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Article: Traumatic Brain Injuries: Comprehensive Management of Complex Clinical Scenarios.

Ganau, Mario / Belli, Antonio / Lawrence, Timothy P / Uff, Chris

2023 Volume 2023, Page(s) 9754321

Language	English
Publishing date	2023-04-20
Publishing country	Egypt
Document type	Editorial
ZDB-ID	2596429-X
ISSN	2090-2859 ; 2090-2840
ISSN (online)	2090-2859
ISSN	2090-2840
DOI	10.1155/2023/9754321
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Article: Clinical Significance of Isolated Third Cranial Nerve Palsy in Traumatic Brain Injury: A Detailed Description of Four Different Mechanisms of Injury through the Analysis of Our Case Series and Review of the Literature.

Uberti, Micaela / Hasan, Shumaila / Holmes, David / Ganau, Mario / Uff, Chris

Emergency medicine international

2021 Volume 2021, Page(s) 5550371

Abstract: Third cranial nerve palsy (3cnP) following traumatic brain injury (TBI) is a worrying neurological sign and is often associated with an expanding mass lesion, such as extradural or acute subdural haematomas. Isolated 3cnP can be found in the absence of ... ...

Abstract	Third cranial nerve palsy (3cnP) following traumatic brain injury (TBI) is a worrying neurological sign and is often associated with an expanding mass lesion, such as extradural or acute subdural haematomas. Isolated 3cnP can be found in the absence of posttraumatic space-occupying mass lesion, yet it is often considered as a devastating prognostic factor in the context of diffuse axonal injury (DAI). Through the analysis of five exemplificative cases and a thorough review of the literature, we identified four possible mechanisms leading to 3cnP: (1) a partial rootlet avulsion at the site of exit from the midbrain, representing a direct shearing injury to the nerve; (2) a direct traction injury due to the nerve stretching against the posterior petroclinoid ligament at the base of the oculomotor triangle secondary to the downward displacement of the brainstem at the time of impact; (3) a direct vascular compression as a result of internal carotid artery (ICA) dissection or pseudoaneurysm; (4) an indirect injury caused by impaired blood supply to the third nerve in addition to the detrimental biochemical effects of the underlying brain injury itself. Understanding the exact mechanism underlying the onset of 3cnP is key to provide an informed clinical decision-making to the patients and ensure their best chances of recovery. Our experience corroborates data from the literature showing that, even in Grade III DAI, prompt recognition of isolated 3cnP can guide adequate treatment. Nonetheless, even when an overall good neurological outcome is achieved, recovery of isolated 3cnP is dismal, and only rarely the visual deficit completely resolves.
Language	English
Publishing date	2021-04-23
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2596429-X
ISSN	2090-2859 ; 2090-2840
ISSN (online)	2090-2859
ISSN	2090-2840
DOI	10.1155/2021/5550371
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Article: Defining New Research Questions and Protocols in the Field of Traumatic Brain Injury through Public Engagement: Preliminary Results and Review of the Literature.

Hasan, Shumaila / Chari, Aswin / Ganau, Mario / Uff, Chris

Emergency medicine international

2019 Volume 2019, Page(s) 9101235

Abstract: Traumatic brain injury (TBI) is the most common cause of death and disability in the age group below 40 years. The financial cost of loss of earnings and medical care presents a massive burden to family, society, social care, and healthcare, the cost of ... ...

