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Neurological cases

L Yang, S S Diao, Y P Ding, S J Huang, T Sun, Y Lu, Q Fang, X Y Cai, Y Kong, Z Xu
Objective: To assess outcome, safety and possible mechanism of loading dose clopidogrel in patients with transient ischemic attack (TIA) and minor stroke. Methods: We reviewed patients with confirmed TIA and minor stroke admitted between July 2016 and December 2017 into the First Affiliated Hospital of Soochow University. Loss-of-function allele carriers of CYP2C19 were included and randomly divided into loading dose group (first dose of 300 mg clopidogrel) and standard dose group (first dose of 75 mg clopidogrel), 100 mg aspirin was gave at the same time, followed by aspirin 100 mg/d plus clopidogrel 75 mg/d maintaining for 20 days...
January 29, 2019: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Davyd Greenish, Karen Watura, Ian Harding
A 73-year-old man underwent bilateral spinal decompression of L4/5 for severe spinal canal stenosis, requiring minimal analgesia and providing immediate relief. Two days post-operatively, he presented with new onset bilateral leg pain and difficulty mobilising. MRI demonstrated spinal epidural lipomatosis (SEL), which was not present pre-operatively, at L5/S1. Further surgery was performed with decompression of L5/S1 through removal of epidural fat. At both 3 weeks and 5 months follow-up clinics, the patient was asymptomatic...
February 15, 2019: BMJ Case Reports
Francesco Pellegrini, Altin Stafa, Daniela Bonsanto, Clare L Fraser
A 71-year-old man was referred to Neuro-Ophthalmology for evaluation of reading problems associated to pituitary adenoma. Perimetry showed a right temporal crescent syndrome ("half moon" syndrome) suggesting left occipital disease. Brain MRI, electroencephalogram and CSF examination (14-3-3 protein) were consistent with a diagnosis of Creutzfeldt-Jakob disease. His neurologic condition rapidly deteriorated with memory problems, myoclonus and apathy followed by death, four months later. This case shows how visual problems may be the first manifestation of this rare prion disease (Heidehain variant of Creutzfeldt-Jakob disease)...
February 14, 2019: Survey of Ophthalmology
Orhan Bican, Charles Cho, Areli Suarez-Roman, Viet Nguyen, Leslie Lee, Scheherazade Le, Jeremy Heit, Robert Dodd, Jaime López
Pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) both mitigate and predict risks associated with endovascular embolization procedures. We present a series of patients undergoing endovascular intracranial embolization predominantly for AVMs both under general anesthesia and awake with the use of IONM. We reviewed our database to identify all patients undergoing endovascular procedures between January 1, 2014 and January 1, 2016. Awake patients were tested with SSEP, EEG and real time neurologic examination while TcMEPs were performed in all anesthetized patients...
February 13, 2019: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Yu Shimizu, Katsuhiro Tsuchiya, Hironori Fujisawa
BACKGROUND: Cerebral venous thrombosis is rare and an uncommon cause of stroke and has diverse etiologies and varied clinical presentations. Here, we report 2 cases of deep cerebral venous thrombosis. CASE DESCRIPTION: A 64-year-old woman presented with cerebral venous thrombosis due to a hypercoagulable state associated with ovarian tumor. On initial fluid-attenuated inversion recovery and diffusion-weighted imaging, there was a diffuse high-intensity lesion in the bilateral thalamus...
February 13, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Yuya Kato, Miki Fujimura, Kenichi Sato, Hidenori Endo, Teiji Tominaga
Moyamoya syndrome (MMS) is an uncommon late complication after cranial irradiation. Its hemorrhagic presentation from the associated pseudo-aneurysm is extremely rare, and the optimal management strategy is undetermined. We herein report a 36-year-old man who developed intraventricular hemorrhage from a pseudo-aneurysm at the extended left anterior choroidal artery as an abnormal collateral of MMS 30 years after surgical removal and cranial irradiation for childhood craniopharyngioma. Catheter angiography confirmed the diagnosis of MMS, and multiple pseudo-aneurysms were evident at the ipsilateral abnormal choroidal collateral, one of which was considered to be a source of bleeding...
