World Neurosurg
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Pituitary apoplexy is an uncommon neurosurgical emergency that may be the initial presentation of undiagnosed pituitary adenomas. Though the exact pathogenesis is unclear, there appears to be an association between pituitary apoplexy and medical interventions that disturb the blood supply and venous drainage of the abnormal sellar region. We present the first case of pituitary apoplexy occurring after an endoscopic retrograde cholangiopancreatography (ERCP). ⋯ Although pituitary apoplexy has been recognized as a sequela of surgical and laparoscopic procedures, it should also be considered in less invasive gastrointestinal procedures which may alter the intraabdominal pressures, such as ERCP. Early detection of this unusual complication allows for rapid diagnosis and timely surgical intervention in select cases to prevent debilitating cranial nerve palsies, preserve visual function, and retain normal pituitary function.
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Patients with chronic subdural hematoma (CSDH) typically present with symptoms of increased intracranial pressure, including headache, nausea/vomiting, and somnolence, or with contralateral weakness. Compression of the convexity cerebral cortex usually causes motor deficit that is more readily appreciated in the upper extremity rather than in the leg, and very subtle deficit may be detected only by looking for pronator drift. The precise pattern of signs and symptoms in CSDH may vary from case to case depending on the specific anatomy of compression, but isolated lower extremity weakness is rare. ⋯ CSDH overlying the cerebral convexity may manifest with isolated foot weakness. Awareness of the potential for this unusual presentation of CSDH may be useful to the clinician assessing a patient with otherwise unexplained foot weakness.
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Neural tube defects are a large health burden for East African countries. Health strategies in the prevention of this disease include nutritional prophylaxis, prenatal diagnosis, and availability of early neonatal neurosurgery. The main objective of this study is to describe our experience in the early surgical management of neural tube defects in the Zanzibar archipelago. ⋯ Neural tube defects are a prevailing condition in East Africa. We believe that more health initiatives should address its prevention, mainly through maternal nutrition. On the basis of our findings, we consider early neonatal neurosurgery as the most important factor in reducing immediate morbidity and mortality.
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Case Reports
Subcortical calculation mapping during parietal glioma surgery in the dominant hemisphere: A case report.
To avoid permanent neurologic deficits and preserve brain function in and near the eloquent area, intraoperative electrical stimulation mapping (IESM) is necessary. However, little is known about how these subcortical regions are involved in calculation processing function in patients with glioma. ⋯ In this report, IESM performed during awake surgery in a subcortical site demonstrated a crucial role played by the dominant parietal lobe in calculation.
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We aimed to investigate the possible predictive factors and longitudinal change in long-term surgical outcome after refractory frontal lobe epilepsy surgery. ⋯ The overall seizure outcome after surgery changed most during the first 2 years. The presence of frontal focal lesions and ictal frontal rhythm predicted favorable outcome. However, APOS was predictive of early epilepsy recurrence.