Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Oct 2006
Case ReportsBilateral C5 motor paralysis following anterior cervical surgery--a case report.
Numerous authors have reported C5 root palsies following posterior cervical surgery, and several mechanisms of injury have been proposed. Similar deficits after anterior cervical procedures are considered to occur less commonly. We report on a 48-year-old male who underwent multi-level anterior discectomy and fusion for cervical spondylotic myelopathy. ⋯ The patient returned to his preoperative occupation as an operating room nurse 6 months following surgery, with complete neurologic recovery occurring over an 11-month period. C5 deficits following anterior cervical surgery occur more frequently than generally assumed. Improved lordosis and longitudinal lengthening of the cervical spinal column in multilevel anterior decompression and interbody fusion can paradoxically result in a traction injury to the spinal cord and C5 nerve roots.
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Clin Neurol Neurosurg · Sep 2006
Review Case ReportsConcomitant choroid plexus papillomas involving the third and fourth ventricles: A case report and review of the literature.
Choroid plexus papillomas (CPP) are histopathologically benign and rare central nervous system (CNS) neoplasms arising from the epithelium of the choroid plexus. The most common site of presentation of these lesions is in the fourth ventricle in adults and lateral ventricles in children. Third ventricular CPP are uncommon. ⋯ Concomitant CPPs may be secondary to mere coincidental tumor occurrence or to biologic seeding of cerebrospinal fluid (CSF) from a primary CPP despite otherwise benign histopathology. The primary treatment for CPP is surgical resection. Post-operative chemotherapy or radiation for CPP is of controversial benefit.
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Clin Neurol Neurosurg · Sep 2006
Randomized Controlled TrialEffect of methylphenidate on ICU and hospital length of stay in patients with severe and moderate traumatic brain injury.
Traumatic brain injury is one of the major causes of death and disability among young people. Methylphenidate, a neural stimulant and protective drug, which has been mainly used for childhood attention deficit/hyperactivity disorder, has shown some benefits in late psychosocial problems in patients with traumatic brain injury. Its effect on arousal and consciousness has been also revealed in the sub-acute phase of traumatic brain injury. We studied its effect on the acute phase of moderate and severe traumatic brain injury (TBI) in relation to the length of ICU and hospital admission. ⋯ There were no significant differences between the treatment and control groups in terms of age, sex, post resuscitation GCS, or brain CT scan findings, in either severely or moderately TBI patients. Methylphenidate was associated with reductions in ICU and hospital length of stay by 23% in severely TBI patients (P = 0.06 for ICU and P = 0.029 for hospital stay time). However, in the moderately TBI patients who received methylphenidate, there was 26% fall (P = 0.05) only in ICU length of stay.
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We report the case of a 20-year-old man with a gunshot injury as an example of spontaneous migration of a metallic foreign body within the brain. Computed tomography (CT) showed the bullet in the left temporoparietal region. At 10 days follow-up, CT revealed that the bullet had migrated posteriorly, due to the effect of gravity, lodging in the occipital lobe. Although there are a few literature reports of spontaneous migration of a bullet within the brain, this case was unique as the patient was fully conscious without any neurological deficit.