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Differentiating iNPH from other neurodegenerative diseases is challenging. Only a portion of the patients clinically suspected of iNPH would respond to surgical intervention. CSF tap test is usually used to predict surgery outcomes and hence aid clinical decision-making, but the work-up varies. Introduce the CSF tap test conducted at our center and examine its power by analyzing data from a series of iNPH cases underwent shunt placement. Analyze common features in the past medical history of our patients and investigate whether they are related to the etiology of iNPH.Data from 20 patients who were positive in the tap tests pre-operatively and received ventriculoperitoneal shunting were retrospectively analyzed. Pre-operative and post-operative performance data were analyzed. History of any underlying medical conditions was taken into consideration. Patients with negative tap test results of same period were also followed-up.We performed VP shunt placement in 20 NPH patients from October 2019 to February 2022. 90% of them exhibited improvement in at least 1 of the clinical triad, proving the predictive power of the PUMCH test workflow. The underlying conditions like hypertension, diabetes and insufficiency in cerebral blood supply were also found to be associated with the onset of NPH.Our evaluation system is a valid tool for NPH assessment and can guide clinical decision-making. Comorbidities should be taken into consideration as they contribute to the pathogenesis and progression of NPH. Better identification of potential iNPH patients will lower the burden exerted on the family and the aging society.

ObjectiveThe purpose of this study was to assess the short-term and long-term outcomes of ventriculoperitoneal shunt (VPS) placement in patients with cryptococcal meningitis (CM).MethodsWe performed a retrospective analysis of all patients with CM admitted to the Peking Union Medical College Hospital from September 1990 to January 2021. We collected related clinical features to analyze the short- and long-term outcomes of VPS at 1 month and 1 year at least the following therapy, respectively. Overall survival (OS) was compared with all patients and a subgroup of critically ill cases by the Kaplan–Meier method with the log-rank test. Univariable and multivariable analyses were also performed using the Cox proportional hazard model to identify statistically significant prognostic factors.ResultsWe enrolled 98 patients, fifteen of whom underwent VPS. Those who received VPS had a lower cerebrospinal fluid (CSF) Cryptococcus burden (1:1 vs. 1:16; p = 0.046), lower opening pressures (173.3 mmH2 O vs. 224 mmH2O; p = 0.009) at lumbar punctures, and a lower incidence of critical cases (6.7 vs. 31.3%; p = 0.049). According to our long-term follow-up, no significant difference was shown in the Barthel Index (BI) between the two groups. Two patients in the VPS group suffered postoperative complications and had to go through another revision surgery. According to survival analysis, overall survival (OS) between the VPS and non-VPS groups was not significantly different. However, the Kaplan–Meier plots showed that critical patients with VPS had better survival in OS (p < 0.009). Multivariable analyses for critical patients showed VPS was an independent prognostic factor.ConclusionA VPS could reduce the intracranial pressure (ICP), decrease the counts of Cryptococcus neoformans by a faster rate and reduce the number of critical cases. The VPS used in critical patients with CM has a significant impact on survival, but it showed no improvement in the long-term Barthel Index (BI) vs. the conservative treatment and could lead to postoperative complications.

ObjectiveThe purpose of this study was to verify that hypothalamus-pituitary dysfunction is one of the risk factors for postoperative central nervous system infections (PCNSIs).MethodWe performed a retrospective analysis of all patients with sellar region lesions who underwent surgery between January 2016 and November 2019 at Peking Union Medical College Hospital. In total, 44 age− and sex-matched controls were enrolled. Univariate and multivariate analyses were performed to identify risk factors for PCNSIs.ResultWe enrolled 88 patients, 44 of whom had PCNSIs. Surgical approach (TCS) (P+ levels(ConclusionTCS, intraoperative CSF leakage, postoperative DI and postoperative adrenal insufficiency are risk factors for PCNSIs in patients with sellar region tumors.

