Clinical Neuroscience

[Importance of hydrocephalus following severe brain injury during postacute rehabilitation]

DÉNES Zoltán, LANTOS Ágnes, SZÉL István, THOMKA Magdolna, VASS Mátyás, BARSI Péter

NOVEMBER 30, 2010

Clinical Neuroscience - 2010;63(11-12)

[Objectives - We report our experiences with hydrocephalus in early rehabilitation over a seven-year period. Method - Retrospective study in Brain Injury Rehabilitation Unit of the National Institute for Medical Rehabilitation, between 1 January 2002 and 31 December 2008. Results - At our institute in the last seven years, we treated 83 patients with secondary and six patients with primary hydrocephalus. The majority of hydrocephalus was of post traumatic origin (52) and remaining 23 following stroke (SAH, AVM, ICH) or brain operation (tumour - seven, and one cranioplasty), and all these patients had undergone ventricular shunt implantation. Mean age of patients was 36 (14-80) years. Hydrocephalus was diagnosed in our rehabilitation unit in 20 of 83 cases and the other patients were shunted before transfer to our unit. The median time point of shunting was 70 (range: 20-270) days after trauma, brain surgery or stroke. Post-operative complications were seen in 12 of 89 patients: six infections and six shunt failure and revision was necessary in 14%. In PTH cases, the post-operative improvement was seen in 40 of 52 patients being shunted and corresponded to FIM scores. At the other 31 cases, with non-traumatic origin, only two patients remain unchanged. Conclusions - Hydrocephalus is considered to be a frequent and important complication after severe brain damage. The incidence of hydrocephalus treated with shunt implantation in our neuro-rehabilitation unit was 4.4%. The postoperative improvement was 77%. Posttraumatic hydrocephalus concerns 5.2% of patients with severe TBI during last seven years in our institution. Diagnosis of posttraumatic hydrocephalus was established in 24%, and complication after shunt implantation (14%) was also recognized in the post-acute rehabilitation unit. It is strongly recommended for the team working at such type of units to obtain clinical practice. Teamwork, good cooperation between acute and postacutecare is necessary for successful rehabilitation of these patients.]



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[While the expected life-time increases dementias will show a pandemic nature. Author analyses the special medical and social concerns of severe states of Alzheimer disease. Having introduced the epidemiologic, diagnostic data and forms of palliatíve therapies he concentrates on the hitherto unsolved problems of patients and caregivers. He belongs to the experts identifying the Alzheimer diseases as a forced aging process. Accepted the theory of L. Hayflick he evaluates the aging process in frame of an evolution model. He states that for aged human beings having already performed the task of reproduction further conditions of living circumstances and even that of death are no more programmed. This hypothesis may have a very negative content at the first sense. But the author rather considers the uncertainty of aging a positive message. He establishes that the occurrence of degenerative processes connecting the aging must be limited by preventive interventions far more efficient than the present possibilities. Concerning these steps we are still on the level of recommendations for preserving our general health and data of relevant science are quite contradictory. Although criteria of “healthy", “qualified” or “assumable” aging are getting defined, we still do not know exactly how we should live optimally and what should we do for this in different epochs of our life. Somatic and psychological parameters are lacking which would be able to signalize the actual level of the aging process in a given person. We, physicians, also do not have exact opinion on the level of severity of dementias at which the patient already lost his her features of personality and individuality on an irreversible way. We have no idea on the phase when the ratio of joy and suffer falls below the value of 1.0 because we still have no tool for its measure. The author pointed the necessity of acceptance of a new preventive attitude and application of new methods in the medical care of the forced or pathological aging, instead of the present approaches based on the “wait and treat” attitude. Because of the intensive increase of the patient population the identification and care of patients can be efficient with a much more involvement of the basic medical network. Financial background can be improved by new theoretical bases of criteria of the palliative treatments. But the direct professional programs can be planned after solution of the existing moral and social dilemmas.]

