Abstract:
:Until recently, warfarin, clopidogrel and aspirin have provided the mainstay for prevention of thrombotic disease in cardiac patients. However, new classes of drugs have recently emerged that promise better clinical outcomes and lower risks. Use of such agents has increased, but increased risk and severity of intra-cranial haemorrhage (ICH) still remain. These cases of intra-cranial bleeds present as emergencies to neurosurgical units. It is of paramount importance that neurosurgical practitioners are aware of those new drugs, useful monitoring tests and available emergency reversal options in case the patient needs emergency intervention. In this review we survey newly available agents in the U.K. at the time of publication. We look at the data provided by the manufacturers, related publications and international guidelines for their use and reversal. New anticoagulants offer a lower incidence of ICH compared with warfarin. Advanced and accurate monitoring tests are emerging, as are prospective data on reversal of anticoagulation in bleeding. Some standard coagulation tests may be of use, whilst reversal agents are available and being evaluated. The trial data shows that new antiplatelet agents have similar or increased incidence and severity of intra-cranial ICH compared with clopidogrel. There is currently limited data on monitoring or reversal. We suggest they may be managed similarly to clopidogrel by using platelet reactivity assays, optimising platelet count and using platelet transfusion with adjunctive agents.
journal_name
Br J Neurosurgjournal_title
British journal of neurosurgeryauthors
Kimpton G,Dabbous B,Leach Pdoi
10.3109/02688697.2015.1029433subject
Has Abstractpub_date
2015-01-01 00:00:00pages
614-21issue
5eissn
0268-8697issn
1360-046Xjournal_volume
29pub_type
杂志文章,评审abstract:BACKGROUND:Deep brain stimulation (DBS) lead revision due to suboptimal therapy is common but there is no standardised protocol. We describe a novel technique using iMRI to perform concurrent new Globus Pallidus Internus (GPi) DBS lead implantation and old lead removal in a dystonia patient. Case-description: A 60-year...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2020.1789556
更新日期:2020-07-10 00:00:00
abstract::An obese woman with benign intracranial hypertension had been managed for several years with lumbo-peritoneal shunting. Following a bilopancreatic procedure performed for management of her obesity dense peritoneal adhesions caused repeated shunt failure. The shunt system was successfully converted to a lumbo-atrial sy...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690601127460
更新日期:2006-12-01 00:00:00
abstract::The azygous anterior cerebral artery (AACA) is a rare anatomical variant, which is frequently associated with saccular aneurysms. These aneurysms are often located in the distal segment of the AACA. Proximal AACA aneurysms are rare and pose considerable challenges, both in radiological characterization and in manageme...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2015.1071333
更新日期:2016-01-01 00:00:00
abstract:UNLABELLED:Object/Background: Vasospasm is a common cause of mortality and morbidity following rupture of intracranial aneurysm. Hemodynamic therapy instituted in these patients in the past has been replaced by direct manipulation of the spastic vessels by angioplasty and intra-arterial infusion of vasodilators. Howeve...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2016.1161172
更新日期:2016-08-01 00:00:00
abstract::The goal of this study was to assess the diagnostic accuracy of 16-row multislice computed tomography angiography (CTA) compared with digital subtraction angiography (DSA) in the detection of aneurysm remnants and arterial patency after clipping of intracranial aneurysms. Thirty-seven consecutive patients with 40 clip...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690701630108
更新日期:2008-02-01 00:00:00
abstract::A true human tail is a rare occurrence and is defined as a caudal, vestigial, midline protrusion with skin covering connective tissue, muscle, vessels and nerves. We report a case of true human tail in a child, which is a very rare happening in humans. ...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688690902912933
更新日期:2009-12-01 00:00:00
abstract::The history of chronic subdural haematoma (CSH), spanning from its possibly earliest beginnings throughout the centuries until the early 1980s, was investigated within the context of four different epochs. In the 'era of uncertainty', successful trephination, the modem method of choice for the treatment of CSH, was de...
