Clinical neurology and neurosurgery

Publisher: Elsevier

Current impact factor: 1.13

Impact Factor Rankings

2016 Impact Factor Available summer 2017
2014 / 2015 Impact Factor 1.127
2013 Impact Factor 1.248
2012 Impact Factor 1.234
2011 Impact Factor 1.581
2010 Impact Factor 1.636
2009 Impact Factor 1.303
2008 Impact Factor 1.323
2007 Impact Factor 1.553
2006 Impact Factor 1.506
2005 Impact Factor 1.089
2004 Impact Factor 0.954
2003 Impact Factor 0.771
2002 Impact Factor 0.743
2001 Impact Factor 0.595
2000 Impact Factor 0.619
1999 Impact Factor 0.564
1998 Impact Factor 0.406
1997 Impact Factor 0.613
1996 Impact Factor 0.619
1995 Impact Factor 0.594
1994 Impact Factor 0.489
1993 Impact Factor 0.326
1992 Impact Factor 0.353

Impact factor over time

Impact factor
Year

Additional details

5-year impact 1.29
Cited half-life 5.60
Immediacy index 0.14
Eigenfactor 0.01
Article influence 0.38
ISSN 1872-6968

Publisher details

Elsevier

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    • Publisher last reviewed on 03/06/2015
  • Classification
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The current study compared clinical outcomes of two diverse therapeutic strategies for upper thoracic (T1-4) spinal tuberculosis with neurological deficits in elderly patients. Methods: A retrospective analysis was performed on 18 cases undergoing single-stage posterior transpedicular decompression, debridement, interbody fusion, and instrumentation (Group A). Sixteen cases underwent single- or two-stage anterior debridement, bone grafting, and posterior instrumentation (Group B). The clinical and radiographic results for these patients were analyzed and compared. Results: Patients were followed up for an average of 40.9±4.0 months (range 36-48 months). Results demonstrated that the average operative duration, blood loss, hospital stays, and operative complication rate were lesser for Group A than for Group B. The average fusion time was 8.1±1.5 months and 7.8±2.9 months in Groups A and B, respectively (p>0.05). Cobb's angles were significantly corrected after surgical management, but loss of correction occurred in both groups. All patients had significant postoperative neurological improvement. Conclusions: Single-stage posterior transpedicular debridement, decompression, interbody fusion and instrumentation might be a better surgical treatment compared with combined posterior and anterior approaches. Such techniques may result in fewer complications and a better quality of life for elderly patients.
    No preview · Article · Feb 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objective: Several neurodegenerative disorders show olfactory dysfunction. In patients with frontotemporal dementia (FTD), olfactory impairment is probably due to the involvement of the temporal and orbitofrontal lobes. We hypothesized that due to the disrupted areas in FTD, there would be an impairment in smell identification, differentiation and association. Moreover, we hypothesized that there would be a correlation between the severity of FTD and the severity of odor dysfunction. Methods: In the current study, we compared odor identification, discrimination and association of nine patients with behavioral variant FTD with eleven healthy controls using the Brief Smell Identification Test and the Odor Perception and Semantics Battery. Results: The results showed significant differences in the odor association test, but not in the identification or discrimination test. There was no correlation between disease severity and the performance in the odor tests. Conclusion: We showed impairment of odor association that is most likely due to disruption of specific associative areas involved in olfactory processing. Specifically, we propose that the impairment may well be due to disrupted areas in the temporal lobe and amygdala.
    No preview · Article · Feb 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: This case presents a clinical course of a frontal lobe dysexecutive syndrome with dementia caused by a primary angiitis of the central nervous system (PACNS) of exclusively very small vessels. An isolated frontal lobe dementia syndrome as a primary manifestation of PACNS highlights the diverse clinical manifestations of the disease. The patient presented with a progressive cognitive decline with loss of memory, disinhibited behavior, inappropriate affect and frontal release signs. The diagnostic workup essentially revealed a lymphocytic pleocytosis in the cerebrospinal fluid and a generalized cortical atrophy without any vascular abnormalities. To grasp a diagnosis for this enigmatic clinical picture of a frontal lobe syndrome with signs of inflammation we targeted a tissue-based diagnosis. A brain biopsy gave the decisive hint towards a microvasculitis. Although the histopathologic picture showed peculiarities, a destruction of the vascular bed of very small vessels by lymphocytic infiltration was evident. Our case illustrates an uncommon clinical picture of a PACNS and points to shortcomings of the current histopathologic criteria if only very small vessels are involved.
