Investigation of a Possible Iatrogenic Case of Creutzfeldt-Jakob Disease After a Neurosurgical Procedure

2006 ◽  
Vol 27 (12) ◽  
pp. 1352-1357 ◽  
Author(s):  
Natalie Keeler ◽  
Lawrence B. Schonberger ◽  
Ermias D. Belay ◽  
Lynne Sehulster ◽  
George Turabelidze ◽  
...  
Keyword(s):  
African American Woman ◽  
Tertiary Care ◽  
American Woman ◽  
Brain Biopsy ◽  
Vital Statistics ◽  
Neurosurgical Procedures ◽  
Care Hospital ◽  
Case Patient ◽  
Neurosurgical Patients ◽  
Jakob Disease

Objective. To investigate a case of Creutzfeldt-Jakob disease (CJD) possibly acquired from contaminated neurosurgical instruments. Design. Retrospective review of medical records, hospital databases, service log books, and state vital statistics. Setting. A tertiary care hospital (hospital A) in Missouri. Patients. The case patient was a 38-year-old African American woman with a 9-month history of progressive memory loss, visual disturbances, and dementia. She underwent neurosurgery in November 1996. CJD was confirmed in April 2004 by immunodiagnostic testing of brain biopsy samples. All patients who underwent neurosurgery at the same hospital within 6 months before or after the case patient's procedure were identified and investigated for preoperative or postoperative evidence of CJD. Results. We reviewed data on 268 neurosurgical procedures, 84 pathology log entries, and 60 death certificates for neurosurgical patients at hospital A and identified 2 suspected cases of CJD. Clinical features and definitive prion testing of stored brain biopsy samples excluded a diagnosis of CJD. Standard operating room procedures were in place, but specific protocols for handling instruments potentially contaminated with prions were not used. Conclusions. Neurosurgical instruments were not implicated as the source exposure for CJD in the case patient. The 2 patients with suspected CJD were identified from different data sources, suggesting good internal consistency in data collection. The key elements of this investigation are suggested for use in future investigations into potential cases of iatrogenic CJD.

Sporadic Creutzfeldt-Jakob Disease: Diagnosing Typical and Atypical Presentations under Limited Circumstances

2021 ◽  
pp. 1-7
Author(s):  
Shazma Khan ◽  
Sara Khan
Keyword(s):  
Developing Countries ◽  
Brain Mri ◽  
Tertiary Care ◽  
Rapid Onset ◽  
Spongiform Encephalopathy ◽  
Care Hospital ◽  
Jakob Disease ◽  
The Central Nervous System ◽  
Missed Diagnosis ◽  
Atypical Presentations

<b><i>Introduction:</i></b> Sporadic Creutzfeldt-Jakob disease (sCJD) is a transmissible disorder of the central nervous system caused by the transformation of normal prion protein into an abnormal misfolded form. The process begins spontaneously and runs a vicious cycle to cause spongiform encephalopathy, rapidly resulting in death. Amply described in the western literature, CJD is scarcely reported in Asia due to certain limitations including missed diagnosis, under-reporting, and rarity of the disease. Brain MRI, electroencephalogram, cerebrospinal fluid testing, and biopsy of the infected brain tissue support the diagnosis in cases of clinical suspicion. However, the diagnosis can still be made with limited available resources in developing countries. <b><i>Method:</i></b> A review of CJD cases evaluated in the neurology department of a tertiary care hospital in Pakistan was done from 2002 to 2018. <b><i>Results:</i></b> Eleven cases labeled as sCJD are identified based on the European MRI-CJD consortium criteria. This is the first study on CJD from Pakistan, which includes both the typical and atypical presentations. <b><i>Conclusion:</i></b> Even with limited testing available, the diagnosis of CJD can be made with confidence in the developing countries, provided the suspicion is kept high in cases of rapid onset dementia and acute behavioral changes.

scholarly journals Duration of In-hospital Stay for Elective Neurosurgical Procedures in a Tertiary Care Hospital

Cureus ◽  
2021 ◽  
Author(s):  
Bilal Khan ◽  
Usman Haqqani ◽  
Sajjad Ullah ◽  
Saima Hamayun ◽  
Zohra Bibi ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Neurosurgical Procedures ◽  
Care Hospital

Using the Transtheoretical Model of Change to Improve Lifestyle Behaviors in a Woman With Metabolic Syndrome

