Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Feb 2009
Efficacy of the revascularization surgery for adult-onset moyamoya disease with the progression of cerebrovascular lesions.
In moyamoya disease, despite its progressive nature of the occlusive lesions in pediatric patients, the prevalence of the progression in adult patients is undetermined. Furthermore, the optimal timing of the revascularization surgery for progressive cases is controversial. To address these issues, we retrospectively investigate four cases with the adult-onset moyamoya disease manifesting as progression before revascularization surgery. ⋯ Adult-onset moyamoya disease, either bilateral or unilateral, has a substantial risk for progression, and careful follow-up is necessary for asymptomatic hemisphere. Once the patient manifests as the progression of cerebrovascular occlusive lesions or ischemic symptoms, we recommend revascularization surgery after the confirmation of the hemodynamic compromise.
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Clin Neurol Neurosurg · Feb 2009
Clinical and cerebral activity changes induced by subthalamic nucleus stimulation in advanced Parkinson's disease: a prospective case-control study.
High-frequency stimulation of the subthalamic nucleus (STN-DBS) improves motor symptoms in advanced Parkinson's disease (PD), but the mechanisms are still unclear. Functional imaging evidenced pathological overactivity in motor cortical areas in advanced PD that can be normalized by effective therapies. ⋯ Effective STN-DBS is associated with neuronal activity changes in brain regions implicated in movement programming and performance. We hypothesize that clinical benefit might be associated with stimulation-induced normalization of the abnormal overactivity within the cortico-basal ganglia-thalamo-cortical motor loop in advanced PD.
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Clin Neurol Neurosurg · Feb 2009
Review Case ReportsManagement of subdural hematoma in immune thrombocytopenic purpura: report of seven patients and a literature review.
Intracranial hemorrhage is a devastating complication of immune thrombocytopenic purpura (ITP). Subdural hematoma (SDH) is rare and the optimal management unsettled. We report a series of seven patients of ITP who developed isolated SDH and subsequently review the literature. ⋯ Reports of isolated SDH in ITP are infrequent. Compared to those developing intracerebral hemorrhage, SDH occurs more in patients who are older, having chronic ITP and having a higher platelet count. Medical management with close monitoring of neurological parameters is a viable treatment option in patients of ITP developing SDH.
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Clin Neurol Neurosurg · Feb 2009
Clinical TrialGamma knife radiosurgery in patients with trigeminal neuralgia: quality of life, outcomes, and complications.
to assess the outcomes, complications, and alteration in quality of life (QOL) in patients with trigeminal neuralgia who were treated with gamma knife radiosurgery (GKRS) in a prospective observational study. ⋯ GKRS positively changes the several aspect of QOL especially those related to pain relief and mental health component of QOL. The rate of diminishing pain in our study is comparable with other series. The GKRS complication is limited in both variety and number.
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Clin Neurol Neurosurg · Feb 2009
Case ReportsMRI documented acute myelitis in a patient with Vogt-Koyanagi-Harada syndrome: first report.
MRI findings in transverse myelitis complicating Vogt-Koyanagi-Harada (VKH) syndrome have not been documented before. Here, we present a case with acute myelitis complicating VKH syndrome and show the MRI findings.