Search

Introduction: Endoscopic third ventriculostomy (ETV) is becoming an increasingly widespread treatment for hydrocephalus, but research is primarily based on paediatric populations. In 2009, Kulkarni et al created the ETV Success score to predict the outcome of ETV in children. The purpose of this study is to create a prognostic model to predict the success of ETV for adult patients with hydrocephalus. The ability to predict who will benefit from an ETV will allow better primary patient selection both for ETV and shunting. This would reduce additional second procedures due to primary treatment failure. A success score specific for adults could also be used as a communication tool to provide better information and guidance to patients. Methods and analysis: The study will adhere to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis reporting guidelines and conducted as a retrospective chart review of all patients≥18 years of age treated with ETV at the participating centres between 1 January 2010 and 31 December 2018. Data collection is conducted locally in a standardised database. Univariate analysis will be used to identify several strong predictors to be included in a multivariate logistic regression model. The model will be validated using K-fold cross validation. Discrimination will be assessed using area under the receiver operating characteristic curve (AUROC) and calibration with calibration belt plots. Ethics and dissemination: The study is approved by appropriate ethics or patient safety boards in all participating countries.

Purpose: Decompressive craniectomy (DC) is an effective treatment of intracranial hypertension. Correspondingly, the procedure is increasingly utilised worldwide. The number of patients rendered vegetative following surgery has been a concern—a matter especially important in children, due to long anticipated lifetime. Here, we report the long-term outcomes of all paediatric DC patients from an 11-year period in a tertiary-level centre that geographically serves half of Finland. Methods: We identified all patients younger than 18 years who underwent DC in the Oulu University Hospital between the years 2009 and 2019. Outcomes and clinicoradiological variables were extracted from the patient records. Results: Mean yearly prevalence of brain injury requiring DC was 1.34/100 000 children—twenty-four patients underwent DC during the study period and 21 (88%) survived. The median age of the patients was 16.0 years, and the median preoperative GCS was 5.0 (IQR 5.0). Fifteen patients (63%) had made a good recovery (Extended Glasgow Outcome Scale ≥ 7). Of the surviving patients, two (9.5%) had not returned to school. After traumatic brain injury (n = 20), the Rotterdam CT score (mean 3.0, range 1 to 5) was not associated with mortality, poor recovery or inability to continue school (p = 0.13, p = 0.41, p = 0.43, respectively). Absent basal cisterns were associated with mortality (p = 0.005), but not with poor recovery if the patient survived DC (p = 0.81). Hydrocephalus was associated with poor recovery and inability to continue school (p = 0.01 and p = 0.03, respectively). Conclusion: Most of our patients made a favourable recovery and were able to continue school. No late mortality was observed. Thus, even in clinically and radiologically severely brain-injured children, decompressive craniectomy appears to yield favourable outcomes.

Primary central nervous system lymphoma (PCNSL) is an aggressive brain disease where lymphocytes invade along perivascular spaces of arteries and veins. The invasion markedly changes (peri)vascular structures but its effect on physiological brain pulsations has not been previously studied. Using physiological magnetic resonance encephalography (MREGBOLD) scanning, this study aims to quantify the extent to which (peri)vascular PCNSL involvement alters the stability of physiological brain pulsations mediated by cerebral vasculature. Clinical implications and relevance were explored. In this study, 21 PCNSL patients (median 67y; 38% females) and 30 healthy age-matched controls (median 63y; 73% females) were scanned for MREGBOLD signal during 2018–2021. Motion effects were removed. Voxel-by-voxel Coefficient of Variation (CV) maps of MREGBOLD signal was calculated to examine the stability of physiological brain pulsations. Group-level differences in CV were examined using nonparametric covariate-adjusted tests. Subject-level CV alterations were examined against control population Z-score maps wherein clusters of increased CV values were detected. Spatial distributions of clusters and findings from routine clinical neuroimaging were compared [contrast-enhanced, diffusion-weighted, fluid-attenuated inversion recovery (FLAIR) data]. Whole-brain mean CV was linked to short-term mortality with 100% sensitivity and 100% specificity, as all deceased patients revealed higher values (n = 5, median 0.055) than surviving patients (n = 16, median 0.028) (p < .0001). After adjusting for medication, head motion, and age, patients revealed higher CV values (group median 0.035) than healthy controls (group median 0.024) around arterial territories (p ≤ .001). Abnormal clusters (median 1.10 × 10₅mm₃) extended spatially beyond FLAIR lesions (median 0.62 × 10₅mm₃) with differences in volumes (p = .0055).

