[Neurological and neurosurgical early rehabilitation in Lower Saxony and Bremen]. / Neurologisch-neurochirurgische Frührehabilitation in den Bundesländern Niedersachsen und Bremen.

INTRODUCTION: We analyzed the delivery of healthcare services among patients in neurological and neurosurgical early rehabilitation programmes in the German states of Lower Saxony and Bremen. METHODS: Patients´applications and admissions for neurological and neurosurgical early rehabilitation in Lower Saxony and Bremen were recorded during a period of two weeks both in November 2015 as well as 2016. The proportion of patients admitted to early rehabilitation within a six-week-period after disease onset was calculated. In addition, factors influencing the probability of admission were investigated. RESULTS: Only 45 % of all patients transferred from a primary neurological / neurosurgical unit to an early rehabilitation facility in Lower Saxony / Bremen were successfully admitted. The probability of admission fell when patients were colonized with multi-drug resistant bacteria (21 % in comparison), in particular Methicillin-resistant Staphylococcus aureus (MRSA) with an admission rate of only 13 %. Deleterious effects were also observed in patients dependent on hemodialysis (20 %), or those with a primary diagnosis of polyneuropathy / Guillain-Barré-Syndrome (33 %) or hypoxic brain damage (37 %), as well as patients on mechanical ventilation (37 %). Patients had a higher probability of being admitted with the primary diagnoses of subarachnoid hemorrhage (52 %) or stroke (51 %). Age, Early Rehabilitation Index (ERI), monitoring, presence of tracheostomy, dysphagia, orientation or behavioral disturbances had no influence on the probability of admission, as well as other primary diagnoses or the number of admissions in one or more rehabilitation centers. CONCLUSION: Over one-half of the patients applying for admission to neurological / neurosurgical early rehabilitation facilities in Lower Saxony and Bremen were not admitted. Apparently, the capacity of early rehabilitation treatment in these two German states is not optimal.

Preparação para a alta hospitalar de pacientes neurocirúrgicos e seus familiares: relato de experiência / Preparation for the hospital discharge of neurosurgical patients and their relatives: experience report

Objetivo: relatar as etapas da preparação para a alta hospitalar de pacientes neurocirúrgicos e seus familiares. Método: relato de experiência vivenciado por residentes da primeira turma de Residência Multiprofissional em Saúde do Amazonas no período de setembro de 2010 a março de 2012. Resultados: a preparação para a alta era realizada nas seguintes etapas: identificação do paciente, levantamento da história clínica, verificação do nível de conhecimento, reuniões para discussão do caso e elaboração do cronograma e plano de ação, reunião com os familiares, visita domiciliar, treinamento no leito, escuta psicológica e orientações sociais, entrega de material didático e, por fim, avaliação do estado de saúde pósalta hospitalar. Conclusão: o relato de experiências com este enfoque auxilia profissionais da área a nortear suas ações, principalmente quando as etapas de preparação para a alta são descritas e detalhadas.(AU)

Lumbociática como forma de presentación de una malformación vascular: síndrome de Foix-Alajouanine / Sciatica as a presentation form of a vascular malformation: Foix-Alajouanine syndrome

La lumbociática y la lumbalgia son el motivo más frecuente de consulta de origen musculoesquelético en atención primaria y especializada. Las malformaciones vasculares medulares y entre ellas las fístulas arteriovenosas son una rara entidad, pero una causa tratable de tetraplejía progresiva. Los síntomas de aparición pueden ser dolor radicular y lumbar, debilidad y alteración de esfínteres entre otros. La fisiopatología de estas malformaciones explica mediante las variaciones de presión venosa la forma de aparición relacionada con los esfuerzos y la clínica tan variable. Es imprescindible un diagnóstico diferencial con otras afecciones con sintomatología neurológica. El diagnóstico y tratamiento precoz puede evitar la progresión. Presentamos el caso de un varón de 40 años diagnosticado inicialmente de lumbociática, que evolucionó de manera aguda a una paraparesia y cuyo diagnóstico resultó ser una fístula arteriovenosa medular. Describimos los tipos de malformaciones arteriovenosas y su fisiopatología (AU)

Sciatica and low back pain are the most frequent reasons for skeletal muscle consultation in primary and specialized care. Spinal cord vascular malformations, among them arteriovenous fistulae, are a rare but a treatable condition of progressive paraplegia and tetraplegia. The initial symptoms may be radicular and lumbar pain, weakness and sphincters disorders, among others. The pathophysiology of these malformations explains the presentation form related to efforts and such variable clinical symptoms according to the variation of venous pressure. A differential diagnosis must be made in regards to other diseases that have neurological symptoms. Early diagnosis and treatment can prevent the disease-progression. We report the case of a 40-year old man initially diagnosed of sciatica that evolved to acute paraparesia. Finally, he was diagnosed of spinal arteriovenous fistula. We describe the different types of arteriovenous malformations and their pathophysiology (AU)

[Nosocomial multidrug-resistant Acinetobacter baumannii meningitis in postoperative neurosurgery: a case study]. / Méningite nosocomiale postopératoire à Acinetobacter baumannii multirésistant en neurochirurgie : à propos d'un cas.

