Neuropsychological Assessment and Management of People in States of Impaired Consciousness: An Overview of Some Recent Studies

2008 ◽  
Vol 9 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Barbara A. Wilson ◽  
Martin R. Coleman ◽  
John D. Pickard
Keyword(s):  
Assessment Tool ◽  
Imaging Techniques ◽  
Impaired Consciousness ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Positron Emission ◽  
Neuro Imaging ◽  
Minimally Conscious ◽  
Behavioural Repertoire

AbstractThis article is concerned with patients in coma, the vegetative, or minimally conscious states. Studies addressing the issue of assessment and management of these patients are described. These include (a) the development of an assessment tool (Wessex Head Injury Matrix, WHIM); (b) use of the WHIM to assess the effects of posture on arousal, showing that some 75% of patients show more behaviours when assessed while they are in a standing frame than when supine; (c) a comparison of the WHIM with the Glasgow Coma Scale, demonstrating that the WHIM is more sensitive than the GCS for measuring the behavioural repertoire of people in states of reduced consciousness; (d) a discussion of situations when neuro-imaging techniques are required to assess residual functioning; and (e) the long term outcome of one of the first vegetative patients to be scanned with Positron Emission Tomography (PET). We conclude with a discussion about neuropsychology and patients in states of impaired consciousness.

The Comparison of STA-MCA Bypass and BMT for Symptomatic Internal Carotid Artery Occlusion Disease A Systematic Review and Meta-analysis of Long-term Outcome

2020 ◽  
Author(s):  
Xinyu Yang ◽  
Shifei Cai ◽  
Hao Fan ◽  
Chao Peng ◽  
Yuzhang Wu
Keyword(s):  
Carotid Artery ◽  
Assessment Tool ◽  
Statistical Significance ◽  
Superficial Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Symptomatic Carotid

Abstract Background: Superficial temporal artery (STA) - middle cerebral artery (MCA) bypass surgery now being widely used in moyamoya disease, and its therapeutic value in SICAO remains divergent. Methods: A systematic search was performed in PUBMED, EMBASE and Cochrane Databases in Feb.2020, and updated in Jun.2019. We have strict inclusion and exclusion criteria. Cochrane Bias Risk Assessment Tool was used to assess the quality of included RCTs. Review Manager 5.3 was used for analysis results in terms of comparing the STA-MCA bypass and BMT. For dichotomous variable outcomes, Risk Ratio (RRs) and 95% confidence intervals (95%CIs) were calculated for the assessment.Results: The total patient cohort consisted of 2419 patients, of whom 1188(49.1%) patients had been grouped in STA-MCA bypass, 1231(50.9%) patients had divided into BMT group. Mean follow-up of including patients was 29 months. The RRs of the seven studies was 1.01, and the 95% confidence interval was .89-1.15, with statistical significance, Z=.13, P=.89, sustaining that STA-MCA bypass was not superior to BMT in symptomatic carotid artery occlusion disease.Conclusion: STA-MCA bypass and BMT were associated with similar rates of a composite of long-term stroke. And the risk of long-term overall stroke was mildly higher with BMT. At present, each patient should receive more precise treatment, by reasonably assess the individual differences of each patient to reduce the recurrence rate of stroke.

scholarly journals Is early response by 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography a predictor of long-term outcome in patients with metastatic colorectal cancer?

2016 ◽  
Vol 7 (3) ◽  
pp. 365-372 ◽  
Author(s):  
Maria Nirvana da Cruz Formiga ◽  
Marcello Ferretti Fanelli ◽  
Aldo Lourenço Abadde Dettino ◽  
Ulisses Ribaldo Nicolau ◽  
Marcelo Cavicchioli ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Metastatic Colorectal Cancer ◽  
Early Response ◽  
Emission Tomography ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Positron Emission

Complete 18FDG positron emission tomography (PET) response after induction chemotherapy (IC) is correlated with long survival in patients (pts) with locally advanced non-small cell lung cancer (LA NSCLC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 17004-17004
Author(s):  
D. Schallier ◽  
H. Everaert ◽  
B. Neyns ◽  
N. Baelde ◽  
M. Meysman ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Standardized Uptake Value ◽  
Complete Response ◽  
Stage Iii ◽  
Rank Test ◽  
Axial Tomography ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Positron Emission

