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  1. Article ; Online: Corticosteroid injection in patients with ulnar neuropathy at the elbow: A randomized, double-blind, placebo-controlled trial.

    vanVeen, Kiril E B / Alblas, Kees C L / Alons, Imanda M E / Kerklaan, Joost P / Siegersma, Marry C / Wesstein, Michel / Visser, Leo H / Vankasteel, Viviane / Jellema, Korné

    Muscle & nerve

    2015  Volume 52, Issue 3, Page(s) 380–385

    Abstract: Introduction: We conducted a randomized, double-blind, placebo-controlled trial to evaluate the effect of ultrasound-guided corticosteroid injection in patients with ulnar neuropathy at the elbow (UNE).: Methods: Fifty-five patients were randomized ... ...

    Abstract Introduction: We conducted a randomized, double-blind, placebo-controlled trial to evaluate the effect of ultrasound-guided corticosteroid injection in patients with ulnar neuropathy at the elbow (UNE).
    Methods: Fifty-five patients were randomized between an ultrasound-guided injection of 1 ml containing 40 mg methylprednisolone acetate and 10 mg lidocaine hydrochloride or a placebo injection. The primary outcome was the subjective change of symptoms after 3 months. The secondary outcomes were change in electrodiagnostic studies and ultrasonography findings.
    Results: A success rate of 30% was found in the corticosteroid injection group versus 28% in the placebo injection group. Only the nerve cross-sectional area changed significantly in the intervention group, from a mean of 11.9 mm(2) to 10.9 mm(2) .
    Conclusions: We could not demonstrate a positive effect of ultrasound-guided corticosteroid injection in UNE compared with placebo. Favorable outcomes may be attributed to the natural course of UNE or the effect of patient education.
    MeSH term(s) Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Aged, 80 and over ; Anesthetics, Local/therapeutic use ; Anti-Inflammatory Agents/therapeutic use ; Cubital Tunnel Syndrome/diagnostic imaging ; Cubital Tunnel Syndrome/drug therapy ; Double-Blind Method ; Elbow ; Female ; Humans ; Injections ; Lidocaine ; Male ; Methylprednisolone/analogs & derivatives ; Methylprednisolone/therapeutic use ; Middle Aged ; Treatment Outcome ; Ulnar Neuropathies/diagnostic imaging ; Ulnar Neuropathies/drug therapy ; Ultrasonography, Interventional ; Young Adult
    Chemical Substances Adrenal Cortex Hormones ; Anesthetics, Local ; Anti-Inflammatory Agents ; methylprednisolone acetate (43502P7F0P) ; Lidocaine (98PI200987) ; Methylprednisolone (X4W7ZR7023)
    Language English
    Publishing date 2015-09
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 438353-9
    ISSN 1097-4598 ; 0148-639X
    ISSN (online) 1097-4598
    ISSN 0148-639X
    DOI 10.1002/mus.24551
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1449: Show issues Location:
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    Zs.MO 551: Show issues

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  2. Article ; Online: D-dimer for the exclusion of cerebral venous thrombosis: a meta-analysis of low risk patients with isolated headache.

    Alons, Imanda M E / Jellema, Korné / Wermer, Marieke J H / Algra, Ale

    BMC neurology

    2015  Volume 15, Page(s) 118

    Abstract: Background: Patients with isolated headache may have cerebral venous thrombosis (CVT). D-dimers are proven sensitive in excluding deep venous thrombosis (DVT) and pulmonary embolism (PE) in low risk patients. We aimed to determine whether D-dimer may ... ...

    Abstract Background: Patients with isolated headache may have cerebral venous thrombosis (CVT). D-dimers are proven sensitive in excluding deep venous thrombosis (DVT) and pulmonary embolism (PE) in low risk patients. We aimed to determine whether D-dimer may play the same role in low risk CVT patients with isolated headache.
    Methods: We included consecutive patients suspected of CVT from our teaching hospital with isolated headache, a normal neurological examination and normal standard head CT in whom D-dimer was determined. Additionally we did a systematic review on articles describing consecutive patients suspected of CVT with isolated headache and their D-dimer values. CVT was investigated with CT or MR venography in all patients.
    Results: A total of 636 consecutive patients were collected from our own data and the literature search. Of 45 CVT patients one had a negative D-dimer (7.5 %). Sensitivity of D-dimer for diagnosing CVT was 97.8 % (95 % CI: 88.2-99.6 %), specificity was 84.9 % (95 % CI: 81.8-87.7 %), positive predictive value was 33.1 % (95 % CI: 25.2-41.7 %), negative predictive value was 99.8 % (95 % CI: 98.9-100 %). Another 56 isolated headache CVT patients were identified in literature, lacking consecutive isolated headache controls. Sensitivity of D-dimer for diagnosing CVT including these patients was 87.1 % (95 % CI: 79.0-93.0 %).
    Conclusions: D-dimers have a high negative predictive value in patients with isolated headache for excluding CVT. Sensitivity is lower but comparable to the values accepted in PE and DVT. Low risk patients were defined as headache patients with a normal neurological examination, normal standard head CT and absence of risk factors such as pregnancy or puerperium. Normal D-dimers in these patients may reduce unnecessary imaging, making it a potential valuable marker.
    MeSH term(s) Adult ; Biomarkers/blood ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Headache/etiology ; Humans ; Intracranial Thrombosis/diagnosis ; Magnetic Resonance Angiography ; Male ; Multidetector Computed Tomography ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Venous Thrombosis/diagnosis
    Chemical Substances Biomarkers ; Fibrin Fibrinogen Degradation Products ; fibrin fragment D
    Language English
    Publishing date 2015-07-28
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Review
    ISSN 1471-2377
    ISSN (online) 1471-2377
    DOI 10.1186/s12883-015-0389-y
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  3. Article ; Online: Prediction of vascular abnormalities on CT angiography in patients with acute headache.

