bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variability in Physician Care Practices for Glucose Treatment in Stroke Patients
Authors: Casaubon Leanne K. , Saltman Alexandra , Peeva Valentina , Ennis Marguerite , Lam Ngan , Silver Frank L. , Kapral Moira K. 
Published: December 2014

Background:Hyperglycemia is noted in up to 60% of stroke patients. Practice guidelines recommend glucose monitoring following stroke but provide few management recommendations. We examined physician care practices for glucose management in stroke patients.Methods:Emergency physicians, family physicians, general internists, intensive care specialists and neurologists in Ontario comprised the study population. A mailed, self-administered survey inquired about glucose management practices. Proportions of responses for survey questions were determined. Chi-square analysis was used for comparing physician groups.Results:Surveys were mailed to 2,280 physicians; 26.8% returned surveys. There were 278 respondents who reported providing stroke patient care. For physicians treating glucose in stroke patients, 16.6% targeted glucose 4.0-6.0 mmol/l, 52% targeted 6.1-8.0 mmol/l, 13.6% targeted 8.1-12.0 mmol/l, 0.8% targeted 12.1-15.0 mmol/l, and 7.5% were unsure. Comparing specialties, 32% of intensivists, 17.5% of neurologists, 13% of general internists, 14% of emergency physicians, and 0% of family physicians reported targeting 4.0-6.0 mmol/l (p=0.026). Overall, 44% reported aiming for target glucose within 12 hours and 77% within 24 hours from hospital presentation. Intensive care specialists treated glucose most aggressively, including 20% treating, with insulin infusion, patients with no diabetes and initial glucose 6.0-8.0 mmol/l. Emergency physicians were most conservative when treating glucose in stroke patients.Conclusion:There is variability in the aggressiveness of glucose management in stroke patients by different physician specialty groups, reflecting the lack of evidence available to guide hyperglycemia management in this setting. These results highlight an important gap in knowledge and recommendations for stroke patient care that must be addressed to ensure optimal patient outcomes.
Alexia With and Without Agraphia: An Assessment of Two Classical Syndromes
Authors: Sheldon Claire A. , Malcolm George L. , Barton Jason J.S. 
Published: December 2014

Background:Current cognitive models propose that multiple processes are involved in reading and writing.Objective:Our goal was to use linguistic analyses to clarify the cognitive dysfunction behind two classic alexic syndromes.Methods:We report four experiments on two patients, one with alexia without agraphia following occipitotemporal lesions, and one with alexia with agraphia from a left angular gyral lesion.Results:The patient with occipital lesions had trouble discriminating real letters from foils and his reading varied with word-length but not with linguistic variables such as part of speech, word frequency or imageability. He read pseudo-words and words with regular spelling better, indicating preserved use of grapheme-to-phoneme pronunciation rules. His writing showed errors that reflected reliance on ‘phoneme-to-grapheme’ spelling rules. In contrast, the patient with a left angular gyral lesion showed better recognition of letters, words and their meanings. His reading was better for words with high imageability but displayed semantic errors and an inability to use ‘grapheme-to-phoneme’ rules, features consistent with deep dyslexia. His agraphia showed impaired access to both an internal lexicon and ‘phoneme-to-grapheme’ rules.Conclusion:Some cases of pure alexia may be a perceptual word-form agnosia, with loss of internal representations of letters and words, while the angular gyral syndrome of alexia with agraphia is a linguistic deep dyslexia. The presence or absence of agraphia does not always distinguish between the two; rather, writing can mirror the reading deficits, being more obvious and profound in the case of an angular gyral syndrome.
Concussion Incidence and Time Lost from Play in the NHL During the Past Ten Years
Authors: Wennberg Richard A. , Tator Charles H. 
Published: December 2014

