Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Post-stroke discharge planning may be aided by accurate early prognostication. Machine learning may be able to assist with such prognostication. The study's primary aim was to evaluate the performance of machine learning models using admission data to predict the likely length of stay (LOS) for patients admitted with stroke. ⋯ Logistic regression was also the best performing model for predicting home vs non-home discharge destination (AUC 0.81). This study indicates that machine learning may aid in the prognostication of factors relevant to post-stroke discharge planning. Further prospective and external validation is required, as well as assessment of the impact of subsequent implementation.
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Review Case Reports
Cerebral vasospasm and delayed ischaemic deficit following elective aneurysm clipping.
Although common after subarachnoid haemorrhage, cerebral vasospasm (CVS) and delayed ischaemic neurological deficit (DIND) rarely occur following elective clipping of unruptured aneurysms. The onset of this complication is variable and its pathophysiology is poorly understood. We report two patients with CVS associated with DIND following unruptured aneurysmal clipping. ⋯ In one patient, this was done promptly and the patient made a complete recovery, but in the other, the diagnosis was delayed for more than 24hours and the patient had residual hemiparesis and dysphasia due to MCA territory infarction. CVS and DIND following treatment of unruptured aneurysms is a very rare event. However, clinicians should be vigilant as prompt diagnosis and management is required to minimise the risk of cerebral infarction and poor outcome.
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Intracranial cerebrospinal fluid (CSF) hypotension usually arises in the context of known or suspected leak of CSF. This can be spontaneous, or due to central nervous system trauma or dural defects created during lumbar puncture or epidural anaesthesia. ⋯ Whilst commonly mild and self-limiting, CSF hypotension may result in life threatening complications and is most often treatable. When the syndrome is severe, prolonged or complicated, epidural blood patching (EBP) is the mainstay of treatment.
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Posterior surgery has been widely used as an initial surgery for cervical ossification of the posterior longitudinal ligament (OPLL). However, some patients require revision surgery because of failure of symptom relief or late neurological deterioration after posterior surgery. The aim of this study is to retrospectively investigated the surgical results and complications of anterior controllable antedisplacement fusion (ACAF) as a revision surgical technique after initial posterior surgery for OPLL. ⋯ The mean postoperative JOA score at last follow-up was significantly better than preoperation (14.8 ± 2.5 vs. 8.5 ± 2.7 points, P < 0.01), with a mean improvement rate of 75.3% ± 12.2%. No complication such as CSF leakage, spinal cord or nerve injury, subsidence and pseudoarthrosis occurred. In conclusion, ACAF is a well choice for revision surgery after initial posterior surgery for OPLL.
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There is a new focus on minimally invasive treatments for medically refractory mesial temporal lobe epilepsy (MTLE). MRI-guided laser interstitial thermal therapy (MRgLITT) is one such minimally invasive procedure, which utilizes MRI guidance and real-time feedback to ablate an epileptogenic focus. A total of 38 patients presenting exclusively with MTLE and no other lesions (including neoplasia), who underwent MRgLITT were reviewed. ⋯ MRgLITT may be an alternative treatment option for high risk surgical patients and, more importantly, could increase referrals for surgery in patients with medically refractory MTLE. However, data is limited and long-term outcomes have not been evaluated. Further investigation is required to understand the potential of this minimally invasive technique for MTLE.