Mild traumatic brain injury

English abstrac

D-dimer as an independent predictor for poor outcome after aneurysmal subarachnoid hemorrhage

Peer reviewe

Spontaneous Spinal Extradural Hematoma : A Rare Neurosurgical Emergency Reply

Non peer reviewe

Spontaneous Spinal Epidural Hematoma : A Surgical Case Series of Ten Patients

BACKGROUND: Spontaneous spinal epidural hematoma (SS-EDH) is a rare neurosurgical emergency. Little is known about predictive factors of outcome in patients with SS-EDH. Here, we present a case series of patients operated on for an SS-EDH. METHODS: We reviewed all cases of patients operated on for an SS-EDH between January 2009 and February 2016 in a large academic neurosurgical center. We recorded preadmission functional status, bleeding characteristics, and postsurgery outcome. Good outcome was defined, according to the Nurick score, as at least being able to walk in a way that did not prevent employment. Mean follow-up time was 19 months (standard deviation, 25 months). RESULTS: Ten patients, with a mean age of 70 years (standard deviation, 10), with SS-EDH were included. The location of SS-EDH was binomially distributed, with the highest frequencies in the upper thoracic region (Th3-5) and middle to low cervical region (C4-6). Five patients had a poor outcome. Of these, 3 remained chair bound or bedridden. No statistically significant association could be found between preoperative characteristics and outcome, but patients with poor preoperative motor function, thoracic hematoma, and more than 4 involved segments had a high rate of poor neurologic outcome. We could not establish any association between time delay from symptom onset to surgery and outcome. CONCLUSIONS: In our series, half of the patients with SS-EDH recovered well after surgery. Although no statistically significant association could be established, hematoma location, size, and preoperative motor function seem to be some of the most important predictive factors of postoperative recovery.Peer reviewe

”Jos ihminen ei oo tinderis, nii sit se on varmaan varattu” : Tinder-sovellus ihmissuhteen välissä ja välittäjänä