Objective: Autologous bone has been the gold standard of cranioplasty materials for decades. Unique to autologous cranioplasty, bone flap resorption is a poorly understood and unclearly defined complication. Even further, it has been unclear, whether the resorption process eventually stabilizes over time. Thus, the sufficient follow-up period after autologous cranioplasty is unknown. The Oulu Resorption Score (ORS) is a straight-forward classification system for the radiological interpretation of bone flap resorption. The aims of the present study were to evaluate the reliability of the ORS using intra-class correlation coefficient (ICC) and to assess the temporal progression of the resorption process. Methods: We identified 108 consecutive autologous cranioplasty patients treated between 2005 and 2018 in two tertiary referral centers. All 365 head CT scans the patients had undergone were evaluated using the ORS in a blinded, independent two-center setting. Intra- and inter-observer reliabilities were calculated. The ORS was applied to study the temporal progression of the resorption process. Results: The intra-observer reliability of the ORS was excellent (ICC 0.94, 95%CI 0.93–0.95). Inter-observer reliability was good-to-excellent (ICCs 0.87 and 0.89, 95%CIs 0.84–0.89 and 0.87–0.91, respectively). In scatterplot smoothing analyses, the progression of bone flap resorption appeared to stabilize 12–24 months after cranioplasty. Conclusions: ORS is the only validated radiological tool for the standardized analysis of bone flap resorption after autologous cranioplasty. Evaluated using the ORS, the resorption process seemed to stabilize during the first two postoperative years after cranioplasty, suggesting that the sufficient follow-up time after autologous cranioplasty is two years.

Background and purpose: For prevention of cerebrovascular diseases at younger age, it is important to understand the risk factors occurring early in life. We investigated the relationship between mothers’ general health during pregnancy and the offspring’s risk of cerebrovascular disease in age of 15 to 52 years. Methods: Within the population-based prospective Northern Finland Birth Cohort 1966, 11,926 persons were followed from antenatal period to 52 years of age. Information on their mother’s ill health conditions, i.e., hospitalizations, chronic diseases, medications, vitamin or iron supplement, fever, anemia, mood, and smoking was collected from 24th gestational week onwards. Ischemic and hemorrhagic cerebrovascular diseases of the offspring were identified from national registers in Finland. Cox proportional hazard models were used to estimate the association of mother’s health conditions with incidence of cerebrovascular disease in the offspring, with adjustments for potential confounders. Results: During 565,585 person-years of follow-up, 449 (2.8%) of the offspring had a cerebrovascular disease. Hospitalization during pregnancy was associated with an increased risk of cerebrovascular disease in the offspring (hazard ratio (HR) = 1.49; 95% confidence interval (CI) 1.06–2.08) after adjustment for confounders, as was having more than three ill health conditions (HR = 1.89; CI 1.14–3.11). Not using vitamin or iron supplement was associated with increased risk for cerebrovascular disease in the offspring (HR = 1.39; CI 1.01–1.89). Conclusions: The results suggest that the risk of cerebrovascular disease may start as early as during the antenatal period, and the health characteristics of mothers during pregnancy may play a role in cerebrovascular disease risk of the offspring.

