Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Aug 2013
Excessively elevated C-reactive protein after surgery for temporal lobe epilepsy.
We present a series of 87 patients who underwent anteromesial temporal lobe resections for therapy refractory temporal lobe epilepsy. In addition to seizure outcome, we observed excessively elevated CRP-levels in this patient population. ⋯ Seizure outcome after surgery for temporal lobe epilepsy was excellent, CRP levels were excessively elevated in these patients in the absence of clinical infection and significantly higher compared to resections of supratentorial lesions.
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Clin Neurol Neurosurg · Aug 2013
Diffusion tensor imaging patterns differ in bulbar and limb onset amyotrophic lateral sclerosis.
Amyotrophic lateral sclerosis (ALS) is characterized by pronounced clinical heterogeneity in terms of onset and disease progression. Widespread changes in white matter fibres could be observed by diffusion tensor imaging (DTI), which detects alterations in the degree (diffusivity, ADC) and directedness (fractional anisotropy, FA) of proton movement. The aim of the current study was to determine whether different ALS onset types were reflected in different DTI brain patterns. ⋯ DTI changes can be regarded as prominent features in ALS. Herein we were able to demonstrate discriminating brain DTI patterns due to bulbar or limb onset.
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Clin Neurol Neurosurg · Aug 2013
Angiogram negative subarachnoid haemorrhage: outcomes and the role of repeat angiography.
Angiogram negative sub-arachnoid haemorrhage (SAH) is generally considered to have a more benign course than SAH of known cause. There is also variability from centre to centre as to what proportion of angiogram negative SAH patients undergo repeat Digital Subtraction Angiography (DSA). We performed a retrospective study looking at the last four years' of SAH patients at our institution in order to ascertain the clinical course, the nature and results of repeat imaging. ⋯ While generally more benign, angiogram negative subarachnoid haemorrhage can have a complicated clinical course. In our experience repeat DSA should be reserved for cases in which there is significant suspicion of occult vascular lesion. However, evidence-based guidelines are needed to aid the development of management protocols for angiogram-negative SAH and ensuring optimal patient outcomes.
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Clin Neurol Neurosurg · Aug 2013
Decompressive craniectomy, interhemispheric hygroma and hydrocephalus: a timeline of events?
Decompressive craniectomy (DC) is a known risk factor for the development of post-traumatic hydrocephalus. The occurrence of subdural hygroma (SH) was also reported in 23-56% of patients after DC and it seemed to precede hydrocephalus in more than 80% of cases. We analyzed the relationship among DC, SH and hydrocephalus. ⋯ Craniectomy close to the midline can predispose patients to the development of hydrocephalus. SH could be generated with the same mechanism, and these three events could be correlated on a timeline.
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Clin Neurol Neurosurg · Aug 2013
Posterior reduction and instrumentation with rod-screw construct for atlanto-axial dislocation: a single institutional study with 21 consecutive cases.
Atlanto-axial dislocation is one of the leading causes for occipito-cervical instability. This study aimed for investigating the clinical outcome of rod-screw construct rather than traditional posterior wiring for atlanto-axial dislocation. ⋯ This surgical procedure provided satisfactory reduction of the atlanto-axial joint with significant neurological improvement. Moreover, we successfully avoided complications of posterior wiring.