journal_title:British journal of neurosurgery
pub_type: 传,历史文章,杂志文章
doi:10.1080/02688690410001660418
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:Solitary Fibrous Tumour (SFT) is a rare tumour occurring mainly in the pleural cavity, with less than 100 cases reported in the Central Nervous System, where it typically presents as a meningeal-based lesion. We describe the case of a SFT located in the fourth ventricle and briefly review the pertinent liter...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688691003675226
更新日期:2010-08-01 00:00:00
abstract::We report a 14-year-old boy with cavernous malformation of the optic chiasm. He had a 2-year history of gradually worsening visual disturbance. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a suprasellar mass, findings compatible with craniopharyngioma. The mass was biopsied and histological e...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690601000238
更新日期:2006-10-01 00:00:00
abstract:PURPOSE:In this study, we investigated the effect of local injection of ropivacaine and bupivacaine with magnesium sulfate on postoperative pain in vertebral laminectomy surgery. DESIGN:This randomized double-blind prospective study was conducted among 60 patients aged 18-65 years old with ASA class I and II. METHODS...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2020.1861430
更新日期:2020-12-17 00:00:00
abstract::Failure to follow patients with hydrocephalus can expose them to potentially fatal consequences. Two cases are used to illustrate this and the merits of follow-up of these patients are discussed. ...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688699844574
更新日期:1998-10-01 00:00:00
abstract::Neurolymphomatosis typically appears as a diffuse lesion with thickening of the affected nerves on magnetic resonance imaging (MRI). MRI in the present case revealed a well-defined, solitary lesion showing continuity with brachial plexus nerves. Findings including clinical symptoms resembled benign nerve sheath tumour...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2012.737959
更新日期:2013-06-01 00:00:00
abstract::Background: Vertebral body compression fractures are one of the most common causes of disability and morbidity, especially among the elderly population. The present study was performed in order to evaluate the effect of percutaneous balloon kyphoplasty (BKP) on patients' pain and quality of life (QOL) in Iran.Methods:...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2020.1777254
更新日期:2020-06-09 00:00:00
abstract::A 46-year old female patient presented with a left-sided superior temporal quadrantanopia due to a recurrent craniopharyngioma. The location of the recurrence was unusual. Imaging showed an enlarged left optic nerve, suggestive of a recurrent intra-optic craniopharyngioma. It was possible to remove the tumour without ...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2020.1760207
更新日期:2020-05-12 00:00:00
abstract::The debate regarding whether to perform an interbody fusion after anterior cervical discectomy (ACD) has been going on for the last 50 years. Several prospective randomized clinical trials have been performed to evaluate the clinical outcome following anterior cervical discectomy with and without interbody fusion. Non...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690802610249
更新日期:2009-02-01 00:00:00
abstract::Background: Cholesterol granulomas of the petrous apex are benign cysts affecting 0.6 patients per 1 million. The pathophysiology involves cholesterol crystals and lipids that are surrounded by giant cells. The cholesterol deposits induce an inflammatory response likely from acute hemorrhage leading to the formation o...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2020.1773400
更新日期:2020-06-09 00:00:00
abstract:BACKGROUND/OBJECTIVE:Hypertensive spontaneous intracerebral hemorrhages (ICH) cause significant morbidity and mortality. In this study, we aimed to investigate the association between calcium level at admission and outcome in hypertensive ICH patients. METHODS:658 hypertensive ICH patients were enrolled from January 2...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2019.1571162
更新日期:2019-04-01 00:00:00
abstract::In vestibular schwannomas (VS), the tumour size, as well as the size of the cystic component, have a considerable bearing on the outcome. This study addresses the differences between the cystic and solid variants of giant vestibular schwannomas. The study included 62 patients with giant VSs, of which 40 were solid and...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690802159031
更新日期:2008-08-01 00:00:00
