British journal of neurosurgery
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An adequate response of hypothalamic-pituitary-adrenal (HPA) axis is important for survival and recovery after a severe disease. The hypothalamus and the pituitary glands are at risk of damage after subarachnoid haemorrhage (SAH). A better understanding of the hormonal changes would be valuable for optimising care in the acute phase of SAH. ⋯ There was an HPA response acutely after SAH with an increase in P-ACTH and S-cortisol. Higher U-cortisol in patients in a better clinical grade may indicate a more robust response of the HPA system. Global cerebral oedema was associated with higher S-cortisol at admission and was a predictor of S-cortisol concentrations. Global cerebral oedema may be the result of the stress response initiated by the brain injury. Periods of suppressed P-ACTH occurred particularly in periods of brain ischaemia, indicating a possible connection between brain ischaemia and ACTH suppression.
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Clinical Trial
Application of a new method of revealing foramen ovale under X-ray in radiofrequency ablation in the treatment of trigeminal neuralgia.
This study is to apply a new method of revealing foramen ovale guided by digital X-ray imaging for precise puncture in radiofrequency ablation (RFA) in the treatment of trigeminal neuralgia. ⋯ By observing the bony mark 'mid-cranial fossa arc', foramen ovale can be clearly displayed in lateral cranial position and under the guidance of X-ray real time imaging this method can be applied successfully in precise puncture of foramen ovale in trigeminal neuralgia radiofrequency ablation.
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Shunts remain the commonest means by which hydrocephalus is treated. Despite the changes in valve and catheter technology, shunt infection and blockage are still a cause of great headache for the patient as well as the neurosurgeon. Antibiotic-laced catheters were proposed as a means by which to reduce shunt colonization and infection. ⋯ In an era of increasing methicillin-resistant Staphylococcus aureus (MRSA) resistance and 'superbugs', is the use of antibiotic-laced catheters adding to the pool of resistant bacteria which may be harder to treat? Vigilance is required, as rare and resistant staphylococci strains occasionally can emerge as causative agents for VP shunt infections, in both adults and children, and their treatment can be difficult.
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Case Reports
An association between cerebral aneurysm re-bleed and CT angiography--more than a coincidence?
Rupture of cerebral aneurysm during CT angiogram is a rare occurrence. Here we present such a case where an aneurysmal re-rupture during CT angiogram was demonstrated.
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We report two cases of cervical spondylotic myelopathy (CSM) with extensive T2-weighted intramedullary changes noted on preoperative imaging extending far beyond the level of compression. A delayed resolution 2 years after cervical oblique corpectomy was noted in both cases. This short report cautions against diagnosing this unusual magnetic resonance imaging (MRI) finding as an intramedullary tumour, demyelination or an inflammatory process.