Publications
183 results found
Brennan PM, Kolias AG, Joannides AJ, et al., 2016, The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom, Journal of Neurosurgery, ISSN: 1933-0693
De Simoni S, Grover PJ, Jenkins PO, et al., 2016, Disconnection between the default mode network and medial temporal lobes in post-traumatic amnesia, Brain, Vol: 139, Pages: 3137-3150, ISSN: 0006-8950
Post-traumatic amnesia is very common immediately after traumatic brain injury. It is characterised by a confused, agitated state and a pronounced inability to encode new memories and sustain attention. Clinically, post-traumatic amnesia is an important predictor of functional outcome. However, despite its prevalence and functional importance, the pathophysiology of post-traumatic amnesia is not understood. Memory processing relies on limbic structures such as the hippocampus, parahippocampus and parts of the cingulate cortex. These structures are connected within an intrinsic connectivity network, the Default Mode Network. Interactions within the Default Mode Network can be assessed using resting state functional magnetic resonance imaging, which can be acquired in confused patients unable to perform tasks in the scanner. Here we used this approach to test the hypothesis that the mnemonic symptoms of post-traumatic amnesia are caused by functional disconnection within the Default Mode Network. We assessed whether the hippocampus and parahippocampus showed evidence of transient disconnection from cortical brain regions involved in memory processing. 19 traumatic brain injury patients were classified into post-traumatic amnesia and traumatic brain injury control groups, based on their performance on a paired associates learning task. Cognitive function was also assessed with a detailed neuropsychological test battery. Functional interactions between brain regions were investigated using resting-state functional magnetic resonance imaging. Together with impairments in associative memory patients in post-traumatic amnesia demonstrated impairments in information processing speed and spatial working memory. Patients in post-traumatic amnesia showed abnormal functional connectivity between the parahippocampal gyrus and posterior cingulate cortex. The strength of this functional connection correlated with both associative memory and information processing speed and normal
Quah BL, Low HL, Wilson MH, et al., 2016, Is There An Optimal Time for Performing Cranioplasties? Results from a Prospective Multinational Study, WORLD NEUROSURGERY, Vol: 94, Pages: 13-17, ISSN: 1878-8750
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- Citations: 27
Hutchinson PJ, Kolias AG, Timofeev IS, et al., 2016, Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 375, Pages: 1119-1130, ISSN: 0028-4793
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- Citations: 609
Wilson MH, 2016, Monro-Kellie 2.0: The dynamic vascular and venous pathophysiological components of intracranial pressure, Journal of Cerebral Blood Flow & Metabolism, Vol: 36, Pages: 1338-1350, ISSN: 0271-678X
For 200 years, the ‘closed box’ analogy of intracranial pressure (ICP) has underpinned neurosurgery and neuro-critical care. Cushing conceptualised the Monro-Kellie doctrine stating that a change in blood, brain or CSF volume resulted in reciprocal changes in one or both of the other two. When not possible, attempts to increase a volume further increase ICP. On this doctrine’s “truth or relative untruth” depends many of the critical procedures in the surgery of the central nervous system. However, each volume component may not deserve the equal weighting this static concept implies. The slow production of CSF (0.35 ml/min) is dwarfed by the dynamic blood in and outflow (∼700 ml/min). Neuro-critical care practice focusing on arterial and ICP regulation has been questioned. Failure of venous efferent flow to precisely match arterial afferent flow will yield immediate and dramatic changes in intracranial blood volume and pressure. Interpreting ICP without interrogating its core drivers may be misleading. Multiple clinical conditions and the cerebral effects of altitude and microgravity relate to imbalances in this dynamic rather than ICP per se. This article reviews the Monro-Kellie doctrine, categorises venous outflow limitation conditions, relates physiological mechanisms to clinical conditions and suggests specific management options.
Chaudery M, Clark J, Morrison JJ, et al., 2016, Can contrast-enhanced ultrasonography improve Zone III REBOA placement for prehospital care?, Journal of Trauma and Acute Care Surgery, Vol: 80, Pages: 89-94, ISSN: 2163-0755
BACKGROUND: Torso hemorrhage is the primary cause of potentially preventable mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been advocated as an adjunct to bridge patients to definitive hemorrhage control. The primary aim of this study was to assess whether contrast-enhanced ultrasonography can improve the accuracy of REBOA placement in the infrarenal aorta (Zone III).METHODS: A fluoroscopy-free “enhanced” Zone III REBOA technique was developed using a porcine cadaver model. A “standard” over-the-wire Seldinger technique was used, which was enhanced with the addition of a microbubble contrast medium to inflate the balloon, observed with ultrasonography. Following this, attending- and resident-level physicians were randomized into two groups. They were taught either the enhanced with ultrasonography guidance (Group A) or the standard measuring length of catheter insertion (Group B) technique as part of a human cadaver trauma skills course. Outcomes assessed included time (seconds) from insertion to inflation, accuracy, and missed targets. All results were benchmarked against three endovascular experts.RESULTS: There were 20 participants who performed REBOA with Group A (51 [31]) being significantly faster than Group B (90 [63]) (p = 0.003) and more accurate (p = 0.023) with no missed targets. Group B had five missed targets, the most common error being inflation within Zone II.CONCLUSION: For Zone III REBOA, contrast-enhanced ultrasonography technique is faster and more accurate than the standard technique. This may have value in time-critical and austere environments. Clinical studies are now required to evaluate this approach further.