Abstract	Traumatic brain injury (TBI) is the most common cause of death and disability in the age group below 40 years. The financial cost of loss of earnings and medical care presents a massive burden to family, society, social care, and healthcare, the cost of which is estimated at £1 billion per annum (about brain injury (online)). At present, we still lack a full understanding on the pathophysiology of TBI, and biomarkers represent the next frontier of breakthrough discoveries. Unfortunately, many tenets limit their widespread adoption. Brain tissue sampling is the mainstay of diagnosis in neuro-oncology; following on this path, we hypothesise that information gleaned from neural tissue samples obtained in TBI patients upon hospital admission may correlate with outcome data in TBI patients, enabling an early, accurate, and more comprehensive pathological classification, with the intent of guiding treatment and future research. We proposed various methods of tissue sampling at opportunistic times: two methods rely on a dedicated sample being taken; the remainder relies on tissue that would otherwise be discarded. To gauge acceptance of this, and as per the guidelines set out by the National Research Ethics Service, we conducted a survey of TBI and non-TBI patients admitted to our Trauma ward and their families. 100 responses were collected between December 2017 and July 2018, incorporating two redesigns in response to patient feedback. 75.0% of respondents said that they would consent to a brain biopsy performed at the time of insertion of an intracranial pressure (ICP) bolt. 7.0% replied negatively and 18.0% did not know. 70.0% would consent to insertion of a jugular bulb catheter to obtain paired intracranial venous samples and peripheral samples for analysis of biomarkers. Over 94.0% would consent to neural tissue from ICP probes, external ventricular drains (EVD), and lumbar drains (LD) to be salvaged, and 95.0% would consent to intraoperative samples for further analysis.
Language	English
Publishing date	2019-10-31
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2596429-X
ISSN	2090-2859 ; 2090-2840
ISSN (online)	2090-2859
ISSN	2090-2840
DOI	10.1155/2019/9101235
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Article ; Online: Images in Neuroscience: Calvarial hyperostosis associated with multiple intracranial tumours.

Ganau, Mario / Paris, Marco / Uff, Chris

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2018

Language	English
Publishing date	2018-02-07
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2018.01.029
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Article ; Online: Cauda equina syndrome. Urinary retention.

Uff, Chris E

BMJ (Clinical research ed.)

2009 Volume 338, Page(s) b1727

MeSH term(s)	Humans ; Polyradiculopathy/complications ; Urinary Retention/etiology
Language	English
Publishing date	2009-04-29
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.b1727
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Article ; Online: Improving Neurosurgery Education Using Social Media Case-Based Discussions: A Pilot Study.

Newall, Nicola / Smith, Brandon G / Burton, Oliver / Chari, Aswin / Kolias, Angelos G / Hutchinson, Peter J / Alamri, Alexander / Uff, Chris

World neurosurgery: X

2021 Volume 11, Page(s) 100103

Abstract: Background: The increasing shift toward a more generalized medical undergraduate curriculum has led to limited exposure to subspecialties, including neurosurgery. The lack of standardized teaching may result in insufficient coverage of core learning ... ...

Abstract	Background: The increasing shift toward a more generalized medical undergraduate curriculum has led to limited exposure to subspecialties, including neurosurgery. The lack of standardized teaching may result in insufficient coverage of core learning outcomes. Social media (SoMe) in medical education are becoming an increasingly accepted and popular way for students to meet learning objectives outside formal medical school teaching. We delivered a series of case-based discussions (CbDs) over SoMe to attempt to meet core learning needs in neurosurgery and determine whether SoMe-based CbDs were an acceptable method of education. Methods: Twitter was used as a medium to host 9 CbDs pertaining to common neurosurgical conditions in practice. A sequence of informative and interactive tweets were formulated before live CbDs and tweeted in progressive order. Demographic data and participant feedback were collected. Results: A total of 277 participants were recorded across 9 CbDs, with 654,584 impressions generated. Feedback responses were received from 135 participants (48.7%). Participants indicated an increase of 77% in their level of knowledge after participating. Of participants, 57% ( Conclusions: SoMe has been shown to be a favorable and feasible medium to host live, text-based interactive CbDs. SoMe is a useful tool for teaching undergraduate neurosurgery and is easily translatable to all domains of medicine and surgery.
Language	English
Publishing date	2021-03-31
Publishing country	United States
Document type	Journal Article
ISSN	2590-1397
ISSN (online)	2590-1397
DOI	10.1016/j.wnsx.2021.100103
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Article ; Online: Importance of lumbar puncture in diagnosing subarachnoid haemorrhage.

