Neurosurgery
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Although the Hunt and Hess Scale (HHS) and World Federation of Neurological Surgeons Scale (WFNSS) are the most widely used subarachnoid hemorrhage (SAH) grading systems, neither system has achieved universal acceptance. We propose a simplified grading system based entirely on the Glasgow Coma Scale (GCS), which compresses the 15-point GCS into five grades that are comparable with those of the HHS and WFNSS. We refer to this system as the GCS grading system and present a direct comparison with the HHS and WFNSS for predictive value regarding patient outcome and interrater reliability. ⋯ We conclude that the GCS grade has equal or greater predictive value regarding outcome after SAH than do the currently used grading systems and that it has greater reproducibility across observers. Broader familiarity with the GCS among medical and paramedical personnel may further enhance the usefulness of the GCS grade over the HHS and WFNSS in providing a standardized, universally accepted grading system for SAH.
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Previous studies have demonstrated that many patients with good neurological outcomes still experience excessive fatigue, cognitive impairments, and lowered work status 1 year after subarachnoid hemorrhage (SAH). Does recovery continue for many years or are survivors of SAH left with permanent disabilities? We describe the long-term outcome. ⋯ Survivors of SAH continue to recover for years and develop good coping skills and a positive attitude toward their recovery, even when they experience ongoing problems. Few are left with disabling headaches or epilepsy.
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We note an additional pathological condition associated with lumbar spinal stenosis that may be responsible for significant postoperative pain. Recognizing that nerve roots are stretched around hypertrophic pedicles in some cases of spinal stenosis, we have altered our surgical management of these cases to address what may be a previously unrecognized but significant anatomic pathological finding. ⋯ Anatomic evidence obtained through intraoperative examination and preoperative imaging techniques indicates that partial pediculectomy may play a role in the treatment of some cases of lumbar stenosis.
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To examine the incidences of hypertension, hypotension, and bradycardia after carotid endarterectomy (CEA) and to identify any hemodynamic variables predictive of postoperative stroke, death, or cardiac complications. ⋯ Hemodynamic instability was commonly observed after CEA, but only postoperative hypertension was associated with stroke or death and, possibly, with cardiac complications. Patients undergoing CEA, especially those at risk for postoperative hypertension, may be monitored best in settings suited to the expeditious management of neurological and cardiovascular emergencies.
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Biography Historical Article
Yi-Cheng Zhao: a founder of neurosurgery in China.
Yi-Cheng Zhao was trained in neurosurgery at the Montreal Neurological Institute by Wilder Penfield in 1938. This article presents Zhao's great contributions to the development of neurosurgery in China. He set up the first independent neurosurgical departments in Tianjin (1952) and in Beijing (1954). ⋯ It plays an important role in the development of Chinese neurosurgery. Zhao devoted nearly 40 years to neurosurgery and died in 1974. The chinese Neurosurgical Association has honored Zhao as "a founder of neurosurgery in China."