1,721,007 research outputs found
Venepuncture during head-up tilt testing in patients with suspected vasovagal syncope - implications for the test protocol.
No full textBACKGROUND AND PURPOSE
Head-up tilt (HUT) testing is a widely used diagnostic tool in patients with suspected vasovagal syncope (VVS). However, no gold standard exists for this examination and the various protocols used have a limited sensitivity and specificity. Our aim was to determine the sensitivity of a sequential HUT testing protocol including venepuncture (VP) and sublingual nitroglycerin application.
METHODS
This was a retrospective analysis of the diagnostic gain of a sequential HUT testing protocol including VP applied 10 min after the start of HUT testing and sublingual application of nitroglycerin 20 min after the start of the test protocol in 106 patients with a final diagnosis of VVS. The sensitivity of the test protocol was compared between patients with positive and negative history for VP induced VVS.
RESULTS
Overall, pre-syncope or syncope occurred in 68 patients (64.2%). Only 17% of all patients fainted spontaneously within 10 min of passive HUT. Another 39.6% fainted within 20 min. Application of nitroglycerin after 20 min of HUT evoked syncope in another 7.5% until the end of 45 min of HUT. The sensitivity of the test protocol for evoking (pre-)syncope was 94.4% in patients with a positive history for VP associated VVS and 58% in patients with a negative history (P < 0.01**); 85.7% of patients with a positive history and 42.9% of patients with a negative history fainted within 20 min of HUT testing (P < 0.01**).
CONCLUSIONS
Implementation of VP in sequential HUT testing protocols allows the sensitivity of HUT testing to be increased, especially in patients with a positive history for VP associated VVS
Monitoring of Brain Function in Neurointensive Care: Current State and Future Requirements
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Spinal Cerebrospinal Fluid Leak as the Cause of Chronic Subdural Hematomas in Non-Geriatric Patients
No full textSpontaneous Intracranial Hypotension due to Calcified Micro-Spurs Perforating the Dura – a Case Series.
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Contrast enhanced ultrasound is feasible and eligible for detection of perfusion deficits in the management of acute ischemic stroke
No full textInfection Rate of Emergency Bolt-Kit vs. Non-Emergency Conventional Implanted Silver Bearing External Ventricular Drainage Cahteters
No full textEuropean survey on follow-up strategies for unruptured intracranial aneurysms.
Full text linkINTRODUCTION
The increasing detection rates of unruptured intracranial aneurysms (UIA) pose a challenge for both neurovascular centers, tasked with managing a growing pool of patients requiring regular monitoring with imaging, and the healthcare system that must bear the costs of such surveillance. While there is consensus on the need for follow-up of UIA, uncertainties persist regarding the optimal cessation of surveillance, especially when considering diverse patient risk factors and, notably, in cases of treated aneurysms with stable rest perfusion. Detailed guidelines on UIA follow-up are currently lacking, exacerbating these challenges.
RESEARCH QUESTION
We sought to investigate European strategies for follow-up of untreated, microsurgically and endovascularly treated UIA.
MATERIAL AND METHODS
An online survey consisting of 15 questions about follow-up management of UIA was sent out to the cerebrovascular section of the European Association of Neurosurgical Societies (EANS).
RESULTS
The survey response rate was 27.3% (68/249). There was consenus upon the necessity for long-term follow-up of UIA (100% [n = 68]). The recommendation to perform follow-up was inversely correlated with patient age and more prevalent among endovascularly compared to microsurgically treated patients (92.6% [n = 63] vs. 70.6% [n = 48]). A majority recommended continued follow-up of treated aneurysms with stable rest perfusion, with lifelong surveillance in patients under 60 years and continuation for 5-10 years in patients aged 61-80, irrespective of whether they underwent microsurgical (38.3% [n = 23]; 33.3% [n = 20]) or endovascular (41.9% [n = 26]; 30.6% [n = 19]) treatment.
DISCUSSION AND CONCLUSION
This survey confirmed a European consensus on the necessity of long-term follow-up for untreated UIA. However, significant variations in follow-up strategies, especially for treated UIA and post-treatment rest perfusion, were noted. Despite limited evidence suggesting low risk from aneurysm remnants, respondents favored long-term follow-up, highlighting uncertainty in management. This underscores the need for collaborative research on aneurysm remnants and standardized follow-up protocols for UIA in Europe
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