Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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In this study we evaluated the effect of donepezil on the neurodegeneration and behavioral impairments induced by mild traumatic brain injury (MTBI). Donepezil is an acetylcholinesterase inhibitor that is used to treat Alzheimer's disease. ⋯ Treatment with a single oral dose of donepezil (12mg/kg) immediately after injury significantly attenuated MTBI-induced neuronal death and cognitive impairment as measured by preservation of neurons in the CA1 region of the hippocampus and a water maze test respectively. However, these neuroprotective effects were prevented by concomitant injection of mecamylamine, a nicotinic acetylcholine-receptor (nAChR) antagonist, indicating that protection is mediated by nAChR activation.
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Clinical Trial
Stereotactic treatment of refractory obsessive compulsive disorder by bilateral capsulotomy with 3 years follow-up.
In order to study the clinical effect of bilateral capsulotomy in patients with refractory obsessive compulsive disorder (OCD), 35 patients with refractory obsessive compulsive disorder for whom anti-OCD medications and psychological/behavior therapy had failed, underwent MRI-guided stereotactic bilateral anterior capsulotomy. Pre- and post-operative Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) scores were determined by psychiatrists. All patients underwent fluorodeoxyglucose positron emission tomography evaluation before and 6 months after the operation. ⋯ Our results show that MRI-guided stereotactic bilateral capsulotomy is a precise, safe and effective therapy for refractory obsessive compulsive disorder. This promising technique may also improve anxiety and depression in addition to OCD. OCD patients who have not responded to medication, psychotherapy or behavioral therapy might benefit from MRI-guided stereotactic bilateral capsulotomy.
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After subarachnoid hemorrhage (SAH) the detection of hemodynamically significant vasospasm is frequently difficult, especially in comatose patients. Most clinicians use transcranial Doppler sonography (TCD) to detect increasing mean blood flow velocities in the basal arteries as markers of cerebral vasospasm, without accounting for the effects of sedation and variations in blood pressure or pCO(2). This study was conducted to test the hypothesis that the arteriovenous difference of oxygen (avDO(2); in terms of % volume) could also be useful for the evaluation of vasospasm. ⋯ TCD velocities alone are poor indicators of the severity of vasospasm. In contrast, daily avDO(2) seems to be a more robust parameter. However, collection of additional metabolic information is warranted.
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Early diagnosis of ventriculostomy-associated cerebrospinal fluid (CSF) infection in acute neurosurgical patients can be difficult. The use of prophylactic antibiotics in intraventricular or subarachnoid haemorrhage decreases the sensitivity of cell counts, Gram staining and bacterial culture as diagnostic tools. We prospectively collected clinical and cerebrospinal data for 16 patients with intraventricular haemorrhage, with an external ventricular drain inserted, with or without spontaneous subarachnoid haemorrhage. ⋯ The two patients with CSF lactate levels of 4-6 mmol/L were grade 5 subarachnoid haemorrhage patients, one with renal impairment. Using a cut-off lactate level of 4 mmol/L, the positive predictive value was 60% and negative predictive value was 100% for CSF infection. A CSF lactate level of above 4 mmol/L should prompt suspicion of CSF infection in intraventricular haemorrhage patients with an external ventricular drain.