    No preview · Article · Feb 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objectives: To review the current practice in the diagnosis, monitoring and management of TCM in SAH patients at our tertiary referral institution and the relevant literature, and to evaluate the effect of certain treatment modalities on the outcome of those patients. Patients and methods: A retrospective institutional chart review of 800 patients with aneurysmal SAH from 2007 to 2014. Eighteen patients were identified to have both aneurysmal SAH and TCM based on echocardiogram. Demographic data, clinical parameters, radiographic findings, treatment modalities, and laboratory results were analyzed. Results: The incidence of typical TCM in our patients was 2.2%. Mortality rate of TCM in SAH was 22% compared to the total mortality rate of all non-traumatic SAH patients of 15% in our institution over the same time period. Use of beta blockers prior to or after the diagnosis of TCM did not seem to affect their outcome. Majority of patients (61%) were on vasopressors prior to the diagnosis of TCM. Of those, 73% had good outcomes. Even after the diagnosis of TCM, good outcomes were observed in 6 of 7 patients who remained on vasopressors. Conclusion: Despite the general agreement on the importance of the avoidance of vasopressors in TCM, our experience showed that the use of vasopressors is safe in these patients. The use of beta blockers in our patients was not associated with significantly better outcomes despite multiple previous reports on beta blocker usage in TCM.
    No preview · Article · Feb 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objective: To establish the incidence and clinical course of Guillain Barré syndrome (GBS) in a well-defined geographical area. Patients and methods: All patients older than 16 years of age diagnosed with GBS were prospectively invited to join a follow-up study for two years. Results: Seventeen patients were diagnosed with GBS; an incidence rate of 2.28/100 000 in 2006/2007, and 3.19/100 000 in 2007/2008 with an equal gender distribution. Eleven patients accepted follow up, and more than 50% had milder forms of GBS with preserved walking ability and a Hughes score ≤2. None required assisted ventilation in this period, and only one patient had a MRC score <40. Three patients were simultaneously diagnosed with SIADH. Nine patients received IvIg treatment and clinical improvement measured by MRC and INCAT was seen during the first three months, but the patients subjective perceptions of health and symptoms measured using VAS, FSS, and SF-36 were reduced the first 12 months after diagnosis. Conclusion: Incidence of GBS in a well-defined area varied between 2.28-3.19/100 000, and more than 50% of patients were mildly affected. Despite a good clinical recovery after three months and subsequent improvement on self-assessed health items, patients with GBS rated their health lower than expected after one year.
    No preview · Article · Feb 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objectives: To assess the diagnostic accuracy of ultrasonographic optic nerve sheath diameter (ONSD) measurement and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure (ICP). Patients and methods: A total 60 patients with (cases, n=30) and without (controls, n=30) acute clinical and computed tomographic findings of elevated ICP due to intracranial mass/hemorrhage were recruited from a teaching hospital. The mean binocular and maximum ultrasonographic ONSDs, as well as the mean binocular Doppler ultrasound waveform indices of the ophthalmic arteries including pulsatility index (PI), resistive index (RI), end-systolic velocity (ESV), peak systolic velocity (PSV) and end-diastolic velocity (EDV) were compared between the two groups. Results: Compared to controls, the case group had significantly higher mean binocular ONSD (5.48±0.52mm vs. 4.09±0.22mm, p<0.001), maximum ONSD (5.63±0.55mm vs. 4.16±0.23mm, p<0.001), mean PI (1.53±0.16 vs. 1.45±0.20, p=0.01), and mean RI (0.76±0.07 vs. 0.73±0.04, p=0.01). The mean EDV, in contrast, was significantly higher in controls (8.55±3.09m/s vs. 7.17±2.61m/s, p=0.01). The two groups were comparable for the mean PSV (30.73±7.93m/s in cases vs. 32.27±10.39m/s in controls, p=0.36). Among the mentioned variables, the mean binocular ONSD was the most accurate parameter in detecting elevated ICP (sensitivity and specificity of 100%, cut-off point=4.53mm). The Doppler indices were only moderately accurate (sensitivity: 56.7-60%, specificity: 63.3-76.7%). Conclusion: While the ultrasonographic mean binocular ONSD (>4.53mm) was completely accurate in detecting elevated ICP, color Doppler indices of the ophthalmic arteries were of limited value.