What is known and objective Low levels of serum triiodothyronine (T3) are a strong predictor of mortality and poor prognosis in critical care patients. Few reports, however, have focused on neurocritical patients. The application of hormone replacement therapy (HRT) in the treatment of neurocritical patients with low T3 syndrome remains controversial. We studied the role of low T3 state as a predictor of outcomes in neurocritical patients and examined the effect of HRT on prognosis. Methods A retrospective analysis was performed on the data of 32 neurocritical patients with low T3 syndrome who were admitted to the neuro-intensive care unit of Peking Union Medical College Hospital between January 2012 and October 2018. While 18/32 (56.25%) patients received HRT (HRT group; n = 18), 14/32 (43.75%) patients did not receive HRT (non-HRT group; n = 14). Patients were followed up for periods ranging from 3 months to 72 months. Baseline clinical and laboratory data were compared between the two groups using Mann-Whitney U tests or the t tests. Overall survival was assessed by Kaplan-Meier curve and compared by log-rank tests. Univariate and multivariate regression analyses were performed to identify the factors associated with prognosis and estimate the effect of HRT. We also assessed the influence of HRT on final neurological function, using the Glasgow Coma Scale (GCS) and the Glasgow Outcome Scale (GOS) scores. Results and discussion The neurocritical events in our cohort included post-operative complications (n = 18), traumatic brain injury (n = 8) and spontaneous intracerebral haemorrhage (n = 6). Mean GCS score in the cohort was 6.41 (6.44 ± 3.14 in HRT group vs 6.36 ± 2.06 in non-HRT group). A total of 15/32 (46.87%) deaths were recorded (7 in the HRT group, 8 in the non-HRT group). In the HRT group, 15 patients underwent repeat thyroid function tests after completion of HRT; the low T3 situation was corrected in only 5/15 (33.3%) patients. Overall survival was significantly shorter in the non-HRT group than in the HRT group (16.45 months vs 47.47 months; P = .034). In univariate regression analysis, the HRT group has the lower mortality risk than the non-HRT group (HR = 0.301, 95% Cl: 0.094-0.964; P = .043). However, multivariate regression analysis showed no significant difference in mortality risk between the two groups (HR = 0.340 95% CI: 0.099-1.172; P = .087). There was no significant difference in effects of HRT on the short- and long-term neurological function between the groups. What is new and conclusion Low T3 syndrome may influence the prognosis of neurocritical patients, attention should be paid to the changes in serum T3 levels during treatment. Although it is unclear to what extent HRT can improve the short or long-term outcomes of neurological function, it can significantly improve the survival rates of neurocritical patients.

Background Low serum T3 level is considered as a strong predictor of mortalities and poor prognosis in critical care patients. Few reports, however, focus on neurocritical patients. The application of hormone replacement therapy (HRT) in neurocritical patients with low T3 syndrome also remains controversial. We studied the role of low T3 state as a predictor in neurocritical patients and presented our experience of HRT from a single-center perspective.Methods From January 2012 to October 2018, a total of 32 neurocritical patients with low T3 syndrome were admitted to the neuro-intensive care unit (NICU) of Peking Union Medical College Hospital. Among them, 18 (56.25%) patients received HRT (HRT group) since the diagnosis of low T3 syndrome, while the other 14 (43.75%) patients did not (non-HRT group). We collected the clinical baseline and laboratory data of all the patients and conducted follow-up from 3 to 72 months. Overall survival was assessed by the Kaplan-Meier curve and compared by the log-rank test. Univariate and multivariate regression analysis was applied to estimate the prognostic power of HRT for mortality. We also performed the Mann-Whitney U test or t-test to assess the influence of HRT on the final neurological function.Results The cohort consists of 32 patients, with an average Glasgow Coma Scale (GCS) of 6.41 (HRT=6.44±3.14, non-HRT=6.36±2.06). The neurocritical events include postoperative complications (n=18), traumatic brain injury (n=8), and spontaneous intracerebral hemorrhage (n=6). A total of 15 (46.87%) deaths were recorded (HRT=7, non-HRT=8). In the HRT group, the low T3 situation in 5 patients (33.3%) was corrected and 10 (66.7%) were not. It turns out that the overall survival rate of the non-HRT group was significantly lower than that of the HRT group (P=0.034, 16.445 vs. 47.470 months). The non-HRT group has 3.322 times the mortality risk of the HRT group, according to univariate regression analysis, while the multivariate regression analysis showed no significant difference in mortality risk between the two groups (P=0.087, HR=0.340 95%CI 0.099-1.172). There was no significant difference in the short and long-term effects of HRT on neurological function (short-term GCS P=0.587, long-term GCS P=0.419, long-term GOS P=0.419).Conclusion Low T3 syndrome can significantly influence the prognosis of neurocritical patients. Therefore much attention should be paid to the changes in serum T3 level during treatment. Although it is unclear to what extent can HRT improve the short or long-term outcome of neurological function, it can significantly benefit the survival of neurocritical patients.