bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychosocial and neurocognitive performance after spontaneous nonaneurysmal subarachnoid hemorrhage related to the APOE-ε4 genotype: a prospective 5-year follow-up study
Authors: Alfieri Alex , Unterhuber Vera , Pircher Martina , Schwarz Andreas , Gazzeri Roberto , Reinert Michael , Widmer Hans R. 
Published: November 2008

Object
In this study, the authors prospectively evaluated long-term psychosocial and neurocognitive performance in patients suffering from nonaneurysmal, nontraumatic subarachnoid hemorrhage (SAH) and investigated the association between the APOE-ε4 genotype and outcome in these patients.

Methods
All patients admitted to the authors' institution between January 2001 and January 2003 with spontaneous nonaneurysmal SAH were prospectively examined (mean follow-up 59.8 months). The APOE genotype was determined in all patients by polymerase chain reaction from a blood sample. Of the 30 patients included in this study, 11 were carriers of the ε4 allele.

Results
All patients showed a good recovery and regained full independence with no persisting neurological deficits. The patients with the ε4 allele, however, scored significantly higher on the Beck Depression Inventory (22.1 ± 6.3 vs 14.1 ± 5.1). At follow-up, depression was more persistent in the group with the ε4 allele compared with the group that lacked the allele. This finding reached statistical significance (p < 0.05). Selective attention was impaired in all patients during the first year of follow-up, with an earlier recovery noted in the patients without the ε4 allele. Moreover, there was a tendency toward a linear relationship between the Beck Depression Inventory and the d2 Test of Attention. Two patients who carried the ε4 allele did not return to their employment even after 5 years.

Conclusions
The findings in this study suggest that the APOE genotypes may be associated with the psychosocial and neurocognitive performance after spontaneous nonaneurysmal SAH, even in the absence of neurological impairment. Physicians should consider patient genotype in assessing the long-term consequences of nonaneurysmal SAH.
Posttraumatic stress disorder in the family and friends of patients who have suffered spontaneous subarachnoid hemorrhage
Authors: Noble Adam J. , Schenk Thomas 
Published: November 2008

Object
Significant others (SOs), such as spouses and life partners, of patients who have survived subarachnoid hemorrhage (SAH) can experience psychiatric symptoms and psychosocial disability. The cause of such symptoms has not been established. Authors of the present study analyzed whether posttraumatic stress disorder (PTSD) subsequent to a loved one's SAH is a plausible explanation for these symptoms.

Methods
The authors examined a large representative sample of 86 patient/SO pairs 3.5 months postictus. All SOs were evaluated using a diagnostic PTSD measure, and coping skills were assessed. The cognitive, physical, and emotional status of patients was comprehensively examined.

Results
Twenty-six percent of SOs met the diagnostic criteria for PTSD, which represents a 3-fold increase in the rate expected within the general population. To establish the cause of PTSD, a logistic regression was performed, and results of this test showed that the use of maladaptive coping strategies was the best predictor of the disorder. A patient's level of disability held no significant association with the development of PTSD in his or her SO.

Conclusions
The elevated incidence of PTSD in SOs helps to explain why these persons report concerning levels of psychiatric symptomatology and psychosocial disability. Greater attention must be given to an SO's adjustment to the experience of having a loved one suffer an SAH. This need is all the more pertinent given that SOs often act as informal caregivers and that PTSD could interfere with their ability to effectively minister. Because bad coping skills seem to be the main cause of PTSD, teaching SOs better strategies might prevent the disorder and any resulting psychosocial disability.
Spontaneous isolated convexity subarachnoid hemorrhage: presentation, radiological findings, differential diagnosis, and clinical course
Authors: Refai Daniel , Botros James A. , Strom Russell G. , Derdeyn Colin P. , Sharma Aseem , Zipfel Gregory J. 
Published: November 2008

Object
The clinical characteristics and overall outcome in patients with spontaneous isolated convexity subarachnoid hemorrhage (SAH) are not well described in the literature. The purpose of this study was to examine the mode of presentation, common origins, radiographic findings, and clinical course in a large case series of such patients.

Methods
A retrospective single-center chart review of all patients in whom nontraumatic primary convexity SAH was diagnosed between 2002 and 2007 was performed. Twenty patients were identified and analyzed for presenting symptoms, radiological and laboratory findings, hospital course, and outcome.

