Papers by Joukje van der Naalt
New England Journal of Medicine
Bohn Stafleu van Loghum eBooks, Nov 14, 2021
World Neurosurgery, 2022
BACKGROUND We aim to quantify the need for additional surgery in chronic subdural hematoma (CSDH)... more BACKGROUND We aim to quantify the need for additional surgery in chronic subdural hematoma (CSDH) patients primarily treated with dexamethasone and to identify patient characteristics associated with additional surgery. METHOD Data were retrospectively collected from 283 CSDH patients, primarily treated with dexamethasone, in three hospitals from 2008 to 2018. Primary outcome was the need for additional surgery. The association between baseline characteristics and additional surgery was analyzed with univariable and multivariable logistic regression analysis and presented as adjusted odds ratios (aOR). RESULTS 283 CSDH patients were included. 146 patients (51.6%) received one dexamethasone course (DXM-group), 30 patients (10.6%) received two dexamethasone courses (DXM-DXM-group) and 107 patients (37.8%) received additional surgery (DXM-SURG-group). Patients who underwent surgery more often had a Markwalder Grading Scale of 2 (as compared to 1, aOR 2.05; 95% CI 0.90 - 4.65), used statins (aOR 2.09; 95% CI 1.01 - 4.33), a larger midline shift (aOR 1.10 per mm; 95% CI 1.01 - 1.21) and larger hematoma thickness (aOR 1.16 per mm; 95% CI 1.09 - 1.23), a bilateral hematoma (aOR 1.85; 95% CI 0.90 - 3.79) and a separated hematoma (as compared to homogeneous, aOR 1.77; 95% CI 0.72 - 4.38). Antithrombotics (aOR 0.45; 95% CI 0.21 - 0.95) and trabecular hematoma (as compared to homogeneous, aOR 0.31; 95% CI 0.12 - 0.77) were associated with a lower likelihood of surgery. CONCLUSION Over a third of CSDH patients primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas.
Kindertraumachirurgie, 2019
Academic Emergency Medicine, Dec 31, 2015
Journal of Clinical Medicine, Jan 27, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Acta Neurologica Scandinavica, Aug 26, 2021
Patients with chronic subdural hematoma (CSDH) can present with a variety of signs and symptoms. ... more Patients with chronic subdural hematoma (CSDH) can present with a variety of signs and symptoms. The relationship of these signs and symptoms with functional outcome is unknown. Knowledge of these associations might aid clinicians in the choice to initiate treatment and may allow them to better inform patients on expected outcomes.
Brain Injury, Jun 21, 2020
van der Naalt (2020): Rating of pre-injury symptoms over time in patients with mild traumatic bra... more van der Naalt (2020): Rating of pre-injury symptoms over time in patients with mild traumatic brain injury: the good-old-days bias revisited, Brain Injury,
PURPOSEChronic traumatic encephalopathy refers to a neurodegenerative disease resulting from repe... more PURPOSEChronic traumatic encephalopathy refers to a neurodegenerative disease resulting from repetitive head injury of participants in contact sports. Similar to other neurodegenerative diseases, neuroinflammation is thought to play a role in the onset and progression of the disease. Limited knowledge is regarding the neuroinflammatory consequences of repetitive head injury in currently active contact sports athletes. PET imaging of the 18-kDa translocator protein (TSPO) allows quantification of microglial activation in vivo, a marker of neuroinflammation. METHODS11 rank A kickboxers and 11 age matched controls underwent TSPO PET using [11C]-PK11195, anatomical MRI, diffusion tensor imaging and neuropsychological testing. Relevant imaging parameters were derived an correlated with the outcomes on the neuropsychological testing.RESULTSOn a group level, no statistically significant differences were detected in non displacable binding potential (BPND) using PET. DTI parameters did not ...