February 13, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Zongze Li, Junlin Lu, Li Ma, Chunxue Wu, Zongsheng Xu, Xiaolin Chen, Xun Ye, Rong Wang, Yuanli Zhao
OBJECTIVEPostoperative neurological deficits impair the overall outcome of revascularization surgery for patients with moyamoya disease (MMD). dl-3-n-butylphthalide (NBP) is approved for the treatment of ischemic stroke in China. This pilot study evaluated the effect of NBP on perioperative stroke and neurological deficits in patients with MMD.METHODSThe authors studied cases in which patients underwent combined revascularization surgery for MMD at their institution, with or without NBP administration. The overall study group included 164 patients (213 surgically treated hemispheres), including 49 patients who received NBP (25 mg twice daily) for 7 postoperative days...
February 15, 2019: Journal of Neurosurgery
Yair M Gozal, Gmaan Alzhrani, Hussam Abou-Al-Shaar, Mohammed A Azab, Michael T Walsh, William T Couldwell
OBJECTIVECavernous sinus meningiomas are complex tumors that offer a perpetual challenge to skull base surgeons. The senior author has employed a management strategy for these lesions aimed at maximizing tumor control while minimizing neurological morbidity. This approach emphasizes combining "safe" tumor resection and direct decompression of the roof and lateral wall of the cavernous sinus as well as the optic nerve. Here, the authors review their experience with the application of this technique for the management of cavernous sinus meningiomas over the past 15 years...
February 15, 2019: Journal of Neurosurgery
Karthik Madhavan, Lee Onn Chieng, Valerie L Armstrong, Michael Y Wang
OBJECTIVEDiscitis and osteomyelitis are seen in end-stage renal disease (ESRD) patients due to repeated vascular access for hemodialysis and urinary tract infections leading to recurrent bacteremia. Discitis and osteomyelitis are underdiagnosed due to the nonspecific initial presentation of back pain. In this article, we review the literature for better understanding of the problem and the importance of early diagnosis by primary care physicians and nephrologists. In addition, we discuss the decision-making, follow-up, management, and neurological outcomes...
February 15, 2019: Journal of Neurosurgery. Spine
Constanze Buus-Gehrig, Thomas Lehrnbecher, Luciana Porto, Martina Becker, Thomas Freiman, Michel Mittelbronn, Konrad Bochennek
Tumors of the central nervous system represent the largest group of solid tumors found in pediatric patients. Pilocytic astrocytoma is the most common pediatric glioma, mostly located in the posterior fossa. The majority of brainstem tumors, however, are classified as highly aggressive diffuse intrinsic pontine gliomas (DIPGs) and their prognosis is dismal.The authors report on the case of a neonate in whom MRI and neuropathological assessment were used to diagnose DIPG. Before initiation of the planned chemotherapy, the tumor regressed spontaneously, and the newborn exhibited a normal neurological development...
February 15, 2019: Journal of Neurosurgery. Pediatrics
Richard Voldřich, Martin Májovský, Martin Chovanec, David Netuka
BACKGROUND: Pneumocephalus is commonly associated with cranial trauma including surgical interventions. Spontaneous pneumocephalus on the other hand is a rare diagnosis. Reported cases were predominantly unilateral. We report unique case of a bilateral spontaneous pneumocephalus probably related to bilateral tegmen defect related to repeated Politzer maneuvers. CASE DESCRIPTION: A 78-year-old man suffered from vertigo, tinnitus, instability and mild expressive aphasia...
February 13, 2019: World Neurosurgery
G Lakshmi Prasad, S Divya
PURPOSE: Spinal eosinophilic granulomas(EGs) are uncommon tumors, constituting <1% of all bone tumors. They are mostly seen in the pediatric age group while adult onset is rare. Cervical spine is an infrequent location for involvement by EG. Available literature remains sparse regarding the clinical and management aspects of these lesions, especially in adults. MATERIALS AND METHODS: Literature review was performed by searching online databases to analyze all the reported cases of adult onset cervical EG...
February 13, 2019: World Neurosurgery
C Frei, T Darocha, G Debaty, F Dami, M Blancher, P N Carron, M Oddo, M Pasquier
AIMS: Cardiac arrest related to accidental hypothermia may occur at temperatures below 32 °C. Our goal was to describe the clinical characteristics and outcomes of patients who suffered from witnessed hypothermic cardiac arrest (CA) and assess the occurrence of hypothermic CA as a function of patient body temperature. METHODS: We conducted a systematic review of the literature on cases of hypothermic CA due to rescue collapse. Patient information data from hypothermic CA patients were collected and combined with additional unpublished data to assess the clinical characteristics and outcome of hypothermic CA patients...
