Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Nov 2018
Clinical and magnetic resonance imaging predictors of the surgical outcomes of patients with cervical spondylotic myelopathy.
To determine whether clinical characteristics and signal and morphologic changes on magnetic resonance (MR) images of the spinal cord (SC) are associated with surgical outcomes for cervical spondylotic myelopathy (CSM). ⋯ A longer duration of symptom, multisegmental T2HSCs on sagittal MR images, and fuzzy focal T2HSCs on axial MR images were highly predictive of a poor surgical outcome for CSM. Smaller transverse area of the SC and bright T2HSCs were also associated with the prognosis of CSM.
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Clin Neurol Neurosurg · Nov 2018
Efficacy of platelet transfusion in the management of acute subdural hematoma.
Oral Antithrombotic Therapy has become a well documented predisposing risk factor in the development of traumatic intracranial hemorrhage. Currently, a reversal protocol for antiplatelet therapy remains ill-defined in the management of non-surgical traumatic subdural hematoma and there is no evidence to suggest a clear benefit of platelet transfusion to mitigate the effect of antiplatelet agents. This study aims to establish parameters in which platelet transfusion would be of benefit in patients with non-surgical traumatic subdural hematoma with preinjury antiplatelet therapy. ⋯ The results of this study suggest that patients with non-surgical traumatic subdural hematomas on presentation are less likely to expand, however the risk of expansion is greater when the patient is on antiplatelet therapy. There is no clear benefit in the use of platelet transfusion as a reversal agent to mitigate the effects of antiplatelet therapy in the setting of non-surgical traumatic subdural hematomas.
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Clin Neurol Neurosurg · Nov 2018
Case ReportsTargeting the hot spot in a patient with essential tremor and Parkinson's disease: Tractography matters.
Thalamic ventralis intermedius deep brain stimulation (VIM-DBS) is generally effective in treating refractory tremor in Parkinson's disease (PD) and in essential tremor (ET), but some patients do not respond well due to side effects or from loss of the effect of stimulation over time. The caudal zona incerta (ZI) has emerged as a promising target in ET, and the effects of ZI-DBS on PD tremor are less studied. Here, we describe a rare situation in which both ET and PD coexist in a 72-year-old male referred for ZI-DBS due to refractory tremor. The aim of this study was to evaluate whether there was a difference in the area stimulated to improve each type of tremor and whether tractography could improve and predict motor outcome. ⋯ Regardless of the type of tremor, DRTT can be the most effective region for stimulation. Tractography should be considered when planning the surgical target since the DRTT is not always symmetrical, and the reconstruction of the VTA together with the tractography can greatly improve the DBS programming, and, probably, the patient's outcome to the stimulation.
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Clin Neurol Neurosurg · Oct 2018
Subacute combined degeneration of the spinal cord following nitrous oxide anesthesia: A systematic review of cases.
Vitamin B12 deficiency can lead to subacute combined degeneration (SCD). Nitrous oxide (N2O) is an anesthetic which oxidizes the cobalt ion of vitamin B12, interfering with its function as a coenzyme. In this study, we conduct a systematic review of reported cases of SCD following nitrous oxide anesthesia. ⋯ In patients with postsurgical myelopathy, surgeons should evaluate B12 status and consider the possibility that nitrous oxide could cause a subclinical B12 deficiency to become overt, particularly in patients with malabsorptive GI comorbidities. Treatment with B12 in this population can result in significant improvement of neurological function.
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Clin Neurol Neurosurg · Oct 2018
Minimizing overdrainage with flow-regulated valves - Initial results of a prospective study on idiopathic normal pressure hydrocephalus.
Overdrainage and frequent reprogramming are common issues with programmable valves after ventriculoperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (iNPH). Flow-regulated valves may address these limitations, but data on their efficacy are sparse. We present our single-center experience with flow-regulated valves focusing on overdrainage and efficiency. ⋯ The use of the Integra® NPH Low Flow Valve leads to a good neurological outcome and has low overdrainage rates without the need for reprogramming. These results are encouraging and justify further investigation of this valve.