Neurosurgery
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Comparative Study
Atlantoaxial rotatory fixation: part 2--new diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging.
This is Part II of a study on atlantoaxial rotatory fixation (AARF) that aims to introduce a new diagnostic paradigm and a new classification of this condition based on motion analysis of C1C2 rotation using computed tomographic (CT) imaging. This phase of the study is possible because Part I succeeded in defining physiological C1C2 axial rotation with CT data from 21 normal children, displayed in a highly concordant composite motion curve, which is used as the normal template for the present study. AARF is defined as flagrant departure from normal motion dynamics as delineated by abnormal motion curves. The new classification is predicated on the graded amount of pathological stickiness in the restricted rotation. ⋯ AARF can be reliably diagnosed with a simple and practical CT protocol and construction of a three-point motion curve superimposed on a reusable normal template. The type of AARF, reflective of the severity of pathological stickiness of rotation, can be identified readily by the shape of the motion curve. This system of classification is useful in selecting the best regimen of management.
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Comparative Study
Rapid administration of antifibrinolytics and strict blood pressure control for intracerebral hemorrhage.
Hematoma growth is a major cause of poor outcome in patients with intracerebral hemorrhage. We evaluated the efficacy of a combination of rapid antifibrinolytic therapy and strict blood pressure control for prevention of hematoma growth in this retrospective study. ⋯ The combination of rapid administration of antifibrinolytics and strict blood pressure control may prevent hematoma growth in patients with intracerebral hemorrhage.
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Comparative Study
Concussion in professional football: brain responses by finite element analysis: part 9.
Brain responses from concussive impacts in National Football League football games were simulated by finite element analysis using a detailed anatomic model of the brain and head accelerations from laboratory reconstructions of game impacts. This study compares brain responses with physician determined signs and symptoms of concussion to investigate tissue-level injury mechanisms. ⋯ Finite element modeling showed the largest brain deformations occurred after the primary head acceleration. Midbrain strain correlated with memory and cognitive problems and removal from play after concussion. Concussion injuries happen during the rapid displacement and rotation of the cranium, after peak head acceleration and momentum transfer in helmet impacts.
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Peduncular hallucinosis is a rare phenomenon characterized by visual hallucinosis and agitation. It appears mainly in vascular lesions affecting the brainstem, and some recent reports describe the preoperative and postoperative appearance of peduncular hallucinosis in patients affected through tumor compression at the brainstem. ⋯ The cranial base neurosurgeon should be aware not only of the phenomenon but the surgical influence in provoking it.