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30 ["Inter-rater reliability of published flow diversion occlusion scales"] 10.1136/neurintsurg-2015-012193 2016-01-20T23:04:34Z ["Surgery", "Clinical Neurology", "General Medicine"] 14 3 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Background</jats:title><jats:p>With increasing use of flow-diverting stents for the treatment of intracranial aneurysms, standardized methods and a common language to evaluate angiographic outcomes are needed. Multiple grading scales have been developed for this purpose but none has been widely adopted.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To analyze these scales to determine interobserver reliability.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Four independent assessors scored the intraprocedural angiograms of patients who underwent flow-diverting stent deployment for an intracranial saccular or fusiform aneurysm at our institution between October 2012 and June 2015. Angiographic outcome immediately after flow-diverting stent deployment was scored using three grading scales (Kamran–Byrne (KB), Simple Measurement of Aneurysm Residual after Treatment (SMART), and O'Kelley, Krings, Marotta (OKM)). Statistical analysis was performed using Light's κ for multiple raters (κ), Kendall's coefficient of concordance (W), and intraclass correlation (ICC).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included the angiograms of 50 consecutive patients (mean age 58 years, range 30–79) who underwent flow-diverting stent deployment for an intracranial aneurysm (40 saccular, 10 fusiform). Six aneurysms were located in the posterior circulation. The inter-rater reliability was typically poor or fair: SMART aneurysm filling (κ=0.30, W=0.36, ICC=0.12), SMART parent vessel stenosis (κ=0.07, W=0.33, ICC=0.12), KB axis I (κ=0.24, W=0.50, ICC=0.25), KB axis II (κ=0.07, W=0.30, ICC=0.06), OKM aneurysm filling (κ=0.23, W=0.45, ICC=0.13), OKM contrast stasis (κ=0.36,W=0.71, ICC=0.54).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Existing flow-diverting stent grading scales have low inter-rater reliability for most categories.</jats:p></jats:sec> 5 [] ["Marcus D Mazur", "Philipp Taussky", "Lubdha M Shah", "Blair Winegar", "Min S Park"] [""] [""] [""]
42 ["Hyper-reflexia in Guillain-Barr\u00e9 syndrome: systematic review"] 10.1136/jnnp-2019-321890 2020-01-14T22:33:50Z ["Surgery", "Psychiatry and Mental health", "Clinical Neurology"] 43 1 ["0022-3050", "1468-330X"] Journal of Neurology, Neurosurgery & Psychiatry <jats:p>Areflexia or hyporeflexia is a mandatory clinical criterion for the diagnosis of Guillain-Barré syndrome (GBS). A systematic review of the literature from 1 January 1993 to 30 August 2019 revealed 44 sufficiently detailed patients with GBS and hyper-reflexia, along with one we describe. 73.3% of patients were from Japan, 6.7% from the USA, 6.7% from India, 4.4% from Italy, 4.4% from Turkey, 2.2% from Switzerland and 2.2% from Slovenia, suggesting a considerable geographical variation. Hyper-reflexia was more frequently associated with antecedent diarrhoea (56%) than upper respiratory tract infection (22.2%) and the electrodiagnosis of acute motor axonal neuropathy (56%) than acute inflammatory demyelinating polyneuropathy (4.4%). Antiganglioside antibodies were positive in 89.7% of patients. Hyper-reflexia was generalised in 90.7% of patients and associated with reflex spread in half; it was present from the early progressive phase in 86.7% and disappeared in a few weeks or persisted until 18 months. Ankle clonus or Babinski signs were rarely reported (6.7%); spasticity never developed. 53.3% of patients could walk unaided at nadir, none needed mechanical ventilation or died. 92.9% of patients with limb weakness were able to walk unaided within 6 months. Electrophysiological studies showed high soleus maximal H-reflex amplitude to maximal compound muscle action potential amplitude ratio, suggestive of spinal motoneuron hyperexcitability, and increased central conduction time, suggestive of corticospinal tract involvement, although a structural damage was never demonstrated by MRI. Hyper-reflexia is not inconsistent with the GBS diagnosis and should not delay treatment. All GBS variants and subtypes can present with hyper-reflexia, and this eventuality should be mentioned in future diagnostic criteria for GBS.</jats:p> 3 ["", ""] ["Antonino Uncini", "Francesca Notturno", "Satoshi Kuwabara"] [""] [""] [""]
