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Traumatic brain injury (TBI) is a global public health problem, causing long-term burden to patients and caregivers. Patients and their families often resort to seeking online information regarding TBI management while awaiting formal health care consultations. Although this information is accessible and immediately available, little is known about the quality of online resources. We evaluated the accessibility, relevance, and readability of information regarding TBI from major online search engines. TBI-related search terms were entered into 2 online search engines (Google and Yahoo), and the first 30 websites per search were assessed for eligibility. Quality (DISCERN score, JAMA Benchmark score) and readability (Flesch–Kincaid Grade Level, Flesch Reading Ease Score) were assessed. Associations between search ranking, quality, and readability were evaluated. In total, 202 websites were evaluated with mean DISCERN score 36.5 ± 9.9/80, signifying poor global quality, and mean JAMA Benchmark score 2.8 ± 1.1/4. The majority required 9–12 years of education (113/202; 55.9%) according to Flesch–Kincaid Grade Level and categorized as "Difficult" on Flesch Reading Ease Score (94/202; 46.5%). Website quality was not associated with search ranking or readability. There is a paucity of high-quality online resources for patients with TBI. Herein, we highlight: 1) the importance of guidance from healthcare professionals regarding online-information seeking; and 2) recommendations for the most useful online resources available. [ABSTRACT FROM AUTHOR]

Chronic subdural hemorrhage (CSDH) is a common neurosurgical pathology. While acute deterioration is managed surgically, the optimal management of patients with neurologically stable CSDH remains uncertain. Despite an increasing interest in the use of corticosteroids, it is unclear whether this reduces the rate of subsequent crossover to surgery. In this study we evaluate rate of crossover to surgery in such patients managed in our Neurosurgical unit. A retrospective database search over a 2-year period was performed. A multi-database literature review was also conducted to identify relevant articles reporting rate of subsequent surgery in CSDH patients managed with corticosteroids. A total of 532 CSDH patients were identified. Subsequently, a total of 364 patients who were managed conservatively were included for further analysis. The majority (315 patients; 59.1%) were managed conservatively. Forty-nine patients (9.2%) received steroids as first-line treatment. There was considerable variation in steroid dosing regimens, with the commonest involving 4 mg dexamethasone three times daily for 5 days. Four patients in the steroid group required subsequent surgery (8.2%), compared with 22 conservatively managed patients (7.0%). Statistical analysis revealed no significant difference in the rate of surgery (chi-square 0.089, difference 1, P = 0.77). Current evidence implicates a potentially beneficial role of dexamethasone in the management of CSDH. However, it remains unclear whether the rate of crossover to surgery is reduced in patients treated with corticosteroids compared with those managed conservatively. A longer duration of study with detailed analysis of individual cases and appropriately randomized cohorts are necessary to draw more reliable conclusions. [ABSTRACT FROM AUTHOR]

• Phenotypic association exist between copy number variant syndromes (CNVs) mediated neurocognitive deficits(NCDs) and congenital heart defects(CHDs), in the absence of surgical intervention. • The size of the CNV is associated with the severity of NCDs and number of CHDs, with no gender bias. • CHDs are often co-morbid with cognitive deficits and specific CHDs are associated with severe neurocognitive deficits. • Current standards of care do not encompass comorbidity of these phenotypes; potentially leading to underprovided clinical management and treatment. Copy number variant (CNV) syndromes are often associated with both neurocognitive deficits (NCDs) and congenital heart defects (CHDs). Children and adults with cardiac developmental defects likely to have NCDs leading to increased risk of hospitalisation and reduced level of independence. To date, the association between these two phenotypes have not been explored in relation to CNV syndromes. In order to address this question, we systematically reviewed the prevalence of CHDs in a range of CNV syndromes associated with NCDs. A meta-analysis showed a relationship with the size of CNV and its association with both NCDs and CHDs, and also inheritance pattern. To our knowledge, this is the first review to establish association between NCD and CHDs in CNV patients, specifically in relation to the severity of NCD. Importantly, we also found specific types of CHDs were associated with severe neurocognitive deficits. Finally, we discuss the implications of these results for patients in the clinical setting which warrants further exploration of this association in order to lead an improvement in the quality of patient's life. [ABSTRACT FROM AUTHOR]

Decompressive craniectomy (DC) is used for the treatment of raised intracranial pressure secondary to traumatic brain injury. Cranioplasty is a reconstructive procedure that restores the structural integrity of the skull following (DC). Seizures are a recognised complication of cranioplasty but its incidence and risk factors in TBI patients are unclear. Accurate prognostication can help direct prophylactic and treatment strategies for seizures. In this systematic review, we aim to evaluate current literature on these factors. A PROSPERO-registered systematic review was performed in accordance with PRISMA guidelines. Data was synthesised qualitatively and quantitatively in meta-analysis where appropriate. A total of 8 relevant studies were identified, reporting 919 cranioplasty patients. Random-effects meta-analysis reveals a pooled incidence of post-cranioplasty seizures (PCS) of 5.1% (95% CI 2.6-8.2%). Identified risk factors from a single study included increasing age (OR 6.1, p = 0.006), contusion at cranioplasty location (OR 4.8, p = 0.015), and use of monopolar diathermy at cranioplasty (OR 3.5, p = 0.04). There is an association between an extended DC-cranioplasty interval and PCS risk although it did not reach statistical significance (p = 0.062). Predictive factors for PCS are poorly investigated in the TBI population to date. Heterogeneity of included studies preclude meta-analysis of risk factors. Further studies are required to define the true incidence of PCS in TBI and its predictors, and trials are needed to inform management of these patients. [ABSTRACT FROM AUTHOR]