Wayne M. Alves

Postconcussive symptoms after uncomplicated mild head injury

Postconcussive symptomatology was studied in 587 patients with uncomplicated mild head injury. There was a linear decrease in symptomatology over the 1-year follow-up period. Headache was the most frequently reported postconcussive symptom. Symptom constellations consistent with postconcussive syndr

Ischemic Stroke: Relation of Age, Lesion Location, and Initial Neurologic Deficit to Functional Outcome

OBJECTIVE Establish the relation between age, gender, initial neurologic deficit, stroke location, prior stroke, hemisphere of stroke, and functional outcome in ischemic stroke. DESIGN Single group, multivariate, repeated measures design with 327 persons having ischemic stroke recruited from 20 participating centers. SETTING Twenty European stroke centers. PATIENTS Consecutive admissions of men and women between the ages of 40 and 85 yrs with a hemispheric stroke caused by middle cerebral artery ischemia and a Unified Neurological Stroke Scale score of 5 to 24. INTERVENTIONS Inpatients enrolled in the trial received traditional rehabilitation therapies including physical therapy, occupational therapy, and speech therapy when appropriate. MAIN OUTCOME MEASURES Barthel Index computed at 7 to 10 days and 3 months poststroke. RESULTS Positive functional outcomes were significantly related to the absence of prior strokes, a younger age, a less severe initial neurologic deficit, stroke involving cortical structures, and dominant (left hemisphere) lesions. CONCLUSIONS Despite some inconsistencies in existing literature, standardized prospective examination of outcome after stroke clearly demonstrated the effect of age, initial severity of stroke, and lesion location as predictors of functional outcome.

Economic Analysis of Tirilazad Mesylate for Aneurysmal Subarachnoid Hemorrhage: Economic Evaluation of a Phase III Clinical Trial in Europe and Australia

This study used data from a multinational phase III randomized, double-blind, vehicle-controlled trial to evaluate the cost-effectiveness of tirilazad mesylate (Freedox) in the treatment of aneurysmal subarachnoid hemorrhage. In men, therapy with 6 mg/kg per day of tirilazad mesylate was associated with significantly increased survival, increased cost of care, and ratios of cost per death averted that compare favorably with the ratios of other life and death interventions. In women, it appeared to have no effects on costs or survival. Further clinical studies may provide additional information about the cost-effectiveness of this intervention.

Restoring social competence in minor head-injury patients.

&NA; The Department of Neurological Surgery at the University of Virginia was awarded a grant from the Robert Wood Johnson Foundation for a project entitled “Restoring Social Competence: Interventions to Reduce the Physical and Socioeconomic Consequences of Injury.” This article describes the role nurse clinicians played in the project and identifies the most effective and efficient nursing contributions in achieving the project goals. Data collected by nurse clinicians, nursing strategies of management, and nursing interventions to treat the consequences of minor head injury are presented. Changes in minor head injury management at the Department of Neurological Surgery have resulted in more efficient use of nurses and decreased economic and psychosocial costs to patients.

Comparison of the use of medical resources and outcomes in the treatment of aneurysmal subarachnoid hemorrhage between Canada and the United States.

OBJECTIVE Using data from a randomized trial of tirilazad mesylate, we assessed the differences between Canada and the United States in the use of medical resources and outcomes in the treatment of aneurysmal subarachnoid hemorrhage during the first 90 days after admission to the hospital. METHODS Of the 877 patients for whom economic data were available, 194 were enrolled in Canada and 683 were enrolled in the United States. The differences between the countries in patient characteristics, use of medical resources, and outcomes were analyzed by comparing means and the 95% confidence intervals (CIs) around the differences in means. These differences also were predicted with use of multivariable regression analysis. RESULTS The average hospital stay was 4.2 days longer (95% CI, 1.3 to 7.1 days) in Canada, but most of the extra stay was among patients admitted to the study in poor neurological condition. In general, however, hospital stays in Canada were substantially less intensive. Patients treated in Canada spent 3.7 fewer days (95% CI, 1.2 to 6.1 days) in nursing homes and rehabilitation centers than did patients in the United States. No statistically significant differences were seen for Glasgow Outcome Scale score, death, and occurrence of vasospasm. CONCLUSIONS For patients admitted to the study in good neurological condition, the apparent difference in length of stay between Canada and the United States was caused by a shift in the sites of formal care rather than to the length of this care. For those admitted in poor neurological condition, both the length and sites of care differed between the two countries. No significant difference in outcomes appeared to justify these differences in the use of medical resources.

Tirilazad and Aneurysmal Subarachnoid Hemorrhage

A randomized double-blind dose-escalation trial of tirilazad mesylate versus placebo was done in patients admitted within 72 hours from SAH. 3 escalating doses of tirilazad were administered (0.6 mg, 2.0 mg, 6.0 mg/kg/day). 245 patients from 12 canadian centers were included in the study: all received concurrent therapy with oral nimodipine, and hypertensive hypervolemic hemodilution therapy as indicated. Out of these patients, 61 received placebo, 51 the 0.6 mg/kg dose, 42 the 2.0 mg/kg dose and 91 the 6.0 mg/kg dose. The group treated with the highest dose presented a significantly higher incidence of thick layers of blood in the subarachnoid space by CT scan.

Less-Than-Severe Head Injury: Pathology and Outcome

Publisher Summary The study of patients with less-than-severe head injuries may be a useful model to understand the pathophysiology of head injury. Head injury is one of the greatest health care concerns in the western world. The Glasgow Coma Scale (GCS) has been widely accepted as a means of judging the severity of head injury. Less-than-severe head injuries are a part of the spectrum of mechanically induced damage to the CNS with the basic pathological process being axonal disruption. The experimental pathology of minor head injury in the Philadelphia head injury model relates exclusively to damaged axons seen in the brain stem. Recovery following head injury may involve the recovery of function of damaged neurons by sprouting or the functional use of alternative neural pathways. As understanding of neuronal plasticity and regenerative responses to injury improves with time, the goal of intervention to restore function to damaged neural tissue becomes more attainable.