abstract::We have reviewed the records of 53 patients with visual impairment secondary to pituitary macroadenomas and studied the visual outcome after surgery. After transsphenoidal procedures visual field defects improved in 89% of the patients and visual acuity improved in 82%. There were 13 cases of acute symptomatic intratu...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688699550041485
更新日期:1995-04-01 00:00:00
abstract::Over a 2-year period, 22 consecutive comatose patients (Glasgow Coma Score of less than or equal to 8) with intraventricular haematomas were managed with prolonged external ventricular drainage via an external one-way valve regulated system. The mean duration of drainage was 12 days. The overall mortality was 23%. Acc...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688698809029600
更新日期:1988-01-01 00:00:00
abstract::The authors report the rare and first documented case of concomitant microvascular decompression of trigeminal, facial and glossopharyngeal nerves for the management of intractable to medical therapy acute onset of trigeminal neuralgia, facial paresis and dysphagia after mild head injury. ...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2013.815327
更新日期:2014-01-01 00:00:00
abstract::Cerebellar haemangioblastomas commonly arise in patients with von Hippel - Lindau disease. We present the case of a 47-year-old male who has successfully undergone 10 separate procedures for symptomatic cerebellar haemangioblastomas. To our knowledge, this case is unique with respect to the frequency of symptomatic re...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690701552864
更新日期:2008-02-01 00:00:00
abstract::Ventriculoperitoneal shunt is a commonly performed procedure. Associated complications have been well described in the literature. This is the first case report of a splenic laceration caused by the distal catheter looping around the spleen, requiring a splenectomy. Careful study of pre-operative imaging is recommende...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2012.657268
更新日期:2012-08-01 00:00:00
abstract:AIM:The aim of this manuscript is to review the current state of knowledge regarding C-reactive protein (CRP) kinetics after standard neurosurgical procedures, and to determine the value of CRP as a screening test for early post-operative infectious complications as opposed to other more commonly used tests, and as a m...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2010.500408
更新日期:2010-12-01 00:00:00
abstract::We present a series of eight patients undergoing circumferential neural decompression and stabilization of the thoracolumbar spine via a single midline posterior approach, with complete vertebrectomy for a variety of indications. Four had primary tumours, two secondary tumours, one patient had tuberculosis and one had...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690701837273
更新日期:2008-04-01 00:00:00
abstract::The aim of this study was to investigate prognostic factors and the most appropriate treatment for patients with ruptured middle cerebral artery (MCA) aneurysms in relation to haematoma distribution. Ninety-two patients with ruptured MCA aneurysms, who underwent surgery during the last 11 years from 1986 to 1996, were...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688699944131
更新日期:1999-02-01 00:00:00
abstract:AIM:To investigate inefficiencies during patients' stay in neurosurgical beds. METHODS:A prospective audit of neurosurgical inpatients was conducted over approximately 2 months. We recorded the causes and duration of inappropriate delays, defined as actions requiring more that 24 h from initiation until completion. R...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688690701649488
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Irrigation may elevate the intracranial pressure (ICP) during neuroendoscopic procedures. It is unlikely that rinsing the ventricles during routine endoscopic ventriculostomy causes persistent neurological impairment or damage, but procedures such as the endoscopic evacuation of intraventricular haematomas (...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2011.619596
更新日期:2012-04-01 00:00:00
abstract::We present a case of recurrent vago-glossopharyngeal neuralgia after previous surgery, treated successfully with microvascular decompression using intra-operative neurophysiology monitoring. ...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.3109/02688697.2015.1039486
更新日期:2015-01-01 00:00:00
abstract::Background: Bow hunter's syndrome (BHS), also known as rotational vertebral artery occlusion syndrome, is rare. Occasionally, it combines with dissection/pseudoaneurysm of the ipsilateral VA.Methods: We report a case of BHS combined with ipsilateral VA dissection/pseudoaneurysm and review eight similar cases reported ...
journal_title:British journal of neurosurgery
pub_type: 杂志文章
doi:10.1080/02688697.2020.1718604
更新日期:2020-02-03 00:00:00