Search

Background: Atlantoaxial subluxation (AAS) is a diagnosis describing misalignment of the C1 vertebra relative to C2. Excessive translation of this joint, located adjacent to the medullary brain stem, can lead to devastating neurological consequences. A higher prevalence of AAS within the Down syndrome (DS) population has been well-established. This study aims to establish a prevalence rate of DS in patients hospitalized for AAS and compare outcomes between AAS patients with and without DS. Methods: This study utilized the National Inpatient Sample (NIS) provided by the Healthcare Cost and Utilization Project (HCUP). In accordance with HCUP 2023 Clinical Classifications Software Refined files, data were queried using the International Classification of Diseases 10th Edition codes for DS and AAS. Demographics, comorbidities, hospital course, and outcomes were examined and compared using binary and linear multivariate regression. IBM SPSS software was used for data analysis. Results: Of the 213,095 patients in the NIS database admitted between 2016 and 2020 with AAS as their primary diagnosis, 7.2% were DS patients. DS patients were significantly younger (26.56 ± 20.81 vs. 49.39 ± 27.63, P < 0.01), less likely to be female (33.30% vs. 52.10%), and had fewer comorbidities (diabetes mellitus, hypertension, and hyperlipidemia) than non-DS patients. There was no significant difference in likelihood to undergo surgical fusion between DS patients and non-DS patients with AAS. Conclusion: This large-scale study using NIS data determined that 7.2% of all patients admitted to hospitals for AAS are DS patients. The analysis of demographics, hospital course, and outcomes can influence the development of treatment protocols for AAS in the DS population.

Background/Objectives: Recent studies reveal an “obesity paradox”, suggesting better clinical outcomes after intracranial hemorrhage for obese patients compared to patients with a healthy BMI. While this paradox indicates improved survival rates for obese individuals in stroke cases, it is unknown whether this trend remains true across all forms of intracranial hemorrhage. Therefore, the objective of our study was to investigate the incidence, characteristics, and outcomes of hospitalized obese patients with intracranial hemorrhage. Methods: The National Inpatient Sample (NIS) database was queried for data from 2015 to 2019 to identify adult patients aged 18 years and older with a primary diagnosis of non-traumatic intracranial hemorrhage. Using International Classification of Disease 10th Edition codes, patients were stratified by BMI categories: healthy weight, overweight, class I–II obesity, and class III obesity. The cohorts were examined for demographic characteristics, comorbidities, stroke severity, inpatient complications, interventions, and clinical outcomes, including length of stay (LOS), discharge disposition, and inpatient mortality. Results: Of 41,960 intracranial hemorrhage patients identified, 13,380 (33.0%) also had an obese BMI. Class I–II obese intracranial hemorrhage patients were more likely to be of white race (OR: 1.101, 95% CI: 1.052, 1.152, p < 0.001), less likely to be female (OR: 0.773, 95% CI: 0.740, 0.808, p < 0.001), and more likely to have diabetes mellitus (OR: 1.545, 95% CI: 1.477, 1.616, p < 0.001) and hypertension (OR: 1.828, 95% CI: 1.721, 1.943, p < 0.001) in comparison to healthy-weight patients. In a matched cohort analysis adjusting for demographics and severity, intracranial hemorrhage patients with class I–II obesity had a shorter length of stay (LOS) (OR 0.402, 95% CI: 0.118, 0.705, p < 0.001), reduced inpatient mortality (OR 0.847, 95% CI: 0.798, 0.898, p < 0.001), and more favorable discharge disposition (OR 1.395, 95% CI: 1.321, 1.474, p < 0.001) compared to their healthy-weight counterparts. Furthermore, these patients were less likely to require decompressive hemicraniectomy (OR 0.697, 95% CI: 0.593, 0.820, p < 0.001). Following an analysis of individual ICH subtypes, obese subarachnoid hemorrhage (SAH) patients demonstrated reduced mortality (OR: 0.692, 95% CI: 0.577–0.831, p < 0.001) and LOS (OR: 0.070, 95% CI: 0.466–0.660, p = 0.039), with no differences in discharge disposition. Similarly, intracerebral hemorrhage patients demonstrated reduced mortality (OR: 0.891, 95% CI: 0.827–0.959, p = 0.002) and LOS (OR: 0.480, 95% CI: 0.216–0.743, p < 0.001). Other ICH subtypes showed improved discharge outcomes (OR: 1.504, 95% CI: 1.368–1.654, p < 0.001), along with decreased mortality (OR: 0.805, 95% CI: 0.715–0.907, p < 0.001) and LOS (OR: −10.313, 95% CI: −3.599 to −2.449, p < 0.001). Conclusions: Intracranial hemorrhage patients with class I–II obesity exhibited more favorable clinical outcomes than those who were of a healthy weight or overweight. Despite its association with risk factors contributing to intracranial hemorrhage, class I–II obesity was associated with improved outcomes, lending support to the existence of the obesity paradox in stroke.

