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Contrast-induced encephalopathy (CIE) is a rare encephalopathic condition after the administration of a contrast agent. The diagnosis of CIE is challenging because of the heterogeneity and non-specificity of the clinical presentation. The clinical course is usually favorable with full recovery within 48-72 h in most patients, although comorbidity is of relevance and contributes to the clinical outcome. It is expected that the incidence of CIE is currently increasing, due to an increase in endovascular and diagnostic imaging procedures using iodinated contrast. It is important to include CIE in the differential diagnosis when patients deteriorate during, or immediately after, contrast administration, even when only a small amount of non-ionic contrast agent is used. When CIE is considered to be the most likely explanation for the clinical symptoms, it is advised to refrain from unnecessary additional contrast studies such as angiography or perfusion CT., (© 2022. The Author(s).)

Background and Objectives: The modified Rankin Scale (mRS) is one of the most frequently used outcome measures in trials in patients with an aneurysmal subarachnoid hemorrhage (aSAH). The assessment method of the mRS is often not clearly described in trials, while the method used might influence the mRS score. The aim of this study is to evaluate the inter-method reliability of different assessment methods of the mRS., Methods: This is a prospective, randomized, multicenter study with follow-up at 6 weeks and 6 months. Patients aged ≥ 18 years with aSAH were randomized to either a structured interview or a self-assessment of the mRS. Patients were seen by a physician who assigned an mRS score, followed by either the structured interview or the self-assessment. Inter-method reliability was assessed with the quadratic weighted kappa score and percentage of agreement. Assessment of feasibility of the self-assessment was done by a feasibility questionnaire., Results: The quadratic weighted kappa was 0.60 between the assessment of the physician and structured interview and 0.56 between assessment of the physician and self-assessment. Percentage agreement was, respectively, 50.8 and 19.6%. The assessment of the mRS through a structured interview and by self-assessment resulted in systematically higher mRS scores than the mRS scored by the physician. Self-assessment of the mRS was proven feasible., Discussion: The mRS scores obtained with different assessment methods differ significantly. The agreement between the scores is low, although the reliability between the assessment methods is good. This should be considered when using the mRS in clinical trials., Trial Registration: www.trialregister.nl ; Unique identifier: NL7859., (© 2021. The Author(s).)

Purpose: A possible disadvantage of endovascular occlusion outside work hours is that complex procedures might expose patients to additional risk when performed in a suboptimal setting. In this prospective cohort study, we evaluated whether treatment during out of office hours is a risk factor for per-procedural complications and clinical outcome., Methods: We included 471 endovascular-treated, consecutive aneurysmal subarachnoid hemorrhage patients (56.6 ± 13.1, 69% female), from two prospective observational databases which were retrospectively analyzed. Primary outcome was the occurrence of per-procedural complications. Secondary outcomes were good clinical outcome (modified ranking scale ≤ 2) and death at 6-month follow-up. We determined odds ratios (OR) with 95% confidence intervals (CI) by ordered polytomous logistic regression analysis and adjusted odds ratios (aOR) for age, World Federation of Neurosurgical Societies grade, and time to treatment., Results: Most patients were treated during office hours (363/471; 77.1%). Treatment during out of office hours did not result in an increased risk of per-procedural complications (OR 0.85 (95% CI 0.53-1.37; p = 0.51). Patients treated during out of office hours displayed similar odds of good clinical outcome and death after 6 months (OR 1.14, 95% CI 0.68-1.97 and 1.16 95% CI 0.56-2.29, respectively) compared to patients treated during office hours., Conclusion: In our study, endovascular coil embolization during out of office hours did not expose patients to an increased risk of procedural complications or affect functional outcome after 6 months.

Background: Patients with signs and/or symptoms of cervical spondylotic myelopathy are frequently encountered in spinal practice. Exact numbers of prevalence or incidence are not known., Methods: A literature search was performed by an experienced librarian in Pubmed, Embase, and Scopus. After selection of articles based on titles and abstracts, a full text review was performed. The prevalence of people needing surgical treatment was also estimated in a neurosurgical practice with a population adherence of 1.7 million people and a known referral pattern of the neurologists; all patients operated upon because of cervical spondylotic myelopathy between July 2009 and July 2012 were collected and prevalence calculated., Results: The search of the literature did not reveal any article reporting an incidence or prevalence of cervical spondylotic myelopathy. Eighty of 5,992 patients were operated upon because of a cervical spondylotic myelopathy: 1.6 per 100,000 inhabitants., Conclusion: Surprisingly, an extensive search of the literature did not reveal exact data about the incidence or prevalence of cervical spondylotic myelopathy. The prevalence of surgically treated cervical spondylotic myelopathy was estimated as 1.6 per 100,000 inhabitants. Although the population adherence to the surgical practice is reasonably fixed and referral patterns are known, this estimate will still be too low for various reasons. At best, this estimate is the minimal prevalence of cervical spondylotic myelopathy that has been operated upon. To address the exact incidence or prevalence of cervical spondylotic myelopathy in general or needing surgical treatment, other investigations are warranted.