    No preview · Article · Feb 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objectives: This study sought to retrospectively compare three different posterior fixation techniques in transforaminal lumbar interbody fusion for two-level lumbar degenerative diseases. Patients and methods: This was a retrospective single-center study including 84 patients who underwent TLIF instrumented with unilateral pedicle screws (UPS), unilateral pedicle screws plus contra-lateral translaminar facet screws (UPSFS), or bilateral pedicle screws (BPS) between June 2008 and May 2012. These patients were divided into three groups: UPS (n=22), UPSFS (n=28) and BPS (n=34) group. Operative time, blood loss, length of hospital stay, hospital bill, fusion status and complications were recorded and analyzed statistically. Visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association Scores (JOA) were used to assess the preoperative and postoperative pain and functional outcome. Sagittal aligment was evaluated by the segment lordosis (SL) and whole lumbar spine lordosis (LL). Results: The mean follow up duration was 46.2 (ranging from 36 to 60) months. A significant decrease occurred in operative time, blood loss and hospital bill in UPS and UPSFS group, compared with BPS group (p<0.05). The average postoperative VAS, ODI and JOA scores improved significantly in each group than the preoperative counterparts (p<0.05), however, there were no significant difference between groups at any follow-up time point (p>0.05). No statistically difference was detected regarding fusion rate and complication rate between groups (p>0.05), except the screw/rod failure rate (p<0.05). Radiographic analysis showed that the LLs in all these groups got improved (p<0.05) and the SLs maintained (p>0.05). Conclusion: UPS or UPSFS instrumented TLIF could achieve satisfactory mid-term clinical outcome comparable to BPS's, with less surgical time, less blood loss, and lower cost; UPS should be prudently performed for two-level cases in case of lower fusion rate, and cannulated screws should be replaced by stronger solid screws in UPSFS to reduce facet screw breakage.
    No preview · Article · Feb 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Corresponding author at: Department of Neurology, China Medical University Hospital, Taichung, Taiwan. Fax: +886 4 22344055.
    No preview · Article · Feb 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objective: (1) To determine the frequency of subarachnoid blood spread following epidural blood patch (EBP) in a cohort of subjects with spontaneous intracranial hypotension (SIH). (2) To describe the outcome of these patients. Patients and methods: In a cohort of 106 patients exhibiting SIH, spiral spinal CT scans were obtained post-lumbar EBP and neuroradiological data was reviewed for evidence of subarachnoideal bleeding. Results: Subarachnoideal blood spread was detected on spinal CT scans following EBP in 9 of 106 patients with SIH. All patients exhibited a complete recovery and no neurological complications were observed. Conclusions: A low incidence of subarachnoideal blood spread was observed following EBP given to treat SIH. Instances of subarachnoideal blood spread were not associated with neurological complications or altered efficacy of the EBP procedure.
    No preview · Article · Jan 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Brain abscesses are frequently caused by poly-microbial conditions. Comparatively, brain abscesses caused by Prevotella species are very rare. Right-to-left cardiac shunting due to a patent foramen ovale may predispose patients to infection. We report an isolated Prevotella brain abscess that occurred in a healthy, young, male patient with a patent foramen ovale. The patient did not have a clinically obvious odontogenic source of infection, and no other distant extracranial infectious sources were observed. The patient was successfully treated with stereotactic aspiration and antibiotics