Frailty is an emerging concept in clinical practice used to predict outcomes and dictate treatment algorithms. Frail patients, especially older adults, are at higher risk for adverse outcomes. Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical emergency associated with high morbidity and mortality rates that have previously been shown to correlate with frailty. However, the relationship between treatment selection and post-treatment outcomes in frail aSAH patients is not established. We conducted a meta-analysis of the relevant literature in accordance with PRISMA guidelines. We searched PubMed, Embase, Web of Science, and Google Scholar using “Subarachnoid hemorrhage AND frailty” and “subarachnoid hemorrhage AND frail” as search terms. Data on cohort age, frailty measurements, clinical grading systems, and post-treatment outcomes were extracted. Of 74 studies identified, four studies were included, with a total of 64,668 patients. Percent frailty was 30.4% under a random-effects model in all aSAH patients (p < 0.001). Overall mortality rate of aSAH patients was 11.7% when using a random-effects model (p < 0.001). There was no significant difference in mortality rate between frail and non-frail aSAH patients, but this analysis only included two studies and should be interpreted cautiously. Age and clinical grading, rather than frailty, independently predicted outcomes and mortality in aSAH patients.

Cerebrovascular injuries resulting from blunt or penetrating trauma to the head and neck often lead to local hemorrhage and stroke. These injuries present with a wide range of manifestations, including carotid or vertebral artery dissection, pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid-cavernous fistula, epistaxis, venous sinus thrombosis, and subdural hematoma. A selective review of the literature from 1989 to 2023 was conducted to explore various neuroendovascular surgical techniques for craniocervical trauma. A PubMed search was performed using these terms: endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, transection, vasospasm, carotid-cavernous fistula, arteriovenous fistula, epistaxis, cerebral venous sinus thrombosis, subdural hematoma, and middle meningeal artery embolization. An increasing array of neuroendovascular procedures are currently available to treat these traumatic injuries. Coils, liquid embolics (onyx or n-butyl cyanoacrylate), and polyvinyl alcohol particles can be used to embolize lesions, while stents, mechanical thrombectomy employing stent-retrievers or aspiration catheters, and balloon occlusion tests and super selective angiography offer additional treatment options based on the specific case. Neuroendovascular techniques prove valuable when surgical options are limited, although comparative data with surgical techniques in trauma cases is limited. Further research is needed to assess the efficacy and outcomes associated with these interventions.

The use of racial variables in genetic studies has become a matter of intense public debate, with implications for research design and translation into practice. Using research on smoking as a springboard, the authors examine the history of racial categories, current research practices, and arguments for and against using race variables in genetic analyses. The authors argue that the sociopolitical constructs appropriate for monitoring health disparities are not appropriate for use in genetic studies investigating the etiology of complex diseases. More powerful methods for addressing population structure exist, and race variables are unacceptable as gross proxies for numerous social/environmental factors that disproportionately affect minority populations. The authors conclude with recommendations for genetic researchers and policy makers, aimed at facilitating better science and producing new knowledge useful for reducing health disparities. [ABSTRACT FROM AUTHOR]

Background and Aims: Ultrasound (US)-guided infraclavicular approach for axillary vein (AXV) cannulation has gained popularity in the last decade. Material and Methods: In this manikin study, we evaluated the feasibility of a training model for teaching AXV cannulation. The learning pattern with this technique was assessed among attending anesthesiologists and residents in training. Results: A faster learning pattern was observed for AXV cannulation among the attending anesthesiologists and residents in training, irrespective of their prior experience with US. It was evident that a training modality for this technique could be easily established with a phantom model and that hands-on training motivates trainees to embrace US-based central venous cannulation. Conclusion: A teaching model for US-guided infraclavicular longitudinal in-plane AXV cannulation can be established using a phantom model. A focused educational program would result in an appreciable change in preference in embracing US-based cannulation techniques among residents.