Wilson MH, Imray CHE, 2016, The cerebral venous system and hypoxia, JOURNAL OF APPLIED PHYSIOLOGY, Vol: 120, Pages: 244-250, ISSN: 8750-7587
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- Citations: 11
Garara B, Wood A, Marcus HJ, et al., 2016, INTRAMUSCULAR DIAPHRAGMATIC STIMULATION FOR PATIENTS WITH TRAUMATIC HIGH CERVICAL INJURIES AND VENTILATOR DEPENDENT RESPIRATORY FAILURE: A SYSTEMATIC REVIEW OF SAFETY AND EFFECTIVENESS, Injury, Vol: 47, Pages: 539-544, ISSN: 0020-1383
BackgroundIntramuscular diaphragmatic stimulation using an abdominal laparoscopic approach has been proposed as a safer alternative to traditional phrenic nerve stimulation. It has also been suggested that early implementation of diaphragmatic pacing may prevent diaphragm atrophy and lead to earlier ventilator independence. The aim of this study was therefore to systematically review the safety and effectiveness of intramuscular diaphragmatic stimulators in the treatment of patients with traumatic high cervical injuries resulting in long-term ventilator dependence, with particular emphasis on the affect of timing of insertion of such stimulators.MethodsThe Cochrane database and PubMed were searched between January 2000 and June 2015. Reference lists of selected papers were also reviewed. The inclusion criteria used to select from the pool of eligible studies were: (1) reported on adult patients with traumatic high cervical injury, who were ventilator-dependant, (2) patients underwent intramuscular diaphragmatic stimulation, and (3) commented on safety and/or effectiveness.Results12 articles were included in the review. Reported safety issues post insertion of intramuscular electrodes included pneumothorax, infection, and interaction with pre-existing cardiac pacemaker. Only one procedural failure was reported. The percentage of patients reported as independent of ventilatory support post procedure ranged between 40% and 72.2%. The mean delay of insertion ranged from 40 days to 9.7 years; of note the study with the average shortest delay in insertion reported the greatest percentage of fully weaned patients.ConclusionsAlthough evidence for intramuscular diaphragmatic stimulation in patients with high cervical injuries and ventilator dependent respiratory failure is currently limited, the technique appears to be safe and effective. Earlier implantation of such devices does not appear to be associated with greater surgical risk, and may be more effective. Further high
Sagoo RS, Hutchinson CE, Wright A, et al., 2016, Magnetic Resonance investigation into the mechanisms involved in the development of high-altitude cerebral edema, Journal of Cerebral Blood Flow & Metabolism, Vol: 37, Pages: 319-331, ISSN: 0271-678X
Rapid ascent to high altitude commonly results in acute mountain sickness, and on occasion potentially fatal high-altitudecerebral edema. The exact pathophysiological mechanisms behind these syndromes remain to be determined. We report astudy in which 12 subjects were exposed to a FiO2¼ 0.12 for 22 h and underwent serial magnetic resonance imaging sequencesto enable measurement of middle cerebral artery velocity, flow and diameter, and brain parenchymal, cerebrospinal fluid andcerebral venous volumes. Ten subjects completed 22 h and most developed symptoms of acute mountain sickness (mean LakeLouise Score 5.4; p< 0.001 vs. baseline). Cerebral oxygen delivery was maintained by an increase in middle cerebral arteryvelocity and diameter (first 6 h). There appeared to be venocompression at the level of the small, deep cerebral veins (116 cm3at 2 h to 97 cm3 at 22 h; p< 0.05). Brain white matter volume increased over the 22-h period (574 ml to 587 ml; p < 0.001) andcorrelated with cumulative Lake Louise scores at 22 h (p< 0.05).We conclude that cerebral oxygen delivery was maintained byincreased arterial inflow and this preceded the development of cerebral edema. Venous outflow restriction appeared to play acontributory role in the formation of cerebral edema, a novel feature that has not been observed previously
Soon WC, Marcus HJ, Wilson MH, 2016, Traumatic acute extradural haematoma – Indications for surgery revisited, British Journal of Neurosurgery, ISSN: 1360-046X
Imray CHE, Grocott MPW, Wilson MH, et al., 2016, Extreme, expedition, and wilderness medicine, The Lancet, Vol: 386, Pages: 2520-2525
Wilson MH, Habig K, Wright C, et al., 2016, Pre-hospital emergency medicine, The Lancet, Vol: 386, Pages: 2526-2534
Grocott MPW, Levett DZH, Martin DS, et al., 2016, Caudwell Xtreme Everest: An Overview, HYPOXIA: TRANSLATION IN PROGRESS, Editors: Roach, Wagner, Hackett, Publisher: SPRINGER, Pages: 427-437, ISBN: 978-1-4899-7676-5
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- Citations: 1
Wilson MH, Hinds J, Grier G, et al., 2016, Impact Brain Apnoea–a forgotten cause of cardiovascular collapse in trauma, Resuscitation