Results
There were 15 women and 5 men in our series, and the mean age was 52 years (range 18–86 years). The most common presenting symptom was headache, with 15 patients experiencing it as a chief complaint. Other frequent manifestations included altered mental status (8 patients), focal neurological deficits (7), and seizure (4 patients). An underlying cause of the hemorrhage was identified in 13 cases, whereas the remainder went unresolved. Of the known causes, 5 were due to posterior reversible encephalopathy syndrome, 3 were caused by thrombocytopenia or anticoagulation, and the remainder were isolated cases of lupus vasculitis, drug-induced vasculopathy, postpartum cerebral angiopathy, hypertensive microangiopathy, and Call–Fleming syndrome. All patients with unknown disease origins had favorable outcomes, whereas 8 of 13 patients with an identifiable underlying disorder experienced favorable outcomes.

Conclusions
Spontaneous isolated convexity SAH is rarely caused by aneurysm rupture, has a distinct mode of presentation, and generally carries a more favorable prognosis than that of aneurysmal SAH.
Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage
Authors: Schmidt J. Michael , Wartenberg Katja E. , Fernandez Andres , Claassen Jan , Rincon Fred , Ostapkovich Noeleen D. , Badjatia Neeraj , Parra Augusto , Connolly E. Sander , Mayer Stephan A. 
Published: November 2008

Object
The authors sought to determine frequency, risk factors, and impact on outcome of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage (SAH).

Methods
The authors prospectively studied 580 patients with SAH admitted to their center between July 1996 and May 2002. Delayed cerebral ischemia (DCI) from vasospasm was defined as 1) a new focal neurological deficit or decrease in level of consciousness, 2) a new infarct revealed by follow-up CT imaging, or both, after excluding causes other than vasospasm. Outcome at 3 months was assessed using the modified Rankin Scale.

Results
Delayed cerebral ischemia occurred in 121 (21%) of 580 patients. Of those with DCI, 36% (44 patients) experienced neurological deterioration without a corresponding infarct, 42% (51 patients) developed an infarct in conjunction with neurological deterioration, and 21% (26 patients) had a new infarct on CT without concurrent neurological deterioration. In a multivariate analysis, risk factors for asymptomatic DCI included coma on admission, placement of an external ventricular drain, and smaller volumes of SAH (all p ≤ 0.03). Patients with asymptomatic DCI were less likely to be treated with vasopressor agents than those with symptomatic DCI (64 vs 86%, p = 0.01). After adjusting for clinical grade, age, and aneurysm size, the authors found that there was a higher frequency of death or moderate-to-severe disability at 3 months (modified Rankin Scale Score 4–6) in patients with asymptomatic DCI than in patients with symptomatic DCI (73 vs 40%, adjusted odds ratio 3.9, 95% confidence interval 1.3–12.0, p = 0.017).

Conclusions
Approximately 20% of episodes of DCI after SAH are characterized by cerebral infarction in the absence of clinical symptoms. Asymptomatic DCI is particularly common in comatose patients and is associated with poor outcome. Strategies directed at diagnosing and preventing asymptomatic infarction from vasospasm in patients with poor-grade SAH are needed.
Polymorphism rs42524 of COL1A2 and sporadic intracranial aneurysms in the Chinese population
Authors: Zhu Yufang , Li Weiju , Ge Mingxu , Xu Shangchen , Zhao Guangyu , Wang Hanbin , Qian Haiyan , Zhu Ningxi , Pang Qi 
Published: November 2008

Object
The COL1A2 gene at 7q22.1 has been shown to be associated with familial intracranial aneurysms (IAs) in the Japanese population. In the present study, the authors investigated the correlation between the presence of the rs42524 polymorphism in COL1A2 and the occurrence of sporadic IAs in Chinese patients.

Methods
The polymorphism rs42524 of the COL1A2 gene was identified by polymerase chain reaction–based restriction analysis in genomic DNA from 226 patients with sporadic IAs (mean age 51.49 ± 11.47 years) and 326 control participants (mean age 52.33 ± 10.50 years). Neurological assessments were performed using the Hunt and Hess grading system, and differences in allelic and genotypic frequencies between the patient and control groups were evaluated with the chi-square test.

Results
There was a significant difference in either the genotype distribution (χ2 = 11.99, p = 0.002) or allelic frequencies (χ2 = 11.96, p = 0.001, odds ratio 2.579, 95% confidence interval 1.486–4.476) between patients with IAs and patients in the control group.