Background:The problem of concussions in professional hockey has attracted much recent attention. To evaluate the current state of this injury in the National Hockey League (NHL), we analyzed the concussion incidence and time lost from play due to concussions during the past ten NHL seasons.Methods:Data were obtained from a complete review of injury reports in two different sports media sources covering the NHL seasons 1997-98 through 2007-08. Time lost from play was measured in missed games per concussion.Results:The incidence of concussions reported in the regular season ranged from a high of 1.81/1000 athlete exposures in 1998-99 to a low of 1.04/1000 athlete exposures in 2005-06. There was a downward trend in the number of concussions reported per season during the past ten years (p=0.01). However, average time lost from play per concussion increased over the same period (p<0.0005). Forwards suffered a disproportionately high percentage of concussions (p<0.0001).Conclusions:Possibly related to injury reduction efforts, the number of concussions reported per season in the NHL has trended downward in recent years. However, the incidence of concussion remains high and the average time lost from play per concussion has increased. This may reflect increased injury severity in recent years or, alternatively, increased adherence to modern management guidelines preventing premature return to play.
Proximity to the Treating Centre and Outcomes Following Subarachnoid Hemorrhage
Authors: O'Kelly Cian J. , Spears Julian , Urbach David , Wallace M. Christopher 
Published: December 2014

Abstract:Background:In the management of subarachnoid hemorrhage (SAH), the potential for early complications and the centralization of limited resources often challenge the delivery of timely neurosurgical care. We sought to determine the impact of proximity to the accepting neurosurgical centre on outcomes following aneurysmal SAH.Methods:Using administrative data, we analyzed patients undergoing treatment for aneurysmal subarachnoid hemorrhage at neurosurgical centres in Ontario between 1995 and 2004. We compared mortality for patients receiving treatment at a centre in their county (in-county) versus those treated from outside counties (out-of-county). We also examined the impact of distance from the patient's residence to the treating centre.Results:The mortality rates were significantly lower for in-county versus out-of-county patients (23.5% vs. 27.6%, p=0.009). This advantage remained significant after adjusting for potential confounders (HR=0.84, p=0.01). The relationship between distance from the treating centre and mortality was biphasic. Under 300km, mortality increased with increasing distance. Over 300km, a survival benefit was observed.Conclusions:Proximity to the treating neurosurgical centre impacts survival after aneurysmal SAH. These results have significant implications for the triage of these critically ill patients.
Spontaneous Intracranial Hypotension: Case Series of Rare Clinical Presentations
Authors: Chaudhary N. , Cooper P. , Lownie S.P. , Ng W. , Duggal N. 
Published: December 2014

Abstract:Background:Spontaneous intracranial hypotension (SIH) is an increasingly described entity, with over 70 cases reported in the literature. The classic triad includes orthostatic headache, diffuse pachymeningeal enhancement on magnetic resonance imaging (MRI) with gadolinium, and low cerebrospinal fluid pressure (CSF) in the lateral decubitus (<60 mm H2O) and sitting positions.Method:We present four rare clinical presentations of SIH, two of which have not been previously described in the literature, to the best of our knowledge.Results:Patient 1 presented with dyspnea, dysphagia, bilateral ptosis, diplopia and seizures. Patient 2 presented with a paradoxical positional pattern of orthostatic hypotension. In Patient 3, bilateral subdural hematomas (SDH) were encountered; while in Patient 4, a recurrent unilateral SDH requiring multiple surgical interventions was demonstrated.Conclusion:Although uncommon clinical presentations, all four cases of intracranial hypotension were spontaneous, demonstrated diagnostic MRI findings, and responded favorably to blood patches or saline injections.
Intracranial Caseating Granulomas with No Infectious Organism Detected
Authors: Ghavanini Amer A. , Munoz David G. 
Published: December 2014