Acinetobacter baumannii is a prolific nosocomial pathogen renowned for its multidrug-resistant nature. However, A. baumannii is a rare cause of nosocomial meningitis, and is an even rarer cause of meningitis outbreaks in neurosurgical units. We report a case of nosocomial meningitis due to multidrug resistant A. baumannii in a postoperative neurosurgery. The diagnosis was retained on a beam of arguments clinical, biochemical and bacteriological. The evolution was unfavourable, and the patient died of multiple complications.

Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours.

Clinical experience suggests that application of the fundamental principles of rehabilitation medicine can improve the care of patients with cancer. Despite the high incidence of neurological and functional deficits in patients affected by brain tumours (BTs), rehabilitation treatment of this population is not as well established as it is for patients with other neurological conditions. To assess functional outcome in brain tumour inpatients who underwent early rehabilitation after surgery. 75 patients who had undergone neurosurgery for primary BTs and 75 patients affected by stroke were enrolled in a case-control study. All patients were evaluated by means of a core set of clinical scales (Functional Independence Measure, Sitting Balance score, Standing Balance score, Hauser Index, Massachusetts General Hospital Functional Ambulation Classification). Patients were evaluated before the beginning (T0) and at the end (T1) of rehabilitation treatment. The neurorehabilitation programme consisted of individual 60-min sessions of treatment, administered once a day, six days a week, for four consecutive weeks. Speech therapy was included when aphasia was diagnosed. All the measures of outcome were indicative of substantial improvements for neuro-oncological and for stroke patients (P = 0.000). Analysis of subgroups showed that patients affected by meningioma achieved better results (in efficiency terms) as regards independence in activities of daily living (P = 0.02) and mobility (P = 0.04) compared with patients affected by glioblastoma or stroke. Rehabilitation after surgery can improve functional outcome, justifying the delivery of rehabilitation services, even during the acute phase, to BTs inpatients, irrespective of tumour type.

Servicio de neurocirugia HC-IPS unidad de educacion medica curso de postgrado: especialista en neurocirugia / Surgery of cerebral aneurisms: Analysis of 103 patients operated in a period of 4 years in the HC-IPS

Las aneurismas cerebrales son dilataciones anormales localizadas en las arterias cerebrales.Se ubican por lo general en las zonas de emergencia de las ramas de arterias principales y especialmente durante su recorrido por el espacio subaracnoideo cisternal.

Assessment of risk and incidence of falls in neurosurgical inpatients / Evaluación de riesgo e incidencia de caídas en pacientes de neurocirugía / Avaliação de risco e incidência de queda em pacientes neurocirúrgicos

Neurosurgical patients may present motor, sensitive and balance impairment and increased risk of falling. The aim of this study was to evaluate the fall-related risk factors and the incidence of falls in the pre and post-operative period of neurosurgical patients. A prospective cohort study with a research population of patients undergoing elective neurosurgical procedures. Ninety-seven patients took part in the study. Eight (8.2 percent) have presented falls with a total of 12 falls (12.4 percent). In two falls (16.7 percent), bed side rails were down, whereas in six falls (50 percent), beds had no rails at all. There was no difference among fall-related risk factors during pre and the post-operative periods. We have concluded that most falls could have been prevented through an improvement in the hospital internal structure and with the introduction of a falls prevention program.

Los pacientes en neurocirugía pueden presentar deficiencias motoras, sensitivas y del equilibrio, lo cual aumenta el riesgo de caídas. El objetivo de este estudio fue evaluar los factores de riesgo y la incidencia por caídas en pacientes de neurocirugía durante el pre-operatorio y post-operatorio. Estudio de cohorte prospectivo, en donde se incluyeron pacientes sometidos a cirugías intra-craneanas y raquídeo-medulares. Participaron del estudio noventa y siete pacientes, de los cuales ocho (8,2 por ciento) tuvieron caídas, totalizando 12 (12,4 por ciento) caídas. En 2 (16,7 por ciento) de las caídas, ocurridas durante el estudio, las barandas no estaban colocadas en la cama y en 6 (50 por ciento) de ellas, la cama no tenía barandas. No se evidenció diferencia entre los factores de riesgo para las caídas en los pacientes durante el pre-operatorio y post-operatorio. Concluimos que la mayoría de las caídas podrían haber sido prevenidas, a través de una mejor estructura hospitalaria, así como con la implementación de programas de prevención para caídas.