    Alons, Imanda M E / Goudsmit, Ben F J / Jellema, Korné / van Walderveen, Marianne A A / Wermer, Marieke J H / Algra, Ale

    Brain and behavior

    2018  Volume 8, Issue 6, Page(s) e00997

    Abstract: Objectives: Patients with acute headache increasingly undergo CT-angiography (CTA) to evaluate underlying vascular causes. The aim of this study is to determine clinical and non-contrast CT (NCCT) criteria to select patients who might benefit from CTA.!# ...

    Abstract Objectives: Patients with acute headache increasingly undergo CT-angiography (CTA) to evaluate underlying vascular causes. The aim of this study is to determine clinical and non-contrast CT (NCCT) criteria to select patients who might benefit from CTA.
    Methods: We retrospectively included patients with acute headache who presented to the emergency department of an academic medical center and large regional teaching hospital and underwent NCCT and CTA. We identified factors that increased the probability of finding a vascular abnormality on CTA, performed multivariable regression analyses and determined discrimination with the c-statistic.
    Results: A total of 384 patients underwent NCCT and CTA due to acute headache. NCCT was abnormal in 194 patients. Among these, we found abnormalities in 116 cases of which 99 aneurysms. In the remaining 190 with normal NCCT we found abnormalities in 12 cases; four unruptured aneurysms, three cerebral venous thrombosis', two reversible cerebral vasoconstriction syndromes, two cervical arterial dissections and one cerebellar infarction. In multivariable analysis abnormal NCCT, lowered consciousness and presentation within 6 hr of headache onset were independently associated with abnormal CTA. The c-statistic of abnormal NCCT alone was 0.80 (95% CI: 0.75-0.80), that also including the other two variables was 0.84 (95% CI: 0.80-0.88). If NCCT was normal no other factors could help identify patients at risk for abnormalities.
    Conclusions: In patients with acute headache abnormal NCCT is the strongest predictor of a vascular abnormality on CTA. If NCCT is normal no other predictors increase the probability of finding an abnormality on CTA and diagnostic yield is low.
    MeSH term(s) Acute Disease ; Adult ; Aged ; Cerebral Angiography/methods ; Cerebrovascular Disorders/complications ; Cerebrovascular Disorders/diagnostic imaging ; Cerebrovascular Disorders/pathology ; Computed Tomography Angiography/methods ; Female ; Headache Disorders/diagnostic imaging ; Headache Disorders/etiology ; Headache Disorders/pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Subarachnoid Hemorrhage/complications ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/pathology ; Tomography, X-Ray Computed
    Language English
    Publishing date 2018-05-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2623587-0
    ISSN 2162-3279 ; 2162-3279
    ISSN (online) 2162-3279
    ISSN 2162-3279
    DOI 10.1002/brb3.997
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  4. Article ; Online: Response to Letter to the Editor Regarding "Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis."

    Alons, Imanda M E / Goudsmit, Ben F J / Jellema, Korne / van Walderveen, Marianne A A / Wermer, Marieke J H / Algra, Ale

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2018  Volume 27, Issue 7, Page(s) 2044–2045

    MeSH term(s) Angiography ; Computed Tomography Angiography ; Headache ; Humans ; Neurologic Examination ; Tomography, X-Ray Computed
    Language English
    Publishing date 2018-03-27
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2018.02.051
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 3519: Show issues Location:
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  5. Article ; Online: Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis.

    Alons, Imanda M E / Goudsmit, Ben F J / Jellema, Korne / van Walderveen, Marianne A A / Wermer, Marieke J H / Algra, Ale

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2017  Volume 27, Issue 4, Page(s) 1077–1084

    Abstract: Background: Patients with acute severe headache, normal neurological examination, and a normal noncontrast head computed tomography (NCCT) may still have subarachnoid hemorrhage, cerebral venous thrombosis (CVT), cervical arterial dissection, or ... ...