Abstract:Background:Caseating granuloma is a classic histopathological feature of mycobacterial infections. Occasionally, no infectious organism is demonstrated despite extensive examination of intracranial caseating granulomas. The pathogenesis and optimal management strategy for patients with such intracranial caseating granulomas with no detectable infectious organism (ICGNs) remain unclear.Methods:The study was a retrospective case-series design in a referral hospital setting. Patients with intracranial caseating granulomas in whom no infectious etiology was identified after appropriate investigations were reviewed.Results:Eight patients with ICGN (four females and four males) were identified in an eight-year-period. Average age on presentation was 46 years (range 21-69 years). Cerebrospinal fluid showed lymphocytic pleocytosis, elevated protein and decreased glucose. Neuroimaging showed multiple or single intraparenchymal and meningeal enhancements. Intracranial ICGN were demonstrated on biopsy. Immunomodulation was tried and resulted in improvement in five out of eight patients. In four patients, anti-mycobacterial treatment resulted in no improvement or worsening of clinical or radiological features.Conclusions:The response to therapy of intracranial caseating granulomas where no organism is identified after thorough investigations hints to non-infectious causes, and suggests current dogma regarding the significance of necrosis in granulomatous diseases should be re-evaluated. Our retrospective series suggests that patients may benefit from an early trial of immunomodulation therapy, a hypothesis to be tested in a randomized trial.
A Quantitative Analysis of Suspected Environmental Causes of MS
Authors: Sloka Scott , Silva Claudia , Pryse-Phillips William , Patten Scott , Metz Luanne , Yong V. Wee 
Published: December 2014

Abstract:Background:Multiple sclerosis (MS) is a disease with purported environmental causes. Consistent correlations have been found in various settings for latitude, smoking exposure, sunlight, and vitamin D deficiency. We analysed the contribution of various environmental factors to the risk of developing MS from a population perspective.Methods:We collated global data of MS prevalence from 54 studies over the previous ten years and calculated the degree of risk contributed by latitude, longitude, ultraviolet radiation (from NASA satellite data and formulae for available sunlight hours), population smoking rates (from WHO data), gender, study date, study demographics, and several socioeconomic factors. We report a very significant negative correlation between MS prevalence and available ultraviolet (UV) radiation.Results:The lack of available UV radiation outweighs other factors by at least 20 fold (p<10∧-8) from single variate regression analysis. Multiple regression analysis revealed that latitude and longitude are also significant factors; smoking may also provide a very minimal role. The eight prevalence studies from Scandinavia produced prevalences that were lower than expected, given their global geospatial positioning.Conclusions:The available ultraviolet radiation is a significant environmental factor, moreso than all the other factors examined.
Procalcitonin Levels in Migraine Patients
Authors: Turan Hale , Horasanli Bahriye , Ugur Murat , Arslan Hande 
Published: December 2014

Abstract:Objectives:Migraine is a risk factor for ischemic stroke. Sterile vascular inflammation may develop during migraine attacks. This study aims to investigate procalcitonin (PCT) levels amongst migraine patients as they are important markers for infection and sepsis, but can also be found at elevated levels in various cases of inflammation.Methods:Eighty adult migraine patients participated in our study. Patients were initially separated into two main groups; Group-1 consisted of 34 patients who had migraines during the attack period. Group-2 consisted of 46 patients during the period in-between attacks. Afterwards, patients were further divided into four subgroups based on their aura status; Group-1a Migraine without aura, 27 patients during attack period, Group-1b Migraine with aura, 7 patients during attack period, Group-2a Migraine without aura, 40 patients during the period in-between attacks, Group-2b Migraine with aura, 6 patients during the period in-between attacks.Results:Average PCT levels in patients during attack periods were found to be higher than the average PCT levels of patients during the period in-between attacks. These elevated levels were determined to be statistically significant(p<0.01). Serum PCT levels of the patients with migraine without aura during the attack period were significantly higher than those of patients during the period in-between attacks(p<0.01).Conclusions:Based on significantly high levels of PCT, our results support the idea that sterile inflammation plays a role in migraine pathogenesis. Further studies are necessary to understand whether PCT is a marker for ischemic stroke risk in patients who go through frequent migraine attacks.
Low Grade Glioma: A Qualitative Study of the Wait and See Approach
Authors: Hayhurst Caroline , Mendelsohn Daniel , Bernstein Mark 
Published: December 2014