Injury-international Journal of The Care of The Injured, Sep 1, 2022
Objective: To update the existing CHIP (CT in Head Injury Patients) decision rule for detection o... more Objective: To update the existing CHIP (CT in Head Injury Patients) decision rule for detection of (intra)cranial findings in adult patients following minor head injury (MHI). Methods: The study is a prospective multicenter cohort study in the Netherlands. Consecutive MHI patients of 16 years and older were included. Primary outcome was any (intra)cranial traumatic finding on computed tomography (CT). Secondary outcomes were any potential neurosurgical lesion and neurosurgical intervention. The CHIP model was validated and subsequently updated and revised. Diagnostic performance was assessed by calculating the c-statistic. Results: Among 4557 included patients 3742 received a CT (82%). In 383 patients (8.4%) a traumatic finding was present on CT. A potential neurosurgical lesion was found in 73 patients (1.6%) with 26 (0.6%) patients that actually had neurosurgery or died as a result of traumatic brain injury. The original CHIP underestimated the risk of traumatic (intra)cranial findings in low-predicted-risk groups, while in highpredicted-risk groups the risk was overestimated. The c-statistic of the original CHIP model was 0.72 (95% CI 0.69-0.74) and it would have missed two potential neurosurgical lesions and one patient that underwent neurosurgery. The updated model performed similar to the original model regarding traumatic (intra)cranial findings (c-statistic 0.77 95% CI 0.74-0.79, after crossvalidation c-statistic 0.73
Jgz Tijdschrift Voor Jeugdgezondheidszorg, Feb 23, 2017
SamenvattingKinderen vormen een risicogroep voor het krijgen van traumatisch hersenletsel na een ... more SamenvattingKinderen vormen een risicogroep voor het krijgen van traumatisch hersenletsel na een fietsongeval. In Nederland is er geen wet-, of regelgeving opgesteld omtrent het gebruik van de fietshelm. Een kind dat van de fiets valt of geschept wordt, valt bijna altijd op zijn hoofd. Dit artikel geeft een overzicht van recent onderzoek naar effectiviteit, gebruik, en implementatie van de fietshelm bij kinderen. Het preventieve effect van de fietshelm is aangetoond. Ook is uit de literatuur bekend dat het verplichten van de fietshelm leidt tot toename van het gebruik van de fietshelm, in het bijzonder als dit beleid maatschappijbreed wordt doorgevoerd.De fietshelm kan een belangrijke bijdrage leveren aan de bescherming tegen risico’s van het vallen van de fiets en bij ongelukken in het verkeer. Daarom adviseren wij dat de fietshelm in Nederland verplicht gesteld dient te worden voor alle kinderen onder de leeftijd van 16 jaar.
Nederlands Tijdschrift voor Geneeskunde, 2016
Patiënt A, een 45-jarige vrouw, wordt door de huisarts verwezen naar de neuroloog in verband met ... more Patiënt A, een 45-jarige vrouw, wordt door de huisarts verwezen naar de neuroloog in verband met klachten van hoofdpijn en concentratiestoornissen. Zij was 6 maanden eerder als fietser aangereden door een auto. Hierbij had ze een schedelbasisfractuur opgelopen, waarbij de CTscan geen intraparenchymateuze afwijkingen had laten zien. Bij opname was zij gedesoriënteerd met een Glasgow-comascore (GCS) van 14 (E4-M6-V4). De fase van posttraumatische amnesie duurde 12 uur. Patiënte had geen andere letsel opgelopen. De volgende dag werd patiente ontslagen met het advies ‘het rustig aan te doen’. Thuis had patiënte klachten van hoofdpijn en duizeligheid die na enkele weken afnamen. Ze pakte haar werk als leerkracht na 6 weken geleidelijk op, in overleg met de bedrijfsarts. Patiënte kreeg hierop aan het einde van de dag last van hoofdpijn en geheugenen concentratiestoornissen, met name als zij veel lesuren had gegeven of les had gegeven aan grote klassen. Na 3 maanden had ze desondanks haar ...
Journal of Neurology, Neurosurgery & Psychiatry, 1996
LL. In-vitro contracture tests in patients with various neuromuscular diseases. BrjAnaesth 1992;6... more LL. In-vitro contracture tests in patients with various neuromuscular diseases. BrjAnaesth 1992;68:72-5. 2 Brownell AKW. Malignant hyperthermia: relationship to other diseases. Br_Aniaesth 1988; 60:303-8. 3 European Malignant Hyperthermia Group. A protocol for the investigation of malignant hyperpyrexia (MH) susceptibility. Br .7 Anaesth 1984;56:1267-9. 4 Ellis FR, Halsall PJ, Christian AS. Clinical presentation of suspected malignant hyperthermia in 402 probands. Aniesthesia 1990;45: 38-41. 5 Larach MG. Should we use muscle biopsy to
Journal of Neurotrauma, Nov 8, 2016
Objectives: This study, as part of the UPFRONT-study, aimed to study the patients that report zer... more Objectives: This study, as part of the UPFRONT-study, aimed to study the patients that report zero complaints early after injury, a group that we named the 'fortunate few'. We focused on their demographic, clinical and premorbid characteristics, and examined whether they would remain asymptomatic. Moreover, we investigated the influence of anxiety and depression (HADS), and determined outcome (GOS-E) and quality of life (WHOQOL-BREF) 1 year after injury. Methods: Patients with MTBI (Glasgow Coma Scale score 13-15), without complaints 2 weeks after injury were included. Follow-up took place at 3, 6 and 12 months after injury. Results: Of the entire UPFRONT-cohort (n = 1151), 10% (n = 119) reported zero complaints 2 weeks after injury. More than half of these patients (57%) developed complaints at a later stage (M = 2, p < .001). Patients with secondary complaints had higher anxiety (p = .004) and depression (p = .002) scores, leading to less favourable outcome (p = .014) and a lower quality of life (p = .006) 1 year after injury compared to patients that remained asymptomatic. Conclusion: One in 10 patients with mTBI report zero complaints early after injury. Although they seem fully recovered early after injury, a substantial part may develop secondary complaints leading to less favourable outcome and lower quality of life, warranting further research of this interesting group.