Intracerebral hemorrhage (ICH) is an acute, catastrophic brain event with significant lifelong consequences. One of the most devastating sequelae is post-stroke epilepsy (PSE). The purpose of this thesis was to examine long-term survival after primary ICH with special focus on PSE. In the context of PSE, the emphasis was on incidence, risk factors and effect on long-term outcome. In addition, we investigated long-term mortality and causes of death in long-term ICH survivors during a particularly long follow-up of up to 25 years. In study I, we retrospectively investigated the incidence and risk factors of PSE in a cohort of 615 three-month survivors of primary ICH. In this cohort, 13.5% of all patients developed PSE, and most cases (77%) occurred during the first two years of follow-up. Subcortical hemorrhage location and early-onset seizures were predictive of subsequent PSE. Intriguingly, patients with hypertension had a significantly lower risk of developing PSE compared to those without. In study II, we evaluated the risk factors for long-term mortality among three-month survivors of primary ICH to evaluate risk factors for long-term mortality in this group, and whether PSE was one of them. We observed that PSE was associated with higher long-term mortality risk, comparable to older age, male sex, requirement of daily assistance at three months after ICH, non-subcortical hemorrhage location and pre-ICH diabetes and cancer. We also observed that patients with PSE were more likely to die due to pneumonia compared to those without. In study III, we used the same cohort as in the previous two studies complemented with those patients who had died during the first three months after the ICH to examine overall mortality and causes of death during a follow-up of up to 25 years. We used controls matched by age, sex and place of residence acquired from Statistics Finland in 1:3 ratio for comparison. A total of 81% of patients died during the course of our follow, Tiivistelmä Aivoverenvuoto (intracerebral hemorrhage, ICH) on vakava aivokatastrofi, jolla on merkittäviä elämänmittaisia jälkivaikutuksia. Tämän väitöskirjatyön tarkoituksena oli tarkastella primaarin ICH:n jälkeistä pitkäaikaisselviytymistä ja erityisenä huomion kohteena aivoverenkiertohäiriön jälkeistä epilepsiaa. Epilepsian osalta painopisteinä olivat ilmaantuvuus, riskitekijät ja pitkäaikaisennuste. Lisäksi tutkimuksessa tarkasteltiin ICH:sta selviytyneiden potilaiden pitkäaikaiskuolleisuutta ja kuolemansyitä 25 vuoden seuranta-ajan puitteissa. Ensimmäisessä osatyössä tutkimuksen kohteena olivat ICH:n jälkeisen epilepsian ilmaantuvuus ja sen kehittymiselle altistavat tekijät. Tutkimuksessa tarkasteltiin takautuvasti 615:a vuosina 1993–2008 primaariin ICH:hon sairastunutta ja vähintään kolme kuukautta elossa selvinnyttä potilasta. Näistä potilaista 13,5 %:lle kehittyi epilepsia seuranta-aikana. Aivokuorenalainen vuoto ja varhaiset epileptiset kohtaukset ennustivat epilepsian kehittymistä. Verenpainetautia sairastavilla potilailla epilepsian kehittymisen riski oli selkeästi alhaisempi kuin niillä potilailla, joilla verenpainetautia ei ollut. Toisessa osatyössä tarkastelun kohteena olivat kuolleisuuden riskitekijät, ja erityisesti ICH:n jälkeisen epilepsian mahdollinen vaikutus. Tutkimuksessa todettiin ICH:n jälkeisen epilepsian olevan yhteydessä kuolleisuuteen. Muita kuolleisuuden riskiä lisääviä tekijöitä tutkimuksessa olivat korkea ikä, miessukupuoli, päivittäinen avuntarve kolmen kuukauden kuluttua vuodosta, vuodon sijainti muualla kuin aivokuoren läheisyydessä sekä ennen ICH:ta todettu diabetes ja syöpäsairaus. Epilepsiaan sairastuneilla potilailla kuolemansyynä oli keuhkokuume huomattavasti useammin kuin niillä potilailla, jotka eivät olleet sairastuneet epilepsiaan. Kolmannessa osatyössä mukana olivat myös ensimmäisten kolmen kuukauden aikana menehtyneet potilaat. Tutkimuksen kohteena olivat kokonaiskuolleisuus ja kuolemansyyt 25 vuoden seurannan aikana. Tu