Tässä pro gradu -tutkielmassa tarkastelen Tinderiä ja sitä, miten sen käyttäjät kokevat sovelluksen käytön ja kommunikoinnin sovelluksessa heidän etsiessään satunnaista seuraa, parisuhdetta tai muuta suhdetta. Näin pyrin pääsemään kiinni siihen, millaisena välittäjänä sovellus näyttäytyy käyttäjien kokemusten perusteella. Aiemmissa deittisovelluksiin ja Tinderiin liittyvissä tutkimuksissa on keskitytty tarkastelemaan sovellusten käyttöä ja sitä, ketkä sovelluksia käyttävät. Lisäksi tutkimuksissa on pyritty selvittämään motiiveja Tinderin käytölle ja sovelluksen tarjoamia hyötyjä ja haittoja käyttäjilleen. Sen sijaan tutkimuksissa on kiinnitetty vähemmän huomiota itse Tinder-sovellukseen ihmissuhteiden välissä olevana välittäjänä. Tutkielmani tavoitteena onkin yrittää ymmärtää, millaisia ulottuvuuksia Tinderillä on välittäjänä ihmissuhteen muodostumisprosessissa. Lisäksi haluan vahvistaa sovellusta koskevaa tutkimusta suomalaisessa kontekstissa. Sovelluksen välityksen nostaminen tutkimuksen keskiöön on yhteiskunnallisestikin tärkeää, sillä Tinderin kaltainen – jo lähes itsestään selvänä pidetty – sovellus muokkaa pinnan alla ihmisten tapoja, normeja ja käyttäytymistä. Tutkielmani laadullinen aineisto koostuu sovelluksen entisten ja nykyisten käyttäjien haastatteluista, jotka toteutettiin keväällä 2022. Haastattelin tutkimukseeni yhdeksäätoista henkilöä, joista haastatteluhetkellä oli Tinderissä aktiivisena kymmenen. Katson, että haastateltavien kokemukset kertovat teknologian ja ihmisen välisestä vuorovaikutuksesta. Pyrin Tinderin käyttäjien kokemusten kautta tunnistamaan, millaista välittyneisyyttä sovellus tuottaa ja miten välitys vaikuttaa käyttäjiin. Tutkielmani kiinnittyy osaksi relationaalisen sosiologian kenttää. Lähestyn Tinderiä tutkimuksessani ei-inhimillisenä toimijana, joka välittäjänä voi vaikuttaa aktiivisesti sosiaalisissa suhteissa. Aineistoni analyysin olen toteuttanut teoriaohjaavalla sisällönanalyysilla, ja teoreettisena viitekehyksenä minulla on toiminut erityisesti Michel Serresin teoria neutraalista välityksestä (enkelit) ja välitykseen liittyvistä häiriötekijöistä (parasiitit). Aineistostani nousee esiin, että Tinder onnistuu neutraalina välittäjänä luomaan mahdollisuuksia ihmissuhteiden muodostamiselle. Sovelluksen koettiin luovan sellaisia mahdollisuuksia, joita käyttäjille ei välttämättä muutoin tarjoutuisi. Samalla sovelluksen positiiviseksi puoleksi koettiin se, että Tinder muodostaa sosiaaliset raamit potentiaalisen partnerin etsimiselle. Sovelluksen käyttäjät voivat siis olettaa muidenkin käyttäjien etsivän mahdollista ihmissuhdetta – oli se sitten seksuaalinen, romanttinen tai jotain muuta. Samankaltaisia huomioita on tehty myös aiemmissa tutkimuksissa. Toisaalta haastateltavien kokemuksista nousi esiin monia ulottuvuuksia, jotka häiritsevät sovelluksen käyttöä. Haastattelemani henkilöt toivat esiin esimerkiksi sen, että sovelluksen käyttö voi aiheuttaa käyttäjälleen stressiä tai pahaa oloa. Moni haastateltavista kertoi sovelluksella olevan addiktoivia vaikutuksia. Myös näiden huomioiden osalta samankaltaisia havaintoja on tehty aiemmissa tutkimuksissa. Lisäksi osa haastateltavista toi esiin, että sovellus on vaikuttanut negatiivisella tavalla heidän suhtautumiseensa muihin ihmisiin. Tämä huomio tukee aiempaa tutkimusta, jossa käyttäjien on havaittu tekevän stereotyyppisiä yleistyksiä muista sovelluksessa olevista ihmisistä. Sovelluksen tarjoama välitys vaikuttaisi olevan myös täynnä erilaisia teknisiä häiriöitä, parasiitteja, jotka tulevat sotkemaan käyttäjiensä toimintaa heidän yrittäessään muodostaa ihmissuhdetta sovelluksen avulla. Aineistoni perusteella näyttää myös siltä, että Tinder muokkaa käyttäjiensä toimintaa niin sisällä sovelluksessa kuin sovelluksen ulkopuolisessa maailmassakin. Uuden näkökulman aiempaan tutkimukseen verrattuna tarjoaa lisäksi havainto, että osa sovelluksen käyttäjistä kokee sovelluksen toimivan itsetuntemuksen välineenä. Käyttäjät kokivat, että sovelluksen välityksellä heidän oli mahdollista tutustua paitsi toisiin ihmisiin myös itseensä

Spontaneous angiogram-negative subarachnoid hemorrhage : a retrospective single center cohort study

Background Spontaneous angiogram-negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications, and outcome of patients with angiogram-negative SAH. Methods We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004-2018 due to spontaneous angiogram-negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale (GOS) at 3 months. We assessed factors that associated with outcome using multivariable logistic regression analysis. Results Of the 108 patients included, 84% had a favorable outcome (GOS 4-5), and mortality was 5% within 1 year. The median age was 58 years, 51% were female, and 93% had a low-grade SAH (World Federation of Neurosurgical Societies grading I-III). The median number of angiograms performed per patient was two. Thirty percent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio = 4.05, 95% confidence interval = 1.05-15.73). Two patients had a new bleeding episode. Conclusion SAH-related complications such as hydrocephalus and vasospasm are common after angiogram-negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. The high rate of SAH-related complications highlights the need for neurosurgical care in these patients.Peer reviewe

Anterior cervical discectomy and fusion in young adults leads to favorable outcome in long-term follow-up