Marcus HJ, Wilson MH, 2015, Insertion of an Intracranial-Pressure Monitor, New England Journal of Medicine, Vol: 373, ISSN: 1533-4406
Maas AIR, Menon DK, Steyerberg EW, et al., 2015, Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study., Neurosurgery, Vol: 76, Pages: 67-80
BACKGROUND: Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. OBJECTIVE: To improve characterization and classification of TBI and to identify best clinical care, using comparative effectiveness research approaches. METHODS: This multicenter, longitudinal, prospective, observational study in 22 countries across Europe and Israel will collect detailed data from 5400 consenting patients, presenting within 24 hours of injury, with a clinical diagnosis of TBI and an indication for computed tomography. Broader registry-level data collection in approximately 20,000 patients will assess generalizability. Cross sectional comprehensive outcome assessments, including quality of life and neuropsychological testing, will be performed at 6 months. Longitudinal assessments will continue up to 24 months post TBI in patient subsets. Advanced neuroimaging and genomic and biomarker data will be used to improve characterization, and analyses will include neuroinformatics approaches to address variations in process and clinical care. Results will be integrated with living systematic reviews in a process of knowledge transfer. The study initiation was from October to December 2014, and the recruitment period was for 18 to 24 months. EXPECTED OUTCOMES: Collaborative European NeuroTrauma Effectiveness Research in TBI should provide novel multidimensional approaches to TBI characterization and classification, evidence to support treatment recommendations, and benchmarks for quality of care. Data and sample repositories will ensure opportunities for legacy research. DISCUSSION: Comparative effectiveness research provides an alternative to reductionistic clinical trials in restricted patient populations by exploiting differences in biology, care, and outcome to support
Chaudery M, Clark J, ap Dafydd D, et al., 2015, The Face, Content, and Construct Validity Assessment of a Focused Assessment in Sonography for Trauma Simulator, Journal of surgical education
Seemungal BM, Arshad Q, Paine H, et al., 2015, What is post-concussion dizziness? Expert neuro-otological assessment in acute Traumatic Brain Injury (TBI), Pages: 52-52
Soon WC, Marcus H, Wilson M, 2015, Traumatic acute extradural haematoma–Indications for surgery revisited, British journal of neurosurgery, Pages: 1-2
Sanborn MR, Edsell ME, Kim MN, et al., 2015, Cerebral Hemodynamics at Altitude: Effects of Hyperventilation and Acclimatization on Cerebral Blood Flow and Oxygenation, Wilderness & environmental medicine
Wilson MH, 2015, The Brain at Altitude-Rewriting the pathogenesis of High Altitude Headache and its translation into trauma care-results of the Caudwell Xtreme Everest Expedition, Pages: A1541-A1542
Murahari S, Hendrickson S, Monzon L, et al., 2015, Venous Sinus Thrombosis with occipital skull fractures-2 years experience at a London Major Trauma Centre, Pages: A1558-A1558
Wilson MH, Imray CHE, 2015, The Cerebral Venous System and Hypoxia, Journal of Applied Physiology, Pages: jap-00327
Forbes AE, Schutzer-Weissmann JM, Wordsworth M, et al., 2015, Profile of cyclists with head injury admitted to a London Major Trauma Centre, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol: 23, Pages: A12-A12
Forbes AE, Schutzer-Weissmann JM, Wang A, et al., 2015, Characteristic of intoxicated cyclists compared to sober cyclists admitted to a London Major Trauma Centre, Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol: 23, Pages: O4-O4
Bimpis A, Marcus HJ, Wilson MH, 2015, Traumatic bifrontal extradural haematoma resulting from superior sagittal sinus injury: case report, JRSM open, Vol: 6
Chaudery M, Clark J, Wilson MH, et al., 2015, Traumatic intra-abdominal hemorrhage control: Has current technology tipped the balance toward a role for prehospital intervention?, Journal of Trauma and Acute Care Surgery, Vol: 78, Pages: 153-163
Hendrickson S, Chacko L, Wilson MH, 2015, Raised intracranial pressure following abdominal closure in a polytrauma patient, JRSM Open, Vol: 6, Pages: 2054270414565958-2054270414565958
Scotter J, Hendrickson S, Marcus HJ, et al., 2014, Prognosis of patients with bilateral fixed dilated pupils secondary to traumatic extradural or subdural haematoma who undergo surgery: a systematic review and meta-analysis, Emergency Medicine Journal, ISSN: 1472-0213
Scotter J, Iorga R, Stefanou D, et al., 2014, Management of malignant middle cerebral artery infarction following a cardiac stab wound - the role of early decompressive craniectomy, BRITISH JOURNAL OF NEUROSURGERY, Vol: 28, Pages: 534-535, ISSN: 0268-8697
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- Citations: 2
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