Objectives: This study aimed to determine whether post-stroke epilepsy (PSE) predicts mortality, and to describe the most prominent causes of death (COD) in a long-term follow-up after primary intracerebral hemorrhage (ICH). Methods: We followed 3-month survivors of a population-based cohort of primary ICH patients in Northern Ostrobothnia, Finland, for a median of 8.8 years. Mortality and CODs were compared between those who developed PSE and those who did not. PSE was defined according to the ILAE guidelines. CODs were extracted from death certificates (Statistics Finland). Results: Of 961 patients, 611 survived for 3 months. 409 (66.9%) had died by the end of the follow-up. Pneumonia was the only COD that was significantly more common among the patients with PSE (56% vs. 37% of deaths). In the multivariable models, PSE (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.06–1.87), age (HR 1.07, 95% CI 1.06–1.08), male sex (HR 1.35, 95% CI 1.09–1.67), dependency at 3 months (HR 1.52, 95% CI 1.24–1.88), non-subcortical ICH location (subcortical location HR 0.78, 95% CI 0.61−0.99), diabetes (HR 1.43, 95% CI 1.07–1.90) and cancer (HR 1.45, 95% CI 1.06–1.98) predicted death in the long-term follow-up. Conclusion: PSE independently predicted higher late morality of ICH in our cohort. Pneumonia-related deaths were more common among the patients with PSE.

Introduction: Chronic subdural haematomas (CSDHs) are one of the most common neurosurgical conditions. The goal of surgery is to alleviate symptoms and minimise the risk of symptomatic recurrences. In the past, reoperation rates as high as 20%–30% were described for CSDH recurrences. However, following the introduction of subdural drainage, reoperation rates dropped to approximately 10%. The standard surgical technique includes burr-hole craniostomy, followed by intraoperative irrigation and placement of subdural drainage. Yet, the role of intraoperative irrigation has not been established. If there is no difference in recurrence rates between intraoperative irrigation and no irrigation, CSDH surgery could be carried out faster and more safely by omitting the step of irrigation. The aim of this multicentre randomised controlled trial is to study whether no intraoperative irrigation and subdural drainage results in non-inferior outcome compared with intraoperative irrigation and subdural drainage following burr-hole craniostomy of CSDH. Methods and analysis: This is a prospective, randomised, controlled, parallel group, non-inferiority multicentre trial comparing single burr-hole evacuation of CSDH with intraoperative irrigation and evacuation of CSDH without irrigation. In both groups, a passive subdural drain is used for 48 hours as a standard of treatment. The primary outcome is symptomatic CSDH recurrence requiring reoperation within 6 months. The predefined non-inferiority margin for the primary outcome is 7.5%. To achieve a 2.5% level of significance and 80% power, we will randomise 270 patients per group. Secondary outcomes include modified Rankin Scale, rate of mortality, duration of operation, length of hospital stay, adverse events and change in volume of CSDH. Ethics and dissemination: The study was approved by the institutional review board of the Helsinki and Uusimaa Hospital District (HUS/3035/2019 §238) and duly registered at ClinicalTrials.go

This thesis evaluated the factors affecting bone flap survival and bone flap resorption after primary cranial reparation surgery, cranioplasty, conducted to repair a cranial bone defect with an autologous cryopreserved bone flap. Emphasis is put on the predictors, progression, and definition of an important yet poorly understood postoperative complication, bone flap resorption. Study I assessed the rates and predictors of bone flap removal and bone flap resorption in a Finnish retrospective multicentre setting. 40% of patients developed complications of whom half required bone flap removal. Bone flap resorption and surgical site infections were the underlying cause in 90% of bone flap removal surgeries. The prevalence of both surgical site infections and bone flap resorption was 9%. In summary, young age was found to predict bone flap resorption and smoking predisposed patients to infections requiring bone flap removal. Study II applied computed tomography-based volumetry to evaluate the prevalence of subclinical bone flap resorption and to monitor its progression. In the follow-up, 90% of patients were found to have decreased bone flap volumes indicating varying degrees of resorption. However, the progression of bone flap resorption as a function of follow-up time was non-linear on the cohort level, and thus routine radiological follow-up seems unjustified. Most bone flaps