World Neurosurg
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Intracranial aneurysm in patients with sickle cell disease is rare, but with an increased incidence in the recent years. This type of intracranial aneurysm possesses distinctive characteristics, and it has been the subject of case reports and series. ⋯ Intracranial aneurysms related to sickle cell disease mainly affected patients in their 20s, with a contradictory sex ratio in children and adults. Aneurysms manifested predisposition for multiplicity and posterior circulation. There was no difference between children and adults regarding shape and location of aneurysms. However, children with lower aneurysm rupturing rates had better outcomes than their adult counterparts did.
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Multicenter Study
Association of plasminogen activator inhibitor 1 (SERPINE1 gene) polymorphisms and aneurysmal subarachnoid hemorrhage.
Genetic variations of the serine proteinase inhibitor family E member 1 (SERPINE1) gene, which encodes plasminogen activator inhibitor 1, correlate with serum levels of its product and are associated with thrombophilia and coronary atherosclerosis. Various SERPINE1 ;gene polymorphisms have been identified. However, only the functional 5G/4G polymorphism has been assessed in the context of aneurysmal subarachnoid hemorrhage (aSAH). We assessed associations of 6 SERPINE1 polymorphisms with the clinical sequelae of aSAH. ⋯ SERPINE1 gene polymorphisms were associated with delayed cerebral ischemia and functional outcome after aSAH. These associations may arise from alterations of plasminogen activator inhibitor 1 levels.
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Essential tremor (ET) is the most common movement disorder of adults, affecting an estimated 7 million Americans. Symptoms of ET range from slightly noticeable to debilitating, with 1 cohort study finding 15% of patients were forced into early retirement. Additionally, depression has also been correlated with the severity of disability of ET. Treatment options include propranolol and primidone. Current treatment options are not very effective, with more than half (56.3%) of patients discontinuing medications because of no changes in symptoms. ⋯ With a better side-effect profile and success in a physiologically related condition, we propose more clinical trials and research be carried out on intrathecal baclofen as a potential treatment option, especially drug refractory ET, so as to increase the quality of life of this patient population.
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The prognosis in cervical spinal cord injury is poor, and surgical and neurointensive care management need further improvement. Monitoring of the intraspinal pressure (ISP) at an early stage after traumatic spinal cord injury (tSCI) is useful clinically. ⋯ A randomized controlled trial is required to determine whether laminectomy with durotomy and monitoring of ISP with SCPP optimization improve neurological recovery after tSCI.
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Vascular anomalies in the form of dural arteriovenous fistulas (DAVFs), arteriovenous malformations, and aneurysms are well described in the literature. Pial arteriovenous fistulas (PAVFs) are described to a lesser extent in the literature. When these anomalies are combined, diagnosis and treatment become complex. ⋯ The exact mechanism of PAVF/DAVF formation is unknown. Hemorrhage predilection of PAVF/DAVF is more difficult to predict than a sole fistula, likely secondary to the complex flow dynamics. To our knowledge, this literature review is the largest review to date regarding PAVFs in adult patients and can provide insight into decision making when evaluating treatment options.