Athanasios Zisakis

Fall-related emergency department admission: fall environment and settings and related injury patterns in 6357 patients with special emphasis on the elderly

Principals. Throughout the world, falls are a major public health problem and a socioeconomic burden. Nevertheless there is little knowledge about how the injury types may be related to the aetiology and setting of the fall, especially in the elderly. We have therefore analysed all patients presenting with a fall to our Emergency Department (ED) over the past five years. Methods. Our retrospective data analysis comprised adult patients admitted to our Emergency Department between January 1, 2006, and December 31, 2010, in relation to a fall. Results. Of a total of 6357 patients 78% (n = 4957) patients were younger than 75 years. The main setting for falls was patients home (n = 2239, 35.3%). In contrast to the younger patients, the older population was predominantly female (56.3% versus 38.6%; P < 0.0001). Older patients were more likely to fall at home and suffer from medical conditions (all P < 0.0001). Injuries to the head (P < 0.0001) and to the lower extremity (P < 0.019) occurred predominantly in the older population. Age was the sole predictor for recurrent falls (OR 1.2, P < 0.0001). Conclusion. Falls at home are the main class of falls for all age groups, particularly in the elderly. Fall prevention strategies must therefore target activities of daily living. Even though falls related to sports mostly take place in the younger cohort, a significant percentage of elderly patients present with falls related to sporting activity. Falls due to medical conditions were most likely to result in mild traumatic brain injury.

What is the incidence of intracranial bleeding in patients with mild traumatic brain injury? A retrospective study in 3088 Canadian CT head rule patients.

Objective. Only limited data exists in terms of the incidence of intracranial bleeding (ICB) in patients with mild traumatic brain injury (MTBI). Methods. We retrospectively identified 3088 patients (mean age 41 range (7–99) years) presenting with isolated MTBI and GCS 14-15 at our Emergency Department who had undergone cranial CT (CCT) between 2002 and 2011. Indication for CCT was according to the “Canadian CT head rules.” Patients with ICB were either submitted for neurosurgical treatment or kept under surveillance for at least 24 hours. Pearsons correlation coefficient was used to correlate the incidence of ICB with age, gender, or intake of coumarins, platelet aggregation inhibitors, or heparins. Results. 149 patients (4.8%) had ICB on CCT. No patient with ICB died or deteriorated neurologically. The incidence of ICB increased with age and intake of anticoagulants without clinically relevant correlation (R = 0.11; P < 0.001; R = −0.06; P < 0.001). Conclusion. Our data show an incidence of 4.8% for ICB after MTBI. However, neurological deterioration after MTBI seems to be rare, and the need for neurosurgical intervention is only required in selected cases. The general need for CCT in patients after MTBI is therefore questionable, and clinical surveillance may be sufficient when CCT is not available.

Effect of Subthalamic Nucleus Stimulation on Pedunculopontine Nucleus Neural Activity

Background: The pedunculopontine nucleus has recently been proposed as an alternative target for deep brain stimulation for the treatment of medically intractable Parkinsons disease. The suggested indication for pedunculopontine nucleus deep brain stimulation is severe and medically intractable axial symptoms such as gait and postural impairment. Objective: Our goal in this study was to describe the effects of subthalamic nucleus stimulation on pedunculopontine nucleus electrophysiological activity. Methods: Fourteen male Wistar rats were divided into a sham stimulation group and an experimental group. In both groups, electrodes were implanted bilaterally into the subthalamic nucleus and into the right pedunculopontine nucleus. Microelectrode recordings were carried out in both groups prior to and during subthalamic nucleus stimulation. Results: Subthalamic nucleus stimulation produced no clear inhibition of neuronal firing in the pedunculopontine nucleus. However, we found that stimulation of the subthalamic nucleus at 60 Hz produces some entrainment of pedunculopontine nucleus neuronal firing and a shift of subthalamic nucleus firing patterns to more tonic and random patterns. These results are consistent with the effects of deep brain stimulation on neuronal activity in the subthalamic nucleus and globus pallidus internus. Conclusion: The result of this study provides additional evidence to improve our understanding of the mechanism of subthalamic nucleus-deep brain stimulation, and its physiological consequences.

Implication of the JAK-STAT Pathway in Gliomagenesis: A Target for Therapy?

Gliomas, being the most prevalent and aggressive malignancy of the central nervous system, are associated with poor prognosis and very low survival rates. Failure of malignant glioma cells to respond to conventional cancer therapies is attributed to their infiltrating and immunosuppressive phenotype along with increased molecular heterogeneity. Current evidence implicates aberrant JAK-STAT signaling and expression of STAT inhibitors in the molecular pathogenesis of gliomas. This review provides a critical account of recent evidence regarding JAK-STAT signaling components in gliomagenesis, highlighting the potential therapeutic benefits and perspectives of targeting this pathway.

What is New and Innovative in Emergency Neurosurgery? Emerging Diagnostic Technologies Provide Better Care and Influence Outcome: A Specialist Review

The development of emergency medical services and especially neurosurgical emergencies during recent decades has necessitated the development of novel tools. Although the gadgets that the neurosurgeon uses today in emergencies give him important help in diagnosis and treatment, we still need new technology, which has rapidly developed. This review presents the latest diagnostic tools, which offer precious help in everyday emergency neurosurgery practice. New ultrasound devices make the diagnosis of haematomas easier. In stroke, the introduction of noninvasive new gadgets aims to provide better treatment to the patient. Finally, the entire development of computed tomography and progress in radiology have resulted in innovative CT scans and angiographic devices that advance the diagnosis, treatment, and outcome of the patent. The pressure on physicians to be quick and effective and to avoid any misjudgement of the patient has been transferred to the technology, with the emphasis on developing new systems that will provide our patients with a better outcome and quality of life.

Cranial Focal Nodular Haematopoietic Hyperplasia: A case report and literature review

Focal Nodular Haematopoietic Hyperplasia (FNHH) is an uncommon, benign, osteolytic lesion and so far, has not been reported cranially. Here, we report the first cranial case of a patient with right frontal bone FNHH and describe the clinical history, management and follow up with review of the literature of this rare pathology.

Bilateral Pallidotomy by Using Deep Brain Stimulation Electrode in Parkinson's Disease

Deep brain stimulation (DBS) is a safe and effective treatment in alleviating motor symptoms and complications in advanced Parkinson’s disease (PD). However, in some patients, the DBS system may need to be removed due to recurrent hardware infection. Here we report a case of a patient who had frequent internal pulse generator (IPG) site infections and eventually underwent bilaterally pallidotomy using previously implanted globus pallidus interna (GPi) DBS electrodes. A 57-yearold woman with advanced PD and was implanted bilateral subthalamic nucleus (STN) DBS. 18 months after she suffered from new onset loss of postural reflexes and frequent falls that were directly related with STN stimulation. Therefore, the STN electrodes were swithched to GPiand one year after switching to GPi DBS, she developed severe infection and skin erosion over the DBS hardware. The hardware had to be removed due to recurrent infections and before explanting the electrodes, bilateral pallidotomy with radiofrequency was performed by using the existing DBS electrodes. Two years after the bilateral posteroventral pallidotomy, the patient had good and stable control of PD. To our knowledge, this is the first case report where existing DBS electrodes were used for bilateral pallidotomy by RF. This technique is safe and efficient, but further studies and large series are needed to confirm its long-term benefits.