All articles in the issue

Related contents

Journal of Nursing Theory and Practice

[Factors influencing Lifestyle Changes following Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ]

HALÁSZ Henrietta, MEIXNER Istvánné

[The aim of the study: In addition, it seeks those methods which might help in keeping the patients motivated so that they participate in regular health education programs, and in calling their attention to the importance of their own responsibility for their health. Material and Methods: Out of the patients who took part in early rehabilitation after a heart attack, a simple random sample of 127 patients was involved (n=127). The survey was conducted by questionnaire and retrospective data analysis. For the analysis, khi2 test, correlation analysis was performed, where p was considered significant if <0.05. Results: 71% of the patients were over the age of 60, 87% were overweight or obese, 39% were smokers at the beginning of the rehabilitation, 85% suffered from hypertension and 39% had diabetes mellitus. As opposed to male patients, females tend to recognise the impact of lifestyle on health (p=0.004). Patients under the age of 60 were more knowledgeable with regards to medicine than patients above the age of 60 (p=0.000). Positive family anamnesis impacts views on lifestyle changes (p=0.01). Conclusion: In order to increase the effectiveness of health education, different methods are needed when teaching patients above the age of 60. Written materials need to supplement verbal information sharing. Patients with positive family anamnesis have already gained some knowledge, which needs to be corrected or extended as required. Nutrition consulting should be made more practical for better feasibility.]

Clinical Neuroscience

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[Background and purpose - Surveyed references indicate improvement of rehabilitation outcomes if based on exploration of personal rehabilitation goals or quality of life goals. Purpose of our study is mapping of quality of life goals of persons entering rehabilitation by structured interviews, and study of applicability of the method. Methods - Structured interviews have been performed with persons consecutively admitted for their first rehabilitation intervention, meeting inclusion criteria. World Health Organization’s quality of life measure brief version and disability module served as guideline for the interviews. For study any negative effect on rehabilitation of our approach we have compared rehabilitation outcomes of consecutively admitted persons immediately before starting our study (58) and those with closed rehabilitation intervention (53). For this purpose the Functional Independence Measure was used. Finally content analysis of the interviews has been performed. Results - In 24 cases complications and psychological instability have prevented the inclusion, seven persons did not agree into participation in the study. Of the 71 interview participants the rehabilitation of 53 persons concluded. Their rehabilitation outcomes are better as of the control group significant difference has been measured in the social functions domain. Quality of life of included persons decreased during the rehabilitation process insignificantly, the autonomy domain showed insignificant improvement, the inclusion domain did not change. Content analysis revealed the outstanding role of the family among quality of life goals. Conclusions - Reported results indicate that exploration of quality of life goals of persons in early phase of rehabilitation after spinal cord injury is feasible. The selected quality of life measure may well support the interviews.]


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Clinical Neuroscience

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Hypertension and nephrology

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FISI Viktória, MAZÁK István, DEGRELL Péter, HALMAI Richárd, MOLNÁR Gergő A., FEHÉR Eszter, NÉMETH Kinga, PINTÉR István, KOVÁCS Tibor, WITTMANN István

[Background: Percutaneous renal biopsy is an essential tool in diagnosis and prognosis of renal diseases. It is well-known that this method has potential complications. The connection between complication occurrence related to renal biopsies and histological diagnoses of the biopsy specimen was analyzed in the present study. We also analyzed the distribution of diagnoses in our population. Methods: In this retrospective survey, 353 patients undergoing renal biopsy was studied. Biopsies were performed after marking the site of puncture with ultrasound imaging. Influence of diagnoses and clinical parameters on complications was evaluated. Results: We found a complication rate of 44.5%. In patients with diabetic nephropathy (likelihood ratio (LR) 0.44) or acute tubular necrosis (LR 0.38) a significantly lower rate of complications was found, while patients with thin basement membrane syndrome had more than 6-fold higher risk for evolvement of intrarenal haemorrhage. Patients with acute interstitial nephritis (LR 3.18) or vasculitis (LR 2.88) have a more than 2-fold risk for arteriovenous shunts while in patients with severe arteriosclerosis the occurrence of this complication was lower (LR 0.46). In rapidly progressive glomerulonephritis, arteriovenous shunts evolved also in a significantly higher rate. Conclusion: Patients with vasculitis, rapidly progressive glomerulonephritis, thin basement membrane syndrome or acute interstitial nephritis should be monitored more carefully after renal biopsy due to the significantly higher risk for complications. ]