17004 Background: PET and computerized axial tomography scan (CT) are complimentary tools in the diagnosis and treatment of pts with LA NSCLC. Recent data have shown that response to IC as determined with PET has a better prognostic relevance for long term outcome than CT (Hoekstra et al JCO 2005;23:33:8362–70). Methods: PET and chest CT were performed before and after 3 cycles of IC in pts with LA NSCLC (D. Schallier et al, Suppl JCO 2005;23:165:7285, 6915). Response was defined according to WHO and EORTC criteria for CT and PET respectively (complete response: CR; partial response: PR; stable disease: SD; progressive disease: PD). PET images corrected for attenuation were acquired in 3D on a Siemens Accel camera starting 60 minutes after administration of 307–606 MBq 18FDG. The maximal standardized uptake value (SUVmax) within the tumor was measured and a SUVmax value ≥2.5 was used as a cut off. PET responses were classified either as complete (resolution of the enhanced uptake within the tumor) or non-complete. For each subgroup, classified according to CT and PET response, time to progression (TTP) and survival (S) was calculated and analysed statistically according to Kaplan-Meier and log rank test. Results: 21 pts were eligible for the PET and CT confrontation. Characteristics: 14 male, 7 female; median age 70 y (39–78); median KS: 90 (80–100); stage III A: 9; stage III B: 12; T1,2,3,4: 4/3/7/7; N0,1,2,3: 4/1/11/5. Response: CT: 12 PR; 9 SD; PET: 6 CR, 9 PR, 5SD, 1PD. Nine/12 PR on CT were also CR (5) and PR (4) on PET. Median TTP was correlated significantly with PR and CR (versus SD and non-CR) on CT and PET respectively (288 versus 606 days, p = 0.045 for CT and 299 versus median not reached p = 0.024 for PET); with a median follow up of 19+ month, median S was not significantly correlated with PR on CT but was highly significantly correlated with CR on PET (439 days versus median not reached p = 0.005). Conclusions: Assessment of response to IC using CT or PET largely overlaps. PET appears to be a more ‘sensitive‘ tool to measure response. CR on PET provides a better accuracy for determination of long term outcome than CT. The present results corroborate previously published results. No significant financial relationships to disclose.

scholarly journals Aortic coarctation in adults: the role of multimodality cardiac imaging. Series of case reports and review of literature

2021 ◽  
Vol 31 (1) ◽  
pp. 76-84
Author(s):  
Carmen Beladan ◽  
Maria Magdalena Gurzun ◽  
Mihai Teodor Bica ◽  
Dan Deleanu ◽  
Pavel Platon ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Case Reports ◽  
Cardiac Computed Tomography ◽  
Coarctation Of The Aorta ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Non Invasive ◽  
Artery Disease

Coarctation of the aorta (CoA) is a relatively frequent congenital defect. Its natural evolution is marked by serious complications including aortic dissection, heart failure, coronary artery disease, infective endocarditis, or cerebral haemorrhages. Correction of CoA before complications arise is associated with a favourable long-term outcome. Timely diagnosis of CoA is therefore of utmost importance in the prognosis of these patients. Non-invasive imaging techniques, ranging from chest radiography to echocardiography, Cardiac Computed Tomography (CCT), and Cardiac Magnetic Resonance (CMR) have evolved to the extent where they can not only suggest but also precisely characterize the lesion and guide further management. We present a series of 3 case reports, highlighting the diagnostic approach and treatment for this pathology.

Balloon dilation for aortic recoarctation: morphology at the site of dilation and long-term efficacy

2001 ◽  
Vol 11 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Christian Mann ◽  
Georg Goebel ◽  
Andreas Eicken ◽  
Thomas Genz ◽  
Walter Sebening ◽  
...  
Keyword(s):  
Balloon Angioplasty ◽  
Vessel Wall ◽  
Imaging Techniques ◽  
Balloon Dilation ◽  
Systolic Pressure ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Main Determinant

