Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Of patients hospitalised for traumatic brain injury (TBI), most pass through a state of altered consciousness known as "post-traumatic amnesia" (PTA). Despite the lack of a consistent definition, PTA is widely used as a construct in neurosurgical practice to guide decision-making and prognosis. Accurate PTA assessment is important, because over-evaluation leads to excess social, financial and opportunity costs, whilst under-evaluation risks patient welfare. ⋯ Although all of these features were fully described (or implied) by the earliest pioneers, most current PTA scores do not assess the complete "post-TBI syndrome". Currently, the Westmead PTA scale (WPTAS) directs most in-hospital TBI management throughout Australasia: however, in addition to general defects, specific limitations have been identified in the levels of evidence for WPTAS validity. We review the literature regarding PTA and, in particular, the continued role of the WPTAS in directing neurosurgical practice.
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Current surgical treatments for refractory trigeminal neuralgia (TN) include microvascular decompression (MVD), percutaneous rhizotomy, and stereotactic radiosurgery (SRS). We aimed to map the trends of utilization of these procedures in the USA and examine factors associated with morbidities and discharge outcome. We performed a retrospective cohort study with time trends of patients admitted to US hospitals for TN between 1988 and 2008 who received MVD, percutaneous rhizotomy, or SRS as reported in the Nationwide Inpatient Sample. ⋯ For SRS, patient age and length of stay were found to be important by multivariate analysis on discharge. Mortality rates for MVD (0.22%), rhizotomy (0.42%), and SRS (0.12%) were low. The clinical practices for surgical treatment of TN have evolved over time with the rise of MVD and dwindling of rhizotomy procedures.
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We studied 25-hydroxyvitamin D (vitamin D) levels in patients with amyotrophic lateral sclerosis (ALS) and the effect of vitamin D supplementation. Vitamin D levels were checked in 37 consecutive patients with ALS. Demographic data, vitamin D supplementation, change in Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score, and side effects from vitamin D were noted over a 9 month follow-up period. ⋯ No side effects secondary to vitamin D supplementation were reported. Vitamin D supplementation at 2000 international units daily was safe over a period of 9 months and may have a beneficial effect on ALSFRS-R scores. Further studies are warranted to determine whether there is a benefit in vitamin D supplementation for all ALS patients.
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Spinal epidural lipomatosis (SEL) is an abnormal accumulation of unencapsulated, epidural fat. SEL can be divided into idiopathic and secondary. Secondary SEL is often associated with chronic steroid use and endocrinopathies. ⋯ SEL has been implicated in a variety of neurologic impairments and surgical decompression has been shown to prevent further worsening or result in improvement. We report a 53-year-old man with obesity and a history of chronic back pain who developed idiopathic SEL diagnosed by MRI, which subsequently resolved completely over an 8 month follow-up period. To our knowledge, this is the first reported case of complete radiographic resolution of SEL without any treatment.
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Deep brain stimulation (DBS) has emerged as a viable therapy for Parkinson's disease (PD). The impact of subthalamic nucleus (STN) lead placement (lateral versus medial) on motor outcome, however, has not been systematically evaluated. Forty-eight patients with PD underwent STN-DBS surgery and were evaluated postoperatively for 48 weeks for motor improvement as measured by the Unified Parkinson's Disease Rating Scale (UPDRS) part III (standardized motor examination) and levodopa equivalent daily dose (LEDD). ⋯ No significant difference in stimulation voltage was noted with respect to lead location. Our study did not find a significant effect for the location of active contact and motor outcome neither within the subregions of the STN nor between the STN and surrounding fibers. Further research is needed to better understand the neurophysiological basis for these results.