RESUMEN
PURPOSE: There are many infectious and inflammatory causes for elevated core-body temperatures, though they rarely pass 40 â (104 â). The term "quad fever" is used for extreme hyperpyrexia in the setting of acute cervical spinal cord injuries (SCIs). The traditional methods of treating hyperpyrexia are often ineffective and reported morbidity and mortality rates approach 100%. This study aims to identify the incidence of elevated temperatures in SCIs at our institution and assess the effectiveness of using a non-invasive dry water temperature management system as a treatment modality with mortality. METHODS: A retrospective analysis of acute SCI patients requiring surgical intensive care unit admission who experienced fevers ≥ 40 â (104 â) were compared to patients with maximum temperatures < 40 â. Patients ≥18 years old who sustained an acute traumatic SCI were included in this study. Patients who expired in the emergency department; had a SCI without radiologic abnormality; had neuropraxia; were admitted to any location other than the surgical intensive care unit; or had positive blood cultures were excluded. SAS 9.4 was used to conduct statistical analysis. RESULTS: Over the 9-year study period, 35 patients were admitted to the surgical intensive care unit with a verified SCI. Seven patients experienced maximum temperatures of ≥ 40 â. Six of those patients were treated with the dry water temperature management system with an overall mortality of 57.1% in this subgroup. The mortality rate for the 28 patients who experienced a maximum temperature of ≤ 40 â was 21.4% (p = 0.16). CONCLUSION: The diagnosis of quad fever should be considered in patients with cervical SCI in the presence of hyperthermia. In this study, there was no significant difference in mortality between quad fever patients treated with a dry water temperature management system versus SCI patients without quad fever. The early use of a dry water temperature management system appears to decrease the mortality rate of quad fever.
Asunto(s)
Médula Cervical , Hipertermia Inducida , Traumatismos del Cuello , Traumatismos de los Tejidos Blandos , Traumatismos de la Médula Espinal , Humanos , Adolescente , Hipertermia , Estudios Retrospectivos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/cirugíaRESUMEN
BACKGROUND: The use of thrombectomy in the treatment for acute ischemic stroke (AIS) affecting the anterior circulation is well established. Comparatively, fewer data exist on the effectiveness of these techniques in treating posterior circulation occlusions. This review analyzes and reports on the usefulness and outcomes of emergent thrombectomy in large-vessel occlusions affecting the posterior circulation. METHODS: A literature review was performed to identify all studies of patients with AIS in the posterior circulation who underwent endovascular mechanical thrombectomy (EMT) with stent retrievers and/or aspiration devices that were reported between January 1, 2015 and February 12, 2019. Favorable outcomes were defined as a modified Rankin Scale (mRS) score 0-2 at 3 months follow-up. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b-3. RESULTS: Twenty-five studies, comprising 1612 EMT-treated patients with posterior circulation AIS, were included in this analysis. The median presenting National Institutes of Health Stroke Scale score was 20.9 (range, 10.5-34). Favorable outcomes at 3 months follow-up were observed in 38% of patients (range, 16%-75%) and a mortality of 30% (range, 4%-64%). Successful reperfusion was achieved in 86% of cases (range, 62%-100%). CONCLUSIONS: In patients with AIS caused by large-vessel occlusion of the posterior circulation, successful reperfusion can be achieved via EMT, with approximately a third of these patients achieving a good functional outcome. However, with similar proportions of treated patients experiencing significant morbidity or mortality, respectively, there is urgent need for additional studies to identify predictive or modifiable factors for a positive outcome.