do not appear to resorb enough to require removal even in the long-term follow-up. Study III addressed the unclarity in the definition of bone flap resorption. The computed tomography-based Oulu Resorption Score was developed to standardise the interpretation of radiological bone flap resorption and to guide follow-up interventions. The score values range from 0 to 9 with increasing values implying more severe bone flap resorption. Coupled with radiological evaluation conducted by independent neurosurgeons, an Oulu Resorption Score of ≥5 was defined to be clinically relevant. Further, th, Tiivistelmä Tässä väitöstyössä selvitettiin potilaan omalla kylmäsäilytetyllä luuistutteella tehtyjen kallon luupuutosten ensikertaisten korjausleikkausten tuloksiin vaikuttavia tekijöitä. Erityisesti tarkasteltiin luuistutteen liukenemisen, erään tärkeän, joskin heikosti ymmärretyn komplikaation ennustavia tekijöitä, etenemistä ja määritelmää. Tutkimuksessa I selvitettiin luuistutteen poiston ja liukenemisen yleisyyttä ja näihin vaikuttavia tekijöitä suomalaisessa takautuvassa monikeskusaineistossa. Potilaista 40 %:lle kehittyi komplikaatio. Komplikaatioista puolet johti istutteen poistoon. Luuistutteen liukeneminen ja leikkausalueinfektiot muodostivat 90 % poistoon johtaneista komplikaatioista. Sekä infektioiden että istutteen liukenemisen esiintyvyys oli 9 %. Nuori ikä altisti istutteen liukenemiselle ja tupakointi leikkausalueinfektiolle. Tutkimuksessa II sovellettiin tietokonetomografiaan perustuvaa tilavuusmittausta luuistutteen oireettoman liukenemisen esiintyvyyden ja etenemistaipumuksen selvittämiseksi. Seurannassa 90 %:lla potilaista todettiin alentunut luuistutteen tilavuus viitaten asteeltaan vaihtelevaan istutteen liukenemiseen. Koko tutkimusjoukon tasolla istutteiden liukeneminen ei kuitenkaan edennyt lineaarisesti seuranta-ajan funktiona, joten rutiininomainen seuranta kuvantamistutkimuksin ei vaikuta perustellulta. Suurin osa luuistutteista liukeni niin vähän, ettei uutta leikkausta tarvittu pitkässäkään seurannassa. Tutkimuksessa III käsiteltiin luuistutteen liukenemisen nykyisellään epäselvää määritelmää ja kehitettiin uusi tietokonetomografiaan perustuva pisteytysjärjestelmä (Oulu resorption score) tarkoituksena vakioida radiologisten luuistutteen liukenemislöydösten tulkinta ja ohjata hoitolinjan valintaa. Pisteytysarvot vaihtelevat välillä 0–9. Kasvava arvo kuvaa luuistutteen liukenemisen vaikeusasteen kasvua. Luokitus yhdistettiin riippumattomien neurokirurgien radiologisiin arvioihin, joiden perusteella pistemäärä ≥5 määriteltiin kliinisesti m

Objective: To assess temporal trends in 1-year healthcare costs and outcome of intensive care for traumatic brain injury in Finland. Design: Retrospective observational cohort study. Setting: Multicenter study including four tertiary ICUs. Patients: Three thousand fifty-one adult patients (≥ 18 yr) with significant traumatic brain injury treated in a tertiary ICU during 2003–2013. Intervention: None. Measurements and Main Results: Total 1-year healthcare costs included the index hospitalization costs, rehabilitation unit costs, and social security reimbursements. All costs are reported as 2013 U.S. dollars ($). Outcomes were 1-year mortality and permanent disability. Multivariate regression models, adjusting for case-mix, were used to assess temporal trends in costs and outcome in predefined Glasgow Coma Scale (3–8, 9–12, and 13–15) and age (18–40, 41–64, and ≥65 yr) subgroups. Overall 1-year survival was 76% (n= 2,304), and of 1-year survivors, 37% (n= 850) were permanently disabled. Mean unadjusted 1-year healthcare cost was $39,809 (95% CI, $38,144–$41,473) per patient. Adjusted healthcare costs decreased only in the Glasgow Coma Scale 13–15 and 65 years and older subgroups, due to lower rehabilitation costs. Adjusted 1-year mortality did not change in any subgroup (p < 0.05 for all subgroups). Adjusted risk of permanent disability decreased significantly in all subgroups (p < 0.05). Conclusion: During the last decade, healthcare costs of ICU-admitted traumatic brain injury patients have remained largely the same in Finland. No change in mortality was noted, but the risk for permanent disability decreased significantly. Thus, our results suggest that cost-effectiveness of traumatic brain injury care has improved during the past decade in Finland.