2016 ◽  
Vol 9 (1) ◽  
pp. 81-87
Author(s):  
Kimberly M. Davis ◽  
Patricia T. Alpert ◽  
Marcia Clevesy
Keyword(s):  
Metabolic Syndrome ◽  
Stages Of Change ◽  
Transtheoretical Model ◽  
African American Woman ◽  
Change Theory ◽  
American Woman ◽  
Lifestyle Behaviors ◽  
Lifestyle Modifications ◽  
Case Patient

Purpose: To provide information on how the stages of change theory can be initiated using a case study of a 64-year-old African American woman with metabolic syndrome. A questionnaire on lifestyle modifications operationalizes the stages of change theory and the case patient illustrates the process of change using this questionnaire. Data Source: An exhaustive literature review was conducted on the stages of change theory. The questionnaire used in the clinical setting presented as part of this case study encapsulates the stages of change theory after being modified from a similar tool used by the Ohio Department of Health Fresh Start Program. Conclusion: Using an objective tool to assess progress made by this case patient demonstrates the value of being able to monitor lifestyle modifications for patients with chronic diseases. Significance for Practice: This questionnaire provides a means to assess change over time and can help both patient and provider identify outcomes of treatment.

The diagnostic utility of brain biopsy procedures in patients with rapidly deteriorating neurological conditions or dementia

2007 ◽  
Vol 106 (1) ◽  
pp. 72-75 ◽  
Author(s):  
S. Andrew Josephson ◽  
Alexander M. Papanastassiou ◽  
Mitchel S. Berger ◽  
Nicholas M. Barbaro ◽  
Michael W. McDermott ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Brain Biopsy ◽  
B Cell Lymphoma ◽  
Clinical Syndrome ◽  
Biopsy Specimens ◽  
Jakob Disease ◽  
Tertiary Care Institution ◽  
Neurological Conditions

Object Obtaining brain biopsy specimens is often the diagnostic test of last resort for patients with unexplained neurological conditions, particularly those with a rapidly deteriorating neurological course. The goals of this analysis were to determine the diagnostic sensitivity of brain biopsy specimens in these types of patients and retrospectively identify features of these disorders that may have enabled an earlier diagnosis, which may prevent the need for diagnostic brain biopsy procedures in the future. Methods The authors reviewed the case records of all brain biopsy procedures that had been performed at a single tertiary care institution between January 1993 and April 2002 in 171 patients. Patients with HIV or nonlymphomatous brain tumors were excluded from this analysis because the utility of brain biopsy specimens for these conditions has been determined from previous studies. A subgroup analysis of this cohort was performed in the 64 patients who had comprehensive medical records and a clinical syndrome involving a progressively deteriorating neurological condition of less than 1 year in duration. The overall sensitivity of brain biopsy procedures for diagnostic purposes in the cohort was 65% (111 of 171 patients). The two most common diagnoses in the subgroup with rapidly deteriorating neurological conditions were primary central nervous system (CNS) B-cell lymphoma in 20.3% (13 patients) and Creutzfeldt–Jakob disease in 15.6% (10 patients), followed by viral encephalitis in 14.1% (nine patients) and CNS vasculitis in 9.4% (six patients). Clinical symptoms and laboratory data were compared among the diagnostic groups. Conclusions These results will help guide the evaluation of patients with neurological conditions that are difficult to diagnose and will provide a foundation for further prospective studies.

scholarly journals Spectrum of Diseases among Neurosurgical Patients in a Tertiary Care Hospital of Nepal: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (234) ◽  
Author(s):  
Harihar Devkota ◽  
Nilam Kumar Khadka ◽  
Poojan Kumar Rokaya ◽  
Pravin Kumar Giri
Keyword(s):  
Care Center ◽  
Skull Fracture ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Fracture Dislocation ◽  
Common Disease ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Neurosurgical Patients

Introduction: The number of neurosurgical cases, especially traumatic injuries, are increasing in remote settings. This study aims to determine neurosurgical cases in a tertiary care center teaching hospital situated in a remote area of Nepal. Methods: It was a descriptive cross-sectional study among 138 neurosurgical patients at Karnali Academy of Health Sciences from 2019 August to 2020 July. A convenient sampling technique was used. The demographic data, the diagnosis, and management offered were recorded, reviewed, and analyzed using Statistical Package for Social Sciences version 16 and Microsoft Excel. Results: Out of 138 cases, trauma was the main finding in 102 (73.91%) cases, and fall injury was the most frequent mechanism of injury in 64 (46.38%) cases. Traumatic Brain Injury was the most common disease in 85 (61.6%) cases followed by Prolapsed Intervertebral Disc in 11 (8%), Spine fracture/dislocation in 11 (8%), stroke in 7 (5.1%), spondylosis in 6 (4.3%) and so on. Among the Traumatic Brain Injuries, normal findings were noted in 28 (20.3%) cases, Extra Dural Hemorrhage in 12 (8.7%), contusion 11 (8%), and skull base fracture in 7 (5.1%). With a mean age of 29.8 years, a maximum number of the cases were 30 (21.74%) from the age group 31-40. Conclusions: Trauma was seen in a majority of neurosurgical cases. Hematoma, Depressed skull fracture, and spinal fractures were the main findings of neurosurgical cases. The burden of neurosurgical cases in this part of the world is quite high, so necessary step should be taken to increase such services.