    No preview · Article · Jan 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objectives: Device subsidence is a well-known complication following cervical disc arthroplasty. Its occurrence has been closely tied with the endplate-implant contact interface. But current literature on the geometry of cervical endplate is very scarce. The aim of this anatomical investigation was to analyze geometry of inferior endplates of the cervical vertebrae, thereby identifying the common endplate shape patterns and providing morphological reference values consummating the design of the implant. Patients and methods: Reformatted CT scans of 85 individuals were analyzed and endplate concave depth, endplate concave apex location, sagittal diameter of endplate, coronal concave angle, as well as transverse diameter of endplate were measured in mid-sagittal plane and specified coronal plane. According to the endplate concave apex location, the inferior endplates in mid-sagittal plane were classified into 3 types: type I with posteriorly positioned apex, type II with middle situated concave apex and type III with anteriorly positioned apex. Moreover, the inferior endplates in specified coronal plane were also classified into three types: concave, flat and irregular. Results: Based on visual assessment, for the mid-sagittal plane, type I endplate accounted for 26.9% of all the 510 endplates of 85 individuals, while the proportion of type II and type III endplates were 53.9 and 19.2% respectively. For the specified coronal plane, 68.6% of all the 510 endplates were evaluated as concave, 26.9% as flat and the remaining 4.5% as irregular. Among all measured segments, C3 had the largest endplate concave depth values in mid-sagittal plane, while C7 the least; C5 and C6 had the largest sagittal endplate diameter values, while C2 the least. For each level, the sagittal endplate concave depth and endplate diameter of females were significantly smaller than those of males (P<0.05). Among all measured segments, C7 had the least coronal concave angle. Gender did not influence coronal concave angle significantly (P>0.05). Increasing from C2 to C7, the endplate transverse diameters of females were significantly smaller than those of males (P<0.05). Conclusion: The exact shape and geometry of cervical endplate are crucial for the design and improvement of cervical disc prosthesis. Gender difference of sagittal and transverse diameters of cervical endplate should be given more attention when implanting a disc prosthesis. These endplate geometrical parameters should be taken into consideration when calculating most suitable geometric parameters of new disc prosthesis.
    No preview · Article · Jan 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Object: Meningiomas constitute 25% of primary spinal tumors and predominantly involve the thoracic spinal cord. Although calcifications are commonly seen in intracranial meningiomas, gross calcifications are observed in only 1-5% of all spinal meningiomas. We report the clinical findings, surgical strategy and histological features of 9 patients with ossified spinal meningiomas (OSMs). Patients and methods: Clinical and surgical features of 9 patients with ossified spinal meningiomas were retrospectively reviewed. Results: There were 8 women and 1 man with a mean age of 59 years. In 7 patients, the lesions were localized in the thoracic segment of the spine while in 2 patients in the lower cervical segment. All patients presented with weakness of the lower limbs and hypoesthesia below the site level of the lesion. Only 2 patients presented with urinary incontinence. Gross-total resection of the tumor was achieved in 6 patients while in 3 a subtotal removal of the meningioma was obtained. In all patients the postoperative course was uneventful. Six patients presented with a significant neurological improvement while in 3 patients a mild improvement was observed. Microscopically, all tumors showed typical histological pattern of ossified meningioma. Conclusions: OSMs are amenable to surgery if the complete removal can be achieved. Because of their hard-rock consistency complete resection can be challenging. In difficult cases, subtotal removal can be advised and follow-up imaging is mandatory. Overall, the risk of long-term recurrence of the lesions is low, and a good clinical outcome after total or subtotal removal can be expected.
    No preview · Article · Jan 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objective: Shunt failure is common in hydrocephalic patients. The cerebrospinal fluid (CSF) infusion test enables the assessment of CSF absorption capacity, which is represented by the resistance to CSF outflow (ROUT) However, shunt failure may not only affect the CSF absorption capacity but also the intracranial compliance or compensatory properties. Spectral analysis of the ICP signal obtained during the infusion test may enable the comprehensive assessment of the overall deterioration caused by shunt failure. Material and methods: A total of 121 hydrocephalic shunted patients underwent the infusion test with continuous intracranial pressure (ICP) and arterial blood pressure (ABP) recording. The maximum amplitudes of three major frequency bandwidths (0.2-2.6, 2.6-4.0 and 4.0-15Hz, respectively) were calculated from the ICP. Statistical analyses were conducted to identify factors significantly associated with shunt failure, to construct an index (i.e., the shunt response parameter, SRP) for detecting shunt failure, and to define thresholds for ROUT and SRP. Results: The ROUT threshold for detecting shunt failure was 7.59mmHg/ml/min, and this threshold showed an accuracy of 82.64%. All spectral parameters were found to be significantly associated with shunt patency (p<0.05). The SRP exhibited significantly better accuracy than ROUT in detecting shunt failure (91.74%). Conclusion: The hydrodynamic assessment of shunted patients enhanced by spectral analysis during the infusion test detected shunt failure with high accuracy. Although further validation is needed, the SRP exhibited promising results.