Conclusions
The rs42524 polymorphism of COL1A2 could be a genetic risk factor for sporadic IAs among individuals of Chinese Han ethnicity. This study is the first to confirm the association between COL1A2 and IAs.
Intravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection
Authors: Yoon Won-Ki , Kim Young-Woo , Kim Sang-Don , Park Ik-Seong , Baik Min-Woo , Kim Seong-Rim 
Published: November 2008

The authors report on a case of intravascular ultrasonography (IVUS)-guided stent angioplasty for iatrogenic extracranial vertebral artery (VA) dissection in a 49-year-old man after coil embolization for an unruptured aneurysm of the right posterior inferior cerebellar artery. Insignificant dissections occurred during the procedure. Postoperatively, the patient experienced gradually worsening posterior neck pain and headache, and follow-up angiography 8 months after the coil embolization revealed expansion of the dissection. The patient underwent stent angioplasty with IVUS guidance and his symptoms improved.
To the authors' knowledge, this is the first report of IVUS-guided stent angioplasty of an extracranial VA dissection. It was safe and feasible to treat extracranial VA dissections with stent placement under IVUS guidance. Intravascular environments are in real time with IVUS, and this technique is useful in the confirmation of a true lumen and evaluation of appropriate stent apposition. More clinical experience with this technique is necessary and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.
Hemodynamic effects of recombinant human erythropoietin on the central nervous system after subarachnoid hemorrhage: reduction of microcirculatory impairment and functional deficits in a rabbit model
Authors: Murphy Amanda M. , Xenocostas Anargyros , Pakkiri Pria , Lee Ting-Yim 
Published: November 2008

Object
The authors investigated the hemodynamic effects of recombinant human erythropoietin (rhEPO) after subarachnoid hemorrhage (SAH) in rabbits.

Methods
The authors used male New Zealand White rabbits in this study divided into the following groups: SAH plus saline (16 rabbits), SAH plus low-dose rhEPO (16 rabbits; 1500 IU/kg on Day 0 and 500 IU/kg on Days 2 and 4), SAH plus high-dose rhEPO (10 rabbits; 1500 IU/kg on Days 0, 2, 4, and 6), and sham (6 rabbits). Computed tomography perfusion studies and CT angiography were performed for 1 hour after SAH on Day 0, and once each on Days 2, 4, 7, 9, and 16 after SAH. Assessments of neurological function and tissue histology were also performed.

Results
The mortality rate was significantly lower after rhEPO treatment (12%) than after saline treatment (44%) (p < 0.05). Neurological outcomes in the low-dose and high-dose rhEPO groups were better than in the saline group after SAH (p < 0.05), and the cerebral blood flow in the high-dose rhEPO group was greater than that in the saline group (p < 0.05). The mean transit time was significantly lower on Days 2 and 4 in the low-dose and high-dose rhEPO groups than in the saline group, but increased significantly on Day 7 in both groups (p < 0.05). The hematocrit increased significantly from baseline values in the high-dose and low-dose rhEPO groups on Days 4 and 7, respectively (p < 0.05).

Conclusions
Treatment with rhEPO after experimental SAH is associated with improved cerebral blood flow and microcirculatory flow as reflected by lower mean transit times. Improved tissue perfusion correlated with reduced mortality and improved neurological outcomes. Further investigation of the impact of increasing hematocrit on hemodynamic changes is needed.
Compensatory cerebral adaptations before and evolving changes after surgical decompression in cervical spondylotic myelopathy
Authors: Dong Yun , Holly Langston T. , Albistegui-Dubois Richard , Yan Xiaohong , Marehbian Jonathan , Newton Jennifer M. , Dobkin Bruce H. 
Published: November 2008

Object
The goal of this study was to compare cortical sensorimotor adaptations associated with neurological deterioration and then recovery following surgical decompression for cervical spondylotic myelopathy (CSM).

Methods
Eight patients with CSM underwent functional MR (fMR) imaging during wrist extension and the 3-finger pinch task, along with behavioral assessments before and 3 and 6 months after surgery. Six healthy control volunteers were scanned twice.