Frontiers in Neurology
Few studies on traumatic brain injury (TBI) have investigated the stability of blood serum biomar... more Few studies on traumatic brain injury (TBI) have investigated the stability of blood serum biomarkers after long-term storage at low temperatures. In the current feasibility study we analyzed acute phase serum samples from patients with mild TBI as well as patients with moderate and severe TBI that were collected more than 10 years ago (old samples). We were particularly interested in mild TBI, because injury effects are more subtle in this category as compared to moderate-severe TBI. Therefore, the primary objective was to find out whether several biomarkers were still detectable for these patients. Additionally, we examined whether biomarker levels varied as a function of injury severity. For comparison, we also analyzed samples from an ongoing mTBI cohort (new samples) and healthy controls. Samples were treated with care and were not being subjected to freeze-thaw cycles. We measured concentrations of interleukins (IL6 and 10) and brain specific markers (total tau, UCH-L1, GFAP, ...
Intensive Care Medicine
Purpose: Severe traumatic brain injury is a leading cause of mortality and morbidity, and these p... more Purpose: Severe traumatic brain injury is a leading cause of mortality and morbidity, and these patients are frequently intubated in the prehospital setting. Cerebral perfusion and intracranial pressure are influenced by the arterial partial pressure of CO 2 and derangements might induce further brain damage. We investigated which lower and upper limits of prehospital end-tidal CO 2 levels are associated with increased mortality in patients with severe traumatic brain injury. Methods: The BRAIN-PROTECT study is an observational multicenter study. Patients with severe traumatic brain injury, treated by Dutch Helicopter Emergency Medical Services between February 2012 and December 2017, were included. Follow-up continued for 1 year after inclusion. End-tidal CO 2 levels were measured during prehospital care and their association with 30-day mortality was analyzed with multivariable logistic regression. Results: A total of 1776 patients were eligible for analysis. An L-shaped association between end-tidal CO 2 levels and 30-day mortality was observed (p = 0.01), with a sharp increase in mortality with values below 35 mmHg. End-tidal CO 2 values between 35 and 45 mmHg were associated with better survival rates compared to < 35 mmHg. No association between hypercapnia and mortality was observed. The odds ratio for the association between hypocapnia (< 35 mmHg) and mortality was 1.89 (95% CI 1.53-2.34, p < 0.001) and for hypercapnia (≥ 45 mmHg) 0.83 (0.62-1.11, p = 0.212). Conclusion: A safe zone of 35-45 mmHg for end-tidal CO 2 guidance seems reasonable during prehospital care. Particularly, end-tidal partial pressures of less than 35 mmHg were associated with a significantly increased mortality.
Acta Neurochirurgica
Objective Chronic subdural hematoma (CSDH) is a common neurological condition, often affecting th... more Objective Chronic subdural hematoma (CSDH) is a common neurological condition, often affecting the elderly. Cognitive impairment is frequently observed at presentation. However, the course and longer term aspects of the cognitive status of CSDH patients are unknown. In this study, we aim to explore the cognitive status of CSDH patients after treatment. Methods An exploratory study in which CSDH patients were assessed 3 months after treatment and compared to healthy controls. A total of 56 CSDH patients (age 72.1 SD ± 10.8 years with 43 [77%] males) and 60 healthy controls were included (age 67.5 ± SD 4.8 with 34 [57%] males). Cognitive testing was performed using the Telephonic Interview of Cognitive Status-modified (TICS-m), a 12-item questionnaire in which a total of 50 points can be obtained on several cognitive domains. Results Median time between treatment and cognitive testing was 93 days (range 76–139). TICS-m scores of CSDH patients were significantly lower than healthy cont...
Uploads
Papers by Joukje van der Naalt