AbstractObjectives: We undertook this study to assess the immediate and long-term outcome of balloon angioplasty performed for recurrent or residual coarctation of the aorta, and to assess the changes in the vessel wall caused by this procedure.Methods: Clinical, echocardiographic, angiographic and hemodynamic data from 71 patients who underwent balloon angioplasty for recoarctation between January 1987 and January 1998 were analysed retrospectively.Results: Angioplasty was performed after a median of 82.6 months (range 1.4 mo – 20.9 y, mean 88.5 mo) following surgery for coarctation. Mean systolic pressure gradients were reduced from 27±15 mmHg to 11 ± 11 m m Hg after angioplasty (p< 0.0001). The mean diameter at the site of recoarctation increased from 5.5±2.5 to 7.5±2.7 mm(p< 0.0001). Outpouchings of contrast agents, indicating the disruption of the inner layers of the vessel wall, were defined as extravasations. They were observed in one-quarter of the angiograms performed immediately after the intervention. Immediate success of angioplasty was achieved in 71%, and persisted in 69% of patients during long-term follow up. The main determinant for immediate success was the age at the time of the procedure (p<0.05), while the main determinant for long-term success was the increase achieved in diameter. Extravasations did not progress to aneurysms, neither acutely nor during echocardiographic follow-up studies. For further follow-up, more sensitive imaging techniques will be necessary to delineate the morphology of the site of extravasation observed immediately after angioplasty.

Behavioural and Psychosocial Outcome Following Vegetative and Minimally Conscious States: Long-Term Follow-Up

2008 ◽  
Vol 9 (3) ◽  
pp. 267-273
Author(s):  
Bonnie-Kate Dewar ◽  
John D. Pickard ◽  
Barbara A. Wilson
Keyword(s):  
Brain Injury ◽  
Diagnostic Criteria ◽  
Vegetative State ◽  
Minimally Conscious State ◽  
Initial Contact ◽  
Psychosocial Outcome ◽  
Impaired Consciousness ◽  
Long Term Outcome ◽  
Minimally Conscious

AbstractThe long-term outcome of persons with impaired consciousness after brain injury remains relatively unclear. The first 12 months post ictus are widely reported as the period of greatest change, with an estimated 20% of persons with traumatic brain injury recovering consciousness. However, beyond 12 months post traumatic and 6 months post-nontraumatic injury the chances of further recovery are thought to diminish significantly. The aim of this study was to investigate the behavioural and psychosocial outcome of 12 patients with impaired consciousness 2 years post ictus. At the time of recruitment five of these patients met the diagnostic criteria defining the vegetative state and seven of these patients met the diagnostic criteria defining the minimally conscious state. Patients were assessed using the Wessex Head Injury Matrix at recruitment and again at least 2 years after initial contact. Functional and psychosocial outcome were also explored. Most patients showed some improvements to their behavioural portfolio, but all were still very dependent physically and all required a high level of support in their activities of daily living. None of the patients had emerged from their original condition, despite exhibiting larger behavioural portfolios. The implications of these findings for the management of patients in low awareness states are discussed.

scholarly journals The comparison of STA-MCA bypass and BMT for symptomatic internal carotid artery occlusion disease: a systematic review and meta-analysis of long-term outcome

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Shifei Cai ◽  
Hao Fan ◽  
Chao Peng ◽  
Yuzhang Wu ◽  
Xinyu Yang
Keyword(s):  
Carotid Artery ◽  
Assessment Tool ◽  
Statistical Significance ◽  
Superficial Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Symptomatic Carotid

Abstract Background Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery is now being widely used in moyamoya disease, and its therapeutic value in SICAO remains divergent. Methods A systematic search was performed in PubMed, EMBASE, and Cochrane Databases in Feb. 2020 and updated in Jun. 2019. We have strict inclusion and exclusion criteria. Cochrane Bias Risk Assessment Tool was used to assess the quality of included RCTs. Review Manager 5.3 was used for analysis results in terms of comparing the STA-MCA bypass and BMT. For dichotomous variable outcomes, risk ratios (RRs) and 95% confidence intervals (95%CIs) were calculated for the assessment. Results The total patient cohort consisted of 2419 patients, of whom 1188 (49.1%) patients had been grouped in STA-MCA bypass and 1231 (50.9%) patients had been divided into the BMT group. Mean follow-up of included patients was 29 months. The RR of the seven studies was 1.01, and the 95% confidence interval was .89–1.15, with statistical significance, Z = .13, P = .89, sustaining that STA-MCA bypass was not superior to BMT in symptomatic carotid artery occlusion disease. Conclusions STA-MCA bypass and BMT were associated with similar rates of a composite of long-term stroke. And the risk of long-term overall stroke was mildly higher with BMT. At present, each patient should receive more precise treatment, by reasonably assessing the individual differences of each patient to reduce the recurrence rate of stroke.

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