Uff, Chris E / Harrison, Catriona

BMJ (Clinical research ed.)

2013 Volume 347, Page(s) f7578

MeSH term(s)	Humans ; Spinal Puncture ; Subarachnoid Hemorrhage/diagnosis
Language	English
Publishing date	2013-12-23
Publishing country	England
Document type	Letter
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.f7578
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Article ; Online: Venous sinus thrombosis in traumatic brain injury: a major trauma centre experience.

Harris, Lauren / Townsend, Dominic / Ingleton, Rose / Kershberg, Alice / Uff, Chris / O'Halloran, Philip J / Offiah, Curtis / McKenna, Grainne S

Acta neurochirurgica

2021 Volume 163, Issue 9, Page(s) 2615–2622

Abstract: Background: This study explores the presentation, management and outcomes of traumatic venous sinus thrombosis (VST) and identifies risk factors associated with poor outcomes.: Methods: This study is a retrospective review of all patients with VST ... ...

Abstract	Background: This study explores the presentation, management and outcomes of traumatic venous sinus thrombosis (VST) and identifies risk factors associated with poor outcomes. Methods: This study is a retrospective review of all patients with VST secondary to trauma who presented to a major trauma centre, between April 2015 and January 2020. VST was confirmed by CT venogram and a consultant neuroradiologist. Results: Forty-six patients were identified (38 male), mean age of 43 (range 12-78) and median follow-up 10.2 months (range 0.7-39.1). Fifty-two percent presented as a severe traumatic brain injury, and all had an associated skull fractures overlying the sinus. Ninety-six percent had cerebral contusions, 96% had an intracranial haematoma, 91% had traumatic subarachnoid haemorrhage (tSAH) and 22% had acute cerebral infarction. Thirty-seven percent of the VSTs were occlusive. Fifty-eight percent had sustained, unprovoked intracranial pressure (ICP) spikes (> 20 mmHg). Fifty percent underwent surgical intervention-20% external ventricular drain and 46% craniotomy/craniectomy. Nine percent were treated with anticoagulation and 4% with antiplatelets, at a median of 13.5 days and 9.5 days post-injury, with no additional complications. Age > 60 was associated with poor outcome (GOS of 3-5) (p = 0.0098). On follow-up CT, 52% of the VSTs remained unchanged, 29% re-canalised, 14% improved and 5% worsened, independent of treatment. Conclusions: This study demonstrated a higher incidence of VST in severe TBI and strong associations with skull fractures, cerebral contusions, tSAH, raised ICP and surgical intervention. Management was inconsistent, with no difference in outcome with or without anticoagulation. Larger, prospective cohort studies are needed to better understand this condition and establish evidence-based guidelines.
MeSH term(s)	Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/diagnostic imaging ; Brain Injuries, Traumatic/epidemiology ; Child ; Child, Preschool ; Humans ; Infant ; Male ; Prospective Studies ; Retrospective Studies ; Sinus Thrombosis, Intracranial/diagnostic imaging ; Sinus Thrombosis, Intracranial/epidemiology ; Sinus Thrombosis, Intracranial/etiology ; Trauma Centers
Language	English
Publishing date	2021-07-03
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-021-04916-x
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Article ; Online: Radiological prediction of contralateral extradural haematoma following evacuation of traumatic acute subdural haematoma.

Crinnion, William / Doke, Thomas / Yordanov, Stefan / Moffat, Daniel / O'Halloran, Phillip J / Mckenna, Grainne / Offiah, Curtis / Uff, Chris

British journal of neurosurgery

2021 Volume 38, Issue 2, Page(s) 367–371

Abstract: Objectives: To identify radiological predictors of contralateral extradural haematoma (CEDH) in patients undergoing evacuation of acute subdural haematoma (ASDH).: Design: Retrospective case-control study.: Subjects: Patients requiring evacuation ... ...

