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    The effects of nimopidine on platelet aggregation in severe head injury
    (Springer-Verlag Wien, 2008) Tatli, M.; Guzel, A.; Kilincer, C.; Batun, S.
    Background. Severe head injury (SHI) is often associated with traumatic subarachnoid haemorrhage (tSAH), vasospasm, and results in an unfavorable outcome. The aim of this study was to evaluate the effect of nimodipine on platelet aggregation in SHI. Method. This prospective study consisted of 80 patients (53 male, 27 female; ages ranging from 17 years to 65 years, mean: 36.2 years) with severe head injury (Glasgow Coma Score, GCS < 8). All patients received antioedema therapy and prophylactic anticonvulsant. The patients were randomly assigned to either the nimodipine group (2 mg/h continuous infusion for one week) (n = 45) or the control group (n = 35). There were 13 patients with tSAH in the nimodipine group and 10 patients with tSAH in the control group. The platelet aggregation ratio (PAR) was measured on the initial day and the 7(th) day. Higher PAR indicates lower circulating platelet aggregates. Findings. The two groups were well matched for age, sex, mode of injury, neurological status and CT scan findings. In fact, comparison of PAR and GCS in the two treatment groups revealed no difference on the first day. Compared to initial values, the nimodipine group showed a significantly higher PAR value (0.6 +/- 0.1 vs. 0.9 +/- 0.2, p < 0.001) and mean GCS value (7.4 +/- 0.7 vs. 13.7 +/- 1.0, p < 0.001) on the 7(th) day. As a result, on the 7(th) day, the nimodipine group had a significantly higher PAR values (0.7 +/- 0.1 vs. 0.9 +/- 0.2, p < 0.001) and mean GCS (12.3 +/- 1.3 vs. 13.7 +/- 1.0, p < 0.001) as compared to the control group. When the analyses were repeated for the subgroups (the patients with tSAH or contusion) nimodipine showed the same effectiveness. Conclusions. Nimodipine effectively inhibits platelet hyperaggregability in severe head injury patients with or without traumatic subarachnoid haemorrhage. Thus, it may have a potential for use in these patients. However, its effect on long-term outcomes such as death and disability rates and quality of life is still to be determined.
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    Pediatric cerebral aneurysms: a report of 9 cases
    (Springer-Verlag Wien, 2008) Tatli, M.; Guzel, A.; Kilincer, C.; Goksel, H. M.
    Background. Intracranial aneurysms are rare in children, constituting less than 2% of all cerebral aneurysms. Relative to their adult Counterparts, published series are few and case numbers are small. Method. Nine children (5 males and 4 females, ages 13-18 years old) are reported. These patients constituted 6% of a total of 150 cerebral aneurysm cases treated at our institution over a 12-year period. Findings. Eight patients presented with subarachnoid haemorrhage; one patient's aneurysm was identified incidentally after head trauma. All but one of the patients were in good clinical grade (Hunt and Hess grades I to III). Aneurysm locations were: internal carotid artery (ICA) (5 cases), anterior communicating artery (2 cases), anterior cerebral artery (1 case) and vertebrobasilar junction (1 case). A giant (ICA bifurcation) aneurysm and bilateral ICA bifurcation aneurysms were each observed in one patient. Angiographic vasospasm was detected in three patients. Clinical deterioration attributable to vasospasm was observed in one of them. Seven patients underwent craniotomy, and aneurysms were clipped succesfully. One patient underwent endovascular coiling for a vertebrobasilar junction aneurysm. One patient died due to rebleeding before surgery on the second day of her initial haemorrhage. The 6-month Glasgow Outcome Score was 5 in seven patients and 4 in one patient. Conclusions. Our treatment regimen for pediatric aneurysms is similar to that used in adults, and consists of surgical clipping as the mainstay of treatment, with endovascular techniques reserved for selected cases. With the exception of one patient who died due to early rebleeding, this regimen resulted in good clinical outcomes.