The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Nicholas Theodore - One of the best experts on this subject based on the ideXlab platform.
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cervical spinal cord Infarction after cervical spine decompressive surgery
World Neurosurgery, 2014Co-Authors: Samuel Kalb, Saeed Fakhran, Udaya K Kakarla, Paul Ruggieri, Bruce L Dean, Jeffrey S Ross, Randall W Porter, Nicholas TheodoreAbstract:Objective To report five patients who underwent cervical decompressive surgeries and developed persistent postoperative neurologic deficits compatible with spinal cord Infarctions and evaluate causes for these rare complications. Methods The clinical courses and imaging studies of five patients were retrospectively analyzed. Imaging findings, types of surgeries, vascular compromise or risk factors, hypotensive episodes, intraoperative somatosensory evoked potentials, concomitant brain Infarctions, and clinical degree and radiographic extent of spinal cord Infarction were studied. The presence of spinal cord Infarction was determined by clinical course and imaging evaluation. Results All five patients had antecedent cervical cord region vascular compromise or generalized vascular risk factors. Four patients developed hypotensive episodes, two intraoperatively and two postoperatively. None of the four patients with hypotensive episodes had imaging or clinical evidence of concomitant brain Infarctions. Conclusions Neuroimaging evaluation of spinal cord Infarction after decompressive surgery is done to exclude spinal cord compression, to ensure adequate surgical decompression, and to confirm Infarction by imaging. Antecedent, unrecognized preoperative vascular compromise may be a significant contributor to spinal cord Infarction by itself or in combination with hypotension.
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Cervical spinal cord Infarction after cervical spine decompressive surgery.
World neurosurgery, 2012Co-Authors: Samuel Kalb, Saeed Fakhran, Udaya K Kakarla, Paul Ruggieri, Bruce Dean, Jeffrey Ross, Randall W Porter, Nicholas TheodoreAbstract:To report five patients who underwent cervical decompressive surgeries and developed persistent postoperative neurologic deficits compatible with spinal cord Infarctions and evaluate causes for these rare complications. The clinical courses and imaging studies of five patients were retrospectively analyzed. Imaging findings, types of surgeries, vascular compromise or risk factors, hypotensive episodes, intraoperative somatosensory evoked potentials, concomitant brain Infarctions, and clinical degree and radiographic extent of spinal cord Infarction were studied. The presence of spinal cord Infarction was determined by clinical course and imaging evaluation. All five patients had antecedent cervical cord region vascular compromise or generalized vascular risk factors. Four patients developed hypotensive episodes, two intraoperatively and two postoperatively. None of the four patients with hypotensive episodes had imaging or clinical evidence of concomitant brain Infarctions. Neuroimaging evaluation of spinal cord Infarction after decompressive surgery is done to exclude spinal cord compression, to ensure adequate surgical decompression, and to confirm Infarction by imaging. Antecedent, unrecognized preoperative vascular compromise may be a significant contributor to spinal cord Infarction by itself or in combination with hypotension. Copyright © 2014 Elsevier Inc. All rights reserved.
Fredrik Romi - One of the best experts on this subject based on the ideXlab platform.
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Long-term outcome after spinal cord Infarctions.
Acta Neurologica Scandinavica, 2014Co-Authors: S. R. Hanson, Fredrik Romi, Tiina Rekand, Halvor NaessAbstract:Hanson SR, Romi F, Rekand T, Naess H. Long-term outcome afterspinal cord Infarctions.Acta Neurol Scand: DOI: 10.1111/ane.12343.© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.Objectives – To investigate long-term outcome in patients withspontaneous spinal cord Infarctions and secondly to compare outcomewith that of patients with cerebral Infarction. Material and methods –The study includes 30 patients with spinal cord Infarction dischargedbetween 1995 and 2010. Surviving patients were contacted bytelephone and sent a questionnaire. Data on employment, function,depression, fatigue, pain, and quality of life were obtained andcompared to similar data obtained from a group of patients withcerebral Infarction. Results – Seven patients with spinal cordInfarction had died after a mean follow-up of 7.1 years. Mortality wasassociated with poor functioning in the acute phase. Thirteen of 20responding patients were able to walk. Compared to patients withcerebral Infarction, patients with spinal cord Infarction hadsignificantly lower mortality, poorer functioning, higher re-employment rate, and more pain. Conclusion – Many patients withspinal cord Infarction experience significant improvement. Eventhough functional outcome is worse, the mortality rate is lower andthe frequency of re-employment higher among patients with spinalcord Infarction compared to patients with cerebral Infarction.