    No preview · Article · Jan 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Corresponding author. Fax: +86 791 8862 3153.
    No preview · Article · Jan 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objective: Deep Brain Stimulation in psychiatric disorders is becoming an increasingly performed surgery. At present, seven different targets have been stimulated in Tourette Syndrome, including the internal globus pallidus. We describe the effects on tics and comorbid behavioral disorders of Deep Brain Stimulation of the anterior internal globus pallidus in five patients with refractory Tourette Syndrome. Methods: This study was performed as an open label study with follow-up assessment between 12 and 38 months. Patients were evaluated twice, one month before surgery and at long-term follow-up. Primary outcome was tic severity, assessed by several scales. Secondary outcomes were comorbid behavioral disorders, mood and cognition. The final position of the active contacts of the implanted electrodes was investigated and side effects were reported. Results: Three males and two females were included with a mean age of 41.6 years (SD 9.7). The total post-operative score on the Yale Global Tic Severity Scale was significantly lower than the pre-operative score (42.2±4.8 versus 12.8±3.8, P=0.043). There was also a significant reduction on the modified Rush Video-Based Tic Rating Scale (13.0±2.0 versus 7.0±1.6, P=0.041) and in the total number of video-rated tics (259.6±107.3 versus 49.6±24.8, P=0.043). No significant difference on the secondary outcomes was found, however, there was an improvement on an individual level for obsessive-compulsive behavior. The final position of the active contacts was variable in our sample and no relationship between position and stimulation effects could be established. Conclusion: Our study suggests that Deep Brain Stimulation of the anterior internal globus pallidus is effective in reducing tic severity, and possibly also obsessive-compulsive behavior, in refractory Tourette patients without serious adverse events or side-effects.
    No preview · Article · Jan 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Corresponding author at: Department of Neurology, Hospital Virgen del Rocío, Avda. Manuel Siurot s/n, Seville 41013, Spain.
    No preview · Article · Jan 2016 · Clinical neurology and neurosurgery
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    ABSTRACT: Objectives: "Long-term epilepsy associated tumors (LEATs)" by definition are tumors primarily causing drug-resistant seizures for two years or more. They include low-grade glial and glioneuronal tumors with normal life expectancy. We studied a large cohort of patients with LEATs who underwent surgery through our epilepsy program. Patients & methods: From 1998-2011, 105 patients with LEATs underwent surgery in our center. We utilized their data archived in a prospective registry to evaluate their electro-clinical-imaging characteristics affecting the long-term seizure outcome. Results: Of 105 patients (age 3-50 years), mean age at surgery was 20 years and mean pre-surgical duration of epilepsy was 10.9 years. 66 (62.8%) had secondary generalized seizures. 82 had temporal tumors, 23 had extra temporal (13 frontal, 3 parietal, 2 occipital and 5 multilobar lesions) and four had associated hippocampal sclerosis. The interictal discharges and ictal onset were concordant to the lesion in 82 (78%) and 98 (93%) patients respectively. Lesionectomy and/or adjoining corticectomy or temporal lobectomy was done. Ganglioglioma was the most dominant pathological substrate in 61 (58%). During a mean follow-up of 7.5 years (range 3-16 years), 78/105 (74.2%) were seizure-free and 45 (57.4%) were totally off drugs. Secondary generalized seizures (p-0.02), temporal location of tumor (p-0.008) and spikes in third month post-operative EEG (p-0.03) caused unfavorable seizure outcome. A pre-surgical duration of epilepsy of more than 6.6 years caused less than optimal surgical outcome CONCLUSIONS: Early surgery should be considered a priority in LEATs. Presence of secondary generalized seizures is the single most important predictor of a poor seizure outcome.
    No preview · Article · Jan 2016 · Clinical neurology and neurosurgery