Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 2018
ReviewManagement of Intracranial Hemorrhage in the Anticoagulated Patient.
Antiplatelet and anticoagulant drugs (antithrombotic drugs) can cause or be associated with intracranial hemorrhage. Patients who take antithrombotic drugs are at higher risk for intracranial hemorrhage after trauma and are neurologically worse acutely compared with patients not on antithrombotic drugs. Treatment of patients on antithrombotic drugs who have intracranial hemorrhage includes reversal of anticoagulant drugs in almost all cases. This article is a synopsis of the data pertaining to intracranial hemorrhage and antithrombotic drugs and methods to diagnose the pharmacologic effects and to reverse the effects of these drugs in patients with traumatic or spontaneous intracranial hemorrhage.
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Neurosurg. Clin. N. Am. · Apr 2018
ReviewPathophysiology and Management of Intracranial Hypertension and Tissular Brain Hypoxia After Severe Traumatic Brain Injury: An Integrative Approach.
Monitoring intracranial pressure in comatose patients with severe traumatic brain injury (TBI) is considered necessary by most experts. Acute intracranial hypertension (IHT), when severe and sustained, is a life-threatening complication that demands emergency treatment. ⋯ In such cases, adding other monitoring modalities can alert clinicians when the patient is in a state of energy failure. This article reviews the mechanisms, diagnosis, and treatment of IHT and brain hypoxia after TBI, emphasizing the need to develop a physiologically integrative approach to the management of these complex situations.
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Despite being the leading cause of spinal cord dysfunction among adults worldwide, little is known about the natural history of degenerative cervical myelopathy (DCM). There is mounting evidence of the effectiveness of surgery for DCM in halting progression of symptoms, and in fact, in improving neurologic outcomes, functional status, and quality of life. However, surgical decision making relies on a weighing of the risks and benefits of alternative strategies. We reviewed the available literature pertaining to the natural course of DCM and the predictors of outcome of nonoperative approaches.
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Neurosurg. Clin. N. Am. · Jan 2018
ReviewEpidemiology and Overview of the Clinical Spectrum of Degenerative Cervical Myelopathy.
Degenerative cervical spondylosis (DCM) is an umbrella term used to describe myelopathy caused by various degenerative changes in the cervical spine. This article outlines the spectrum of DCM and reviews the epidemiology of each factor composing DCM. The uniform term of DCM is expected to elucidate the epidemiology of myelopathy caused by degenerative changes of the cervical spine."
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Neurosurg. Clin. N. Am. · Jan 2018
ReviewIntraoperative Neurophysiologic Monitoring for Degenerative Cervical Myelopathy.
Multimodal intraoperative neurophysiologic monitoring is a reliable tool for detecting intraoperative spine injury and is recommended during surgery for degenerative cervical myopathy (DCM). Somatosensory evoked potential (SEP) can be used to monitor spine and peripheral nerve injury during positioning in surgery for DCM. Compensation technique for transcranial evoked muscle action potentials (tcMEPs) should be adopted in intraoperative monitoring during surgery for DCM. Free-running electromyography is a useful real-time monitoring add-on modality in addition to SEP and tcMEP.