Primary intracerebral hemorrhage (pICH) is a severe, suddenly occurring disease involving high mortality and poor functional outcome. In the absence of curative treatment patient management is mainly supportive with the emphasis on preventing hematoma enlargement and complications. Better understanding of the factors predicting outcome are needed to define effective treatments. An unselected population-based registry study of 982 pICH patients admitted to Oulu University Hospital during the years 1993 to 2008 was conducted The study revealed that concomitant use of warfarin and serotonin-modulating antidepressants at the time of pICH increases the case fatality rate compared to patients with warfarin alone. An elevated C-reactive protein value on admission was an independent predictor of unfavorable outcome after pICH. This association was not explained by pre-existing heart disease, diabetes, severity of the bleeding, or infections. Patients undergoing surgical hematoma evacuation were observed to have improved 3-month survival compared to conservatively treated patients. Improved survival was noticed especially in patients with ≤70 years of age with ≥30ml supratentorial ICHs. Hematoma evacuation did not improve functional outcome. Earlier ischemic stroke was found to be an independent predictor of recurrent pICH. Diabetes seemed to increase and treated hypertension decrease the risk for fatal recurrence. Aspirin or serotonin-modulating antidepressants did not seem to increase the risk of recurrence., Tiivistelmä Primääri aivoverenvuoto (pICH) on vakava, yhtäkkisesti alkava sairaus, johon liittyy korkea kuolleisuus ja vaikea vammautuminen. Parantavan hoidon puuttuessa on hoito lähinnä elintoimintoja tukevaa vuodon laajenemisen ja komplikaatioiden estämistä. Ennusteeseen vaikuttavien tekijöiden parempi tunteminen on ehto tehokkaiden hoitojen löytämiseksi. Väitöskirjatutkimustani varten kerättiin Oulun yliopistollisen sairaalan alueelta vuosien 1993–2008 aikana 982 aivoverenvuotoon sairastuneen potilaan väestöpohjainen aineisto. Tutkimus osoitti, että varfariinin ja selektiivisen serotoniinin takaisinoton estäjän (SSRI) yhteiskäyttö aivoverenvuodon aikana lisäsi kuolevuutta pelkkään varfariiniin nähden. Alkuvaiheen koholla oleva C-reaktiivinen proteiini oli itsenäinen aivoverenvuodon jälkeistä vammautuneisuutta ennustava tekijä. Yhteys ei selittynyt olemassa olevalla sydänsairaudella, diabeteksella, aivoverenvuodon vaikeudella tai infektioilla. Kirurginen aivoverenvuodon poistoleikkaus paransi kolmen kuukauden ennustetta verrattuna potilaisiin ilman leikkausta. Erityisesti leikkaus auttoi alle 70-vuotiaita potilaita, joilla oli yli 30 millilitran kokoinen pinnallisempi vuoto. Leikkaus ei parantanut fyysistä kuntoutumista. Aiempi sairastettu aivoinfarkti oli itsenäinen aivoverenvuodon uusiutumista ennustava tekijä. Diabetes saattaa lisätä ja hoidossa oleva verenpainetauti laskea riskiä tappavaan uusintavuotoon. Aspiriinin tai SSRI:n käyttö eivät lisänneet uusintavuodon riskiä.