Results
Cervical spine MR imaging demonstrated successful cord decompression. The patients improved after surgery on the modified Japanese Orthopaedic Association score for the upper extremity, which correlated with the changes in task-associated activation in specific sensorimotor regions of interest. Pinch-related activation in sensorimotor cortex contralateral to the movement paradigm was reduced before surgery then increased toward the extent of healthy controls after surgery. Before surgery, patients showed broader activation in ipsilateral sensorimotor cortex during wrist extension than during pinch, but activations became similar to those of healthy controls after surgery. Pinch-related activation volume in the ipsilateral sensorimotor cortex and the magnitude of activation in the contralateral dorsal premotor cortex evolved linearly across time after surgery, along with wrist extension–related activation magnitude in the contralateral supplementary motor area.

Conclusions
Serial fMR imaging studies in CSM can capture the adaptations in specific sensorimotor cortices that accompany clinical deterioration and postsurgical improvement in sensorimotor function associated with damage and partial recovery of conduction in corticospinal pathways. These adaptive regions can be monitored by serial fMR imaging to detect a critical loss of supraspinal reserve in compensatory plasticity, which might augment clinical information about the need for surgical decompression.
Thecal shunt placement for treatment of obstructive primary syringomyelia
Authors: Lam Sandi , Batzdorf Ulrich , Bergsneider Marvin 
Published: November 2008

Object
The most commonly reported treatment of primary syringomyelia has been laminectomy with duraplasty or direct shunting from the syrinx cavity. Diversion of cerebrospinal fluid (CSF) from the spinal subarachnoid space to peritoneal, atrial, or pleural cavities has been described previously in only a few case reports. Shunting of the CSF from the subarachnoid space rostral to the level of myelographic blockage may reduce the filling force of the syrinx cavity and avoids myelotomy and manipulation of the spinal cord parenchyma. The authors report on 7 patients who underwent thecal shunt placement for primary spinal syringomyelia.

Methods
This study is a retrospective review of a consecutive series. The authors reviewed the medical records and neuroimaging studies of 7 adult patients with posttraumatic, postsurgical, or postinflammatory syringomyelia treated with thecoperitoneal, thecopleural, or thecoatrial shunt placement at the University of California Los Angeles Medical Center. Myelographic evidence of partial or complete CSF flow obstruction was confirmed in the majority of patients. The mean duration of follow-up was 33 months (range 6–104 months).

Results
Six (86%) of 7 patients showed signs of clinical improvement, whereas 1 remained with stable clinical symptoms. Of the 6 patients with available postoperative imaging, each demonstrated a reduction in syrinx size. Three patients (43%) had ≥ 1 complication, including shunt-induced cerebellar tonsillar descent in 1 patient and infections in 2.

Conclusions
If laminectomy with duraplasty is not possible for the treatment of primary syringomyelia, placement of a thecoperitoneal shunt (or thecal shunt to another extrathecal cavity) should be considered. Although complications occurred in 3 of 7 patients, the complication rate was outweighed by a relatively high symptomatic and imaging improvement rate.
Risk factors for closure of lamina after open-door laminoplasty
Authors: Matsumoto Morio , Watanabe Kota , Tsuji Takashi , Ishii Ken , Takaishi Hironari , Nakamura Masaya , Toyama Yoshiaki , Chiba Kazuhiro 
Published: November 2008

Object
This retrospective study was conducted to evaluate the prevalence and clinical consequences of postoperative lamina closure after open-door laminoplasty and to identify the risk factors.

Methods
Eighty-two consecutive patients with cervical myelopathy who underwent open-door laminoplasty without plates or spacers in the open side (Hirabayashi's original method) were included (62 men and 20 women with a mean age of 62 years and a mean follow-up of 1.8 years). In 67 patients the cause of cervical myelopathy was spondylotic myelopathy, and in 15 it was caused by ossification of posterior longitudinal ligament. Radiographic measurements were made of the anteroposterior diameters of the spinal canal and vertebral bodies from C3–6, and the presence of kyphosis were assessed. Lamina closure was defined as ≥ 10% decrease in the canal-to-body ratio at the final follow-up compared with that immediately after surgery at ≥ 1 vertebral level. The impact of lamina closure on neck pain, patient satisfaction, Japanese Orthopaedic Association scores, and recovery rates were also evaluated.

