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Objective To explore the feasibility of quantitative EEG parameters for prognostic prediction of patients with severe aneurysmal subarachnoid hemorrhage(SaSAH)90 d after the onset of the disease.Methods Patients with SaSAH admitted to the Neurosurgical Intensive Care Unit(NSICU)of Henan Provincial People's Hospital from September 2022 to September 2023 were prospectively consecutively enrolled,and baseline data were collected,including age,gender,medical history(hypertension,diabetes mellitus,coronary artery disease,and stroke),history of smoking,history of drinking,location of aneurysm(anterior circulation,posterior circulation),surgical modality(craniotomy,interventional surgery,hybrid surgery),Hunt-Hess classification,Glasgow coma scale(GCS)score,acute physiology and chronic health status scoring system Ⅱ(APACHE Ⅱ)score,subarachnoid hemorrhage early brain edema score(SEBES),first randomized blood glucose level after admission to NSICU,lactate level,and duration of NSICU stay.Quantitative EEG monitoring was performed in all patients within 48 h after admission to the NSICU,and amplitude-integrated electroencephalogram(aEEG)upper and lower boundaries,95％spectral edge frequency(SEF95),α change,(δ+θ)to(α+β)power ratio(DTABR),brain symmetry index(BSI),and spectral entropy were collected.Based on modified Rankin scale(mRS)scores 90 d after onset,patients were categorized into good prognosis(mRS score 2 points)and poor prognosis(mRS score 3-6 points)groups.Spearman rank correlation was used to analyze the correlation between quantitative EEG parameters and mRS scores in SaSAH patients.Multifactorial Logistic regression analysis was used to screen for correlates of poor prognosis,and receiver operating characteristic(ROC)curves were plotted to evaluate the efficacy of each index in predicting patients'poor prognosis.Results(1)A total of 72 patients with SaSAH were included,with 47 in the poor prognosis group and 25 in the good prognosis group,and the poor prognosis rate at 90 d after the onset was 65.3％.There was no statistically significant difference between the two groups in terms of gender,age,hypertension,diabetes mellitus,coronary artery disease,history of stroke,history of smoking,history of drinking,location of aneurysm,surgical modality,lactate level,and length of hospitalization in the NSICU(all P＞0.05);the differences between the Hunt-Hess grading,SEBES,and random blood glucose were statistically significant upon comparison(all P＜0.05).Compared with the good prognosis group,the changes of aEEG upper and lower boundary,SEF95,α change and spectral entropy were lower in the poor prognosis group,but DTABR and BSI were higher(all P＜0.05).(2)Spearman rank correlation analysis showed that the upper border of aEEG(r=-0.41,P＜0.01),lower border of aEEG(r=-0.54,P＜0.01),SEF95(r=-0.46,P＜0.01),α change(r=-0.53,P＜0.01)and spectral entropy(r=-0.39,P＜0.01)were negatively correlated with the mRS scores of SaSAH patients,and DTABR(r=0.52,P＜0.01)and BSI(r=0.33,P＜0.01)were positively correlated with poor prognosis of SaSAH patients.(3)The results of multifactorial Logistic regression analysis showed that Hunt-Hess grading(level Ⅳ vs.Ⅲ:OR,1.203,95％CI 1.005-1.441,P=0.044;level V vs.Ⅲ:OR,1.661,95％CI 1.109-2.487,P=0.014),SEBES(OR,1.647,95％CI 1.050-2.586;P=0.030),aEEG lower border(OR,0.687,95％CI 0.496-0.953l;P=0.024),SEF95(OR,0.436,95％CI0.202-0.937;P=0.034),α change(OR,0.368,95％CI0.189-0.717;P=0.003),DTABR(OR,1.324,95％CI 1.064-1.649;P=0.012),and BSI(OR,1.513,95％CI 1.026-2.231;P=0.036)were influencing factors of poor prognosis in SaSAH patients.ROC curve analysis showed that all of the above seven indicators had a certain predictive value for poor prognosis in SaSAH patients,among which the area under the curve of DTABR was the highest as 0.862(95％CI 0.761-0.932),with sensitivity 85.11％and specificity 80.00％.Conclusion Quantitative EEG parameters aEEG lower border,SEF95,α change,DTABR,and BSI may have certain predictive value for the short-term prognosis of SaSAH patients,which needs to be further confirmed in future multi-center large-sample studies.
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The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.
