World Neurosurg
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The presence of hemiparesis on arrival in patients with subarachnoid hemorrhage (SAH) is presumed to affect prognosis; intracranial hematomas with mass effect responsible for hemiparesis are frequently observed in these patients. The aim of this study was to clarify characteristics and outcomes of patients who presented with hemiparesis on arrival with no responsible hematomas (hemiparesis without hematoma) having mass effect demonstrated on computed tomography. ⋯ Hemiparesis can be expected to improve in patients with SAH with hemiparesis without hematoma, and such patients appear to have a better prognosis than patients with SAH with hemiparesis and responsible hematomas. A possible major mechanism of hemiparesis without hematoma based on the characteristics identified is a combination of transient ipsilateral hemispheric functional failure caused by the impact of aneurysmal rupture and transient ischemia of the perforators originating from the internal carotid artery.
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Review Case Reports
Multiple Intracranial Aneurysms from Coccidioidal Meningitis: A Case Report Featuring Aneurysm Formation and Spontaneous Thrombosis with Literature Review.
Coccidioidal meningitis can progress to vasculitis with aneurysm formation. Although aneurysmogenesis is rare, it carries exceptionally high mortality. Except in one instance, prior case reports have documented universally fatal consequences. ⋯ Coccidioidal aneurysms carry a high mortality. The mainstay of therapy remains lifelong triazole antifungal therapy with the addition of liposomal amphotericin in cases of treatment failure. Steroid use is controversial but should be considered whenever there is vascular involvement. Although watchful waiting is reasonable in light of the possibility of spontaneous thrombosis with medical management, dynamic changes in aneurysm size or configuration should prompt timely endovascular or operative interventions.
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Review Case Reports
Pituitary Adenoma and Craniopharyngioma Collision Tumor: Diagnostic, Treatment Considerations and Review of the Literature.
Different diseases may occur within the same anatomic space and invade one another. Lesions of this nature are described as collision tumors. Collision tumors of the sella are rare, with pituitary adenoma-craniopharyngiomas having been described in only 15 cases. We discuss common and rare lesions of the sellar region, their neurodiagnostic qualities, and treatment considerations. ⋯ Many mechanisms for the development of collision lesions have been theorized, and further investigation may provide definitive answers regarding the origin of these neoplastic entities.
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Intracranial arterial dissection (IAD) is a rare cerebrovascular disease that is likely underdiagnosed because of the inherent difficulty of visualizing the subtle radiographic signs of the pathologic small intracranial arteries. No widespread consensus exists on the treatment of IAD, and thus it is often managed empirically because of the absence of major randomized controlled trials. In this study, we conducted a systematic review to evaluate the management and treatment options for IAD. ⋯ Given these findings, clinicians should prescribe antiplatelet therapy for patients with IAD presenting with ischemia and consider endovascular treatment for those presenting with hemorrhage. However, further investigation is required given the heterogeneity of methods and reporting outcomes in the investigated studies.
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Prescription opioid medications negatively affect postoperative outcomes after lumbar spine surgery. Furthermore, opioid-related overdose death rates in the United States increased by 200% between 2000 and 2014. Thus, alternatives are imperative. Mindfulness-based stress reduction (MBSR), a mind-body therapy, has been associated with improved activity and mood in opioid-using patients with chronic pain. This study assessed whether preoperative MBSR is an effective adjunct to standard postoperative care in adult patients undergoing lumbar spine surgery for degenerative disease. ⋯ During hospital admission, no significant dose-response effect of mindfulness techniques was found. At 30 days postoperatively, MBSR use was associated with less back pain. Further research is needed to assess the effectiveness of preoperative MBSR on postoperative outcomes in lumbar spine surgery for degenerative disease.