Results
The mean canal-to-body ratio at C3–6 was 0.69–0.72 preoperatively, 1.25–1.28 immediately after surgery, and 1.18–1.24 at the final follow-up examination. Lamina closure was observed in 34% of patients and was not associated with sex, age, or cause of myelopathy, but was significantly associated with the presence of preoperative kyphosis (p = 0.014). Between patients with and without lamina closure, there was no significant difference in preoperative (9.7 ± 3.1 vs 10.6 ± 2.5) and postoperative (13.7 ± 2.4 vs 13.1 ± 2.7) Japanese Orthopaedic Association scores, recovery rates (53.9 ± 29.9% vs 44.3 ± 29.5%), neck pain scores (3.5 ± 0.7 vs 3.3 ± 1.0), or patient satisfaction level (4.0 ± 1.4 vs 4.8 ± 1.0).

Conclusions
Lamina closure at ≥ 1 vertebral level occurred in 34% of patients. Although patients with lamina closure obtained equivalent recovery from myelopathy in a short-term follow-up, they tended to be less satisfied with surgery compared with those who did not have closure. The only significant risk factor identified was the presence of preoperative cervical kyphosis, and preventative methods for lamina closure, therefore, should be considered for patients with preoperative kyphosis.
Surgeon and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion
Authors: Bindal Rajesh K. , Glaze Sharon , Ognoskie Meghann , Tunner Van , Malone Robert , Ghosh Subrata 
Published: November 2008

Object
Minimally invasive transforaminal lumbar interbody fusion (TLIF) is an increasingly popular procedure. The technique involves use of fluoroscopy to assist with pedicle screw (PS) placement. The potential exists for both the surgeon and the patient to become exposed to significant amounts of radiation. The authors undertook this study to quantify the radiation dose to the surgeon and patient during minimally invasive TLIF.

Methods
The authors undertook a prospective study of 24 consecutive patients who underwent minimally invasive TLIF. All surgeries were performed by the senior author (R.K.B.), who used techniques previously described. The surgeon wore a radiation monitor under an apron-style lead shield at waist level, at an unshielded collar location, and as a sterile ring badge containing a thermoluminescent dosimeter on the dominant (right) hand ring finger. Dosimeter readings were obtained for each case. A total of 33 spinal levels were treated in 24 patients. All treated levels were between L3–4 and L5–S1. In all cases of 1-level disease, 4 PSs were placed, and in all cases of 2-level disease, 6 screws were placed.

Results
. Mean fluoroscopy time was 1.69 minutes per case (range 3.73–0.82 minutes). Mean exposure per case to the surgeon on his dominant hand was 76 mRem, at the waist under a lead apron was 27 mRem, and at an unprotected thyroid level was 32 mRem. Mean exposure to the patient's skin was 59.5 mGy (range 8.3–252 mGy) in the posteroanterior plane and 78.8 mGy (range 6.3–269.5 mGy) in the lateral plane.

Conclusions
To the authors' knowledge, this is the first study of radiation exposure to the surgeon or patient in minimally invasive TLIF. Patient exposures were low and compare favorably with exposures involving other common interventional fluoroscopically guided procedures. Surgeon exposures are limited but require careful monitoring. Annual dose limits could be exceeded if a large number of these and other fluoroscopically guided procedures were performed.
The preservation of methanesulphonic acid in frozen ice-core samples
Authors: Abram Nerilie J. , Curran Mark A.J. , Mulvaney Robert , Vance Tessa 
Published: November 2008

AbstractIce-core records of methanesulphonic acid (MSA) provide a potentially powerful tool for producing proxy records of sea ice, a critical but poorly understood component of the Earth’s climate system. However, MSA is able to diffuse through solid ice, and here we examine the effect of two different methods of frozen storage on the preservation of MSA in archived ice-core samples. Re-analysis of archived ice sticks confirms that MSA diffuses out of ice cores archived in this manner. Despite MSA losses of up to 39% after 7 years storage, the ice sticks studied here preserve much of the variability of the original MSA record, suggesting that useful proxy records can be obtained from archived ice sticks. Furthermore, re-analysis of ice-core samples that had been refrozen into discrete bottled samples for storage demonstrates that it is possible to archive ice samples in a way that prevents MSA loss. In this case, accurate records of MSA variability and concentration were preserved even over storage periods of 15 years. This has important implications for the storage of ice cores and subsequent determination of MSA, and demonstrates that ice storage history needs to be considered when interpreting MSA records.