49 Nature, content and shifts over time of the most impactful unruptured intracranial aneurysms articles: a bibliometric analysis 10.1136/neurintsurg-2020-016238 2020-06-30T21:27:03Z ["Surgery", "Clinical Neurology", "General Medicine"] 29 0 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Background</jats:title><jats:p>The management of unruptured intracranial aneurysms (UIAs) has evolved significantly over the last few decades. Our objective was to evaluate the 100 most cited UIA articles by bibliometric analysis to identify nature, content and shifts over time.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Elsevier’s Scopus database was interrogated for the 100 most cited articles that focused on UIA. Older versus newer articles were compared, with categorical data analyzed using Pearson’s Chi-square, and continuous data analyzed using Wilcoxon’s rank-sum test.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The 100 most cited articles were published between 1975 and 2015, with the majority of these reporting patient clinical outcomes (n=69). There were 47/69 (68%) articles that described surgical intervention, with 38/47 (81%) and 18/47 (38%) including endovascular and open approaches, respectively . Publications peaked in 2004 (n=8), and the most common country of correspondence was the United States (n=59). Compared to older articles, newer articles had statistically higher citation rates (P&lt;0.01), higher number of authors (P&lt;0.01) with more multiple institution collaborations (P=0.01), greater disclosures of funding (P&lt;0.01), more focus on endovascular treatments (P=0.04), in more journals with a clinical, non-surgical focus (P&lt;0.01) published under open access policies (P&lt;0.01).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In the 100 most cited articles about UIAs to date, there is a distinct shift towards more co-authored efforts utilizing multi-institutional efforts focused on endovascular approaches supported by funding. The emergence of endovascular techniques has refreshed the need for more contemporary rupture risk prediction models and natural history data to validate current attitudes towards clinical management after these minimally invasive procedures for UIAs.</jats:p></jats:sec> 4 ["", ""] ["Victor M Lu", "Stephanie H Chen", "Christopher C Young", "Robert M Starke"] ["R01NS111119-01A1"] ["Foundation for the National Institutes of Health"] ["10.13039/100000009"]
59 ["Diagnosis and management of acute ischaemic stroke"] 10.1136/practneurol-2020-002557 2020-06-07T21:19:36Z ["Clinical Neurology", "General Medicine"] 130 0 ["1474-7758", "1474-7766"] Practical Neurology <jats:p>Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team. The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients. All patients should be admitted directly to an acute stroke unit for close monitoring for early neurological deterioration and prevention of secondary complications. Prompt investigation of the mechanism of stroke allows patients to start appropriate secondary preventative treatment. Future objectives include improving accessibility to endovascular thrombectomy, using advanced imaging to extend therapeutic windows and developing neuroprotective agents to prevent secondary neuronal damage.</jats:p> 4 ["", ""] ["Robert Hurford", "Alakendu Sekhar", "Tom A T Hughes", "Keith W Muir"] [""] [""] [""]
63 ["TM2-2\u2005Analysis of adverse events in the management of chronic headache by occipital nerve stimulation"] 10.1136/jnnp-2019-abn.41 2019-02-14T22:48:47Z ["Surgery", "Psychiatry and Mental health", "Clinical Neurology"] 0 0 ["0022-3050", "1468-330X"] Journal of Neurology, Neurosurgery & Psychiatry <jats:sec><jats:title>Objectives</jats:title><jats:p>To analyse long-term adverse events of occipital nerve stimulation (ONS).</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective open-label observational study.</jats:p></jats:sec><jats:sec><jats:title>Subjects</jats:title><jats:p>134 patients with refractory headaches implanted between 2007–2014 in a single specialised centre.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Information was collected on ONS device, implantable pulse generator (IPG) site and adverse event rates. The impact of implanter experience and the association between IPG site and adverse event rates was also explored.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Mean follow up was 46 months (6–108 months). A total of 139 adverse events were recorded in 75 patients (56%). A total of 59 additional surgeries were needed in 39 patients. A significant difference was seen in the rates of adverse events recorded between 2007–2010 and 2011–2014 (60.7% vs 42.6%, p=0.002). A significant reduction in ONS revision was seen over time (25.7% vs 5.9%, p=0.002). Analysis of adverse events with IPG site showed those with abdominal implants recorded higher adverse event rate that those with an IPG in the chest (65.8% vs 40.3%, p=0.004).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In specialist centres, adverse event rates of ONS can be much lower than reported in the literature. Our results suggest implanter experience and IPG site both have an effect on adverse event rate.</jats:p></jats:sec> 3 [] ["S Miller", "L Watkins", "M Matharu"] [""] [""] [""]