February 13, 2019: Resuscitation
Steve Balian, David G Buckler, Audrey L Blewer, Abhishek Bhardwaj, Benjamin S Abella
AIM OF THE STUDY: Regionalization of care for out-of-hospital cardiac arrests (OHCA) may improve patient outcomes. We evaluated inter-hospital variations in post-arrest care provision and the relation between hospital case volume and survival in Pennsylvania. METHODS: This retrospective study (2013-2017) used data from adult OHCA cases in Pennsylvania from the Cardiac Arrest Registry to Enhance Survival. Analysis was performed on hospitals reporting greater than 40 cases/5 years with sustained return of spontaneous circulation upon emergency department arrival and survival to hospital admission...
February 13, 2019: Resuscitation
O Varpuluoma, J Jokelainen, A-K Försti, M Turpeinen, M Timonen, L Huilaja, K Tasanen
No abstract text is available yet for this article.
February 13, 2019: Journal of the American Academy of Dermatology
Tiyasha Sarkar, Nisha Patro, Ishan K Patro
Early life Stress is a worldwide concern linked with development of later life neurological disorder. Early developmental age is sensitive to many prominent environmental insults like malnourishment, immune inflammation, abuse, maternal separation, alcohol and drugs. Hence, an individual during an early age encounters more than one simultaneous stressor that leads to impairment of cognitive and behavioral abilities, a symptom common to most of the neurological disorders. Stressors like malnourishment and immune inflammation are common and encountered by a huge number of populations, contributing enormously to a damaged CNS and in most of the cases they act synergistically in dependency to each other, giving rise to the concept of multi-hit...
February 13, 2019: Brain Research Bulletin
Andrew S Moon, Carly A Cignetti, Jonathan A Isbell, Chong Weng, Sakthivel Rajan Rajaram Manoharan
PURPOSE: Hyperextension-distraction type injury of the thoracolumbar spine is an unstable fracture pattern that generally necessitates surgical stabilization by posterior instrumentation. Care must be taken when positioning these patients from supine to prone due to the unstable nature of their injury. The study objectives were (1) to describe a novel modification of the Jackson table turn technique, which may be safer and more effective than the conventional log-roll method and traditional Jackson table technique for positioning patients with hyperextension-distraction injuries of the thoracolumbar spine from supine to prone in the operating room and (2) to present two cases in which this technique was successfully performed...
February 15, 2019: European Spine Journal
Robert Belvís, Ángel L Guerrero
BACKGROUND: The occipital neuralgia affects 3 out of every 100,000 people and includes the neuralgia of the greater occipital nerve (GON) and the neuralgia of the minor and third occipital nerves. These nerves emerge from the posterior branches of the first cervical roots, innervate the muscles of the nape, and provide the sensitivity of the scalp. The most frequent issue is not to find causes that justify neuralgia for what is usually idiopathic. The nerve that most often causes neuralgia is the GON that is usually wrongly called Arnold's nerve, so neuralgia is also called Arnold's neuralgia...
February 15, 2019: Neurological Sciences
Mitchell T Wallin, William J Culpepper, Jonathan D Campbell, Lorene M Nelson, Annette Langer-Gould, Ruth Ann Marrie, Gary R Cutter, Wendy E Kaye, Laurie Wagner, Helen Tremlett, Stephen L Buka, Piyameth Dilokthornsakul, Barbara Topol, Lie H Chen, Nicholas G LaRocca
OBJECTIVE: To generate a national multiple sclerosis (MS) prevalence estimate for the United States by applying a validated algorithm to multiple administrative health claims (AHC) datasets. METHODS: A validated algorithm was applied to private, military, and public AHC datasets to identify adult cases of MS between 2008 and 2010. In each dataset, we determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. We applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the United States cumulated over 3 years...
February 15, 2019: Neurology
Lorene M Nelson, Mitchell T Wallin, Ruth Ann Marrie, W J Culpepper, Annette Langer-Gould, Jon Campbell, Stephen Buka, Helen Tremlett, Gary Cutter, Wendy Kaye, Laurie Wagner, Nicholas G Larocca
OBJECTIVE: Considerable gaps exist in knowledge regarding the prevalence of neurologic diseases, such as multiple sclerosis (MS), in the United States. Therefore, the MS Prevalence Working Group sought to review and evaluate alternative methods for obtaining a scientifically valid estimate of national MS prevalence in the current health care era. METHODS: We carried out a strengths, weaknesses, opportunities, and threats (SWOT) analysis for 3 approaches to estimate MS prevalence: population-based MS registries, national probability health surveys, and analysis of administrative health claims databases...
February 15, 2019: Neurology
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