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comparing patients with spinal cord Infarction and cerebral Infarction clinical characteristics and short term outcome
Vascular Health and Risk Management, 2011Co-Authors: Halvor Naess, Fredrik RomiAbstract:BACKGROUND: To compare the clinical characteristics, and short-term outcome of spinal cord Infarction and cerebral Infarction. METHODS: Risk factors, concomitant diseases, neurological deficits on admission, and short-term outcome were registered among 28 patients with spinal cord Infarction and 1075 patients with cerebral Infarction admitted to the Department of Neurology, Haukeland University Hospital, Bergen, Norway. Multivariate analyses were performed with location of stroke (cord or brain), neurological deficits on admission, and short-term outcome (both Barthel Index [BI] 1 week after symptom onset and discharge home or to other institution) as dependent variables. RESULTS: Multivariate analysis showed that patients with spinal cord Infarction were younger, more often female, and less afflicted by hypertension and cardiac disease than patients with cerebral Infarction. Functional score (BI) was lower among patients with spinal cord Infarctions 1 week after onset of symptoms (P < 0.001). Odds ratio for being discharged home was 5.5 for patients with spinal cord Infarction compared to cerebral Infarction after adjusting for BI scored 1 week after onset (P = 0.019). CONCLUSION: Patients with spinal cord Infarction have a risk factor profile that differs significantly from that of patients with cerebral Infarction, although there are some parallels to cerebral Infarction caused by atherosclerosis. Patients with spinal cord Infarction were more likely to be discharged home when adjusting for early functional level on multivariate analysis.
Alan S Go - One of the best experts on this subject based on the ideXlab platform.
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chronic kidney disease and risk for presenting with acute myocardial Infarction versus stable exertional angina in adults with coronary heart disease
Journal of the American College of Cardiology, 2011Co-Authors: Alan S Go, Malini Chandra, Nisha Bansal, Phenius V Lathon, Stephen P Fortmann, Carlos Iribarren, Mark A HlatkyAbstract:Objectives The aim of this study was to examine whether kidney dysfunction is associated with the type of clinical presentation of coronary heart disease (CHD). Background Reduced kidney function increases the risk for developing CHD, but it is not known whether it also influences the acuity of clinical presentation, which has important prognostic implications. Methods A case-control study was conducted of subjects whose first clinical presentation of CHD was either acute myocardial Infarction or stable exertional angina between October 2001 and December 2003. Estimated glomerular filtration rate (eGFR) before the incident event was calculated using calibrated serum creatinine and the abbreviated MDRD (Modification of Diet in Renal Disease) equation. Patient characteristics and use of medications were ascertained from self-report and health plan databases. Multivariable logistic regression was used to examine the association of reduced eGFR and CHD presentation. Results A total of 803 adults with incident acute myocardial Infarctions and 419 adults with incident stable exertional angina who had baseline eGFRs ≤130 ml/min/1.73 m2 were studied. Mean eGFR was lower in subjects with acute myocardial Infarctions compared with those with stable angina. Compared with eGFR of 90 to 130 ml/min/1.73 m2, a strong, graded, independent association was found between reduced eGFR and presenting with acute myocardial Infarction, with adjusted odds ratios of 1.36 (95% confidence interval: 0.99 to 1.86) for eGFR 60 to 89 ml/min/1.73 m2, 1.55 (95% confidence interval: 0.92 to 2.62) for eGFR 45 to 59 ml/min/1.73 m2, and 3.82 (95% confidence interval: 1.55 to 9.46) for eGFR <45 ml/min/1.73 m2 (p < 0.001 for trend). Conclusions An eGFR <45 ml/min/1.73 m2 is a strong, independent predictor of presenting with acute myocardial Infarction versus stable angina as the initial manifestation of CHD.
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population trends in the incidence and outcomes of acute myocardial Infarction
The New England Journal of Medicine, 2010Co-Authors: Stephen Sidney, Malini Chandra, Michael Sorel, Joseph V Selby, Alan S GoAbstract:Background Few studies have characterized recent population trends in the incidence and outcomes of myocardial Infarction. Methods We identified patients 30 years of age or older in a large, diverse, community-based population who were hospitalized for incident myocardial Infarction between 1999 and 2008. Age- and sex-adjusted incidence rates were calculated for myocardial Infarction overall and separately for ST-segment elevation and non–ST-segment elevation myocardial Infarction. Patient characteristics, outpatient medications, and cardiac biomarker levels during hospitalization were identified from health plan databases, and 30-day mortality was ascertained from administrative databases, state death data, and Social Security Administration files. Results We identified 46,086 hospitalizations for myocardial Infarctions during 18,691,131 person-years of follow-up from 1999 to 2008. The age- and sex-adjusted incidence of myocardial Infarction increased from 274 cases per 100,000 person-years in 1999 to 28...
Michael C Gibson - One of the best experts on this subject based on the ideXlab platform.