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Objective:To investigate the value of metagenomic next-generation sequencing (mNGS) in central nervous system infection (CNSI) of critically ill patients from Neurosurgery.Methods:A prospective study was conducted. From October 2019 to April 2021, 52 patients with highly suspected CNSI in the Department of Neurosurgical Intensive Care Unit (NICU) of our hospital were chosen. The collected cerebrospinal fluid (CSF) samples were simultaneously performed mNGS and traditional culture; the clinical diagnosis of CNSI was taken as the standard, and the sensitivity, specificity, positive predictive value, negative predictive value, and time from sample collection to result feedback of these two methods were compared. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic values of mNGS and traditional culture in CNSI.Results:Eventually, 25 patients with CNSI were clinically confirmed; 23 were with positive mNGS, including 16 with bacterial infection, 4 with viral infection, 1 with fungal infection, and 2 with mixed infection (1 with bacteria+virus+fungus, 1 with bacteria+virus); 8 were with positive traditional culture, all of which were bacterial infections. The sensitivity, specificity, positive predictive value, and negative predictive value of mNGS were 92.0%, 85.2%, 85.2%, and 92.0%, respectively; those of traditional culture were 32.0%, 100.0%, 100.0%, and 61.4%, respectively; the time from sample collection to result feedback of mNGS and traditional culture was (31.77±5.23) h and (101.83±9.15) h, respectively, with significant difference ( P<0.05). ROC curve showed that the area under the curve (AUC) of mNGS for diagnosis of CNSI was 0.886 ( 95%CI: 0.786-0.986, P<0.001); the AUC of traditional culture for diagnosis of CNSI was 0.660 ( 95%CI: 0.508-0.812, P=0.002). Conclusion:For patients with CNSI from NICU, mNGS has good diagnostic efficacy and application value and can effectively compensate for the lack of traditional cerebrospinal fluid culture.
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Objective:To explore the effect of problem-originated clinical medical curriculum(PCMC) teaching method combined with PDCA(plan, do, check and action) circulation in the training of craniocerebral ultrasound for neurologically intensive refresher physicians.Methods:Thirty-two refresher physicians who entered the neurosurgery ICU of Henan Provincial People's Hospital from January 2018 to December 2019 were divided into test group ( n=18) and control group ( n=14) according to the time of admission. The test group accepted the teaching mode of PCMC teaching method combined with PDCA circulation, the control group accepted the traditional teaching methods of demonstration, student practice and teacher evaluation. One week before graduation, the differences between two groups in the theoretical assessment, operational skills and questionnaire were compared to evaluate the effectiveness of teaching mode. SPSS 23.0 was used for t-test and chi-square test. Results:Compared with the control group, the individual scores and total scores of the theoretical and operational assessments of craniocerebral ultrasound in the test group were significantly improved, and the questionnaire survey showed that the test group was superior to the control group in all the 7 items of teaching effect and satisfaction with the teaching method, with statistical significance ( P < 0.05). There was no significant difference between the two groups in increasing their interest in learning ( P > 0.05). Conclusion:PCMC teaching method combined with PDCA circulation can improve the training effect and satisfaction of clinical teaching of craniocerebral ultrasound.
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Objective:To analyze the correlation between electromagnetic perturbation index and intracranial pressure (ICP) in patients with acute ischemic stroke (AIS) after mechanical thrombectomy, and to explore their values in early warning of decompressive craniectomy (DC).Methods:Forty-three patients with AIS after mechanical thrombectomy admitted to our hospital from January 1, 2018 to December 31, 2019 were enrolled in our prospective cohort study. Electromagnetic perturbation index and invasive ICP were continually monitored for 1-5 d in all patients 24 h after mechanical thrombectomy. According to the mean ICP on the first d, all patients were divided into normal ICP group (ICP<15 mmHg), mild increased ICP group (15≤ICP≤22 mmHg) and moderate to severe increased ICP group (ICP>22 mmHg). According to the implementation of DC, these patients were divided into decompressive craniectomy group and non-decompressive craniectomy group. The differences in clinical data of patients in different ICP groups were compared. The correlation between electromagnetic perturbation index and ICP was analyzed by Pearson correlation method. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of electromagnetic perturbation index in increased ICP (ICP>22 mmHg). Multivariate Logistic regression analysis was used to determine the independent influencing factors for DC after mechanical thrombectomy in AIS patients. ROC curve was used to evaluate the diagnostic values of electromagnetic perturbation index and ICP in DC implementation after mechanical thrombectomy in AIS patients.Results:(1) In these 43 patients, 8 had normal ICP, 13 had mild increased ICP, and 22 had moderate to severe increased ICP. There were significant differences in baseline Glasgow Coma Scale (GCS) scores, baseline National Institutes of Health Stroke Scale (NIHSS) scores, baseline Alberta stroke program early CT scale (ASPECTS) scores, percentage of patients accepted DC, and electromagnetic perturbation index among the 3 groups ( P<0.05). Correlation analysis showed that electromagnetic perturbation index was negatively correlated with ICP ( r=-0.699, P=0.000). ROC curve showed that the area under curve (AUC) of electromagnetic perturbation index in diagnosing ICP>22 mmHg was 0.850 ( 95%CI: 0.690-1.000, P=0.000), enjoying the optimal cutoff value of 126. (2) Among the 43 patients, 27 were in the decompressive craniectomy group and 16 were in the non-decompressive craniectomy group. Multivariable Logistic regression analysis showed that baseline NIHSS scores, baseline ASPECTS scores, electromagnetic perturbation index, and ICP were independent risk factors for DC implementation after mechanical thrombectomy in AIS patients ( P<0.05). ROC curve showed that the AUC of ICP in predicting DC implementation after mechanical thrombectomy was 0.851 ( 95%CI: 0.728-0.973, P=0.000), enjoying the optimal cutoff value of 18.5 mmHg; the AUC of electromagnetic perturbation index in predicting DC implementation after mechanical thrombectomy was 0.764 ( 95%CI: 0.609-0.919, P=0.004), enjoying the optimal cutoff value of 137.5. Conclusion:There is a good correlation between electromagnetic perturbation index and ICP, which can be used as reference indexes for early warning of DC after mechanical thrombectomy in AIS patients.