scholarly journals Cost and usage patterns of antibiotics in a tertiary care neurosurgical unit

2012 ◽  
Vol 01 (01) ◽  
pp. 041-047
Author(s):  
Ashish Suri ◽  
Sarat Chandra ◽  
Shashank Kale ◽  
Arti Kapil ◽  
Bhawani Sharma ◽  
...  
Keyword(s):  
Body Fluid ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Internal Controls ◽  
Neurosurgical Procedures ◽  
Infection Rates ◽  
Neurosurgical Patients ◽  
Usage Patterns ◽  
Cost Effectiveness Study

Abstract The routine use of prophylactic antibiotics in neurosurgery has been shown to significantly reduce surgical site infection rates. The documentation of non-surgical site, nosocomial infections in neurosurgical patients remains limited, despite this being a stimulus for prolific antibiotic usage. The actual quantum of antibiotic use in neurosurgery and its role in infection control remain both undocumented and controversial. The authors address this issue with a cost-effectiveness study using historical controls. Bacteriologically positive body fluid samples were used to quantify infection rates in the year 2006 and compared with those in the year 1997. Itemized drug lists obtained from dedicated neurosurgical intensive care units and wards were used to quantify antibiotic usage and calculate their costs. Results were compared using both historical and internal controls. The monetary conversion factor used was INR 40=US$1. A total of 3114 consecutive elective and emergency neurosurgical procedures were performed during the study period. 329 patients (10.6%) were recorded to have bacteriologically positive body fluid samples, and 100,250 units of antibiotics were consumed costing Rs. 14,378,227.5 ($359,455.7). On an average, an operated patient received 32.2 units of antibiotics valued at Rs. 4,617 ($115.4). The crude infection rates were recorded to have reduced significantly in comparison to 1997, but did not differ between mirror intra-departmental units with significantly different antibiotic usage. Antibiotics accounted for 31% of the per capita cost of consumables for performing a craniotomy in the year 2006. This estimate should be factored into projecting future package costs.

Frequency and Outcomes of Hyperlactatemia After Neurosurgery

ICU Director ◽  
2011 ◽  
Vol 2 (6) ◽  
pp. 211-214 ◽  
Author(s):  
Roopa Kohli-Seth ◽  
Satyanarayana Reddy Mukkera ◽  
Andrew B. Leibowitz ◽  
Nimish Nemani ◽  
John M. Oropello ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Vascular Surgery ◽  
Spinal Surgery ◽  
Lactate Level ◽  
Tertiary Care ◽  
Elevated Serum ◽  
Serum Lactate ◽  
Care Hospital ◽  
Neurosurgical Patients ◽  
The Brain

Objectives. The aim of this study was to evaluate the incidence and significance of elevated serum lactate and its impact on outcome in postoperative neurosurgical patients admitted to neurosurgical intensive care unit (NSICU). Design. This study’s design is a retrospective analysis in a 13-bed NSICU in a tertiary care hospital. A total of 673 patients were screened and 328 patients were included in the study. Methods. Patients were divided into neurosurgery versus nonneurosurgical admissions. Neurosurgical patients were further grouped as brain surgery, spinal surgery, or intracranial vascular surgery. Reason for admission, length of stay, serum lactate levels, and survival were analyzed. Results. The incidence of hyperlactatemia (lactate level ≥2.0 mmol/L) ranged from 67% in the brain tumor group to 33% in the nonneurosurgery group. Mean serum lactates were significantly higher in the brain tumor (3.17 ± 1.99) and spinal surgery groups (2.79 ± 1.51) than in the nonneurosurgery group (1.86 ± 1.10), P < .05, but not in the intracranial vascular surgery group (2.28 ± 1.71), P > .05. The serum lactate level was not significantly associated with survival. Conclusion. Postoperative hyperlactatemia occurs frequently in neurosurgery patients but appears benign.

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