Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Aug 2014
Therapeutic hypothermia for adult community-acquired bacterial meningitis-historical control study.
Despite advances in antibiotic therapy and critical care, community-acquired bacterial meningitis (CABM) continues to have poor outcome in a significant portion of patients. This study was designed to assess the efficacy of therapeutic hypothermia (TH) in the treatment of CABM. ⋯ The new therapeutic concept based on hypothermia significantly improves the outcome in adult patients with severe CABM.
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Clin Neurol Neurosurg · Aug 2014
Overlapping stents for blood blister-like aneurysms of the internal carotid artery.
Blood blister-like aneurysms (BBAs) are unique due to their high risk of recurrent bleeding associated with their fragile neck. The best treatment for BBAs is still controversial. This paper sought to evaluate the safety and efficacy of stent-assisted coiling and subsequent overlapping stents (SAC+OS) in the treatment of BBAs. ⋯ Stent-assisted coiling and subsequent overlapping stents are feasible and safe for BBAs. It can be helpful to further decrease the risk of recanalization with more stents. Early angiographic follow-up within 2 weeks is recommended.
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Clin Neurol Neurosurg · Aug 2014
Clinically relevant complications related to posterior atlanto-axial fixation in atlanto-axial instability and their management.
The Magerl transarticular technique and the Harms-Goel C1 lateral mass-C2 isthmic screw technique are the two most commonly used surgical procedures to achieve fusion at C1-C2 level for atlanto-axial instability. Despite recent technological advances with an increased safety, several complications may still occur, including vascular lesions, neurological injuries, pain at the harvested bone graft site, infections, and metallic device failure. ⋯ Atlanto-axial fixation surgery remains a challenging procedure because of the proximity of important neurovascular structures. Nevertheless, on the basis of our current experience, the C1 lateral mass-C2 isthmic screw technique appears to be safe with a low incidence of clinically relevant complications. Postoperative C2 neuralgia, as the most frequent problem, is due to surgical manipulation during preparation of the C1 screw entry point.
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Clin Neurol Neurosurg · Jul 2014
ReviewA review of modifying factors affecting usage of diagnostic rating scales in concussion management.
Sport-related concussion has gained increasing recognition as a result of recent legislation, public health initiatives and media coverage. Moreover, there have been substantial paradigm shifts in the management of concussion. This article will discuss the variables that affect the use of diagnostic rating scales such as ImPACT and SCAT in the current management of concussed individuals. Specifically, patient-specific modifying factors affecting test interpretation, including age, gender, fitness level, psychiatric conditions, learning disorders and other components of medical history will be addressed, as well as methodological concerns with baseline testing.