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Objective:To analyze the risk factors for hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) after mechanical thrombectomy, and explore the clinical value of bedside ultrasound measurement of optic nerve sheath diameter (ONSD) in predicting postoperative HT.Methods:Clinical data of 268 patients with AIS, accepted mechanical thrombectomy in our hospital from April 2017 to October 2019, were collected. Bedside ultrasound measurement of ONSD was performed in all patients. According to dynamic cerebral imaging 7 d after surgery, patients were divided into HT group ( n=57) and non-HT group ( n=211). Patients from HT group were classified according to the European Acute Stroke Collaborative Study (ECASS) classification. Clinical data of patients from the two groups were compared, and multivariate Logistic regression analysis was used to analyze the influencing factors for HT in patients with AIS after mechanical thrombectomy. The predictive value of ONSD in incidence of postoperative HT in AIS patients was analyzed by receiver operating characteristic (ROC) curve. The clinical data of HT patients with different classification subtypes were compared. Results:HT patients had significantly longer time from puncture to recanalization, significantly higher percentage of patients having more than three times of thrombectomy, significantly higher percentage of patients having baseline collateral circulation scale score of 0, statistically lower baseline Alberta stroke program early CT scale (ASPECTS), and significantly increased ONSD within 7 d of surgery as compared with the NHT patients ( P<0.05). Multivariate Logistic regression analysis indicated that time from puncture to recanalization (OR=1.012, 95%CI: 1.001-1.023, P=0.037), percentage of patients having more than three times of thrombectomy(OR=2.467, 95%CI:1.107-5.501, P=0.027), baseline collateral circulation scale scores (OR=0.578, 95%CI: 0.338-0.989, P=0.045), and ONSD within 7 d of surgery (OR=1.405, 95%CI: 1.008-1.082, P=0.019) were independent influencing factors for HT in patients with AIS after mechanical thrombectomy. The optimal cut-off value of ONSD for diagnosis of HT was 5.035 mm, area under curve (AUC) was 0.777 (95% confidence interval: 0.704-0.849). In HT patients, parenchyma hemorrhage (PH)-1 type patients had significantly higher ONSD and proportion of patients with ONSD≥5.035 mm within 7 d of surgery as compared with hemorrhagic infarction (HI)-2 type patients, and PH-2 type patients had significantly higher ONSD and proportion of patients with ONSD≥5.035 mm within 7 d of surgery as compared with PH-1 type patients ( P<0.05). Conclusions:ONSD within 7 d of mechanical thrombectomy is an independent risk factor for HT in AIS patients; when ONSD≥5.035 mm, patients are prone to have HT, which is related to the severity of HT. Bedside ultrasound measurement of ONSD is helpful for early evaluation of HT after mechanical thrombectomy in anterior circulation AIS patients.
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Objective To discuss the clinical value of interventional treatment for Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage, and to report 1 patients with this disease who were successfully treated with interventional treatment. Methods One female children patient with clinically confirmed Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage were enrolled in this study, who was underwent the embolization of arteriovenous fistula in the spinal. Results The interventional procedure was successfully accomplished in this case. The patient's clinical symptoms was disappeared gradually. No complications occurred. Conclusion For the treatment of Klippel-Trenaunay syndrome complicated by spinal arteriovenous fistula and subarachnoid hemorrhage, interventional management is minimally-invasive, safe and Reliable.