    Abstract Background: Patients with acute severe headache, normal neurological examination, and a normal noncontrast head computed tomography (NCCT) may still have subarachnoid hemorrhage, cerebral venous thrombosis (CVT), cervical arterial dissection, or reversible cerebral vasoconstriction syndrome (RCVS). Computed tomography angiography (CTA) is used increasingly in the emergency department for evaluating this, but its added value remains controversial.
    Methods: We retrospectively collected data on the diagnostic yield of CTA in patients with acute severe headache, normal neurological examination, and normal NCCT who received additional CTA in the acute phase in 2 secondary referral centers for vascular neurology. We combined data of our patients with those from the literature and performed a meta-analysis.
    Results: We included 88 patients from our hospital files and 641 patients after literature search. Of 729 patients 54 had a vascular abnormality on CTA (7.4%; 95% confidence interval [CI] 5.5%-9.3%). Abnormalities consisted of aneurysms (n = 42; 5.4%; 95% CI 3.8%-7.0%), CVT (n = 3, .5%), RCVS (n = 4, .5%), Moyamoya syndrome (n = 2, .3%), arterial dissection (n = 2, .3%), and ischemia (n = 1, .1%). Because most of the aneurysms were probably incidental findings, only 12 (1.6%) patients had a clear relation between the headache and CTA findings. The number needed to scan to find an abnormality was 14 overall, and 61 for an abnormality other than an aneurysm.
    Conclusion: Diagnostic yield of CTA in patients with acute headache, normal neurological examination, and normal NCCT is low, but because of the possible therapeutic consequences, its use might be justified in the emergency setting. Prospective studies confirming these results including cost-effectiveness analyses are needed.
    MeSH term(s) Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Cerebral Angiography/methods ; Cerebrovascular Disorders/complications ; Cerebrovascular Disorders/diagnostic imaging ; Cerebrovascular Disorders/physiopathology ; Computed Tomography Angiography ; Female ; Headache/diagnostic imaging ; Headache/etiology ; Headache/physiopathology ; Humans ; Male ; Middle Aged ; Multidetector Computed Tomography ; Neurologic Examination ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Risk Factors ; Severity of Illness Index
    Language English
    Publishing date 2017-12-23
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Review
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2017.11.016
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 3519: Show issues Location:
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  6. Article ; Online: Procalcitonin in cerebrospinal fluid in meningitis: a prospective diagnostic study.

    Alons, Imanda M E / Verheul, Rolf J / Kuipers, Irma / Jellema, Korné / Wermer, Marieke J H / Algra, Ale / Ponjee, Gabriëlle

    Brain and behavior

    2016  Volume 6, Issue 11, Page(s) e00545

    Abstract: Objectives: Bacterial meningitis is a severe but treatable condition. Clinical symptoms may be ambiguous and current diagnostics lack sensitivity and specificity, complicating diagnosis. Procalcitonin (PCT) is a protein that is elevated in serum in ... ...

    Abstract Objectives: Bacterial meningitis is a severe but treatable condition. Clinical symptoms may be ambiguous and current diagnostics lack sensitivity and specificity, complicating diagnosis. Procalcitonin (PCT) is a protein that is elevated in serum in bacterial infection. We aimed to assess the value of PCT in cerebrospinal fluid (CSF) in the diagnosis of bacterial meningitis.
    Methods: We included patients with bacterial meningitis, both community acquired and post neurosurgery. We included two comparison groups: patients with viral meningitis and patients who underwent lumbar punctures for noninfectious indications. We calculated mean differences and 95% confidence intervals of procalcitonin in CSF and plasma in patients with and without bacterial meningitis.
    Results: Average PCT concentrations in CSF were 0.60 ng mL
    Conclusion: Procalcitonin in CSF was significantly higher in patients with bacterial meningitis when compared with patients with viral or no meningitis. PCT in CSF may be a valuable marker in diagnosing bacterial meningitis, and could become especially useful in patients after neurosurgery.
    MeSH term(s) Adult ; Calcitonin/blood ; Calcitonin/cerebrospinal fluid ; Community-Acquired Infections/blood ; Community-Acquired Infections/cerebrospinal fluid ; Community-Acquired Infections/diagnosis ; Female ; Humans ; Male ; Meningitis, Bacterial/blood ; Meningitis, Bacterial/cerebrospinal fluid ; Meningitis, Bacterial/diagnosis ; Meningitis, Bacterial/microbiology ; Meningitis, Viral/blood ; Meningitis, Viral/cerebrospinal fluid ; Meningitis, Viral/diagnosis ; Middle Aged ; Prospective Studies
    Chemical Substances Calcitonin (9007-12-9)
    Language English
    Publishing date 2016-08-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2623587-0
    ISSN 2162-3279 ; 2162-3279
    ISSN (online) 2162-3279
    ISSN 2162-3279
    DOI 10.1002/brb3.545
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