Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Dec 2007
Aneurysms unsuitable for endovascular intervention: surgical outcome and management challenges over a 5-year period following International Subarachnoid Haemorrhage Trial (ISAT).
To analyse outcome of surgical management of aneurysms unsuitable for endovascular intervention in a tertiary referral neurosurgical unit over a 5-year post-ISAT period. To compare secondary parameters such as operating time, number of clips required, and training over last 5 years with similar number of patients in the pre-ISAT period. ⋯ Ruptured cerebral aneurysms deemed unsuitable for endovascular intervention are also difficult cases to treat surgically. However, with neurovascular sub-specialisation, it is possible to achieve favourable surgical outcome in a higher percentage of cases than reported in the ISAT study and the National Study of Subarachnoid Haemorrhage. These cases, due to their technical complexities, unfortunately offer limited training potential for pre-certification Neurosurgical trainees.
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Clin Neurol Neurosurg · Dec 2007
Case ReportsIschemic stroke in a child mistaken as functional disorder.
Stroke is a rare but increasingly recognized disorder in children. Lack of published clinical trials and experience in most institutions has resulted in significant challenges for clinicians who manage children with stroke. We report a case of 16-year-old male child who was presented with history of sudden onset of weakness 2 months back and before he could consult the physician, the weakness improved significantly and a misdiagnosis of functional disorder was made at a peripheral hospital. Children with stroke may have subtle manifestations and to make an early diagnosis of stroke in children there is need of awareness about this entity in children.
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Clin Neurol Neurosurg · Dec 2007
Decompressive hemicraniectomy in a space-occupying presentation of hemiconvulsion-hemiplegia-epilepsy syndrome.
A case of an acute life-threatening presentation of hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome requiring an urgent decompressive hemicraniectomy is described. A 9 month-old baby had a status epilepticus following a sustained fever, leading to a comatose state and a right pupillary dilatation associated with a left hemiplegia. The MRI showed a swelling right hemisphere with marked temporal herniation. ⋯ The histological findings were unspecific, showing a gliotic spongiosis with disseminated granular cells. The post-operative MRI depicted a right hemisphere atrophy. To our knowledge, a space-occupying presentation of HHE syndrome requiring surgical decompression has never been described before while only a few reports dealt with the neuropathological aspects of this syndrome.