Neurology India
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Development of cerebral infarcts following clipping of ruptured intracranial aneurysm is one of the major determinants of functional outcome in patients with subarachnoid hemorrhage (SAH). The aim of this study is to evaluate the factors affecting development of postoperative infarcts, its incidence, pattern, and functional outcome. ⋯ Development of symptomatic infarct is the sole important predictor of functional outcome. A crowded neurovascular neighborhood and complex variations in local angioarchitecture make anterior communication (ACOM) territory predisposed to operative insults. Elective TC and aggressive management of cerebral vasospasm are recommended to prevent development of infarcts.
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Meta Analysis
Role of Decompressive Craniectomy in Traumatic Brain Injury - A Meta-analysis of Randomized Controlled Trials.
Several studies have indicated that decompressive craniectomy (DC) for traumatic brain injury (TBI) is lifesaving. However, there is lack of level 1 evidence to define the role of DC in TBI. We performed a meta-analysis of all the randomized controlled trials (RCTs) published so far on the role of DC in adult patients with TBI. ⋯ Based on the available RCTs on DC in TBI, the results of our meta-analysis show that there is a mortality benefit of performing a DC over the best medical management in adult patients. Furthermore, surviving following DC, a greater incidence of a poor neurological outcome is noted. In the event of small number of high-quality RCTs, our results must be interpreted with caution.
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Aneurysm rupture is often a fatal complication of giant intradural aneurysm (GIA) treatments. The purpose of this study was to review aneurysm rupture in GIA treatment. ⋯ Intraoperative and delayed aneurysm ruptures were the most challenging in endovascular treatment of GIAs. Giant VBA aneurysm had the highest rupture risk after treatment. FD seemed to elevate the delayed rupture proportion of giant paraclinoid aneurysms.
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Brachial plexus neuropathies are uncommon and are rarely caused by a tumor. The clinical presentation of a brachial plexus neuropathy caused by a tumor depends on the degree of malignancy of the tumor and its localization. We report an illustrative case of a 27-year old female subject with a progressively increasing mass lesion causing brachial plexus compression, ipsilateral shoulder pain, C8 dermatomal paresthesia, and impairment of motor power. ⋯ The histopathological diagnosis revealed a hibernoma, an extremely rare tumor described only once previously in this location. A systematic review of the literature was performed utilizing the PubMed database to access articles published before March 2018, using: A - the term 'hibernoma' in the title/abstract associated with the following MeSH terms: brachial plexus neuropathies OR brachial plexus neuropathy OR nerve compression syndrome, OR brachial plexus; B - the MeSH term 'brachial plexus' associated with the term 'non neural sheath nerve tumor' or 'peripheral non-neural sheath nerve tumor'. The origin of the hibernoma, as well as its metabolic influence, pathology, and treatment have been discussed.
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Shoulder stability, abduction and external rotation are vital for the performance of usual daily tasks. ⋯ SASNT is a consistent procedure to achieve functional recovery of shoulder abduction after a partial or complete plexus injury, but the outcomes of external rotation were quite disappointing in both the groups.