O paciente neurocirúrgico pode apresentar déficits motores, sensitivos e de equilíbrio, aumentando o risco de queda. O objetivo deste estudo foi avaliar os fatores de risco e a incidência de queda em pacientes neurocirúrgicos durante o pré e pós-operatório. Estudo de coorte prospectivo, onde foram incluídos pacientes submetidos a cirurgias intracranianas e raquimedulares eletivas. Noventa e sete pacientes participaram do estudo, sendo que oito (8,2 por cento) apresentaram queda, totalizando 12 (12,4 por cento) quedas. Em 2 (16,7 por cento) quedas ocorridas, neste estudo, as camas apresentavam as grades abaixadas e em 6 (50 por cento) delas a cama não possuía grades. Não houve diferença entre os fatores de risco para queda no paciente no pré e no pós-operatório. Conclui-se que a maioria das quedas poderiam ter sido prevenidas com a melhoria da estrutura hospitalar e com a implementação de programa de prevenção de quedas.

When did neurologists and psychiatrists stop talking to each other?

Patients with epilepsy have a significantly higher prevalence of psychiatric comorbid disorders involving depression, anxiety, psychotic, and attention deficit disorders. Accordingly, one would expect that psychiatrists would be actively involved in the evaluation and management of these patients. This, however, is hardly the case. Patients who undergo temporal lobectomies, for example, are known to experience postsurgical depression and occasionally psychotic disorders. Yet, most epilepsy centers in North America do not include a psychiatric evaluation as part of the presurgical work-up. Collaboration between epileptologists and psychiatrists is often sparse, despite the intimate relationship between psychiatric comorbidities and epilepsy. The purpose of this paper is to highlight this bizarre phenomenon and to identify some of the reasons behind it.

Effect of passive range of motion on intracranial pressure in neurosurgical patients.

PURPOSE: A prospective patient study was done to evaluate the effect of passive range of motion (PROM) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in neurosurgical patients. MATERIALS AND METHODS: Twelve adult patients admitted to the neurological-neurosurgical intensive care unit of a community teaching hospital were enrolled in the study. The study patients all required ICP monitoring and they underwent a total of 20 PROM sessions. Six patients (10 PROM sessions) were mechanically ventilated, and six patients (10 PROM sessions) were breathing spontaneously. Mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), and ICP were measured at baseline and at 1-minute intervals during the physical therapy session. CPP was calculated as the difference between MAP and ICP. RESULTS: No significant changes were detected in MAP, ICP, HR, or RR during the study period. Calculated CPP remained unchanged. Mean duration of PROM intervention was 7 +/- 1 minute. Mean Glasgow Coma Scale (GCS) for mechanically ventilated patients was 7 +/- 1.3 and for spontaneously breathing patients 13 +/- 0.8. CONCLUSION: PROM results in no significant changes in ICP or CPP in stable, neurosurgical patients in the absence of intracranial hypertension.

[After care and rehabilitation following surgery of peripheral nerves]. / Nachbehandlung und Rehabilitation nach Operationen an peripheren Nerven.

In cases with direct nerve repair we consider a plaster cast immobilization of three weeks as adequate; for those with nerve grafts, two weeks are sufficient. In the later course, the patient should regularly be examined also for Tinel's sign, to make sure that this progresses distally corresponding to normal nerve regeneration. If after four to five months the Tinel's sign has not progressed distally, the regenerating nerve fibres are most likely to be blocked by scar tissue formation, and revisional surgery may be indicated. As in all surgery of the hand, the role of a postoperative hand therapy program is of critical importance. In many cases specific sensory reeducation may definitely contribute to improve the final functional result after restoration of peripheral nerves.

[The social rehabilitation of neurosurgical patients]. / Issledovanie sotsial'noi reabilitatsii neirokhirurgicheskikh bol'nykh.

The authors analyze the theoretical problems of estimating the effectiveness of rehabilitation of patients with brain lesions. Describe an original scale for assessing social rehabilitation of neurosurgical patients. Relate the results of the follow-up of a group of patients after brain surgery. Analyze the dependence of the effectiveness of social rehabilitation on some demographic, clinical and neuropsychological criteria.

Rizotomía selectiva posterior limitada a tres dorsales: una variable para el tratamiento neuroquirúrgico de la espasticidad / Neurosurgical treatment of spasticity, selective posterior rhizotomy. A new procedure

Introducción. La rizotomía selectiva posterior (RSP) es efectiva para reducir la espasticidad asociada con la parálisis cerebral infantil (PCL). Para evitar una hipotonía postoperatoria se presentó una variante a la técnica quirúrgica clásica. Material y métodos. Diceséis niños con espasticidad secundaria a PCI fueron evaluados antes y después de la rizotomía. Se comparó el grado de espasticidad de miembros superiores y de miembros inferiores. Se disecaron las raíces dorslaes de L4, L5 y S1. Resultados. En todos los grupos musculares analizados se observó una disminución de la espasticidad sin hipotonía asociada. Conclusiones. La técnica quirúrgica propuesta en este estudio es efectiva para reducir la espasticidad tanto en los miembros superiores com en los inferiores. Espasticidad; rizotomía selectiva posterior; parálisis cerebral