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Delayed cerebral ischaemia (DCI) is a significant complication of aneurysmal subarachnoid haemorrhage (aSAH) and is strongly associated with poorer outcome. The Alberta Stroke Program Early Computer Tomography (ASPECT) score is an established scoring tool, used in acute ischaemic stroke, to quantify early ischaemic changes on CT head scans. We aim to identify if ASPECT scoring correlates with functional outcome in DCI following aSAH. Retrospective case–control study. Inclusion criteria: admission to the Department of Neurosurgery at Leeds Teaching Hospitals NHS Trust (a tertiary neurosurgical centre in the United Kingdom) between 2014 and 2018, with a diagnosis of anterior circulation aneurysmal subarachnoid haemorrhage; as confirmed by initial CT scan and subsequent CT angiography or catheter digital subtraction angiography. Cases were those who developed DCI (n = 43) and controls were randomly selected from those who did not develop DCI (n = 46) but otherwise met the same inclusion criteria. The primary outcome measure was Glasgow Outcome Score (GOS): assessed at discharge and 3 months. ASPECT scores were calculated from non-contrast CT head scans by three researchers blinded to each other and clinical outcome. Spearman’s rank correlation was used to calculate correlation between ASPECT scores and GOS. ASPECT score positively correlated with GOS in the cases both at discharge (Spearman rho 0.436, p = 0.003) and at 3 months (Spearman rho 0.431, p = 0.004). When corrected for Fisher grading, the adjusted odds ratio of having a high GOS with a low ASPECT score at discharge was OR 0.74 (95% CI 0.61–0.94, p = 0.003), and 3 months OR 0.73 (95% CI 0.59–0.91, p = 0.005). ASPECT score significantly correlates with clinical outcome in DCI post aSAH, even after correcting for Fisher grade. ASPECT scoring may identify patients at risk of poor outcome following DCI and represents a quick and reliable tool that aids in clinical decision-making and prognostication.

OBJECTIVE Delayed ischemic neurological deficit (DIND) is seen as a clinical manifestation of cerebral vasospasm and is a significant cause of morbidity and mortality following aneurysmal subarachnoid hemorrhage (aSAH). Currently, the standard of care for DIND prevention in patients who have sustained aSAH is prophylactic nimodipine therapy and ensuring adequate fluid intake, alongside other treatments such as bowel care. Osmotic laxatives trap water within the bowel lumen to accelerate the transport of the gut contents through the bowel. Given the potential for DIND secondary to cerebral vasospasm, it is perhaps counterintuitive that gastrointestinal fluid loss and use of osmotic laxatives are not commonly considered in many aSAH management protocols. METHODS A retrospective case note analysis was performed for all adult patients (aged > 16 years) admitted to the Department of Neurosurgery at Leeds General Infirmary with a diagnosis of aSAH between August 2019 and September 2020. RESULTS A total of 105 patients were included, 62% of whom were female, with a mean and median age of 54 years (range 24–84 years). Diarrhea was noted in 12 patients (11.4%), 58% of whom subsequently developed DIND (OR 15.30, CI 3.92–59.14; p = 0.0001). All patients received osmotic laxatives (97% having received ≥ 2 laxative agents). CONCLUSIONS Patients with aSAH who subsequently developed diarrhea had significantly increased odds of developing DIND. Enteral volume loss due to osmotic laxative use is a potential risk factor for DIND after aSAH.

Radiological investigations are a powerful tool in the assessment of patients with intracranial vascular anomalies. ‘Visual’ assessment of neurovascular lesions is central to their diagnosis, monitoring, prognostication and management. Computed tomography and magnetic resonance imaging are the two principal non-invasive imaging modalities used in clinical practice for the assessment of the cerebral vasculature, but these techniques continue to evolve, enabling clinicians to gain greater insights into neurovascular pathology and pathophysiology. This review outlines both established and novel imaging modalities used in modern neurovascular practice and their clinical applications.

Our aim was to describe the epidemiology of isolated adult lower limb burns presenting to the Pinderfields Regional Burns Centre, Wakefield, United Kingdom between 2003 and 2018. Data was obtained using our local records of the international Burn Injury Database (iBID). 6059 patients were treated in our department during this period. 18.7% presented with isolated lower limb burns (n = 1133). 65.4% of patients were male (n = 741). Scald was the most common mechanism of injury. Work-related burns accounted for 23.4% of the injuries (n = 265). 36% of patients were admitted (n = 408), and 11.7% underwent surgical intervention (n = 133). Isolated lower limb burns are common in patients in the working age group. Work-related injuries are preventable. Targeted education to highlight the risks, reduce the incidence, and improve awareness of first aid measures are recommended.

We have investigated the fundamental properties of central auditory glycinergic synapses in early postnatal development in normal and congenitally deaf ( dn/dn) mice. Glycinergic miniature inhibitory postsynaptic currents (mIPSCs) were recorded using patch-clamp methods in neurons from a brain slice preparation of the medial nucleus of the trapezoid body (MNTB), at 12-14 days postnatal age. Our results show a number of significant differences between normal and deaf mice. The frequency of mIPSCs is greater (50%) in deaf versus normal mice. Mean mIPSC amplitude is smaller in deaf mice than in normal mice (mean mIPSC amplitude: deaf, 64 pA; normal, 106 pA). Peak-scaled fluctuation analysis of mIPSCs showed that mean single channel conductance is greater in the deaf mice (deaf, 64 pS; normal, 45 pS). The mean decay time course of mIPSCs is slower in MNTB neurons from deaf mice (mean half-width: deaf, 2.9 ms; normal, 2.3 ms). Light- and electron-microscopic immunolabeling results showed that MNTB neurons from deaf mice have more (30%) inhibitory synaptic sites (postsynaptic gephyrin clusters) than MNTB neurons in normal mice. Our results demonstrate substantial differences in glycinergic transmission in normal and congenitally deaf mice, supporting a role for activity during development in regulating both synaptic structure (connectivity) and the fundamental (quantal) properties of mIPSCs at central glycinergic synapses.