Background:There is no consensus on the best management of adults with presumed low grade glioma (LGG). Studies have suggested uncertainty and anxiety associated with a wait and see approach contribute to reduced quality of life. This study aims to explore the impact of a diagnosis of LGG, to address concerns regarding the uncertainty of the diagnosis and the role of wait and see from the patient's perspective.Methods:Qualitative research methodology was used. A semi-structured interview was conducted with 24 patients with imaging evidence of LGG but no prior intervention. All patients had been followed for at least one year prior to interview. Verbatim transcripts were subjected to thematic analysis.Results:The median age of participants was 47 (range 21 - 82) and the median duration of follow-up 37 months (range 12 - 156 months). Fifty percent presented with seizures. Five overarching themes emerged from the data; 1) patients experience initial devastation followed by acceptance and low anxiety; 2) absence of symptoms mitigates anxiety concerning the possibility of progression; 3) patients would prefer to defer surgery until there is progression or a change in their quality of life; 4) anxiety is reduced by trust in the physician; 5) quality of life is not affected by the diagnosis, as fear of morbidity from intervention is greater than the fear of uncertainty.Conclusions:The wait and see approach does not contribute to anxiety or reduction in quality of life in patients with LGG.
Minimally Invasive versus Open Approach for Cervical Laminoforaminotomy
Authors: Winder Mark J. , Thomas Kenneth C. 
Published: December 2014

Background:Minimally invasive posterior cervical foraminotomy for radicular symptoms has become more prevalent. The reported experience with microscopic tubular assisted posterior cervical laminoforaminotomy (MTPF) for the treatment of radicular pain is lacking. Tubular assisted techniques have been considered to offer significant benefit, over open procedures, in terms of minimizing tissue damage, operative time, blood loss, analgesic requirements and length of hospital stay. We hypothesized that MTPF reduces post-operative analgesic requirements and length of hospital stay over the traditional open laminoforaminotomy, with no difference in complication rates and, secondly, that MTPF is comparable to endoscopic posterior foraminotomy (EPF).Methods:We conducted a retrospective review of 107 patients who underwent posterior cervical laminoforaminotomy for radicular pain between 1999 and 2009. Patient demographics, intra-operative parameters, length of hospitalization, post-operative analgesic use, complications and short-term neurological outcome were compared between groups.Results:Between 1999 and 2009, a total of 107 patients were identified to have undergone a cervical foraminotomy. An open approach was used in 65 patients, while 42 underwent MTPF. Operative time and complications were comparable between groups. Significant differences favoring MTPF were observed in operative blood loss, post-operative analgesic use and length of hospital stay (p<0.001). All results were comparable to previous reports utilizing EPF.Conclusions:MTPF for the treatment of cervical radiculopathy significantly reduces blood loss, post-operative analgesic use and length of hospital stay compared to the standard open approach. Operative time and complication rates were comparable between both techniques, whilst MTPF offered similar results compared to EPF.
Meaningful Change in Cognition in Multiple Sclerosis: Method Matters
Authors: Walker L. A. S. , Mendella P. D. , Stewart A. , Freedman M. S. , Smith A. M. 
Published: December 2014

Objective:To determine if different methods of evaluating cognitive change over time yield measurably different outcomes.Methods:Twelve cognitively impaired patients with clinically definite Multiple sclerosis (10 relapsing-remitting, 2 secondary progressive) underwent neuropsychological testing (baseline, 6, 12 months). Data was analysed using: t-tests evaluating group differences on individual tests, group differences in composite scores, reliable change analyses at the level of the individual, and comparisons regarding number of tests failed at each time point.Results:Group t-tests on individual tests yielded no change. When tests were grouped according to theoretical constructs, analyses revealed change in processing speed. Reliable change estimates revealed that 16% of the sample deteriorated. When change was measured with respect to the number of domains affected at each time point, 58% of the sample deteriorated on at least one subtest.Conclusions:Methodology has a significant impact on interpretation of longitudinal data. In the same group of subjects, traditional group analyses documented no change in individual test scores or change on a single composite score. Analyses of individual results documented change from 16 to 58% of the sample. Advantages and disadvantages of each method were discussed. Findings have implications for interpretation of longitudinal studies.
Outcomes after Carotid Angioplasty and Stenting in Symptomatic Octogenarians
Authors: Almekhlafi M. A. , Couillard P. L. , Pandya A. , Shobha N. , Morrish W. F. , Wong J. H. , Hill M. D. 
Published: December 2014

