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Role of serum magnesium in post-aneurysmal subarachnoid hemorrhagic hydrocephalus

Sat, 01 Nov 2025 00:00:00 GMT

Title: Role of serum magnesium in post-aneurysmal subarachnoid hemorrhagic hydrocephalus Authors: Kim, M.; Jung, H.; Kim, S. B.; Hwang, J. H.; Jeon, H.; Chung, Y.; Shim, Y.; Kim, J. H.; Byun, J.; Cousins, Aiden; Park, W.; Park, J. C.; Ahn, J. S.; Lee, S. Abstract: Abstract Background Post-hemorrhagic hydrocephalus (PHH) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), yet the relationship between serum magnesium (Mg) level and PHH remains unclear. To our knowledge, this is the first prospective study to specifically examine the association between admission serum Mg level and PHH in aSAH patients. Methods In this prospective, multicenter study (October 2019–October 2024), 131 patients with confirmed aSAH were enrolled from four neuro-intensive care units. Patients were stratified by admission serum Mg level as <2.2 mg/dl or ≥2.2 mg/dl. The primary outcome was PHH incidence; secondary outcomes were cerebral vasospasm (CV), delayed cerebral ischemia (DCI), and 30-day modified Rankin Scale (mRS) score. Results Baseline characteristics were similar between groups. Serum Mg ≥2.2 mg/dl was not significantly associated with reduced vasospasm, DCI, or poor functional outcome. However, serum Mg >2.5 mg/dl correlated with lower PHH incidence in univariate analysis (odds ratio, 0.36; P=0.027) but not in multivariate analysis (P=0.136). Independent predictors of PHH were posterior circulation aneurysm, high Fisher grade, and high Hunt and Hess grade. Poor 30-day mRS was independently associated with high Fisher and Hunt and Hess grades. Conclusions Admission serum Mg level was not independently associated with PHH, although a potential protective trend was noted at higher levels (>2.5 mg/dl). These findings suggest a possible role of Mg in PHH prevention. Further prospective trials are warranted to clarify the therapeutic potential of Mg and to establish optimal monitoring and correction strategies in aSAH management. Keywords: cerebral aneurysm, hydrocephalus, magnesium, stroke, subarachnoid hemorrhage, surgery

Connect, pause and reflect: Multidisciplinary clinicians' shared challenges and sustaining strategies caring for children with Severe Neurological Impairment

Sat, 01 Nov 2025 00:00:00 GMT

Title: Connect, pause and reflect: Multidisciplinary clinicians' shared challenges and sustaining strategies caring for children with Severe Neurological Impairment Authors: Nevin, S. M.; Le Marne, F. A.; Kelada, L.; Wakefield, C. E.; Beavis, E.; Macintosh, R.; Palmer, E. E.; McLoughlin, R.; ClinEquip Advisory group; Sachdev, R.; Nunn, K.; Bye, A. Abstract: Aim: Patients with Severe Neurological Impairment (SNI) have progressive conditions of the central nervous system, resulting in permanent cognitive and motor disabilities and enduring hypercomplexity. This study aimed to explore clinicians' shared psychosocial experience of caring for families of children with SNI, including the challenges, and components of care that bring clinicians meaning and purpose, to identify resource pathways to sustain clinicians. Method: We purposively recruited multidisciplinary clinicians with expertise caring for patients with SNI to participate in a series of four sequential and semi-structured reflective practice workshops. We recorded workshops and performed a qualitative content analysis, following verbatim transcription. Results: We conducted sixteen workshops with multidisciplinary clinicians including paediatricians (n = 14), paediatric neurologists (n = 5), allied health professionals (n = 3), clinical geneticists (n = 2), clinical nurse specialists (n = 2), a paediatric nephrologist (n = 1), a neurosurgeon (n = 1) and a metabolic specialist (n = 1). Workshops focused on three primary domains: 'the struggle', 'making a difference' and 'finding purpose and meaning'. Clinicians acknowledged psychosocial challenges and the limits to their medical expertise, emphasising the importance of ongoing reflective practice and proactive multidisciplinary collaboration to sustain themselves and empower patients. In the final workshop series, clinicians identified their preferences for multipronged, multimodal resources, centred on connection, reflection, and support. Conclusion: This research provides in-depth insight into how multidisciplinary clinicians caring for patients with SNI cope with challenges and gain meaning and purpose in their role. Co-designed clinician interventions, coupled with integrated and structured reflective practice will address identified challenges and foster clinician meaning and purpose, in supporting their patients.