Traumatic brain injury can be a catastrophe for an individual and a huge economic burden for a society. Such injuries are common especially among young men and as many as half of the patients are under the influence of alcohol at the time of injury. Traumatic brain injuries can also frequently cause epileptic seizures. On the other hand, epileptic seizures are often caused by alcohol. A significant reduction in the tax on alcohol in Finland in 2004 led to a 10% increase in its consumption at the population level and a considerable increase in mortality rate among patients with alcoholic liver diseases. The risk of subsequent epileptic seizures and traumatic brain injuries among intoxicated head trauma subjects has not been evaluated before. The present cohort consists of all subjects who were admitted to the emergency room at Oulu University Hospital in 1999 on account of head trauma. These subjects were then followed-up for 10 years, which enabled the effect of the tax reduction on the long-term outcome to be observed. The effect of being under the influence of alcohol at the time of the index head trauma on the onset of a new epileptic seizure problem and further traumatic brain injuries was investigated. The mortality rate among head trauma subjects with harmful drinking increased significantly after the reduction in the alcohol tax, and the subjects with recorded alcohol-related seizure problems experienced an increased risk of death after the price reduction. Head trauma under the influence of alcohol predicted both new-onset seizure problems and traumatic brain injury during the follow-up. The results are in accordance with the previous observations of a rapid increase in mortality among heavy drinkers following a sharp reduction in alcohol prices. Inebriated head trauma subjects have an increased risk of subsequent traumatic brain injury and epileptic seizure., Tiivistelmä Traumaattinen aivovamma voi olla potilaalle katastrofi ja yhteiskunnalle valtava taloudellinen tappio. Aivovammat ovat yleisiä erityisesti nuorilla miehillä, ja jopa puolet niistä tapahtuu alkoholin vaikutuksen alaisena. Aivovammat aiheuttavat usein epileptisiä kohtauksia, jotka toisaalta usein johtuvat alkoholista. Vuonna 2004 Suomessa tapahtunut mittava alkoholiveron alennus lisäsi väestötasolla alkoholin kokonaiskulutusta 10 % vuoden aikana. Kuolleisuus erityisesti alkoholimaksasairauksiin lisääntyi voimakkaasti. Aiemmin ei ole tiedetty humalassa ilmaantuneen pään vamman vaikutuksesta potilaan riskiin saada uusi aivovamma tai uusi epileptinen kohtaus. Tutkimuskohortin muodostivat vuonna 1999 Oulun yliopistollisen sairaalan päivystyksessä hoidetut päähän vammautuneet potilaat. Heitä seurattiin rekisteritietojen avulla vuoden 2009 loppuun, minkä ansiosta voitiin tutkia veronalennuksen vaikutusta potilaiden pitkäaikaisennusteeseen. Tutkimuksessa havainnoitiin humalassa tapahtuneen pään vamman vaikutusta epileptisen kohtauksen ja uuden aivovamman ilmaantumiseen seuranta-aikana. Haitallisesti alkoholia käyttävien päähän vammautuneiden potilaiden kuolleisuus lisääntyi merkitsevästi alkoholiveron alennuksen jälkeen. Myös alkoholiin liittyvän epileptisen kouristuksen sairastaneilla kuolleisuus lisääntyi merkitsevästi. Alkoholin vaikutuksen alaisena tapahtunut pään vamma oli riskitekijä uudelle epileptiselle kohtaukselle sekä uudelle aivovammalle seuranta-aikana. Tulokset vahvistavat aiempia havaintoja siitä, että alkoholin hinnan voimakas lasku lisää nopeasti alkoholin suurkuluttajien kuolleisuutta. Humalassa päätään loukanneella on lisääntynyt riski saada uusi aivovamma sekä uusi epileptinen kohtaus.