Objective:Octogenarians were excluded from participation in many carotid endarterectomy trials due to the high complication rates observed in past studies. However, stroke resulting from carotid stenosis is expected to increase with the aging population. Moreover, advances in Carotid Angioplasty and Stenting (CAS) techniques have resulted in perceived improved safety of this procedure. We sought to review our experience with carotid stenting in symptomatic octogenarians with an emphasis on short-term outcomes and complications.Methods:This is a retrospective longitudinal cohort study of all symptomatic patients who underwent CAS in our center between 1997 and 2007. Thirty-day stroke and death rates, and length of hospitalization were compared between the symptomatic octogenarians and non-octogenarians.Results:A total of 214 procedures were performed on 211 symptomatic patients (56 females). Fifty-nine patients (14 females) were octogenarians. The median (interquartile range) age on procedure date for the octogenarian cohort was 83 (4) years. Periprocedural death occurred in two (3.4%) octogenarians and five (3.3%) non-octogenarians (p = 0.97). At 30 days from the procedure, stroke occurred in four (6.8%) octogenarians and seven (4.6%) non-octogenarians (p= 0.52). The mean hospital stay (4.8 days) was not different between the two cohorts. Age was not a predictor of the 30-day risk of composite stroke or death.Conclusion:The complications rate observed in octogenarians was not significantly higher than non-octogenarians. Our findings suggest that octogenarians should be included in randomized trials examining CAS to better define the risk-benefit profile of this procedure in the elderly.
Posterior Fossa Measurements in Patients With and Without Chiari I Malformation
Authors: Dufton John A. , Habeeb Syed Yaser , Heran Manraj K. S. , Mikulis David J. , Islam Omar 
Published: December 2014

Purpose:To determine if there is a correlation between cerebellar tonsillar descent in patients with and without Chiari I malformation and three skull morphometric measurements: clivus length, anteroposterior diameter of the foramen magnum, and Boogard's angle.Methods:Cerebellar tonsillar descent, clivus length, anteroposterior diameter of the foramen magnum, and Boogard's angle were measured in mid-sagittal T1-weighted magnetic resonance images of 188 patients. The study included 81 patients with Chiari I malformations (CMI). Without identifiable pathology, 107 patients served as a comparison group. Two-sample t-tests were used to assess for significance. A Pearson correlation matrix was constructed to assess the strength of linear dependence between measured parameters for the study population.Results:A negative correlation was found between tonsillar herniation and clivus length (r = -0.30, P < 0.001), while a positive correlation was found between tonsillar herniation and foramen magnum size (r = 0.15, P = 0.0431), and Boogard's angle (r = 0.23, P = 0.0014). Clivus length was shorter (P = 0.0009) in CMI patients (4.02 cm ± 0.45) than comparison patients (4.23 cm ± 0.42). In addition, the anteroposterior diameter of the foramen magnum was wider (P = 0.0412) (3.74 cm ± 0.40 compared to 3.63 ± 0.30) and Boogard's angle was larger (P = 0.0079) (123.58 degrees ± 8.27 compared to 120.62 degrees ± 6.79) with CMI.Conclusion:A greater degree of cerebellar tonsillar herniation is associated with a shorter clivus length, a wider anteroposterior diameter of foramen magnum, and a wider Boogard's angle.