Background Context Anterior cervical discectomy and fusion (ACDF) procedures is thought to lead to accelerated degeneration of the adjacent cervical discs and in some cases can be symptomatic (adjacent segment disease, or ASD). The occurrence of ASD is of particular interest when treating young individuals, as the cumulative disease burden may become increasingly significant during their expectedly long lifetime. However, the overall impact of a surgical intervention on the lifetime prognosis of ASD remains unclear. Purpose Our goal was to study the long-term outcomes of ACDF surgery among those members of the young adult population who have been operated on between the ages of 18 and 40. Study design Retrospective study. Patient Sample All patients between 18 and 40 years of age at the time of surgery who underwent ACDF due to degenerative cervical disorders at Helsinki University Hospital between the years of 1990 and 2005 (476 patients). Outcome Measures Cervical reoperation rate, satisfaction with the surgery, employment status, Neck Disability Index (NDI) Methods We retrospectively analyzed the medical records of all patients between 18 and 40 years of age at the time of surgery who underwent ACDF due to degenerative cervical disorders at Helsinki University Hospital between the years of 1990 and 2005. We sent questionnaires to all available patients at the end of the follow-up (median 17.5 years) to assess their current neck symptoms, general situations, and levels of satisfaction with the surgery. Furthermore, we compared the results for different types of ACDF surgeries (i.e., discectomy only versus synthetic cage or bone autograft implantation for fusion) in propensity-score-matched groups. Results Of the 476 patients who were included in the study, surgery was performed in 72% of the cases due to intervertebral disc herniation and in 28% due to spondylotic changes. The total reoperation rate during the entire follow-up (median 17.5 years) was 24%, and 19.5% if early reoperations (Peer reviewe

Favorable long-term outcome in young adults undergoing surgery for lumbar disc herniation

Purpose The purpose of the study was to evaluate the long-term outcome after surgery for lumbar disc herniation in a young adult population. Methods A total of 526 consecutive patients between 18 and 40 years of age who underwent surgery for lumbar disc between 1990 and 2005 were included in the study. The primary outcomes were the need for new lumbar spine surgery during the follow-up and secondary outcomes were short-term subjective outcome, the Oswestry Disability Index (ODI) score, and the ability to carry out employment at the end of the long-term follow-up. Results A total of 96% of the patients had a reduction in their symptoms at the clinical follow-up (median of 50 days postsurgery). Twenty-one patients (4.0%) had a reoperation within 28 days. Excluding these early reoperations, 136 patients (26%) had additional lumbar spine surgery and 18 patients (3.4%) underwent lumbar fusion during the follow-up of median 18 years. The annual risk for new surgery was 1.4%. In total, 316 patients (60%) returned the ODI questionnaire, and their mean score was 8.1. Patients with a higher number of additional lumbar spine surgeries (p < 0.001) reported deteriorating ODI scores. Conclusion Patients showed excellent short-term recovery from their symptoms. In the long term, the mean ODI score for the patients was comparable to the normative population. However, a notable proportion of the patients required additional lumbar surgery during the follow-up period, and a higher number of lumbar surgeries was associated with poor ODI scores.Peer reviewe

Spontaneous angiogram-negative subarachnoid hemorrhage : a retrospective single center cohort study

Background Spontaneous angiogram-negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications, and outcome of patients with angiogram-negative SAH. Methods We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004-2018 due to spontaneous angiogram-negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale (GOS) at 3 months. We assessed factors that associated with outcome using multivariable logistic regression analysis. Results Of the 108 patients included, 84% had a favorable outcome (GOS 4-5), and mortality was 5% within 1 year. The median age was 58 years, 51% were female, and 93% had a low-grade SAH (World Federation of Neurosurgical Societies grading I-III). The median number of angiograms performed per patient was two. Thirty percent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio = 4.05, 95% confidence interval = 1.05-15.73). Two patients had a new bleeding episode. Conclusion SAH-related complications such as hydrocephalus and vasospasm are common after angiogram-negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. The high rate of SAH-related complications highlights the need for neurosurgical care in these patients.Peer reviewe