- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: This work aims to determine how antibiotic therapy influences MR spectroscopic findings in patients undergoing treatment for pyogenic brain abscess. METHODS: This prospective, single center study included all patients who received treatment for brain abscesses at the Neurosurgery Department of University Hospital Ostrava between 2012-2017. Preoperative MR imaging was carried out on all patients including diffusion-weighted imaging and in vivo single-voxel proton spectroscopy with intermediate echo time. The following factors were evaluated: duration of antibiotic therapy, characteristics of MR imaging and spectra findings and culture results. RESULTS: MR spectroscopy findings characteristic of brain abscesses, i.e. the resonances of at least one of the metabolites concerned (amino acids, acetate, alanine and succinate), were observed in 23 patients who had undergone antibiotic therapy for less than 72 hours beforehand (median 7 hours; IQR 30 hours). The 20 patients who underwent antibiotic therapy for longer than this (the median time was 336 hours with an IQR of 284 hours) showed no abscess-specific metabolites, only nonspecific lactate and/or lipid resonance (P<0.0005). These results were further compared with culture findings of pus samples taken intraoperatively: a significantly higher rate of positive culture (78.2%) was determined in cases where antibiotics were administered less than 72 hours before MRS (P<0.0005). CONCLUSIONS: Prolonged antibiotic therapy can influence MRS findings in pyogenic brain abscesses - a fact which is certainly necessary to take into account in its differential diagnosis. The disappearance of the characteristic metabolites can be indirectly interpreted as an indicator of successful antibiotic therapy in cases where surgical intervention is not possible. Further study in this field is required to confirm the results of this study.
Cíl práce: Toto souhrnné sdělení popisuje epidemiologii, etiopatogenezi a management nejen traumatických disekcí magistrálních tepen mozku. Obsah: Cerviko-kraniální arteriální disekce je vzácnou příčinou CMP u mladších jedinců. Vzniká na podkladě ruptury v cévní stěně se vznikem okluzivní stenózy či disekujícího aneuryzmatu. Vedoucím příznakem je zpravidla bolest hlavy s přidruženými neurologickými příznaky (typicky parciálním Hornerovým syndromem či parézou hlavových nervů) či projevy akutní ischemie. Základem diagnostiky je v akutní fázi ultrasonografie, zpravidla s doplněním následné angiografie, diagnosticky cenná je také magnetická rezonance. Terapie extrakraniálních disekcí je zpravidla medikamentózní s akutní heparinizací, u intrakraniálních disekcí je pro vysoké riziko subarachnoidálního krvácení vhodnější intervenční léčba se stentáží postiženého úseku. Poslední možností je léčba chirurgická. Prognóza pacientů je poměrně příznivá, s kompletní úpravou u 75–85 % pacientů s extrakraniální disekcí, prognóza intrakraniálních disekcí je výrazně horší. Závěr: Akutní cerviko-kraniální arteriální disekce je závažným stavem vyžadujícím promptní diagnostiku i terapii, především při postižení intrakraniálních tepen. Rozšiřující se možnosti intervenční terapie však přináší nové terapeutické možnosti.
- MeSH
- intrakraniální aneurysma MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- traumatické intrakraniální krvácení * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- hodnotící studie MeSH
Objective of the thesis: This summary statement describes epidemiology, etiopathogenesis and management of not only traumatic dissections of the parent cerebral arteries. Content: Craniocervical arterial dissection is a rare cause of CVA in younger individuals. It develops on the basis of a rupture in the vascular wall with the formation of occlusive stenosis or dissecting aneurysm. As a rule, the primary symptom is headache with associated neurological symptoms (typically partial Horner’s syndrome or paresis of the head nerves) or manifestations of acute ischaemia. The basis of the diagnostics is in the acute phase of ultrasonography, usually with the addition of subsequent angiography; magnetic resonance is also diagnostically valuable. Therapy of extracranial dissections is usually medicamental with acute heparinisation; in intracranial dissections, interventional treatment with stenting of the affected segment is preferred due to high risk of subarachnoid haemorrhage. The last option is the surgical treatment. The prognosis of patients is relatively favourable, with a complete recovery in 75-85% of patients with extracranial dissection; the prognosis for intracranial dissections is significantly worse. Conclusion: Acute craniocervical arterial dissection is a serious condition requiring prompt diagnosis and therapy, especially where intracranial arteries are affected. However, the expanding possibilities of intervention therapy bring new therapeutic possibilities.