Abstract	Objectives: To identify radiological predictors of contralateral extradural haematoma (CEDH) in patients undergoing evacuation of acute subdural haematoma (ASDH). Design: Retrospective case-control study. Subjects: Patients requiring evacuation of traumatic ASDH via craniotomy/craniectomy with contralateral skull fracture were analysed in two groups: those who developed CEDH postoperatively and those who did not. Materials and methods: Retrospective analysis of severe traumatic brain injury admissions over 24 months (2017-2019) at a major trauma centre. Pre- and post-operative CT scans were reviewed by a Consultant Neuroradiologist for initial fracture haematoma (FH) and specific contralateral skull fracture features (CLFF) comprising: complex petrous fracture, suture diastasis and fractures involving foramen spinosum or middle meningeal groove (MMG). Results: 35 patients had ASDH evacuation (age: 11-74); 7 with craniotomy, 28 with craniectomy. 9/35 developed CEDH of whom 7 underwent bilateral craniotomy/craniectomy. 8/9 with CEDH had FH, 6/26 of those without CEDH had FH. All patients with CEDH had CLFF. 6/9 had >1 CLFF. CLFF was identified in 9/26 patients without CEDH and only 3/26 non-CEDH had >1 CLFF. Analysis using univariate logistic regression identified statistically significant factors for the development of CEDH which were: younger age, FH on initial CT, increasing number of CLFF and MMG involvement alone. After multivariate analysis, only younger age and FH were significant. Conclusions: FH and CLFF on CT enable prediction of CEDH in patients undergoing evacuation of traumatic ASDH. These features raise a high index of suspicion for this complication and may expedite investigation and management for CEDH.
MeSH term(s)	Humans ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Hematoma, Subdural, Acute/diagnostic imaging ; Hematoma, Subdural, Acute/etiology ; Hematoma, Subdural, Acute/surgery ; Retrospective Studies ; Case-Control Studies ; Craniotomy/adverse effects ; Hematoma, Subdural/surgery ; Skull Fractures/complications ; Skull Fractures/diagnostic imaging ; Skull Fractures/surgery ; Hematoma, Epidural, Cranial/diagnostic imaging ; Hematoma, Epidural, Cranial/etiology ; Hematoma, Epidural, Cranial/surgery ; Hematoma, Subdural, Intracranial/surgery ; Treatment Outcome
Language	English
Publishing date	2021-02-11
Publishing country	England
Document type	Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.1080/02688697.2021.1877612
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Article ; Online: Aneurysm management in patients over 80 years old with good grade subarachnoid haemorrhage.

British journal of neurosurgery

2023 , Page(s) 1–7

Abstract: Background: An increasing proportion of aneurysmal subarachnoid haemorrhage (aSAH) occurs in older patients, in whom there is widespread variability in treatment rates due to a different balance of risks. Our aim was to compare outcomes of patients over ...

Abstract	Background: An increasing proportion of aneurysmal subarachnoid haemorrhage (aSAH) occurs in older patients, in whom there is widespread variability in treatment rates due to a different balance of risks. Our aim was to compare outcomes of patients over 80 years old with good grade aSAH who underwent treatment of their aneurysm with those who did not. Methods: Adult patients with good grade aSAH admitted to tertiary regional neurosciences centres contributing to the UK and Ireland Subarachnoid Haemorrhage Database (UKISAH) and a cohort of consecutive patients admitted from three regional cohorts were included for analysis. Outcomes were functional outcome at discharge, three months and survival at discharge. Results: In the UKISAH, patients whose aneurysm was treated were more likely to have a favourable outcome at discharge (OR 2.34, CI 1.12-4.91, Conclusions: Better early functional outcomes in those undergoing aneurysm treatment appear to be explained by differences in frailty and comorbidity. Therefore, treatment decisions in this patient group are finely balanced with no clear evidence overall of either benefit or harm in this cohort.
Language	English
Publishing date	2023-05-05
Publishing country	England
Document type	Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.1080/02688697.2023.2205939
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