World Neurosurg
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Patients with central nervous system (CNS) hemorrhage who receive anticoagulation (AC) therapy are at high risk for progressive or recurrent hemorrhagic and thromboembolic (TE) events. The authors conducted a survey at the 2010 American Association of Neurological Surgeons (AANS) annual meeting to determine how these patients are currently being managed by neurosurgeons. ⋯ This study is the first to describe how patients with CNS hemorrhage who receive AC therapy are currently being managed by clinicians. An apparent neurosurgical preference to avoid hemorrhagic complications is at odds with a suggested early risk for TE. These data suggest that the neurosurgical management of patients with CNS hemorrhage who receive AC therapy is an area that could benefit from consensus-based practice guidelines and an organized effort at knowledge translation and mobilization.
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An intramedullary spinal cord abscess is a rare, albeit widely publicized entity. Classically, patients have an acute onset of symptoms with fevers and leukocytosis supporting the diagnosis. We present a case of intramedullary spinal cord without classic history or imaging characteristics in which the diagnosis was made with diffusion weighted magnetic resonance imaging (MRI). ⋯ The use of diffusion weighted imaging in the spine is a novel application of technology that provided an accurate preoperative diagnosis and allowed us to tailor our surgical approach and provide a rapid focal decompression.
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Case Reports
Successful repair of a gunshot wound to the head with retained bullet in the torcular herophili.
Nonlethal missile injuries to the dural venous sinus system are rare. To date successful repair of isolated penetrating injury to the torcular herophili has not been reported without significant associated morbidity. We report the case of a gunshot wound injury to the occipital region with retained bullet fragment in the confluence of the sinuses causing traumatic sinus venous thrombosis. ⋯ Gunshot wounds with retained bullet fragments in the torcula can be successfully repaired with preservation of neurological function after retrieval of metallic foreign body and restoration of venous sinus patency.
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To analyze the characteristics of brain arteriovenous malformations (AVMs) associated with cerebral aneurysms. ⋯ Our findings suggest that AVMs associated with cerebral aneurysms are frequently associated with initial hemorrhage presentation and infratentorial AVM location.
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Hyponatremia in patients with traumatic brain injury: etiology, incidence, and severity correlation.
Hyponatremia is common in patients with traumatic brain injury (TBI). This study aims at ascertaining the incidence of hyponatremia in TBI with its etiologic diagnosis, biochemical confirmation, and severity correlation with initial Glasgow Coma Scale (GCS) score and computed tomography (CT) abnormality. ⋯ Hyponatremia due to SIADH is more common in TBI. FEUA measurement is not consistent enough to make a distinction between SIADH and CSWS. CT scoring of severity is more predictive of hyponatremia than initial GCS.