Exploring Parkinson's disease prevalence in regional, rural and remote Australia: A systematic scoping review

Fri, 01 Dec 2023 00:00:00 GMT

Title: Exploring Parkinson's disease prevalence in regional, rural and remote Australia: A systematic scoping review Authors: Fealy, S.; Logan, P. A.; Micalos, P. S.; Rossiter, R.; Jones, D.; Irwin, P.; Schwebel, D.; Carroll, V.; Wong, A; Fung, V. S. C.; Morales-Briceno, H. Abstract: Introduction: Idiopathic Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide. Due to ageing populations, prevalence estimates for PD are set to increase in western countries including Australia. Objective: This study aims to investigate the prevalence of PD in regional, rural and remote areas of Australia, to inform the provision of equitable PD-specific care. Design: A scoping review, following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), was conducted. An electronic search of four databases and the search engine google scholar was completed in May 2022 and updated in September 2023. Article screening and quality appraisal were undertaken independently by at least two reviewers. Findings: Of 514 records screened, six articles (between 1966 and 2019) were identified and included for review. Wide variations in PD prevalence were evident, ranging from 0.58 to 8.5 per 1000 people. Two studies suggested prevalence may be higher in regional, rural and remote areas of Australia than in urban localities. Discussion: The limited number of studies identified, and wide variation in prevalence rates makes it difficult to draw firm conclusions to inform heath care planning and resource allocation. Conclusion: A paucity of reliable prevalence data indicates the need for well-designed, country-specific epidemiological studies to be conducted to estimate the actual impacts of the disease to inform public health planning, particularly in regional, rural and remote areas where access to PD-specific care is already inequitable.

Fundoscopy use in neurology departments and the utility of smartphone photography: a prospective prevalence and crossover diagnostic accuracy study amongst neurology inpatients.

Mon, 01 Aug 2022 00:00:00 GMT

Title: Fundoscopy use in neurology departments and the utility of smartphone photography: a prospective prevalence and crossover diagnostic accuracy study amongst neurology inpatients. Authors: He, G.; Dunn, H.P.; Ahmad, K.E.; Watson, E.; Henderson, A.; Tynan, D.; Leaney, J.; White, A.J.; Hewitt, A.W.; Fraser, C.L. Abstract: BACKGROUND AND PURPOSE Although fundoscopy is a crucial part of the neurological examination, it is challenging, under-utilized and unreliably performed. The aim was to determine the prevalence of fundus pathology amongst neurology inpatients and the diagnostic accuracy of current fundoscopy practice compared with systematic screening with smartphone fundoscopy (SF) and portable non-mydriatic fundus photography (NMFP). METHODS This was a prospective cross-sectional surveillance and diagnostic accuracy study on adult patients admitted under neurology in an Australian hospital. Inpatients were randomized to initial NMFP (RetinaVue 100, Welch Allyn) or SF (D-EYE) followed by a crossover to the alternative modality. Images were graded by neurology doctors, using telemedicine consensus neuro-ophthalmology NMFP grading as the reference standard. Feasibility parameters included ease, comfort and speed. RESULTS Of 79 enrolled patients, 14.1% had neurologically relevant pathology (seven, disc pallor; one, hypertensive retinopathy; three, disc swelling). The neurology team performed direct ophthalmoscopy in 6.6% of cases and missed all abnormalities. SF had a sensitivity of 30%-40% compared with NMFP (45.5%); however, it had a lower rate of screening failure (1% vs. 13%, p < 0.001), a shorter examination time (1.10 vs. 2.25 min, p < 0.001) and a slightly higher patient comfort rating (9.2 vs. 8/10, p < 0.001). CONCLUSION Our study demonstrates a clinically significant prevalence of fundus pathology amongst neurology inpatients which was missed by current fundoscopy practices. Portable NMFP screening appears more accurate than SF, whilst both are diagnostically superior to routine fundoscopic practice, feasible and well tolerated by patients.