Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Aug 2020
Review Meta AnalysisMonoclonal antibodies as a preventive therapy for migraine: A meta-analysis.
Calcitonin gene-related peptide (CGRP) antagonists have recently grabbed the attention of clinicians for migraine prophylaxis. The present meta-analysis aimed to assess the efficacy and safety of CGRP monoclonal antibodies (mAbs) in patients with chronic and episodic migraine using a systematic therapeutic regimen. More specifically, double-blind placebo-controlled randomized clinical trials (RCTs) which assessed the therapeutic potential of monthly subcutaneous injections were included. ⋯ No significant differences between groups were noted in TRAEs. CGRP mAbs provide highly efficacious and safe outcomes which start early after the first injection. The tolerability of these medications surpasses that of other small-molecule CGRP antagonists.
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Clin Neurol Neurosurg · Jul 2020
Review Case ReportsEthical and medicolegal aspects in the management of neurosurgical emergencies among Jehovah's Witnesses: Clinical implications and review.
When an incapacitated Jehovah's Witness neurologically deteriorates and requires immediate craniectomy, institutional protocols may delay surgery if the patient's refusal of blood products is ambiguous. We are among the first to describe such an ethically contentious case in emergency neurosurgery, review the morbidity of operative delays, discuss medicolegal concerns raised, and provide a detailed guide to hemostasis in patients who refuse blood products. We discuss the case of a 46-year-old woman presented with nausea, vomiting, and right-sided weakness, progressing to stupor over several hours. ⋯ Since operative delay is a preventable cause of mortality in patients requiring urgent craniectomy, and the likelihood of requiring a transfusion from hemorrhage is minimal, an ambiguous blood consent should not postpone a potentially life-saving treatment. For the beneficence and autonomy of Jehovah's Witness patients, institutional policies should respect the family's wishes in order to expedite surgical decompression. In addition to discussing the nuances of such ethical considerations, we also provide a detailed list of commonly used, topical and parenteral hemostatic agents from the neurosurgical operating room which, depending on whether they are blood-derived, either should or should not be used when treating a Jehovah's Witness.
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Clin Neurol Neurosurg · Sep 2020
Randomized Controlled Trial Comparative StudyThe treatment of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency thermocoagulation via the foramen rotundum and foramen ovale compared with semilunar ganglion radiofrequency thermocoagulation.
To compare the advantages and disadvantages of V2 + V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency (RF) thermocoagulation (PRF) via the foramen rotundum (FR) and foramen ovale (FO) with those of semilunar ganglion RF thermocoagulation (GRF) under local anesthesia, for exploring a new and available surgical method for patients with V2 + V3 idiopathic trigeminal neuralgia. ⋯ The PRF surgery, like GRF, is another prospective treatment for V2 + V3 idiopathic trigeminal neuralgia by virtue of its excellent immediate effect, accurate positioning and high safety.
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Clin Neurol Neurosurg · Aug 2020
Meta AnalysisHyperbaric oxygen therapy for post-stroke depression: A systematic review and meta-analysis.
Post-stroke depression (PSD) is common consequence of stroke. However, today the majority of PSD patients remains untreated or inadequately treated, especially in the developing countries. Herein, we performed a meta-analysis to evaluate efficacy and safety of hyperbaric oxygen (HBOT) therapy for PSD. ⋯ Based on our pooled analysis, HBOT is effective and safe therapeutic approach for PSD. However, results should be cautiously interpreted due to a relatively poor methodological quality.
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Clin Neurol Neurosurg · Nov 2020
ReviewDyspneic and non-dyspneic (silent) hypoxemia in COVID-19: Possible neurological mechanism.
SARS-CoV-2 mainly invades respiratory epithelial cells by adhesion to angiotensin-converting enzyme 2 (ACE-2) and thus, infected patients may develop mild to severe inflammatory responses and acute lung injury. Afferent impulses that result from the stimulation of pulmonary mechano-chemoreceptors, peripheral and central chemoreceptors by inflammatory cytokines are conducted to the brainstem. Integration and processing of these input signals occur within the central nervous system, especially in the limbic system and sensorimotor cortex, and importantly feedback regulation exists between O2, CO2, and blood pH. ⋯ Thus, SARS-CoV-2-associated neuronal damage may influence the control of respiration by interacting in neuromodulation. This would open up possible lines of study for the progress in the central mechanism of COVID-19-induced hypoxia. Future research is desirable to confirm or disprove such a hypothesis.