Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Case Reports
Vasospasm followed by diastolic flow reversal in the intracranial arteries after subarachnoid haemorrhage.
Vasospasm and raised intracranial pressure (ICP) are common complications in subarachnoid haemorrhage (SAH) due to ruptured intracranial aneurysm. Vasospasm can be reliably monitored by repeated transcranial Doppler (TCD) examinations. The changes in flow velocities due to vasospasm are useful for early diagnosis, monitoring effectiveness of treatment and determining prognosis. ⋯ These temporal changes observed during serial TCD examinations were well correlated with the ICP. Transcranial Doppler is a reliable, beat-to-beat, non-invasive and reproducible bedside test that can be used to monitor vasospasm and ICP in SAH. The use of TCD can be extended to other intracranial diseases that can potentially lead to an abnormally high ICP.
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Brain involvement with hydatid disease occurs in 1-2% of all Echinococcus granulosus infections. Cerebral hydatid cysts are usually supratentorial, whereas infratentorial lesions are quite rare. Here we report a 19-year-old man with hydatid cysts in the right cerebellopontine cistern with the involvement of internal acoustic canal and jugular foramen. ⋯ Surgery was performed in the semi-sitting position using a lateral suboccipital approach for a right-sided craniotomy. Magnetic resonance imaging clearly demonstrated cisternal, neural and vascular relationships which aided in intact surgical removal of the lesion using microsurgical techniques. Total removal without rupture should be the surgical goal in all hydatid cysts.
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Clinical Trial
Outcome of and prognostic factors for decompressive hemicraniectomy in malignant middle cerebral artery infarction.
Decompressive hemicraniectomy as an appropriate treatment for malignant middle cerebral artery (MCA) infarction is still a controversial issue. This study aimed to determine the survival rate and functional outcome, and factors associated with these, in patients with malignant MCA infarction. From January 2000 to December 2003, 60 patients with malignant MCA infarction were treated in our hospital. ⋯ The factors associated with favourable outcome were age<60 years and treatment within 24 hours of ictus, before clinical signs of herniation were noted. Decompressive hemicraniectomy should be performed in patients younger than 60 years within 24 hours of ictus before clinical signs of herniation develop. Age, timing of surgery and clinical signs of herniation are prognostic factors for mortality and functional outcome.
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Comparative Study
Recombinant human erythropoietin decreases myeloperoxidase and caspase-3 activity and improves early functional results after spinal cord injury in rats.
Inflammatory response and apoptosis have been proposed as mechanisms of secondary injury of the spinal cord after primary insult. Recent studies have shown that erythropoietin (EPO) has neuroprotective properties. In this study, we assessed the efficacy of recombinant human erythropoietin (r-Hu-EPO) in the treatment of acute spinal cord injury (SCI) in rats. ⋯ MPO and caspase-3 enzyme activity levels were significantly reduced in animals treated either with r-Hu-EPO or MPSS. In addition, we observed significant early functional recovery in EPO-treated rats. EPO has anti-apoptotic and anti-inflammatory effects, and improves early clinical results after SCI.
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The aim of this retrospective study is to evaluate the role of the implanted peripheral nerve stimulator in patients with pain in a peripheral nerve distribution. The current study is the largest in the literature that examines the role of the implantable peripheral nerve stimulator in the chronic pain patient. Our patient sample included 38 patients (with 41 nerve stimulators), consisting of 19 males and 19 females with a mean age of 44 years (SD=11 years). ⋯ Eighteen of 38 (47%) patients reported a significant improvement in their activity levels following stimulator implant. In conclusion, over 60% of patients had a significant improvement in their pain and lifestyle following implantation of peripheral nerve stimulators. We therefore conclude that peripheral nerve stimulation can be useful in decreasing pain in well selected patients with severe pain in the distribution of a peripheral nerve.