- MeSH
- intrakraniální aneurysma MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- traumatické intrakraniální krvácení * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- hodnotící studie MeSH
INTRODUCTION: Pyocephalus always presents serious complications in the treatment of brain abscesses, and is associated with high rates of mortality and morbidity. This study aimed to comprehensively evaluate this understandably feared complication from a purely medical perspective by using an evidence-based approach and drawing comparisons from the available literature, which mostly comprises case reports. METHODS: This was a prospective monocentric study of all patients treated for brain abscesses at the Neurosurgery Clinic of the University Hospital Ostrava between 2012 and 2017. The cohort was divided into two groups for statistical comparison; one group comprised those in which pyocephalus occurred before or during treatment, while the other group comprised patients without this complication. Particular consideration was given to the effect of pyocephalus on morbidity and mortality rates and C-reactive protein levels, as well as to the identification of risk factors, and to its possible therapeutic influence. Patients were followed up for six months. RESULTS: A total of 43 patients were treated for a brain abscess. An unequivocal diagnosis of pyocephalus was established via CT and MRI brain scans in five cases (11.6%). In the cohort as a whole, mortality and morbidity rates were 23.3% and 48.8% respectively. Among patients with pyocephalus the incidence of mortality and morbidity was 40% and 66.6% respectively. The presence of pyocephalus is not a significant predictor of either morbidity (p 0.575) or mortality (p 0.664). In patients with pyocephalus, we determined elevated CRP levels on the day of surgery (p 0.038). The occurrence of epileptic seizures in the acute phase of the disease is associated with a poor outcome (p 0.039). CONCLUSIONS: Pyocephalus will continue to be a serious complication in the treatment of brain abscesses, although we were unable to determine its utility as a prognostic factor. Patients with this complication have elevated CRP levels on the day of operation.
- MeSH
- absces mozku * MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- záchvaty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
V naší kazuistice popisujeme případ fatálního vzdáleného zakrvácení do mozečku u pacienta po supratentoriální kraniotomii pro exstirpaci glioblastomu spánkového laloku. Přinášíme přehled literatury a diskuzi o možných příčinách této komplikace.
In our case report, we describe a case of fatal remote cerebellar haemorrhage in a patient following supratentorial craniotomy due to extirpation of temporal lobe glioblastoma. We also present an overview of expert literature dealing with this issue, and a discussion regarding possible causes of this complication.
- MeSH
- gliom * diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory mozku diagnostické zobrazování chirurgie MeSH
- neurozobrazování metody MeSH
- počítačová rentgenová tomografie metody MeSH
- pooperační krvácení * diagnostické zobrazování terapie MeSH
- smrt MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND We investigated the properties and effects of 5 mechanical thrombectomy procedures in patients with acute ischemic stroke. The relationships between the type of procedure, the time required, the success of recanalization, and the clinical outcome were analyzed. MATERIAL AND METHODS This prospective comparative analysis included 500 patients with acute ischemic stroke and large-vessel occlusion. We compared contact aspiration thrombectomy (ADAPT, n=100), stent retriever first line (SRFL, n=196), the Solumbra technique (n=64), mechanical thrombectomy plus stent implantation (n=81), and a combined procedure (n=59). RESULTS ADAPT provided shorter procedure (P<0.001) and recanalization times (P<0.001) than the other techniques. Better clinical outcome was achieved for ischemia in the anterior circulation than ischemia in the posterior fossa (P<0.001). Compared to the other techniques, patients treated with ADAPT procedure had increased odds of achieving better mTICI scores (P=0.002) and clinical outcome (NIHSS) after 7 days (P=0.003); patients treated with SRFL had increased odds of achieving better long-term clinical status (3M-mRS=0-2; P=0.040). Patients with SRFL and intravenous thrombolysis (IVT) had increased odds of better clinical status (3M-mRS=0-2; P=0.031) and decreased odds of death (P=0.005) compared to patients with SRFL without IVT. The other treatment approaches had no additional effect of IVT. Patients with SRFL with a mothership transfer had increased odds of achieving favorable clinical outcome (3M-mRS) compared to SRFL with the drip-and-ship transfer paradigm (P=0.015). CONCLUSIONS Our results showed that ADAPT and SRFL provided significantly better outcomes compared to the other examined techniques. A mothership transfer and IVT administration contributed to the success of the SRFL approach.
- MeSH
- cévní mozková příhoda chirurgie terapie MeSH
- ischemie mozku terapie MeSH
- ischemie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mechanická trombolýza metody MeSH
- prospektivní studie MeSH
- senioři MeSH
- stenty MeSH
- trombektomie metody MeSH
- trombolytická terapie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
