hemorrhage-related hydrocephalus(aSAH-H)refers to a clinical syndrome of excessive secretion,obstructive absorption,or circulatory disturbance of cerebrospinal fluid(CSF)with subarachnoid hemorrhage following rupture of aneurysm that leads to excessive accumulation of intracranial CSF and enlargement of ventricles impairing neurological function.aSAH is an important risk factor for hydrocephalus[1,2].According to fluid dynamics,aSAH-H is divided into communicating and obstructive hydrocephalus;according to the time of occurrence.

Application of Keyhole Microneurosurgery in China

INTRODUCTIONMicroneurosurgery made its debut in the early 1960s. It became popular in the medical field and became a primary operation method in neurosurgery since it improved the efficacy of neurosurgery with a less surgery-related injury. Over the past five decades, the accumulation of experience of microsurgery, improvement of microsurgery techniques, refined micro-instruments, and advanced preoperative diagnostic imaging allowed the evolution of microneurosurgery techniques and further reduced surgery-related trauma.

Distinctive distribution of lymphocytes in unruptured and previously untreated brain arteriovenous malformation

Aim:To test the hypothesis that lymphocyte infiltration in brain arteriovenous malformation(bAVM)is not associated with iron deposition(indicator of micro-hemorrhage).Methods:Sections of unruptured,previously untreated bAVM specimens(n=19)were stained immunohistochemically for T-lymphocytes(CD3+),B-lymphocytes(CD20+),plasma cells(CD138+)and macrophages(CD68+).Iron deposition was assessed by hematoxylin and eosin and Prussian blue stains.Superficial temporal arteries(STA)were used as control.Results:Both T-lymphocytes and macrophages were present in unruptured,previously untreated bAVM specimens,whereas few B cells and plasma cells were detected.Iron deposition was detected in 8 specimens(42%;95%confidence intervals=20-67%).The samples with iron deposition tended to have more macrophages than those without(666±313 vs.478±174 cells/mm2;P=0.11).T-cells were clustered on the luminal side of the endothelial surface,on the vessel-wall,and in the perivascular regions.There was no correlation between T-lymphocyte load and iron deposition(P=0.88).No macrophages and lymphocytes were detected in STA controls.Conclusion:T-lymphocytes were present in bAVM specimens.Unlike macrophages,the load and location of T-lymphocytes were not associated with iron deposition,suggesting the possibility of an independent cell-mediated immunological mechanism in bAVM pathogenesis.

Cerebral ischemia at early postoperative period of direct revascularization for moyamoya disease: a case report and literature review

Hypoperfusion and hyperperfusion could be causes of early postoperative complications that lead to neurological deterioration in patients with moyamoya diseases (MMD) after superficial temporal artery (STA) and middle cerebral artery (MCA) anastomosis. Here, the authors described a case of child-onset bilateral MMD that manifested transient cerebral ischemia in the contralateral hemisphere after left STA-MCA bypass in young adulthood. A new onset of cerebral ischemia in the contralateral hemisphere and transient neurological deterioration suggested the fragile hemodynamics of MMD during early perioperative period. Serial evaluation of postoperative cerebral hemodynamics and perfusion might facilitate targeted management in patients with unstable or advanced MMD.