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relation between myocardial infarct size and ventricular tachyarrhythmia among patients with preserved left ventricular ejection fraction following fibrinolytic therapy for st segment elevation myocardial Infarction
American Journal of Cardiology, 2009Co-Authors: Yuri B Pride, Evan Appelbaum, Erin Lord, Sarah Sloan, Christopher P Cannon, Marc S Sabatine, Michael C GibsonAbstract:In the era of early reperfusion therapy for ST-segment elevation myocardial Infarction, preserved left ventricular (LV) function is common. Despite preservation of LV ejection fraction (LVEF), there remains a spectrum of risk for adverse cardiovascular events, including ventricular tachycardia (VT) and ventricular fibrillation (VF). Larger infarct size has been independently associated with death, VT/VF, and heart failure in the post−myocardial Infarction population. It was hypothesized that infarct size, as estimated by peak serum creatine kinase (CK)–MB concentration, would be associated with the incidence of VT/VF in patients with preserved LV function after ST-segment elevation myocardial Infarctions. The Clopidogrel as Adjunctive Reperfusion Therapy–Thrombolysis In Myocardial Infarction 28 (CLARITY-TIMI 28) study enrolled 3,491 patients with ST-segment elevation myocardial Infarctions who underwent fibrinolytic therapy. The association between estimated infarct size (ratio of peak CK-MB to the upper limit of normal), the LVEF (measured using left ventriculography or echocardiography), and the incidence of VT/VF through 30 days was assessed. A total of 1,436 patients underwent assessments of LV function, of whom 1,133 had adequate CK-MB for analysis. The median LVEF in this group was 55% (interquartile range 45% to 65%), and most patients (n = 814 [87.1%]) had LVEF ≥40%. Among patients with LVEF ≥40%, the ratio of peak CK-MB to the upper limit of normal was significantly associated with the incidence of VT/VF through 30 days (2.2%, 3.7%, and 5.5% across tertiles, respectively, p = 0.041 for trend) and the incidence of the composite of cardiovascular death, heart failure, shock, and VT/VF through 30 days (3.7%, 6.0%, 8.5%, respectively, p = 0.018 for trend). In conclusion, in patients with ST-segment elevation myocardial Infarction with preserved LV function after reperfusion therapy, larger infarct size, as estimated by peak serum CK-MB concentration, is significantly associated with VT/VF as well as other adverse clinical outcomes.
Samuel Kalb - One of the best experts on this subject based on the ideXlab platform.
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cervical spinal cord Infarction after cervical spine decompressive surgery
World Neurosurgery, 2014Co-Authors: Samuel Kalb, Saeed Fakhran, Udaya K Kakarla, Paul Ruggieri, Bruce L Dean, Jeffrey S Ross, Randall W Porter, Nicholas TheodoreAbstract:Objective To report five patients who underwent cervical decompressive surgeries and developed persistent postoperative neurologic deficits compatible with spinal cord Infarctions and evaluate causes for these rare complications. Methods The clinical courses and imaging studies of five patients were retrospectively analyzed. Imaging findings, types of surgeries, vascular compromise or risk factors, hypotensive episodes, intraoperative somatosensory evoked potentials, concomitant brain Infarctions, and clinical degree and radiographic extent of spinal cord Infarction were studied. The presence of spinal cord Infarction was determined by clinical course and imaging evaluation. Results All five patients had antecedent cervical cord region vascular compromise or generalized vascular risk factors. Four patients developed hypotensive episodes, two intraoperatively and two postoperatively. None of the four patients with hypotensive episodes had imaging or clinical evidence of concomitant brain Infarctions. Conclusions Neuroimaging evaluation of spinal cord Infarction after decompressive surgery is done to exclude spinal cord compression, to ensure adequate surgical decompression, and to confirm Infarction by imaging. Antecedent, unrecognized preoperative vascular compromise may be a significant contributor to spinal cord Infarction by itself or in combination with hypotension.
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Cervical spinal cord Infarction after cervical spine decompressive surgery.
World neurosurgery, 2012Co-Authors: Samuel Kalb, Saeed Fakhran, Udaya K Kakarla, Paul Ruggieri, Bruce Dean, Jeffrey Ross, Randall W Porter, Nicholas TheodoreAbstract:To report five patients who underwent cervical decompressive surgeries and developed persistent postoperative neurologic deficits compatible with spinal cord Infarctions and evaluate causes for these rare complications. The clinical courses and imaging studies of five patients were retrospectively analyzed. Imaging findings, types of surgeries, vascular compromise or risk factors, hypotensive episodes, intraoperative somatosensory evoked potentials, concomitant brain Infarctions, and clinical degree and radiographic extent of spinal cord Infarction were studied. The presence of spinal cord Infarction was determined by clinical course and imaging evaluation. All five patients had antecedent cervical cord region vascular compromise or generalized vascular risk factors. Four patients developed hypotensive episodes, two intraoperatively and two postoperatively. None of the four patients with hypotensive episodes had imaging or clinical evidence of concomitant brain Infarctions. Neuroimaging evaluation of spinal cord Infarction after decompressive surgery is done to exclude spinal cord compression, to ensure adequate surgical decompression, and to confirm Infarction by imaging. Antecedent, unrecognized preoperative vascular compromise may be a significant contributor to spinal cord Infarction by itself or in combination with hypotension. Copyright © 2014 Elsevier Inc. All rights reserved.
